Top-Down English Policy and Bottom-Up Teacher Take: An Interview-Based Insight from the Balochistan Province of Pakistan

Provinces in Pakistan have initiated teaching English as a compulsory subject in Grade 1 onwards in their government schools by following the latest National Education Policy (NEP) of 2009. The policy states that the measure shall develop the students’ English proficiency that would later help them compete. In this study we intended to understand whether the policy was implemented successfully in the province of Balochistan. By drawing upon the language planning framework proposed by Kaplan, Baldauf, and Kamwangamalu (2011) and applying convenient sampling technique, the researchers conducted thirty-one semi-structured interviews with urban and rural male and female teachers who teach in Grades 1 to 5. We found that issues such as limited teaching time for the English subject, lack of qualified teachers, inappropriate English textbooks, teachers’ customary teaching methodology, paucity of resources, and gap between policymakers and practitioners impacted the policy. The study offers recommendations that could help the Pakistani policymakers to align the policy with practice, research, and the teachers’ voices in order to achieve the desired outcomes

Provincial inequalities in Iran: A comprehensive planning model for budget allocation

Although regional disparities were declining in Iran between 2001-2013, the provincial allocation of budgetary resources in Iran is not done fairly. The absence of a clear model for optimal budget distribution hinders achieving regional balance between Iran’s provinces. Making use of applied research, this study identified 47 development indicators in 3 main development dimensions (economic-infrastructural, educational-cultural, and health-therapeutic) as the indictors to assess the characteristics of each province (level of development) to identify provincial inequalities of development in Iran. Descriptive analysis and the VIKOR model were used for the provincial development ranking in Iran during the years 2011 to 2021. Using comparative analysis, the K-means clustering method, the CV method, and GIS were used for calculating and mapping provincial inequalities. The results revealed severe inequalities among provinces. Tehran and Yazd provinces have had the highest development levels. CV calculations of the provincial indicators based on two scenarios (equal coefficients and AHP coefficients) showed that a budgetary resource distribution model that provides the percentage of budget allocation, by taking into account the territorial divisions, features, and sustainable development indicators of each province, might reduce inter-provincial inequalities, and would help achieve sustainable and equitable development at the provincial level. This model uses a method that optimally allocates financial and budgetary resources based on the degree of development of the regions and environmental characteristics

Periodontal medicine : oral inflammatory conditions with special emphasis on immunological aspects

Systemic effects of periodontal disease have been a subject of interest for the past century, with intense focus converging since the past decade. Both rheumatoid arthritis (RA) and periodontal disease (PD) are immuno-inflammatory diseases with osteolysis as its hallmark feature. Activated T cells are known to modulate osteoclastogenesis. This thesis aimed to analyze the influence of PD on systemic inflammatory and immunological markers in both PD and RA subjects. Periodontal parameters, clinical (PI, BOP, PPD 3-<5mm and PPD ≥5mm) and radiographic (marginal bone loss or MBL) were investigated in four groups: RA with PD, RA without PD, PD and healthy groups. Immunosuppression of T cell activation via targeted surface protein was also studied. AIMS Study I aimed to investigate the expression and functional importance of low-density lipoprotein receptor-related protein1 (LRP1) in T cells. Study II aimed to investigate serum cytokines, chemokines, growth factors, enzymes and costimulatory proteins in association with periodontal conditions in PD and RA subjects. Study III aimed to investigate the serum markers osteopontin (OPN), tumor necrosis factor receptors 1 (TNFR1) and 2 (TNFR2) receptor activator of nuclear factor‐kappa B ligand (RANKL) and RANKL/ osteoprotegerin (OPG) ratio and compare them in PD and RA groups. Study IV aimed to investigate the severity of both PD and RA and investigate a correlation between glycemia and periodontal disease parameters using ΣPPD Total and ΣPPD Disease index. RESULTS Study I showed that T cells shed LRP1, which probably explains the low LRP1 expression in T cells. Shedding of LRP1 antagonizes T cell adhesion to integrin ligands and TCR-induced activation. Integrin ligands and CXCL12 antagonize shedding through a TSP-1-dependent pathway, whereas ligation of CD28 antagonizes shedding independent of TSP-1. The disappearance of LRP1 from the cell surface may provide basic immunosuppression at the T-cell level. Study II showed significant positive correlations for ST1A1, FGF-19 and NT-3 whereas EN-RAGE, DNER, CX3CL1 and TWEAK associated inversely with BOP, PPD≥ 5mm and MBL but positively with number of teeth. CD markers (CD244, CD40, CDCP1, LIF-R, IL-10RA, CD5 and CD6) were found to be associated with BOP, shallow and deep pockets, MBL and number of teeth, either directly or inversely. CCL8, CX3CL1, CXCL10, CXCL11, CCL11, CCL4, CCL20, CXCL5, CXCL6, and CCL23 were positively associated with number of teeth. Other growth factors were directly associated with MBL (HGF) and number of teeth (VEGF-A, LAP TGFbeta-1). Study III showed OPN, TNFR1, TNFR2 and RANKL serum levels were the highest in the RA group with PD, while the RA group without PD were comparable to PD subjects only. The RANKL/OPG ratios were comparable between PD group and both RA groups with and without PD. Serum RANKL levels were associated with and PPD ≥ 5mm. Study IV showed that the indices correlated strongly with number of deep pockets. DAS28 score correlated positively with RF in RA subjects with and without PD. Serum levels of HbA1c were higher in PD, RA with PD and without PD subjects as compared to the healthy group. HbA1c levels associated positively with PPD Total, PPD Disease, and MBL. Tooth adjusted PPD Total correlated with all periodontal parameters except for shallow pockets. CONCLUSIONS This thesis shows that periodontal disease is mirrored by a range of systemic immune markers, particularly those involved in inflammation. Furthermore, peripheral osteoclastogenesis is a feature of PD, comparable to RA. Overall, this thesis signifies the peripheral involvement of host immune system in combating PD essentially as an osteolytic disease and the need to approach PD measurement via a novel continuous index. The thesis also shows evidence that LRP1 controls motility, adhesion and activation in T cells

OCCURRENCES OF SOLID INCLUSIONS OF SILICATE AND BASE METAL SULFIDE MINERALS IN CHROMITITE OF KHANOZAI OPHIOLITE, PAKISTAN: EVIDENCE FROM MELT EVALUATIONS: Array

Chromitite bodies occur in the wide mantle portion of Khanozai ophiolite. This peridotite is largely composed of harzburgite, dunite and minor lherzolite. Chromitite occurs in Khanozai ophiolite mainly in massive, disseminated, banded and nodular forms. The Khanozai chromitites contains a variety of silicate and BMS mineral inclusions. They include anhydrous silicates like olivine, clinopyroxene, hydrous silicate inclusions of amphibole, and BMS mineral inclusions such as millerite, chalcopyrite, stibnite, and occasional pyrite and linnaeite. The silicate mineral inclusions occur as monomineralic as well as polymineralic phases. The shapes of these inclusions tend to follow the growth plane of host chromite. Textures and forms of these inclusions reveal that some inclusions were trapped during magmatic stage, whereas many inclusions were trapped during recrystallization of chromite. BMS inclusions are millerite, chalcopyrite, and stibnite. They occur isolated inclusions and at some places associated with silicate mineral inclusions. It is suggested that these BMS inclusions were generated due to the separation of sulfide-bearing liquid from silicate magma

The Outcome of Subaxial Cervical Injury in Adult Patients Managed Surgically Through an Anterior Approach

Objectives:&nbsp;&nbsp;We determined the Outcome of subaxial cervical injury management in adults through anterior approach open reduction and fixation injury &lt; 72 hours. Material and Methods:&nbsp;&nbsp;A total of 71 patients declared to have a recent chronicle of traumatic cervical spine injury with a conventional diagnosis of subaxial injury by Magnetic Resonance Imaging (MRI) and X-Ray anteroposterior and lateral views. ASIA Impairment Scale was used for assessment and was done at the time of admission and after six months. Results: Mean age of the patients in our study was 38.54 ± 5.47 years. According to American Spinal Injury Association (ASIA) scale, improvement by two grades was seen in 18 cases and improvement by one – grade was observed in 48 cases. Mortality was seen in 5 cases, where 2 deaths were related to associated injury, one related to a complication of surgery and other 2 died due to aspiration complications. Out of 66 cases, the outcome was good in 49 (74.29%) and fair in 17 (25.76%). Conclusion:&nbsp;&nbsp;The study results revealed that Anterior Cervical Discectomy and Fusion (ACDF) is considered to be a better treatment choice for better anatomical stabilization of the spine with early reduction. Keywords:&nbsp;&nbsp;Subaxial cervical injury, anterior approach, ASIA (American Spinal Injury Association) scoring

Transpedicular Fixation via Posterior Approach for Dorsal and Lumbar Spine Tuberculosis

Objective:  To determine the outcome of Transpedicular Fixation via Posterior Approach for Dorsal and Lumbar Spine Tuberculosis. Material/Methods:  This study was cross-sectional and conducted from 01/02/2015 to 30/7/2020 in the department of neurosurgery. A total of 36 patients with dorsal and lumbar spine tuberculosis were operated on for transpedicular fixation. Assessment scores were used pre-operative and post-operative and patients were kept on follow-up till six months after the surgical procedure. Variables like age, gender, spinal level, preoperative, and follow-up clinical status were calculated. Results:  There were 19 (53%) male and 17 (47%) female patients with a mean age of 27 ± 8. Thoracolumbar was the commonest segment involved in 17 (47%) patients, followed by lower thoracic in 8 (22%) and lumbar in 7 (19%). There were 7 (19%) patients on the preoperative American Spinal Injury Association (ASIA) impairment scale in grade B, 12 (33%) in grade C, 15 (42%) in grade D, and 2 (5%) in grade E. The follow-up assessment at 6 months showed that ASIA grade B was seen in 3 (8%), grade C in 4 (11%), grade D in 16 (44%), and Grade E in 13 (36%) patients. Preoperative and follow-up scores on the ASIA impairment scale, COBS ANGLE, and ESR showed a significant difference (p-value &lt; 0.05). Conclusion:  We concluded that transpedicular fixation can restore the stability of the spine in thoracic and lumbar tuberculosis. The procedure is important for the improvement of clinical symptoms, correction of kyphosis, and stabilization of the spinal column

Assessment of Modes of Injury and Outcome in Patients with Traumatic Posterior Fossa Extradural Hematomas: A Study of a Tertiary Care Hospital

Objective:&nbsp;&nbsp;The aim of study to assess the prevalence of divergent modes of injuries in traumatic posterior fossa extradural hematomas (PFEDH) along with the description of surgical and clinical management. Material and Methods:&nbsp;&nbsp;A descriptive study was performed at the Jinnah Postgraduate Medical Centre (JPMC), Karachi from May 2014 to October 2020. Total 37 patients who presented with posterior hematoma of any age and gender were included. CT scan Brain plain with the bone window was performed for a basic diagnosis to assess the volume, and any associated fracture, or any injury in the posterior fossa. The outcome was calculated from the scores of the Glasgow Coma Scale (GCS). Results:&nbsp;&nbsp;70% were male and around 30% were female patients. The mean calculated age was 32 ± 5.33 years. A road traffic trauma was the major cause of brain injury in 25 (67.56%) cases. The majority (56.75%) of patients reported headache, nausea and vomiting. 35% of patients were conservatively managed, with an average hematoma size of 3 cm on CT scan and GCS &gt; 12 while 64.86% patients were operated, with the average size of hematoma &gt; 3 cm and GCS &lt; 10 while 61% of the patient had an occipital fracture. The majority of patients (8.1%) reported complications such as brain contusions and post-traumatic hydrocephalus. Conclusion:&nbsp;&nbsp;Post fossa EDH should be managed aggressively, especially those with low GCS (&lt; 8), and volume &gt; 3 cm. Patients who are to be managed conservatively also require close observation. &nbsp

Outcome in Normal Pressure Hydrocephalus after Ventriculoperitoneal Shunt in Tertiary Care Hospital

Objective:&nbsp;&nbsp;To determine the outcome of the ventriculoperitoneal shunt in normal pressure hydrocephalus. Material and Methods:&nbsp;&nbsp;This study was conducted at Jinnah Postgraduate Medical Centre, a tertiary care hospital in Karachi. Patients with idiopathic normal pressure hydrocephalus (NPH) were included. Gender distribution, presentation of symptoms and post-operative outcome based on the Stein Langfitt Scale were assessed. CSF was sent for microbiological and biochemical analyses. All patients were evaluated preoperatively and compared postoperatively during 6 months duration for improvement and any associated complication. Results:&nbsp;&nbsp;In this study, we had 47 patients, 38 were male and 9 were female. 22 patients presented with dementia, 18 with urinary incontinence, 17 with gait disturbance 17, while 21 had headache based on Stein and Langfitt Scale. The 78.8% patients had an excellent outcome, 17% had a good outcome and 4.2% had poor results. Conclusion:&nbsp;&nbsp;Ventriculoperitoneal (VP) shunt had promising results selected on history and examination of normal pressure hydrocephalus and improved radiological in Evan’s ratio CT brain scan. Keywords:&nbsp;&nbsp;Normal Pressure Hydrocephalus (NPH), VP Shunt, Stein and Langfitt Scale

Comparison of Oral Ivermectin and Permethrin 1% Shampoo in the Treatment of Pediculosis Capitis

Objective: To compare the efficacy of Oral Ivermectin with Permethrin 1% Shampoo in the treatment of Pediculosis Capitis Study Design: Randomized controlled trial Setting &amp; Study duration: This study was conducted at the Department of Dermatology, Bolan Medical College/ Sandeman Provincial Hospital, Quetta from December 24, 2016 to June 23, 2017 (6 months) Materials and Methods: All children of either gender having age 5 and above weight more than 15 kg presented with head-lice infestation confirmed by combing the wet hair with a fine-toothed detection comb were enrolled. All patients were randomly allocated into two groups. Patients in group A received oral Ivermectin in dose of 200mcg/kg while patients in group B received application of 1% Permethrin Shampoo. They were called after one week and they received second dose of oral Ivermectin in same dose of 200mcg/kg and application of Permethrin 1% Shampoo and re-evaluated after one week. Treatment was considered effective by absence of live lice by day 15 of treatment. Data was analyzed in SPSS version 17.Mean age of the patient in the sample was calculated. Male to female ratio was determined in the sample. In both the groups, frequency of patients having no live louse in the head on 15th day was calculated. The frequency in both groups was compared by applying chi square test keeping p-value≤ 0.05. Results: Majority of the patients presented were females in both group, i.e. 20 (66.7%) and 23 (76.7%) respectively. Insignificant difference was observed in the mean age in between group (p- value 0.482). Efficacy was found significantly higher in oral Ivermectin group 26 (86.7%) as compared to 1% Permethrin Shampoo. (p-value &lt;0.001). Conclusion: The efficacy of oral Ivermectin group was considerably higher as compared to 1% Permethrin Shampoo in our cohort