Pleuropulmonary Blastoma: A Case Report and Review of the Literature

The case of 38-month-old boy is being reported who was brought to the pediatrics clinic with fever, cough, hemoptysis, and breathing difficulty. Imaging studies revealed a right lower chest mass. Lobectomy and histopathological examination revealed it to be predominantly solid pleuropulmonary blastoma type II. It is a rare pediatric pleuropulmonary tumor with aggressive behavior and tendency to spread to the brain. The case is being presented to make the general histopathologist aware of this rare entity and to highlight to the pediatric physicians/surgeons, radiologists, and histopathologists the fact that lung cysts in infants and young children should be evaluated seriously and sampled thoroughly to diagnose cases of type I pleuropulmonary blastoma which will progress over time to type II or type III tumors. Also the siblings and first degree relatives of the patient should be screened for associated pulmonary and extrapulmonary benign and malignant conditions

Estimation of Consumption Functions: The Case of Bangladesh, India, Nepal, Pakistan and Sri Lanka

The study uses annual data from 1971 to 2013 and appliesKeynesian Consumption Function (KCF) and the PermanentIncome Hypothesis (PIH) in order to estimate consumption functionsof SAARC countries. The empirical results show that in the shortrun, the difference between KCF and PIH under Marginal Propensityto Consume (MPCs) is quite large. This difference, therefore,indicates that in the short run consumers’ consumption decisionare based on current income. However, another point worth notingis that, in the short run smaller values of MPCs under the PIHindicate that consumers are unable to anticipate their future incomein developing countries, like Bangladesh, India, Nepal, Pakistanand Sri Lanka. Moreover, the study also estimates the MPCs underthe PIH in the long run. The results demonstrate that in the long runthe values of MPCs are higher than the MPCs while using PIH,which indicates that in the long run consumers anticipate theirfuture income and accordingly make consumption decisions on thebasis of permanent income

Functional, cognitive and psychological outcomes, and recurrent vascular events in Pakistani stroke survivors: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>There is little direct data describing the outcomes and recurrent vascular morbidity and mortality of stroke survivors from low and middle income countries like Pakistan. This study describes functional, cognitive and vascular morbidity and mortality of Pakistani stroke survivors discharged from a dedicated stroke center within a nonprofit tertiary care hospital based in a multiethnic city with a population of more than 20 million.</p> <p>Methods</p> <p>Patients with stroke, aged > 18 years, discharged alive from a tertiary care centre were contacted via telephone and a cross sectional study was conducted. All the discharges were contacted. Patients or their legal surrogate were interviewed regarding functional, cognitive and psychological outcomes and recurrent vascular events using standardized, pretested and translated scales. A verbal autopsy was carried out for patients who had died after discharge. Stroke subtype and risk factors data was collected from the medical records. Subdural hemorrhages, traumatic ICH, subarachnoid hemorrhage, iatrogenic stroke within hospital and all other diagnoses that presented like stroke but were subsequently found not to have stroke were also excluded. Composites were created for functional outcome variable and depression. Data were analyzed using logistic regression.</p> <p>Results</p> <p>309 subjects were interviewed at a median of 5.5 months post discharge. 12.3% of the patients had died, mostly from recurrent vascular events or stroke complications. Poor functional outcome defined as Modified Rankin Score (mRS) of > 2 and a Barthel Index (BI) score of < 90 was seen in 51%. Older age (Adj-OR-2.1, <it>p </it>= 0.01), moderate to severe dementia (Adj-OR-19.1, <it>p </it>< 0.001), Diabetes (Adj-OR-2.1, <it>p </it>= 0.02) and multiple post stroke complications (Adj-OR-3.6, <it>p </it>= 0.02) were independent predictors of poor functional outcome. Cognitive outcomes were poor in 42% and predictors of moderate to severe dementia were depression (Adj-OR-6.86, <it>p </it>< 0.001), multiple post stroke complications (Adj-OR-4.58, <it>p </it>= 0.01), presence of bed sores (Adj-OR-17.13, <it>p </it>= 0.01) and history of atrial fibrillation (Adj-OR-5.12, <it>p </it>< 0.001).</p> <p>Conclusions</p> <p>Pakistani stroke survivors have poor outcomes in the community, mostly from preventable complications. Despite advanced disability, the principal caretakers were family rarely supported by health care personnel, highlighting the need to develop robust home care support for caregivers in these challenging resource poor settings.</p

Gender Differences in Risk Factors, Mortality, and Length of Stay of Patients Discharged From a Pakistani Stroke Unit: A Comparative Cross-Sectional Study

BACKGROUND: Differences between women and men in relation to stroke are increasingly being recognized. There is a scarcity of data on gender-based differences in stroke risk factors and outcomes from Pakistan. METHODS: We enrolled 231 consecutive patients diagnosed with acute stroke. All patients received care along a standardized stroke pathway in a single stroke unit. We analyzed demographic and medical factors, NIHSS scores, and outcomes. RESULTS: Of 213 consecutive hospitalized patients, 135 patients were men and 76 were women. The male to female ratio was 1.84. The mean age of males was 62.3913.56, as compared to females 61.15911.60 years. Hypertension, smoking, and dyslipidemia were more commonly found in men whereas ischemic heart disease, atrial fibrillation, and history of prior stroke were more frequently encountered in women. However, after adjustment for age and gender smoking in men (P.059) and atrial fibrillation (P.054) and prior stroke (P.017) in women, these were found to be independent predictors of stroke. Diabetes was equally distributed between the two genders. Women were more likely to be dependent prestroke (P.524), have more severe strokes (P.142), and more likely to have a longer hospital stay (P.942). In-hospital mortality was higher in women than in men (6.7% vs 5%; P.524) and they had poorer discharge modified Rankin Scale scores (mRS 5; 8.5% vs 5%; P.775); however, these differences were not statistically significant. CONCLUSION: There appear to be gender-based differences in the risk factor profile and perhaps outcome in Pakistani patients despite standardized care in a dedicated stroke unit

Exploring the Policy Reforms and Productivity Nexus: Evidence from Indian Banking Sector

The study investigates the effect of deregulation of the Indian financial system in 1991 followed by various financial sector reforms on productivity growth of Indian scheduled commercial banks, with exclusion of Regional Rural Banks, over the period of time, from 2002 to 2010.The results of our study show that the performance of the Indian banking industry remained satisfactory for the said period despite of the financial turmoil that literally hampered the financial institutions all over the world. This was because Indian financial system remained sheltered from such external shocks as a result of having flexible exchange rate regime, the foreign reserves were high, the capital account is not yet fully convertible, and banks and their customers have limited foreign exchange exposure. Therefore, we recommend that the policy makers should carry on with their current economic policy as it has been successful in sheltering them from external shocks. Furthermore, the study found that the deposits and credits are negatively related with financial system reforms of deregulation, which is surprising. As increase in deposits results in increase in credits. So, we would recommend the policy makers to emphasize on increasing the deposit base of the banks by increasing the interest rates on deposits. Keywords: Financial Sector Reforms, Indian Banking industry, Productivity, Financial turmoil, Deregulatio

On some properties of ideal convergent double sequences in fuzzy normed spaces

Recently, Rashid et al. [Rashid, Mohammad HM and Kočinac, Ljubiša DR. Ideal convergence in 2–fuzzy 2–normed spaces, Hacettepe Journal of Mathematics and Statistics, 46(1):149–162, 2017] defined the notion of ideal convergence of single sequences in 2–fuzzy 2–normed linear spaces. The aim of this paper is to generalize this notion to the double sequences in such spaces. For the sake of generalizing we define some concepts that contribute basically to outcomes that we came up with and study some basic properties of these new definitions.Publisher's Versio

Knowledge, awareness and practices regarding dengue fever among the adult population of dengue hit cosmopolitan.

Background: The World health Organization (WHO) declares dengue and dengue hemorrhagic fever to be endemic in South Asia. Despite the magnitude of problem, no documented evidence exists in Pakistan which reveals the awareness and practices of the country\u27s adult population regarding dengue fever, its spread, symptoms, treatment and prevention. This study was conducted to assess the level of knowledge, attitudes and practices regarding dengue fever in people visiting tertiary care hospitals in Karachi, Pakistan. Methods: A cross-sectional pilot study was conducted among people visiting tertiary care hospitals in Karachi. Through convenience sampling, a pre-tested and structured questionnaire was administered through a face-to-face unprompted interview with 447 visitors. Knowledge was recorded on a scale of 1-3. Results: About 89.9% of individuals interviewed had heard of dengue fever. Sufficient knowledge about dengue was found to be in 38.5% of the sample, with 66% of these in Aga Khan University Hospital and 33% in Civil Hospital Karachi. Literate individuals were relatively more well-informed about dengue fever as compared to the illiterate people (p\u3c0.001). Knowledge based upon preventive measures was found to be predominantly focused towards prevention of mosquito bites (78.3%) rather than eradication of mosquito population (17.3%). Use of anti-mosquito spray was the most prevalent (48.1%) preventive measure. Television was considered as the most important and useful source of information on the disease.Conclusion: Adult population of Karachi has adequate knowledge related to the disease \u27dengue\u27 on isolated aspects, but the overall prevalence of \u27sufficient knowledge\u27 based on our criteria is poor. We demonstrated adequate prevalence of preventive practices against the disease. Further studies correlating the association between knowledge and its effectiveness against dengue will be helpful in demonstrating the implications of awareness campaigns

Left atrial volumes and associated stroke subtypes.

Background: Cardio embolism and cerebrovascular atherosclerosis are two major mechanisms of stroke. Studies investigating associations between advanced echocardiographic parameters and stroke mechanisms are limited. Methods: This study is a standardized review of 633 patients admitted to the stroke service of a tertiary care hospital following a standardized stroke investigation and management pathway. Stroke subtypes were characterized using the Causative Classification System, using the hospitals online radiologic archival system with CCS certified stroke investigators. Patients with two mechanisms were excluded. Results: Patients with cardioembolic stroke had a higher proportion of atrial fibrillation (p \u3c 0.001), acute myocardial infarction (p \u3c 0.001) and ischemic heart disease (p \u3c 0.001). On electrocardiogram (ECG) and transthoracic Echo (TTE), patients with cardioembolic stroke had a greater atrial fibrillation (p \u3c .00), left ventricular thrombus (p \u3c .00), left ventricular ejection fraction \u3c30% (p \u3e\u3c .00) and global hypokinesia (p \u3c .00) Patients with cardioembolic stroke had higher mean left atrial volume indices (LAVi) (p \u3c 0.001), mean left ventricular mass indices (LVMi) (p \u3c 0.05) and mean left atrial diameters (LAD) (p \u3c 0.05). At LAVi of 29–33 ml/m2 , the risk of atherothrombotic stroke increased. The risk of cardioembolic stroke increased with LAVi of 34 ml/m2 and above. Conclusion: Left atrial volume indices may be linked to specific stroke phenotype. At mild increases in left atrial dimensions, the risks of atherosclerotic stroke are high, and probably reflect hypertension as the unifying mechanism. Further increases in left atrial dimensions shifts the risk towards cardioembolic stroke