Pakistan's trade competitiveness & complementarities in South Asia

Over the past decade Pakistan remained involved in two major trade agreements with in the South Asia (Pakistan & Sri-Lanka FTA and SAFTA). It is meaningful from an operational and policy perspective to evaluate Pakistan's trade performance in South Asia against its objectives of greater trade integration and suggest policy interventions to improve its effectiveness. In order to achieve this objective, current study evaluates the Pakistan’s overall and chapter-wise trade performance with SAARC major SAARC economies for the last seven years (2003-09). This study has been disaggregated into two parts: In the first part of the study, an assessment of trade performance of SAARC members is carried out with respect to the rest of the world. Pakistan's trade performance vis-à-vis other SAARC members is the focus of this part. In the second part Pakistan’s trade performance in South Asia has been analyzed and policy interventions have been suggested to improve its effectiveness. Certain trade indicators like Trade Complementarity Index (TCI), Trade Specialization Index (TSI), Grubel Lloyd Index (GLI), Revealed Comparative Analysis (RCA), Bilateral Revealed Comparative Analysis BRCAs and Revealed Market Access (RMA) have been employed to achieve the above objectives.International Trade, Regionalism

Regional trade in south Asia-impediments and the way forward

The paper sets out to suggest that regional trade between South Asia is quite low when compared to other regional blocks like NAFTA, EU 15, ASEAN, and MERCOUSER. The paper identifies non cooperation between India and Pakistan to be the main reason behind low trade in South Asia. The paper focuses on the pending trade issues between both countries that are preventing India and Pakistan to increase bilateral trade and economic cooperation. The first issue discussed in the paper is granting of MFN status to India by Pakistan. The paper finds that it is in the benefit of both countries if Pakistan gives MFN status to India. But before such a step is taken, it is essential that Pakistan moves from a positive list approach to a negative list approach. Pakistan can include industries like textiles in the negative list to prevent the flood of cheap Indian textiles. Once MFN status is granted to India, Pakistan would be able to raise more substantive issues, notably Indian NTBs, subsidies, and protective tariffs. Currently India practices various forms of NTBs against Pakistan. The visa restrictions and absence of financial services are the major NTBs. Such NTBs have prevented Pakistan to export more to India. Another trade issue highlighted in the paper is that of transit facility. India does not provide Pakistan a transit route to Nepal and Bhuttan. In contrast Pakistan has provided Afghanistan transit route to India, though Pakistan does not allow India a transit route to Afghanistan or beyond. The paper finds that there is a high risk of informal trade in case Pakistan provides India with the land route to Afghanistan through its territory. It is anticipated that most Indian exports to Afghanistan would be smuggled back into Pakistan affecting Pakistan’s local industry. The transit facility is by far the most complicated trade issue of the three. Though the paper concludes in favor of granting India MFN and against the imposition of NTBs, It only gives a conditional recommendation in favor of granting India transit route to Afghanistan in case India provides Pakistan transit route to Nepal and Bhuttan.Regional Trade Agreements, Barriers to Trade, WTO

Out-of-Pocket Expenditure on Delivery Care in Public and Private Health Sectors – A Study in a Rural District of Pakistan

Pakistan witnessed a significant improvement in maternal health outcomes during the past two decades. However, persistent urban-rural and socio-economic inequalities exist in access to maternal healthcare services across the country. The objective of this study was to estimate out-of-pocket expenditure (OOPE) on delivery care by women in the public and private health sectors in RajanPur district. This was a cross-sectional study conducted, among 368 randomly selected mothers who had childbirths from 1st October to 31st December 2020. The study applied multi-stage random sampling technique to select the study participants. The results showed that about two-thirds of mothers preferred public hospitals for most recent delivery. The percentage of cesarean deliveries conducted in private hospitals (43.8%) was 4.7 times higher than in public hospitals (9.3%). About 99% of mothers incurred OOPE during delivery care, and the mean OOPE incurred during delivery care was PKR 2840 (US$17.75) in public hospitals and PKR 25596 (US$159.9) in private hospitals. OOPE on cesarean delivery in private hospitals (PKR 39654.7, US$247.8) was 2.5 times higher than the public hospitals (PKR16111.9, US$100.69), whereas OOPE incurred on normal delivery care in private hospitals (PKR14339, US$89.62) was 9.5 times higher than OOPE in public hospitals(PKR 1501.4, US$9.38).To conclude, the findings and recommendations drawn from the research would provide some insights to health policymakers and planners in developing an integrated and viable maternal healthcare program in Pakistan

Pakistan's trade competitiveness & complementarities in South Asia

Over the past decade Pakistan remained involved in two major trade agreements with in the South Asia (Pakistan & Sri-Lanka FTA and SAFTA). It is meaningful from an operational and policy perspective to evaluate Pakistan's trade performance in South Asia against its objectives of greater trade integration and suggest policy interventions to improve its effectiveness. In order to achieve this objective, current study evaluates the Pakistan’s overall and chapter-wise trade performance with SAARC major SAARC economies for the last seven years (2003-09). This study has been disaggregated into two parts: In the first part of the study, an assessment of trade performance of SAARC members is carried out with respect to the rest of the world. Pakistan's trade performance vis-à-vis other SAARC members is the focus of this part. In the second part Pakistan’s trade performance in South Asia has been analyzed and policy interventions have been suggested to improve its effectiveness. Certain trade indicators like Trade Complementarity Index (TCI), Trade Specialization Index (TSI), Grubel Lloyd Index (GLI), Revealed Comparative Analysis (RCA), Bilateral Revealed Comparative Analysis BRCAs and Revealed Market Access (RMA) have been employed to achieve the above objectives

Risk factors of Oral cancer- A hospital based case control study

Oral cancer is a highly prevalent malignancy in Pakistan. Among various risk factors associated with this neoplasm, habits such as smoked and smokeless tobacco usage, betel quid, and betel nut consumption are the major culprits in our society. In the present study, we aimed to ascertain prevalent risk factors for OC in our population and to compare our findings with healthy controls to establish their significance. A hospital-based case control study was conducted at Dow University of Health Sciences, Pakistan from January 2015 ? September 2016. Information pertaining to unhealthy oral habits was obtained from 62 oral cancer patients (cases) and 62 healthy controls on specifically designed proforma by the principal investigator. Smokeless tobacco is strong, independent risk factor for oral cancer development in our study population. Buccal mucosa is the predominantly affected site (71%) which corresponds with high smokeless tobacco use. All studied habits increase risk of oral cancer as demonstrated by high odds ratio. Despite advancement in our knowledge and understanding of carcinogenic potential of these hazardous substances not enough efforts have been put forth to effectively control their widespread sale and consumption, particularly by the youth in our society

Meropenem-induced pancytopenia in a preterm neonate: A case report

Background: A post-marketing surveillance study has reported an association between meropenem use and the incidence of hematologic abnormalities, including leukopenia, thrombocytopenia, hemolysis, and neutropenia, but the precise incidence in neonates is unknown. Here, we report meropenem-induced pancytopenia in a preterm neonate.Case presentation: A preterm newborn Pakistani received intravenous meropenem 40 mg/kg every 8 hours to treat Klebsiella pneumoniae in blood cultures and suspected meningitis. The baby developed severe thrombocytopenia, with a platelet count of 22 × 103 cells/mm3, low hemoglobin level of 9.7 g/dl, and low absolute neutrophil count (ANC) of 816 cells/mm3 on days 3, 14, and 17 of meropenem therapy, respectively. Based on the blood culture and institutional guidelines, meropenem treatment was continued with monitoring and supportive care for a total of 19 days. After discontinuation of meropenem, the baby was monitored continuously for hematological changes, and low counts persisted for 3 days. ANC improved to \u3e 1500 cells/mm3 on the fourth day, and the platelet count reached \u3e 150 × 103 cells/mm3 for the first time on the seventh day of meropenem discontinuation. All subsequent complete blood count (CBC) reports showed improving trends. The baby was discharged on the 48th day of life (DOL), with follow-up monitoring of CBC. The baby was kept on iron supplements, and hemoglobin level of 11.2 g/dl was observed on the 59th DOL.Conclusion: Neonatal pancytopenia may lead to serious health complications; therefore, clinicians and pharmacists need to vigilantly monitor CBC in this vulnerable population, even when administering meropenem in septic doses for the recommended duration

Role of contrast enhanced computed tomography in assessing cervical lymph node metastases in oral cavity squamous cell carcinoma

Objective: To evaluate the diagnostic accuracy of contrast-enhanced computed tomography scan in detecting cervical nodal metastasis in oral cavity squamous cell carcinoma.Methods: The retrospective cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. and comprised records from January 1, 2015, to October 31, 2016, of patients diagnosed with oral cavity squamous cell carcinoma and who underwent surgical resection of primary tumour along with neck dissection after having a contrast-enhanced computed tomography scan of head and neck. Diagnostic accuracy of the scans was calculated using final histopathology as the gold standard. All scans were reviewed by a consultant radiologist. Data was analysed using SPSS 23.Results: Of the 100 patients whose records were reviewed, 70(70%) were female, 55(55%) had buccal and 32(32%) had tongue cancer.. The scans had sensitivity 83%, specificity 61.7%, positive predictive value 70.9%, negative predictive value 76.3% and overall diagnostic accuracy 73%.Conclusions: Computed tomography scan was found to be a useful tool for preoperative staging of oral cavity squamous cell carcinoma. However, due to low specificity and negative predictive value, elective neck dissection should still be done in a negative scan for cervical lymph node metastases

Otorhinolaryngology consultations in a multidisciplinary hospital - their effects on residents training on floor

Objective: To determine all types and severity of Otolaryngology consultation requests at our tertiary care center and spectral records of problems related to otorhinolaryngology come across initially by residents which will help in re-shaping residency programmes and enhance patient related care. Methodology: All otorhinolaryngology consultation received over a three-month period were recorded prospectively. Information collected for each encounter included the time, date, reason for consult at primary service and admission with final ENT diagnosis, any surgical or non-surgical intervention, and basic patient demographics. Results: A total of 127 consults for inpatients were reviewed from April 2020 to June 2020. Out of total, 84 (66.1%) patients were male and 43 (33.8%) were females. Adult patient consultations amounted to 87(68.5%) while 18(14.1%) were in the age range of 6-18 years. Only 4(3.1%) consultations were raised for neonatal patients. Routine consultation were had for 64(50.3%) while 45(35.4%) patients were reviewed as an emergency. Operative interventions were required by 43(33.8%) among which tracheostomy was the most common operative procedure performed in 26(20.7%) patients. If we broadly classified ENT consultations, 40 (31.4%) were of problems related to head and neck region while 38 (29.9%) were related to the laryngology sub-specialty. Most common consultation was for airway assessment in 26(20.7%) patients followed by otorrhoea, in 15 (11.8%) patients. Conclusions: In inpatients, upper airway assessment, aural discharge and epistaxis were the most frequent complaints for seeking ENT review. This study should prove to be beneficial in forming a curriculum of educational programme for junior residents

EFFECT OF CROSS FIT EXERCISES ON WEIGHT LOSS OF MALES IN LAHORE

The purpose of this research was to explore the effect of Cross Fit, a latest fitness techniques being used all over the world to get a good physique and health, in reducing weight of male persons ranging from 18 to 25 years. A sample of 8 male students ranging age from 18 to 25 years to measure the change in variables like Body weight, %age Fat ratio, %age of Total Body Water contents, %age of Lean Muscle Mass after applying Cross Fit training program in pre and post analysis. After designing and applying a 28 days Cross Fit plan and diet plans for each individual according to their Basal Metabolic Rate (BMR) and Total Daily Energy Expenditure (TDEE), it was found that there is a positive significant change in these variables mentioned above which showed that Cross Fit training program d

Etiology of stroke in young pakistani adults; results of a single center study

The aim of this study was to determine the demographic profile and incidence of young stroke at a tertiary care setup in Islamabad, Pakistan. Materials and Methods: This single centre, cross sectional study was conducted by recruiting 119 patients of either gender, ≥ 12and ≤ 45 years of age with stroke and receiving care at Pakistan Institute of Medical Sciences, Islamabad. Results: Total number of young strokes was 119 out of a total of 322 strokes i-e-, 36.9 %; 1/3rd strokes were in ≤ 45 years of age. Ischemic arterial strokes were 47% (56 out of 119) while venous ischemic strokes were 11.7 % (14 out of 119) and almost all in females (13 out of 14; 92.8 %).Infective causes of central nervous system were identified in24.3 % (29 out of 119). 49 patients (41.1 %) had hemorrhagic strokes. Major individual risk factors for stroke included hypertension identified in 35 (29.4 %)followed by diabetes mellitus in 8 (6.7 %) patients. Amongst infectious causes, CNS tuberculosis was the major infection associated with young stroke i-e-, 89.6 % (26 out of 29). Conclusion: Nearly 1/3rd of strokes in our population are in young.While risk factors in general for stroke stand true for young stroke as well namely hypertension and diabetes, CNS infections are a major cause of young stroke in Pakistan; particularly CNS TB. While majority of strokes in elderly are ischemic, strokes in young comparatively are almost equally divided between ischemia and hemorrhage i-e-, 1.4:1. 1/5th of these ischemic strokes are due to cerebral venous thrombosis. National level guidelines should therefore adopt different strategies for primary and secondary prevention, laboratory work up and imaging, and treatment of stroke in young