Pakistan’s Debt Problem: Its Changing Nature and Growing Gravity

It has been evident for some time that Pakistan’s debt burden is extremely onerous. The danger of external debt default first emerged in 1996 towards the end of the second Benazir government. Following the nuclear explosions by first India and then Pakistan and the subsequent imposition of economic sanctions by the Western countries in mid-1998, Pakistan froze the foreign currency deposits, a major source of balance of payments financing in recent years, and went into a technical default on external debt. Following a fresh agreement with the IMF in January 1999, Paris and London Clubs provided substantial debt relief in the form of rescheduling of debt payments due in 1998-99, 1999-2000 and the first half of 2000-1. Despite debt relief, the burden of external debt remains extremely heavy and the danger of default has not disappeared. In any case, the access to international financial markets has been greatly curtailed, if not eliminated, especially because The Paris Club has applied the ‘comparability of treatment’ to claims of private sector investors. On the domestic side, the heavy burden of servicing public debt has made the much needed fiscal adjustment both difficult and disorderly. The rise in interest payments from 2.2 percent of GDP in 1979-80 to 4.9 percent in 1988-89 and to the peak of 7.3 percent in 1998-99 made reductions in fiscal deficit hard to achieve. As interest payments now account for over 45 percent of government revenues, the fiscal deficit reduction has come mainly at the cost of development spending. Clearly the debt overhang is a major factor in the decline in the investment rate to 15 percent of GDP in 1998-99 and 1999-2000, the lowest level in more than two decades. Unless the debt burden can be brought down to more manageable levels, macro-economic management will remain problematical and growth prospects will remain clouded.

Learning from the Past: A Fifty-year Perspective on Pakistan's Development

In some ways, Pakistan’s economic growth since 1947 has been remarkable. The country’s economic viability was considered, in some quarters,1 in serious doubt at its emergence, but it has managed, despite a quadrupling of the population, to bring about significant improvement in the average living standards. Per capita GNP growth, on average around 2 percent per annum over a long stretch of nearly fifty years, has been the best among countries of the subcontinent. This growth has meant an increase in average income of about 150 percent over 1950–96. But Pakistan, like many other developing countries, has not been able to narrow the gap between itself and rich industrial nations which have grown faster on a per head basis. Also, Pakistan has lost substantial economic ground to the rapidly growing economies of East Asia notably China, South Korea, Thailand, Malaysia and Indonesia. In 1960, South Korea’s per capita income was only marginally ahead of Pakistan’s. In the short period of one generation, Korea had an income level which on purchasing power parity basis five times that of Pakistan in 1995. On the same basis, Thailand and Malaysia enjoyed a per capita income advantage of 200 to 300 percent over Pakistan.

Pakistan at the Threshold of the 21st Century: How to Shape a Better Economic Future?

Pakistan has been facing a deep-seated economic and financial crisis and seemingly intractable governance issues for the last few years. Factors such as international sanctions and global economic slowdown, which have worsened Pakistan’s economic difficulties, were beyond Pakistan’s control. But by and large, the country’s economic and financial difficulties are the result of economic mismanagement in key areas over long periods. Bad governance, as reflected in widespread corruption and poor delivery of public services, and especially poor law and order have given birth to a crisis of confidence in the state. It is argued here that despite this scenario, a long and arduous process of building institutions, setting the policies right, and enforcing a rule-based governance stressing both merit and accountability can put Pakistan back on the road to shared prosperity. Resolving financial problems, accelerating demographic transition, exploiting tremendous agricultural potential, improving both availability and quality of education, increasing competitiveness and bringing about structural change in exports and industry, and reforming the government are crucial policy actions that can help shape a better future for the country and end the economic drift.

Implementing Sustainable Tourism practices in luxury resorts of Maldives: Sustainability principles & Tripple Bottomline Approach

The aim of the research paper is to understand the sustainability challenges faced by resorts mainly luxury in Maldives and to implement the sustainable tourism practices. The Maldives economy is dependent mostly on the fishing, boat building, boat repairing and tourism. Over recent years there is a drastic change that has took place in Maldives in tourism industry. Maldives has progressed to be the upper middle-income country and luxury resorts are the reason for increased GDP in the country. Although there are some practices associated with the luxury resorts to follow in terms of environmental concerns. Present study focuses on the triple bottom line approach and the 12 major Sustainable Tourism Principles as a framework for sustainability practices and its implementation including the challenges associated in Maldives. The paper suggests some recommendations on several paradigm of enforcing laws and regulations, waste management facilities, fostering collaboration along with promoting local agriculture. The study also contemplates on several other areas such as on the impact of sustainability initiatives, coral restoration, and the use of sustainable supply chains. The intent of the current research is to suggest methods to promote the sustainable practices in luxury resort in Maldives

Invasive retroperitoneal infection due to basidiobolus ranarum with response to potassium lodide: Case report and review of the literature

We report a case of invasive retroperitoneal zygomycotic infection caused by Basidiobolus ranarum in a healthy 8-year-old boy. The youngster responded dramatically to potassium iodide. The clinical and pathological features are reviewed to highlight the problems encountered in the management of this rare infection

Frequency and Characteristics of Breast lymphomas presenting to a tertiary care hospital, Pakistan

Objective: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms. Methods: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information. Results: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total number of NHLs (Nodal and extra Nodal) was 2632. Thirty (n=30) patients accounting for 1.13% were diagnosed to have lymphomatous involvement of the breast. The Female to Male ratio was13.5:1; age range was 12-92 years with a median age of 43 years (Mean age 46.5 years and Standard deviation of age was 16.88 years). The sites of the lesions were the right breast in 11 cases (37.93%), left breast in 9 cases (31.03%) and both breasts in 2 cases (6.89%), while the location of 8 masses (27.58%) was unknown. Immunohistochemical studies were negative for cytokeratins (MNF and Cam 5.2) in all cases. All cases of DLBCL expressed B cell lineage antigens and were positive for LCA and Pan B (CD20 and 79a). Conclusion: We concluded that breast lymphomas represent 1.13% of all NHL and 0.5% of all breast malignancies in this study. The most frequent morphologic type was diffuse large B-cell lymphoma. As patients with primary breast lymphoma have a better prognosis than those with carcinoma of the breast or patients with extranodal lymphomas, a multidisciplinary approach including surgery, radiotherapy, and chemotherapy when needed would result in a more favourable outcome

Immunophenotypic analysis of Non-Hodgkin\u27s Lymphoma

One hundred and three cases of Non-Hodgkin’s lymphoma were evaluated immunohistochemically using a panel of monoclonal antibodies which includes leucocyte common antigen (LCA), CD45R (Pan-B marker), L-26 (CD 20-Pan-B marker) and UCHL-1 (Pan-T marker). Of the total 63 cases (61.17%) showed a B-cell phenotype while 40(38.83%) were of T-cell origin. Most B-cell neoplasms belonged to intermediate (79.36%) or high grade (15.87%) according to the international Working Formulation (WF). Most T- cell lymphomas were of either intermediate (52.5%) or high grade (32.5%) neoplasms. Some T-cell neoplasms presented as specific clinicopathological entities like lymphomatoid granulomatosis (2 cases), mycosis fungoides (1 case) and AILD type NHL (1 case). in 27 cases the immunostaining pattern of two .Pan-B markers i.e., L26 and CD45R was compared. L26 staining was expressed in all 27 cases (100% sensitivity) while CD45R showed positive reaction in 22 cases (82% sensitivity). UCHL-1 is proved to be a sensitive and lineage specfic T-cell markerand in 67% cases the staining pattern was moderate (++) to intense (+++). The mean age for the B-cell lymphomas was 49 years and 36 years in T-cell neoplasm. Male to female ratio in both types of lymphomas was 2:1. The study indicates a high prevalence of T-cell lymphomas when comparing the data from western countries and lower to those from Japan and Caribbean countries

Clinico-morphological pattern and frequency of bone cancer

Objective: The present study was done to find out the frequency of malignant tumors of bone and to categorize the prevelence of various histological types of osseous malignancies with respect to age, sex and site of origin. Setting: This study included consecutive cases of malignant bone tumors, which were diagnosed in the department of pathology at the Aga Khan University Hospital, Karachi during the period of three years (1995-1997). Methods: These tumors were initially evaluated on H & E stained section from paraffin embedded tissue blocks. Special stains and immunohistochemical analysis was performed whenever required. Results: A total of 169 malignant bone tumors were diagnosed during the study period. Metastatic tumors accounted for 28.4% of all malignant tumors of bone. Osteogenic sarcoma (27.2%) was the most frequent primary tumor of bone followed by Ewing’s sarcoma (12.4%), Non- Hodgkin’s lymphoma (10.6%), Chondrosarcoma (8.3%), Plasma Cell Myeloma (8.3%) and other rare entities (4.8%) in order of frequency. Conclusion: The most common malignant neoplasm diagnosed in osseous biopsies was metastatic tumors. Osteogenic sarcoma was the most frequent primary bone tumor in this series. The bone tumors were relatively more prevalent in males. The frequency of malignant bone tumor was relatively high as compared to developed countries

Diagnostic Surgical Pathology: the importance of Second Opinion in a Developing Country

Objective: To review the cases sent to the section of histopathology, Aga Khan Universty (AKU) for second opinion and see whether there are significant differences in the original outside diagnosis and the subsequent diagnosis submitted by us. Methods: A retrospective study of all consecutive cases for second opinion in the form of paraffin blocks from 1st Novemver 2001 to 31st July 2002. The primary submitted diagnosis in each case was compared with the subsequent AKU diagnosis. Results: The study included a total of 381 cases. However, in 45 cases (11.81%), initial histopathological diagnosis was not provided. Out of the remaining 336 cases, there were differences between the original diagnosis and the subsequent AKU diagnosis in 120 cases (35.71%). Out of these 120 cases, immunohistochemistry was performed in 65 cases (54.16%) only. Conclusion: In a developing country like Pakistan, where few laboratories are equipped to function as modern histopathology units, second opinion on difficult cases is very important. Worldwide, the concept of second opinion in surgical pathology is well established