An interesting case of genital infantile hemangioma

Vascular lesions are commonly seen in newborns. They may be present at birth or appear in the days, weeks or months that follow. Most are benign and self-limiting but rarely they may be part of complex syndromes or systemic disorders, or they may be associated with complications requiring treatment. This is a case of a 2-month-old baby presenting with an Infantile hemangioma in the genital region

Omphalocele and macroglossia: a case of Beckwith-Wiedemann syndrome

Beckwith-Wiedemann syndrome (BWS) is a pediatric overgrowth disorder which predisposes to tumor development. The following case study examined a prenatal finding of omphalocele with postnatal findings of macroglossia and cutaneous hemangioma, ultimately leading to a diagnosis of BWS. This case highlighted the features of BWS, the diagnostic principles and the importance of a multidisciplinary team approach to its management

Remedies to Challenge Arbitral Awards in Pakistan

Available remedies to challenge arbitral awards in Pakistan are modification, remission, annulment and revocation of recognition and enforcement. Arbitration is a method through which disputing parties resolve their disputes outside the Court by avoiding technicalities of procedural law. If there is irregularity regarding process and procedure of arbitral tribunal, parties to an arbitration agreement may apply against it in the Court. Arbitrator files an arbitral award in the Court after completion of arbitral proceedings. If arbitral award is domestic and comes under ambit of Civil Court, arbitrator files arbitral award there but in case of foreign arbitral award, parties to arbitration agreement are required to file arbitral award with arbitration agreement and in case if arbitral award and arbitration agreement are not in official language of Pakistan, translation in official language is required to be submitted before High Court for implementation of arbitral award in Pakistan. Aggrieved party to arbitration agreement may challenge arbitral award before the Court for modification under section 15, for remission under section 16 and for setting aside under section 30 of the Arbitration Act 1940. Recognition and enforcement of an arbitral award may be challenged under article 5 of the New York Convention 1958. The UNCITRAL Model Law 1985 and other relevant International Conventions are not applicable in Pakistan thus aggrieved party may not avail grounds mentioned in these Statutes for modification, remission, setting aside and revocation. Pakistan is an Islamic country hence no award can be implemented in Pakistan if it is against injunctions of Islam under the light of Holy Quran and Sunnah of Prophet Muhammad ï·º which comes under ambit of public policy which is one of the grounds for revocation of recognition and enforcement of an arbitral award in Pakistan

A case report of pyrexia of unknown origin in a 15-year-old boy

We present a case of a 15-year-old boy presenting with a 3-week history of fever whilst visiting relatives in the United Sates (US). Despite extensive workup, a definitive diagnosis was not reached. The clinical history and course of the disease required consideration of broad range of differential diagnosis. This case highlights the importance of clinical history and examination in the assessment of fever of unknown origin (FUO)

Atypical myocardial infarction masquerading as gastroenteritis

Acute coronary syndrome (ACS) encompasses unstable angina and myocardial infarction (MI). MI typically presents as chest pain that may radiate to the arm or jaw and is described as dull, heavy, tight, or crushing. However, it may present atypically with symptoms other than chest pain including epigastric pain, often described as burning in character or like indigestion. This is a case of a 51-year-old patient who presented with symptoms of epigastric pain, nausea and vomiting resembling gastroesophageal disease. The patient was initially evaluated by a physician as a non-urgent case of gastroenteritis. Following further assessment due to ongoing symptoms, he was diagnosed with ST elevation MI (STEMI) and treated according to ACS treatment guidelines. To accurately diagnose ACS, clinicians must demonstrate competent communication, history taking and physical examination skills, identify red flags and make use of appropriate investigations. Correct medications and timely referral to secondary care services is vital to prevent morbidity and mortality.

Pronunciation of English velar nasal (angma) by undergraduate students in Pakistani universities

Pakistani English (PakE) is an emerging variety of English that is in the process of developing its own norms and standards. Besides, distinguishing lexical and syntactic structures, it also has unique phonological features (Baumgardner, 1993; Hassan, 2004; Rahman 1991). Many Pakistani linguists have discussed unique consonantal and vocalic features of Pakistani English (PakE). However, there has not been any significant research conducted on the pronunciation of English velar nasal or angma /ŋ/ by Pakistani English speakers. This study analyses the pronunciation of English velar nasal by Pakistani English speakers. The sample was selected from 20 undergraduate students of the Department of English studying in the first semester of a large-scale public sector university located in Lahore, Punjab, Pakistan. A number of 20 English lexical items were selected and were divided into three categories according to the distribution of angma in the English language. The items were presented to the participants in diagnostic sentences. PRAAT, the speech and phonetics analysis software, was used to analyse the data. The findings revealed that Pakistani English speakers pronounce angma inaccurately in the medial position and insert velar plosive /ɡ/ in the poly-morphemic words. However, in the final position, angma is pronounced correctly by most Pakistani English speakers. The findings highlight that Pakistani English speakers are not concerned about the morpheme boundary and pronounce angma without /ŋɡ/ coalescence. Thus, it is found that Pakistani English speakers have distinguished pronunciation. The study recommends more research on Pakistani English pronunciation as well

Monitoring and Varietal Preference of Mango Midge, Procontarinia mangicola (Diptera: Cecidomyiidae)

Abstract.-The current study was planned to evaluate the efficiency of colored sticky traps and plastic sheets in capturing adults and larvae of Procontarinia mangicola, respectively. The susceptibility of different varieties of mango against P. mangicola was also explored. Amongst the eight types of color traps, orange colored traps captured the highest number (145.6±19.7/trap) of P. mangicola adults while white-colored traps captured the lowest numbers (23.7±3.4/trap). The peak adult and larval population was observed on ). The highest numbers of galls/leaf and larvae/trap recorded on Sufaid Chaunsa indicated that it was the most preferred mango variety. The research findings will be helpful for the proper management of P. mangicola and to avoid losses to the mango industry

Green nanotechnology for plant bacterial diseases management in cereal crops: a review on metal-based nanoparticles

Cereals are an important source of nutrients for animals. Several diseases cause severe yield loss in cereal crops. Bacterial diseases result in varying yield losses across cereals: Wheat (5-40%), maize (15-98.9%), rice (20-70%), pearl millet (3-35%), and oats (15-49%). Diseases may be bacterial diseases, fungal or viral. Bacterial diseases are traditionally treated by pesticides. Chemically synthesized pesticides are toxic and hazardous to the environment. Nanotechnology is emerging and novel field for agriculture, especially in plant pathology as a strong antimicrobial agent. Nanoparticles have been synthesized in various ways i.e., biological, physical, and chemical methods. Chemical and physical methods of nanoparticles are costly and toxic to the environment. The biological method for the synthesis of nanoparticles is eco-friendly and economical. Microorganisms or plant extracts are used for metal nanoparticle synthesis. The application of nanoparticles in agriculture has a wide scope and it can bring nano-revolution. This review summarizes the antibacterial activity of biosynthesized metal nanoparticles and their role in bacterial disease management of cereals

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial