Etiology, clinical characteristics, and outcome of infective endocarditis: 10-year experience from a tertiary care center in Pakistan

This study was conducted to assess the clinical characteristics, causative agents, complications, and outcomes of infective endocarditis (IE) among patients presenting to our tertiary care center over the last decade. This retrospective cohort study included all adult patients admitted to the Aga Khan University Hospital with the diagnosis of IE over a ten-year period from 2010 to 2020. Outcomes variables included complications during hospitalization, surgical intervention, mortality, and length of stay. We identified a total of 305 cases out of which 176 (58%) were males and 129 (42%) were females. The mean age of the patients was 46.9±18.8 years. 95 (31%) had prosthetic valves in place. Staphylococcus aureus was isolated in 54 (39%) patients followed by coagulase-negative Staphylococcus in 23 (17%). Echocardiography revealed vegetations and abscesses in 236 (77%) and 4 (1%) patients, respectively. The most common valvular complication was mitral valve regurgitation found in 26 (9%) patients, followed by tricuspid valve regurgitation in 13 (4%) patients and aortic valve regurgitation in 11 (3%) patients. Furthermore, 81 (27%) patients suffered from heart failure and 66 (22%) from a stroke during hospitalization. The mean hospital length of stay was 10.4 ± 10.6 days. 64 (21%) patients required surgical repair and the overall mortality rate was 25%. Prosthetic valve endocarditis (OR = 3.74, 95% CI = 2.15-6.50,

Factors Affecting Investment Decision Making of Equity Fund Managers

Traditional theories of finance assume that investors use all available information and make rational investment decision but in reality the scenario is different. Based upon the growing importance of behavioral finance the present study is an attempt to investigate the effect of behavioral factors such as heuristics, risk aversion, use of financial tools and firm level corporate governance on the decision making of equity fund managers of Pakistan. The study collected response from 327 equity fund managers of insurance companies, commercial banks, and equity investment companies applying stratified random sampling technique. The results of the study demonstrate that a positive and significant relationship exist among heuristics, use of financial tools, risk aversion, firm-level corporate governance, and investment decision making. The results further demonstrate that firm-level corporate governance plays a pivotal role and is an important factor affecting investment decision making. Equity fund managers of institutions apply heuristics and financial tools while formulating their decisions. Equity fund managers of institutions are also found to be risk averse. Regulatory authorities and stock exchanges may use the results of the study. Regulatory authorities and exchanges may also use the results to create awareness by educating investors about the importance of behavioral factor and firm-level corporate governance. It may help to increase investors’ confidence

Factors Affecting Investment Decision Making of Equity Fund Managers

Traditional theories of finance assume that investors use all available information and make rational investment decision but in reality the scenario is different. Based upon the growing importance of behavioral finance the present study is an attempt to investigate the effect of behavioral factors such as heuristics, risk aversion, use of financial tools and firm level corporate governance on the decision making of equity fund managers of Pakistan. The study collected response from 327 equity fund managers of insurance companies, commercial banks, and equity investment companies applying stratified random sampling technique. The results of the study demonstrate that a positive and significant relationship exist among heuristics, use of financial tools, risk aversion, firm-level corporate governance, and investment decision making. The results further demonstrate that firm-level corporate governance plays a pivotal role and is an important factor affecting investment decision making. Equity fund managers of institutions apply heuristics and financial tools while formulating their decisions. Equity fund managers of institutions are also found to be risk averse. Regulatory authorities and stock exchanges may use the results of the study. Regulatory authorities and exchanges may also use the results to create awareness by educating investors about the importance of behavioral factor and firm-level corporate governance. It may help to increase investors’ confidence

The Use of Fractional Fourier Transform for the Extraction of Overlapped Harmonic Chirp Signals

ABSTRACT In ultrasound harmonic imaging, high bandwidth is essential to provide good axial resolution at the receiver. However, increasing the bandwidth will cause overlapping amongst the nonlinear harmoni

MORPHOLOGIC SPECTRUM AND CLINICO-PATHOLOGICAL CORRELATION OF GASTROINTESTINAL STROMAL TUMOURS: AN EXPERIENCE OF SIX YEARS AT A TERTIARY CARE HOSPITAL.

Objective: The objective of this study was to determine the morphologic spectrum and risk category of gastrointestinal stromal tumour (GIST) and compare with overall patient survival.Materials and Methods: It is a descriptive observational study. The study was carried at Shifa International Hospital, Islamabad. Duration of the study was from January 2009 to January 2015. A total of 31 patients with the diagnosis of GIST were included, irrespective of age and gender. Data were retrieved from laboratory information system. Results were analysed by statistical software, Statistical Package of the Social Sciences. Morphologic type, site of tumour, risk category and overall survival were determined and mean, standard deviation, frequencies and percentages were calculated for age site and risk category. Results: Of 31 patients, 21 (67.7%) were male and 10 (32.3%) were female. Site of tumour was as follows: Gastric 13 (41.9%), extra visceral 6 (19.4%), small intestine 9 (29.0%), rectum 2 (6.5%) and pancreas 1 (3.2%). According to risk categorisation, one was categorised as (3.2%) very low risk, 3 (9.7%) low risk, 5 (16.1%) intermediate risk and 22 (71%) high risk. Follow-up was available in 21 patients. 7 patients (22.5%) lost to follow-up. 8 (25%) had recurrence and 4 (12.9%) died. Conclusion: Majority of cases diagnosed at our centre were gastric in origin followed by small intestine, and as per risk categorisation, most were high risk. Patient survival with high-risk tumours was dismal. Key words: Gastrointestinal stromal tumour, immunohistochemistry, risk categorisation

Community-level interventions for pre-eclampsia (CLIP) in Pakistan: A cluster randomised controlled trial

Objectives: To reduce all-cause maternal and perinatal mortality and major morbidity through Lady Health Worker (LHW)-facilitated community engagement and early diagnosis, stabilization and referral of women with preeclampsia, an important contributor to adverse maternal and perinatal outcomes given delays in early detection and initial management.Study design: In the Pakistan Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial (NCT01911494), LHWs engaged the community, recruited pregnant women from 20 union councils (clusters), undertook mobile health-guided clinical assessment for preeclampsia, and referral to facilities after stabilization.Main outcome measures: The primary outcome was a composite of maternal, fetal and newborn mortality and major morbidity.Findings: We recruited 39,446 women in intervention (N = 20,264) and control clusters (N = 19,182) with minimal loss to follow-up (3∙7% vs. 4∙5%, respectively). The primary outcome did not differ between intervention (26·6%) and control (21·9%) clusters (adjusted odds ratio, aOR, 1∙20 [95% confidence interval 0∙84-1∙72]; p = 0∙31). There was reduction in stillbirths (0·89 [0·81-0·99]; p = 0·03), but no impact on maternal death (1·08 [0·69, 1·71]; p = 0·74) or morbidity (1·12 [0·57, 2·16]; p = 0·77); early (0·95 [0·82-1·09]; p = 0·46) or late neonatal deaths (1·23 [0·97-1·55]; p = 0·09); or neonatal morbidity (1·22 [0·77, 1·96]; p = 0·40). Improvements in outcome rates were observed with 4-7 (p = 0·015) and ≥8 (p \u3c 0·001) (vs. 0) CLIP contacts.Interpretation: The CLIP intervention was well accepted by the community and implemented by LHWs. Lack of effects on adverse outcomes could relate to quality care for mothers with pre-eclampsia in health facilities. Future strategies for community outreach must also be accompanied by health facility strengthening.Funding: The University of British Columbia (PRE-EMPT), a grantee of the Bill & Melinda Gates Foundation (OPP1017337)

What Does Matter? Liquidity or Profitability: A Case of Sugar Industry in Pakistan

Keeping in mind the Keynes of the Pakistan's Sugar Industry in its overall economic well-being, the current work objects to examine the liquidity-profitability trade off in Sugar Industry of Pakistan. Secondary data of the non-financial companies which are listed on KSE is used for sugar industry over the last five years. Present study used different analytical tools like Reliability Analysis, Descriptive Statistics, Multiple Regression Analysis, Correlation and tests of significance to test the causal linkage in liquidity and profitability. Results of regression analysis showed that, hypothesis one is rejected because liquidity generates positive impact on ROA and found significant at 1% level. Hypothesis two of the current study is rejected because liquidity causes positive impact on ROE and found significant at 1% level. According to regression analysis, hypothesis three is also rejected because liquidity influences ROCE positively and found significant at 1% level. Results of correlation analysis discovered that liquidity of Sugar Mills is positively and significantly correlated with all measures of profitability i.e. ROA, ROE and ROCE. Findings of current research suggest managers to come out of the dilemma with respect to liquidity and profitability tradeoff. It is further concluded that managers can increase the firm's profitability and shareholder's value if they invest effectively and efficiently in liquid assets. Finally this study's results make it important for the reason that it is one of the fewer researches going in contrast to the existing knowledge base. Keywords: Liquidity, Profitability, Trade-off, Sugar Industry of Pakistan JEL Classification: G3

Mandibular Third Molars and Lower Anterior Crowding: Comparison of Opinions of Oral-Maxillofacial Surgeons and Orthodontists

Objective: To compare the opinion of orthodontists and oral-maxillofacial surgeons on relation between erupting mandibular third molars and lower incisal crowding.Patients and Methods: This descriptive study involved 100 Pakistani clinicians (50 orthodontists, 50 oral-maxillofacial surgeons) to answer online questionnaire regarding their opinions on link between erupting Mandibular Third Molars along with their extraction opinion with reference to development and prevention of lower incisal crowding. Data was analyzed using SPSS version 21.0. Pearson's chi-square test was applied and statistical significance was defined at <=0.05.Results: Statistically insignificant differences were found between oral-maxillofacial surgeons and orthodontists regarding question of erupting mandibular third molars in causing lower incisal crowding. Similarly, statistically insignificant differences between oral-maxillofacial surgeons and orthodontists were found regarding question of recommending preventive extraction of mandibular third molars for developing lower incisal crowding.Conclusion: No opinion differences were observed between Pakistani oral surgeons and orthodontists, regarding the link of lower third molar as a cause of lower incisal crowding