Editing is a Happy Marriage, and Divorce is Not an Option!

“A great editor is fundamental to a journal’s health and success”. First of all, I would like to present my tribute to leaving editor and the editorial board for providing great contribution to PIMS and SZABMU especially Prof. Dr. Tanwir Khaliq, Prof. Dr. Syeda Batool Mazhar, Prof. Rizwan Aziz Qazi, Prof. Dr. Muhammad Amjad Chaudhry, Dr. Ayesha Isani Majeed and Prof. Dr. Abid Zaheer Farooqi. However, every great editor has to eventually make way for their successor. The transition period between editors can be a complex process, involving contracts, systems, mentoring and above all, careful timing. It’s never too early to start thinking about transition planning. It can take a year to manage the whole process - recruiting, appointing and handing over to a new editor - and the longer the lead-in time, the more organized the process can be. I am looking for new editors and editorial board from all medical disciplines to continue this great journal

Returns to Facilitating Farmers’ Organisations for Distributary Maintenance: Empirical Results from a Pilot Project in Southern Punjab

Institutional reforms currently underway in Pakistan’s irrigation and drainage sector require that farmers take over the operation and maintenance responsibilities of their secondary canals. However, the farmers need to be organised first, for which investments are a prerequisite. A great deal of skepticism about the farmers’ collective ability and willingness to undertake the needed tasks exists, even now when they are actually organised. This skepticism originates from past experiences when direct subsidies were offered to induce collective action. Theoretically, collective action can be more sustainable if investments are made in capacity building for the tasks that the farmers have to perform to improve the service delivery. Farmers are being organised for distributary operation and maintenance. So far, the delay in formulation of an appropriate legal framework has prevented the irrigation departments from formally transferring the operation and maintenance responsibilities to farmers. Self-help-based maintenance has been the only avenue for farmers to participate in the management of the irrigation system. The paper uses data pertaining to the cost of facilitation and estimates the amount of resources mobilised for two successive years from a pilot project. The analysis shows that investments made for facilitation do pay off. Investment in facilitation returns 69 percent higher than the actual investment per year during the initial years. In the short-run, the returns to facilitation indicate an increasing trend. The paper argues that when compared to previous approaches adopted in Pakistan, investments for facilitation and capacity building have a greater chance of prompting sustainable collective action for irrigation and drainage management.

FROM REPRESENTATIVE TO TRANSFORMATIVE USER PARTICIPATION – A CASE STUDY OF PUBLIC HEALTHCARE DIGITALIZATION

User participation in IS implementation is a core topic for the IS community. While most of our current participation theories emerged in the 1990s and 2000s, recent developments such as the emergence of large half-built products and the increased emphasis on digital transformation necessitate revisiting current understanding of participation. User participation is not anymore about merely representing the organization\u27s domain knowledge - what we call representative participation. Users participating in modern IS implementation projects need to possess additional types of knowledge and skills. This includes knowledge about the products, knowledge about the intended transformation, and leadership skills, to name a few. We investigate this emerging type of user participation - what we call transformative participation through a case study of an IS implementation project within healthcare. We discuss the knowledge and skills needed to function as transformative users as well as the challenges faced by these users

Vitamin D Supplementation does not Effect Adiposity in Healthy Adults

Introduction: Vitamin D is crucial for skeletal and extraskeletal health outcomes as Vitamin D binding receptors are located through out body, and epidemiological data supports its link with many conditions. Data on vitamin D levels and especially Vitamin D supplementation in U.A.E. is essentially inadequate.Design: Subjects (n=20) in this 1 month prospective study were given 2000 IU of daily Vitamin D without any special dietary or physical activity changes. Anthropometrics (weight, waist circumference, hip circumference), Vitamin D/ Calcium food frequency questionnaire and 24 –Hour recall were collected.Results: Mean age of subjects was 28.7 years, and baseline mean serum Vitamin D level of 17.5 ng/mL ±6.47. It increased Vitamin D serum levels by a mean of 6.76 ng/mL. Hip Circumference also reduced statistically significantly by moderate 2% (p 0.03 ±0.59),Conclusion: Vitamin D supplementation moderate dose daily can be pivotal in acquiring health benefits and reducing adiposity related factors. However, this surely calls for further investigation for longer period

Returns to Facilitating Farmers’ Organisations for Distributary Maintenance: Empirical Results from a Pilot Project in Southern Punjab

Institutional reforms currently underway in Pakistan’s irrigation and drainage sector require that farmers take over the operation and maintenance responsibilities of their secondary canals. However, the farmers need to be organised first, for which investments are a prerequisite. A great deal of skepticism about the farmers’ collective ability and willingness to undertake the needed tasks exists, even now when they are actually organised. This skepticism originates from past experiences when direct subsidies were offered to induce collective action. Theoretically, collective action can be more sustainable if investments are made in capacity building for the tasks that the farmers have to perform to improve the service delivery. Farmers are being organised for distributary operation and maintenance. So far, the delay in formulation of an appropriate legal framework has prevented the irrigation departments from formally transferring the operation and maintenance responsibilities to farmers. Self-help-based maintenance has been the only avenue for farmers to participate in the management of the irrigation system. The paper uses data pertaining to the cost of facilitation and estimates the amount of resources mobilised for two successive years from a pilot project. The analysis shows that investments made for facilitation do pay off. Investment in facilitation returns 69 percent higher than the actual investment per year during the initial years. In the short-run, the returns to facilitation indicate an increasing trend. The paper argues that when compared to previous approaches adopted in Pakistan, investments for facilitation and capacity building have a greater chance of prompting sustainable collective action for irrigation and drainage management

Ultrasound Assisted Pleural Biopsy with Abram Needle is a Valuable Tool in diagnosing Exudative Lymphocytic Pleural Effusions

Objectives: To evaluate the efficacy and safety of US assisted pleural biopsy using Abram Needle. Study Design: A non-randomized prospective study. The study was approved by Ethical Board of Gulab Devi Chest hospital Lahore. Methodology: The study was conducted at the Department of Respiratory Medicine, Gulab Devi Chest Hospital Lahore. 141 male patients with undiagnosed, unilateral, exudative, lymphocytic pleural effusion were included in the study during Jan. 2014 to Nov. 2015. Pleural biopsy was performed with Abram needle after an informed consent, having localized the biopsy point by chest radiographs & sonography.  Tissue samples underwent histopathological evaluation. Diagnosis was made on histopathology reports. Statistics was applied. Results: Six samples were inadequate while 135 were adequate.  31.11% cases were malignant while 68.88% were nonmalignant. Out of 93 nonmalignant cases, 7.52 % were normal pleurae, 46.23% were caseous granulomatous inflammation, 25.80% were chronic nonspecific pleuritis, 10.75 % cases were chronic pleuritis with fibrous thickening, 9.67 % cases were acute pleuritis. Biopsy success rate was 95.74%. All patients tolerated the procedure well. No serious complication occurred. Conclusions:  Abram needle pleural biopsy using ultrasound assistance is very safe and excellent diagnostic tool in diagnosing exudative lymphocytic pleural effusions.  &nbsp

Concordance of Clinical Examination and Duplex Scan Findings for Prediction of Surgery in Patients Presenting with Varicose Vein

Objective: To assess the concordance of clinical examination and duplex scan findings for prediction of surgery in patients having varicose vein.Methodology: The cross sectional study was conducted in tertiary referral vascular surgery unit, Dublin, Ireland. From January 2015 to December 2016. The study conducted on the patients with varicose veins between 18-50 years who had duplex scan performed over the last two years (n=175) in the hospital. Clinical diagnosis was done by using Clinical-Etiological-Anatomical-Pathophysiology (CEAP) classification. Numerical variables age, duration of symptoms, weight, height and BMI were presented. Categorical variables gender and presence of varicose vein on clinical examination CEAP grade ≥2 and colored duplex ultrasound for the prediction of surgery was presented as concordance.Results: In 95% (n=166) of patient’s surgery was predicted and in remaining surgery was not predicted. 171 (97.7%) were diagnosed with incompetent varicose vein on Duplex Scan while 4 (2.3%) were not. Forty seven percent (n=82) patients had incompetent SFJ, 36% (n=63) had Incompetent SPJ and 11% (n=19) had mixed type of varicose veins when diagnosed on Duplex Ultrasound. The study results showed that in 97.7%(171) patient’s surgery was predicted by Duplex Ultrasound and in remaining surgery was not predicted.Conclusion. There is increase in prediction of surgery for varicose veins with duplex scan modality

An Updated Mini Review of Vitamin D and Obesity: Adipogenesis and Inflammation State

Vitamin D related research continues to expand and theorise regarding its involvement in obesity, as both hypovitaminosis D and obesity strike in pandemic proportions. Vitamin D plays an important role in immune system through Vitamin D Receptors (VDR), which are transcription factors located abundantly in the body. Due to this characteristic, it is potentially linked to obesity, which is a state of inflammation involving the release of cytokines from adipose tissue, and exerting stress on other organs in a state of positive energy balance. Research trials in the past couple of years and systematic reviews from SCOPUS and MEDLINE will be discussed. The role of Vitamin D throughout the lifespan (from fetal imprinting until older age), and in various other obesity mediated chronic conditions shall be highlighted. Various mechanisms attributed to the inverse relationship of Vitamin D and obesity are discussed with research gaps identified, particularly the role of adipokines, epigenetics, calcium and type of adipose tissue