Effectiveness of Monitoring Unit in Improving Physical Resources at Primary School Level in Khyber Pakhtunkhawa, Pakistan

The nature of the study was survey design. Population of the study was consisting of all primary school male and female teachers and all male and female data collection and monitoring assistants in Khyber pakhtunkhawa. The sample was randomly selected  from urban and rural  schools in which 248 male and 154 female teachers out of 8268 and 5164 respectively from Primary Schools and 24 Male  and 24 female  data collection and monitoring assistants out of 48  from district Bannu and Lakki Marwat Through Stratified Random Sampling technique. Single questionnaire was developed by using five point likert scales. Data is properly analyzed by using arithmetic mean and standard deviation. The major purpose of the study was to know the effectiveness of monitoring unit in improving physical facilities at Primary School Level. It is conclude from the collected information that monitoring unit play impact role in  monitoring the condition of school building, availability of boundary walls, proper provision of electricity, drinking water, toilet facility for teachers and students, and make sure the presence of non-teaching staff. In the light of conclusion it is recommended that existing monitoring unit must concentrate on the provision of quality physical resource. It is also recommended that monitoring unit make sure the availability of A.V aids, setting arrangements, and others teaching facilities for improving educational quality at primary school level in Khyber pakhtunkhawa. Keywords: Independent Monitoring Unit, Primary school, Physical facilities, Effectiveness

Desert Power: Exploring How Jordan Can Democratize Through Tribalism

This independent study project will analyze tribal institutions in Jordan to understand how conducive they are to democracy. In the wake of the Arab Spring and the collapse of many burgeoning democracies in the Middle East, it is important to find ways in which pro-democracy advocates can build strong democratic states in the Middle East. Democracy allows a polity to choose who rules them. Furthermore, it has proven that peopling living in a democracy live longer, more fulfilling lives than those who do not. Given Jordan’s unique history as a stable regime with a strong tribal tradition, the researcher has chosen Jordan as his field site to conduct this research. Using qualitative methods, the researcher has concluded that the best way to ensure this democratization takes place in Jordan is if pro-democracy advocates build an inclusive system around tribalism, specifically, the tribal mediation process. While the researcher has found that the structures of tribalism itself may be incompatible with democracy, he has established that the values derived from the tribal mediation process such as transparency, reliance and accessibility ought to be incorporated in a democracy

The Contagious Nature of SARS-CoV-2 Omicron Variant and Vaccine Efficacy

Background: Since the first COVID-19 outbreak, variants of SARS-CoV-2 have continued to dominate the global population. The repeated waves of emerging variants, each replacing the previous one with a greater rate of transmissibility and mutations, are the primary cause of the global pandemic. Public health concerns dramatically rose when a highly mutated variant (VOC) omicron (B.1.1.529) emerged in late 2021. omicron has more than 50 mutations, and over 30 mutations are in their spike protein that contributes to the virologic characteristics of the variant. Omicron is more contagious than previously reported SARS-CoV-2 strains and can re-infect people who have already contracted other SARS-CoV-2 infections. The variant has acquired a unique immune escape mechanism against monoclonal antibodies and vaccines. Currently, no therapeutic drug or vaccine is specifically available to prevent omicron infection and sublineage emergence. Method: The review was designed to search the recent research and literature and compile the most pertinent data on the virologic characteristics of the variant of concern. Result: The study reviewed and discussed the present prevalence, infectivity, dominance, immune evasion, therapeutic options, vaccine efficacy, and the future prospect of the omicron variant. Conclusion: Omicron variant has become a global public health concern due to the emergence of highly mutated sublineages. Developing variant-specific therapeutic drugs or vaccines is desirable to prevent the spread of these contagious variants globally.Keywords: COVID-19, SARS-CoV-2, Omicron variant, Vaccine efficacy, Immune evasion

Two Congenital Left-to-Right Shunt Anomalies in a Septuagenarian: ARare Occurrence

Atrial septal defect (ASD) and patent ductus arteriosus (PDA) are common congenital anomalies presenting in childhood. Life expectancy of an uncorrected PDAis shortened to half; and ASD of a significant size has increased morbidity and mortality. Their co-existence in an elderly patient with first presentation at 70 years of age is a rarity. We present the case of a 70-year woman with one-week history of dyspnea with high blood pressure and signs of heart failure. She was found to have a PDA and an ASD with left-to-right shunt. She was managed conservatively. She was offered cardiac catheterization, but she refused. This is the first documented case in local literature with two such congenital heart defects presenting in a septuagenarian. In a country where average life expectancy is in the 60\u27s, the survival of the patient with two heart defects, beyond-average survival age, is interesting

Poetic Experience

Nature of poetic experience is hereby redefined. The present article initially deals with the perennial nature of true poetic experience and its essential relevance to the world. It attempts to elaborate the process through which a poet is uplifted in a creative moment beyond terrestrial boundaries and is aligned with the ‘state of Perfection'. The role of successive generations of audiences in rediscovering the meaning of a poetic image is defined as life principle of all great poetry. Shakespeare is discussed as the ultimate example of this principle since his popularity remains an irreversible phenomenon  

Are BP readings taken after a patient-physician encounter in a real-world clinic scenario the lowest of all the readings in a clinic visit.

Objective: To determine the difference in Blood Pressure (BP) readings taken before, during and after the clinic encounter. Study Design: Descriptive study. Place and Duration of Study: Cardiology Clinic, The Aga Khan University Hospital, Karachi, from January to August 2013. Methodology: Hypertensive and normotensive participants aged ≥ 18 years were recruited. Pre-clinic BP was measured by a nurse and in-clinic BP by a physician. After 15 minutes, two post-clinic BP readings were taken at 1 minute interval. All readings were taken using Omron HEM7221-E. Results: Out of 180 participants, males were 57% and 130 (71%) were hypertensive. Mean SBP (Systolic BP) taken preclinic, in-clinic, post-clinic 1 and post-clinic 2 were: 126 ± 20 mmHg, 131 ± 23 mmHg, 126 ± 20 mmHg and 121 ± 21 mmHg respectively (p \u3c 0.001). Mean DBP (Diastolic BP) taken pre-clinic, in-clinic, post-clinic 1 and post-clinic 2 were 77 ± 12 mmHg, 81 ± 13 mmHg, 79 ± 12 mmHg and 79 ± 11 mmHg respectively (p \u3c 0.001). Conclusion: BP taken in the post-clinic setting may significantly be the lowest reading in a clinic encounter, making in-clinic BP unreliable to diagnose or manage hypertension

Sleep Fainting: A Neurocardiogenic Entity

Fainting is a common clinical presentation, with vagally mediated (neurocardiogenic) causes being the most common for syncope presentation to the emergency room, and for hospital admissions. Classic teaching is that upright posture is a prerequisite for vagally mediated syncope (VMS) and that syncope in the supine position has more sinister causes. We present five patients, three males and two females, with a mean age of 44.4 (range 29-67) years, who presented with VMS in the supine position (sleep fainting). Four patients also had a history of classic upright syncope. Based on their clinical features and thorough investigations, we excluded other causes of loss of consciousness and diagnosed these patients to be having VMS in the supine position (sleep fainting). We further describe the management and follow-up of these patients. Sleep fainting/syncope is a new entity and has to be recognized for appropriate management. A diagnosis can be established if there is clinical suspicion, preserved left ventricular function without evidence of coronary artery disease, no high-risk electrocardiographic evidence of pre-excitation, long or short QT syndrome, Brugada syndrome or arrhythmogenic right ventricular dysplasia, and normal neurological work-up