Unwanted penile engorgement in pediatric patients under anesthesia: The role of anesthetic technique and other contributing factors

Background: The mechanism behind intraoperative penile engorgement (PE) is complex. One common myth is that PE occurs more frequently during spinal anesthesia than the general anesthesia. Objective: The objective of this study was to report the incidence and management of intraoperative PE in pediatric patients undergoing urogenital operations under spinal anesthesia with or without sedation over a period of 1 year. Methods: Patients aged between 2 and 12 years, posted for elective urogenital surgery of expected duration <1 h, were given spinal anesthesia with or without supplemental sedation as per child’s cooperation. Incidence of unwanted intraoperative PE, time of onset of the SA, length of surgery, attempts of successful lumbar puncture, need for supplemental systemic sedation, conversion to general anesthesia, and perioperative complications were recorded. Results: A total of 348 patients were included in the study. Only two (0.005%) cases developed PE intraoperatively. 225 (64.6%) children required systemic sedation along with spinal blockade. 123 (35.3%) cases were successfully operated under spinal alone without any sedation. None of the cases required conversion into general anesthesia. The mean time of onset of spinal blockade was 100±54 s. First attempt success rate of lumbar puncture was 83% while 16.9% of patients required the second attempt. There were no major complications in any child in the perioperative period. Conclusion: Spinal anesthesia is associated with very less incidence of PE and can be practiced safely in the pediatric patients. Just the fear of development of PE should not bias the choice of an esthetic technique toward general anesthesia

Universal Design for Learning (UDL): A Paradigm Shift in Inclusive Education

Present article aims to explain the basis nuances pertaining to the concept of Universal Design for Learning (UDL) and its possible application in inclusive class room setting. UDL is an instructional approach with flexible, interactive, proactive and multiple means of engagement in content delivery, students’ reactions and assessment mechanism during the teaching and learning process. It incorporates the philosophy of need based shifting of pedagogical aspects from text to audio-visual, traditional to blended & OER, one size fit curricula for all to need based varying, passive to interactive, mono content delivery & assessment system to multiple one. It also envisages for providing equal learning opportunities to all types of learners with regards to their varying abilities. Removal of architectural, pedagogical and curricular barriers from academic institutions is the fundament and inherent aspects of UDL. It addresses one’s right to access the quality education as per his learning styles and approaches. However, inclusive education is also regarded for providing equal learning opportunities but with the limitations of not offering much options regarding pedagogical aspect of teaching and learning as UDL supposed to provide. In true sense, UDL has the potential to meet out the diverse need of learners of inclusive classroom setting and it may be regarded as the paradigm shift in inclusive education. Keywords: Universal Design for Learning; Inclusive Education; Challenges DOI: 10.7176/JEP/14-25-01 Publication date:September 30th 202

Texture analysis using local ternary pattern for face anti-spoofing

This paper proposes a new face anti-spoofing approach based on analysis of texture characteristics. Photo images are used for spoofing the face recognition and verification system. These photos are similar to the images of a live person which are exhibiting quite different contrast and texture characteristics when compared to real face images. Various feature extraction methods for texture classification including local Binary Patterns emerge as one of the most popular method because of its simplicity and classification accuracy. However, in homogenous regions, the order of the pixel with respect to its neighbors is quite noisy which can affect the performance of Local Binary Pattern. This paper demonstrates the use of local Ternary Pattern (LTP) in face liveness detection system to overcome this problem. The LTP approach is tested on three publicly available NUAA Photograph Imposter database, CASIA Face Anti -Spoofing Database and REPLAY-ATTACK database. Moreover, different experiments are performed by applying different sizes of neighbor pixels and radius of the patches. The test results are compared with the LBP operator and other state-of art work. The proposed face anti-spoofing method performs better than conventional texture based methods

The Economics Profession in Pakistan: A Historical Analysis

Economics is a policy science: its claim is to describe policies that can improve peoples' lives. Its usefulness for policymaking, therefore, depends on how well economists understand and interpret economic behaviour. In other words, successful economic policy entails a good understanding of the dynamics of economic change. In turn, a model of economic change requires analysis of institutions and organisations in the society. Institutions are the informal conventions (customs) and formal rules by which the members of a society organise the production and distribution of goods and services. Organisations are the players in the economy, including the state (executive, legislature and judiciary), private businesses (profit-seeking individuals and corporate entities), and private non-profit associations (NGOs, professional groups and bodies). Both institutions and organisations change with the evolution of each society and economy. Much as economists disagree on the underlying assumptions and interpretation of "facts" about economic change, they have a broad agreement that the discipline of economics must be embedded in the study of interactions between institutions and organisations.

Risk factors for multidrug-resistant tuberculosis in urban Pakistan: A multicenter case-control study

Objective: To evaluate risk factors for multidrug-resistant tuberculosis (MDR-TB) in an urban setting of Pakistan.DESIGN AND Methods: In this multicenter case-control study, patients aged 15years old or older with sputum culture and sensitivity (C/S) diagnosed with pulmonary MDR-TB were defined as cases, whereas patients aged 15years old or older with sputum C/S diagnosed and susceptible to pulmonary TB were regarded as controls. Fifty cases and 75 controls were enrolled from three tertiary-care hospitals in Karachi.Results: Multivariable logistic regression models showed that cases were more likely to have had a TB patient in the house prior to the diagnosis of MDR-TB (adjusted odds ratio [ORadj]=3.1, 95% confidence interval [CI]: 1.2, 8.3) or had a history of prior TB treatment (ORadj=4.2, 95% CI: 1.1, 15.4). Furthermore, cases compared with controls tended to be male (ORadj=3.6, 95% CI: 1.4, 9.7), 15-25years of age (ORadj=3.7, 95% CI: 1.2, 11.3), of Sindhi ethnicity (adjusted OR=9.1, 95% CI: 1.9, 43.4) or with low educational attainment (ORadj OR=5.5, 95% CI: 1.7-17.6, for no formal schooling; ORadj=3.8, 95% CI: 1.1-14.1, 1 for 1-5 school years).CONCLUSIONS: A TB patient in the house or a history of prior TB treatment was strongly associated with MDR-TB in this study. Furthermore, younger age, male gender, Sindhi ethnicity and poor educational attainment entailed a high risk for MDR-TB. Targeted educational intervention for patients and their contacts may minimize the noncompliance with prescribed TB treatment and lessen MDR-TB magnitude in settings like Karachi

Group Work Assessment: Assessing Peer Assessment at Global College of Engineering and Technology

Students learning and autonomy can be improved by involving them in teaching and learning, especially in group work assessments, this can also greatly help cut down the amount of time spent by teachers on marking and providing feedback. Although peer assessment of student work can also accomplish these goals, but its application is frequently restricted to evaluating each participant's input or participation to a cooperative effort. This paper reports the considerations and lesson learnt to successfully develop a group work assessment and marked based on the individual’s contribution to avoid conflicts. It’s worth mentioning that the peer-assessed marks are not significantly different from those allocated by faculty based on evaluative criteria, quality definitions, and a scoring strategy

Retinoblastoma tells the story of our health care system

Objective: To review cases of retinoblastoma. Setting: Department of Pathology Aga Khan University Hospital Karachi. Method: Twenty three specimens from cases of retinoblastoma received over a period of eight years were routinely processes and stained with haematoxylin and Eosin stain Other stains were used for tuberculosis and melanin. Immunochemistry was resorted to in undifferentiated tumors. Results: Over 60% cases of retinoblastoma were diagnosed after 5 years and nine cases showed involvement of opti-nerve. Conclusion: Late diagnosis of retinoblastoma effects the stage of the tumors and the prognisis

Primary drug resistance to anti-tuberculous drugs in Karachi

Objective: To assess the frequency of primary drug resistance among newly diagnosed tuberculosis cases in Karachi. Study Design: Cross-sectional study. Place and Duration of Study: Multicentric study involving various TB clinics and treatment centres of Karachi between April to December 2005.Methodology: The frequency of drug resistance among new TB patients was evaluated using a non-probability convenient sampling methodology. Sputum sample was obtained from 140 newly diagnosed sputum smear-positive patients of pulmonary tuberculosis from various centres of Karachi. Sensitivities were performed by proportion method. Results: Fifteen (11.5%) samples in 130 eligible patients showed primary resistance to one or more drugs. Ten (7.6%) of the isolates tested were resistant to a single drug, none were resistant to 2 drugs, 4 (3.0%) to 3 drugs and 1 (0.76%) to 4 drugs while 1 (0.76%) to all 5 first line agents. Resistance to streptomycin (10 ug/ml) was seen in 8 (6.1%), isoniazid (1ug/ml) in 12 (9.2%), Rifampicin (5 ug/ml) in 4 (3.0%), ethambutol (10 ug/ml) in 1 (0.76%) and pyrazinamide in 6 (4.6%) samples. Primary Multi-Drug Resistance (PMDR) was found in 2 (1.5%) patients. (Isoniazid 1 ug/ml, rifampicin 5 ug/ml with or without other drugs). Conclusion: In the studied patients, primary drug resistance to at least one anti-tuberculosis drug was 11.5%. It requires an efficiently working anti-tuberculosis programme to prevent escalation including resistance