Metastatic Extrapulmonary Small Cell Carcinoma Presenting as Obstructive Jaundice

Extrapulmonary small cell carcinoma (EPSCC) is a rare cancer with a poor prognosis. It can arise from almost any site and is usually associated with extensive metastasis at the time of diagnosis. Due to the rarity of this cancer, very limited data is available in the literature and most of the recommendations for its evaluation and treatment are based on retrospective studies and expert opinion. This case report shares one such presentation of EPSCC. A 78-year-old male was admitted to the hospital with presenting symptoms of abdominal pain and discoloration of the eyes and urine for 2 months. Initial laboratory investigation revealed obstructive jaundice and leukocytosis. His infectious workup was negative. An ultrasound abdomen was performed, showing multiple liver deposits. He received a computed tomography chest, abdomen, and pelvis with contrast also showing multiple liver deposits highly indicative of metastatic disease. No other obvious abnormality or mass in other visceral organs was reported. He underwent endoscopy and endoscopic retrograde cholangiopancreatography, showing normal pancreatic-biliary ducts. A plastic stent was deployed to help with biliary drainage. A liver biopsy was performed and showed poorly differentiated small cell carcinoma of extrapulmonary origin. His abdominal pain improved after stent placement; however, liver tests continued to worsen. During his hospital stay, he was seen by oncology and given metastatic disease; he was offered palliative chemotherapy. Understanding his poor prognosis, the patient himself opted for comfort care and decided to go home with hospice care. Within days, he became lethargic, likely secondary to hepatic encephalopathy, and expired in the span of the next few days

Transformative Trade Credit Takaful Model: A Progressive Alternative to Credit Insurance

Trade credit insurance is a common method of risk management used by suppliers to safeguard themselves against non-payment by credit buyers. The manufacturer extending trade credit risks facing cash flow problems and potential customer non-payment. Manufacturers can increase sales with the aid of trade credit insurance and significantly reduce their default risk. A few companies in certain countries have introduced trade credit insurance as a relatively new service. However, they do not offer the Takaful model. Generally, people increasingly seek Shariah-compliant solutions, such as Islamic banking, to address their financial needs. Therefore, the government must bolster its presence in this domain. The overarching objective of this study is to propose an innovative Credit-related Takaful industry product for consideration. This study employed a qualitative approach, with unstructured interviews conducted to gather insights. The study sample comprises experts from the Shariah compliance department, Shariah scholars, and the Takaful industry experts, who were interviewed to gain a comprehensive understanding of Shariah principles. These interviews were conducted to gather insights into which Takaful model would be most suitable for Trade Credit in Pakistan. The majority of Shariah Scholars recommended the Waqf Wakalah model for the implementation of Credit Takaful in Pakistan. The findings of this study will help the Takaful industry of Pakistan to launch a new product for credit trading. This study will help further to know the importance of Credit Takaful and tap the gap in the Credit Takaful market, especially in Pakistan. Lastly, the findings will help the regulators of the Takaful industry to introduce new rules for the industry, providing a baseline for researchers to enhance their knowledge. Further investigation into Credit Takaful in Pakistan will build off the findings of this study to fill out the full circle of the Islamic financial system. It is a step in the right direction toward ending poverty and income inequality and increasing public awareness of the importance of Credit Takaful in today's world

Field Assessment of Non-nuclear Methods Used for Hot Mix Asphalt Density Measurement

Destructive nature along with the associated higher cost of the traditional core method used for hot mix asphalt density measurement has convinced researchers switching to some non-destructive technique for this purpose which is cost efficient as well. Earlier, nuclear density gauges were introduced for this purpose which was non-destructive as well. Since such devices were associated with the use of gamma rays, therefore, leading to safety and health issues. Last decade observed a revolution in asphalt density measurement technique with the evolution of non-nuclear density gauges. This research work is carried out with the objective to determine the efficiency and accuracy of a newly developed non-nuclear density gauge i.e. PQI-380 for field conditions as it needs its thorough evaluation prior to future uses in many of the developing countries including Pakistan. Density data obtained using standard core method and non-nuclear density gauge for 195 location confirms the satisfactory performance of the instrument. Results obtained show that the coefficient of correlation is near to 0.9. which refers to a strong correlation between the density data. Moreover, performance criteria e.g. root mean square error and mean absolute error between the density data set is also very low confirming the good measuring abilities of the device. Instrument performed well for repeatability analysis giving maximum coefficient of variance less than 5 percent

An Investigation of the Major Wheat Weeds in Different Zones of Dera Ismail Khan

On account of huge yield losses, weed infestation is a serious threat in wheat crops throughout the country. A comprehensive survey to find out the major weeds in wheat in Dera Ismail Khan was carried out during the crop season of 2012-13. Wheat fields at seed farms of Rakhmanghan, RakhZandani, Rata Kulachi and adjacent farmer’s fields to each seed farm were investigated. Data was collected at the peak growth stage of weeds and the quadratic method was used to record relative density (RD), relative frequency (RF), relative crowding coefficient (RCC) and importance value index (IVI). The results revealed that the major and most problematic weed of wheat at all the locations was Avena fatua (wild oat) on account of having maximum IVI at Rakh Manghan (78.51 & 77.44), Rata Kulachi (77.82 & 77.54) and Rakh Zandani (77.51 & 77.53) seed Farms and Farmer’s fields respectively. Rumex dentatus (dock) and Convolvulus arvensis (Lehli) were the second and third abundantly occurring weeds at almost all the seed farms and farmer fields on account of having the second and third highest IVI values at all the locations. Therefore Avena fatua (wildoat), Rumex dentatus (dock) and Convolvulus arvensis (lehli) seed were collected to find out the yield losses through further experimentation

Community acquired and post-transfusion hepatitis C is there a difference?

We analyzed 77 consecutive hepatitis C antibody positive patients to compare the history, laboratory data and histological features of community acquired (CA) and post-transfusion (PT) hepatitis C. Forty-six patients had CA and 31 PT hepatitis C. Mean age in both groups was same (45.67 vs 46 years). Male to female ratio was 2:1 in the CA group and 1:2.4 in the PT group. Mean duration between jaundice and first presentation was 8.9 years in the CA group and the mean duration between transfusion and first presentation was 9.8 years in PT group. No significant difference was found between two groups in the laboratory data. Liver biopsy was done in 32 patients (19 CA and 13 PT group). Mean histological score for disease activity was 9.3 in both groups, although more (68%) patients in the CA group had cirrhosis with chronic active hepatitis, (CAH) as compared to the PT (54%) group. Hepatitis C is an important cause of CA hepatitis. PT hepatitis C is more common in females because of increased likelihood of receiving transfusion for obstetric and gynaecological reasons. There is no significant difference in the laboratory and histological features between CA and PT hepatitis C

Peer Observation : A Professional Learning Tool for English Language Teachers in an EFL Institute

The key aim of this study is to explore the perceptions of English as foreign language (EFL) teachers about peer observation as a tool for professional development that is implemented in an English Language Institute of a Saudi Arabian university. This paper reviews literature on peer observation to develop a conceptual and theoretical understanding of peer observation systems in different contexts. It utilizes a mix-method approach and applies a questionnaire and semi-structured interviews as data collection tools. Questionnaire is used to get information about EFL teachers’ perceptions whereas semi-structured interviews provide an insight into their practices in the form of peer observation and future amendments for PD. The participants share their lived experiences who consider the current practice of peer observation a consistent professional challenge due to several factors, i.e. their lack of autonomy in deciding about the peers, trust deficit between administration and EFL teachers, rarely held pre-observation conferences due to the loads of teaching hours, observers’ insufficient training and qualifications in conducting PO, and the element of threat and insecurity. Based on the findings, recommendations are made to improve the existing peer observation system for the benefit of the EFL teachers, English language learners and the institute