A case of transient diabetes insipidus following cardiopulmonary bypass

Cardiopulmonary bypass surgery has been linked with a number of postoperative complications. One of the frequently reported physiological alterations is the relative diuresis seen in the immediate post-op period. Rarely reported though is the development of full-blown diabetes insipidus in such patients. The etiology is unknown and has only been hypothesized in the past. We present the clinical course of a 54 year old male who developed transient diabetes insipidus post bypass surgery with subsequent recovery following exogenous vasopressin administration. The physiological alteration leading to the development of diabetes insipidus in a small fraction of bypass patients remains unknown. We propose that the variation in natriuretic peptide levels in the post-bypass period could account for the transient event

Perceptions, knowledge and attitudes towards the concept and approach of palliative care amongst caregivers: A cross-sectional survey in Karachi, Pakistan

Background: Limited comprehension of the concept of palliative care and misconceptions about it are barriers to meaningful utilisation of palliative care programs. As caregivers play an integral role for patients with terminal illness, it is necessary to assess their perceptions and attitudes towards the palliative care approach.Method: A cross-sectional survey was conducted. Data was collected from the Aga Khan Hospital in-patient and out-patient departments and home-based palliative care services. All adult caregivers who met the inclusion criteria and consented, completed a questionnaire till the sample size was reached. Univariate and multivariate multivariable analysis was done and results were reported as crude prevalence\u27s, crude and adjusted prevalence ratios with 95% confidence intervals using Cox-proportional hazard algorithm. Mean difference of knowledge and attitude scores by caregiver variables were assessed using one-way ANOVA. SPSS version 18 was used and a p-value of less than 5% was treated as significant.Results: Out of 250 caregivers more than 60% were 40 years or less, majority were males and at least graduates. Approximately 70% of the respondents agreed with the statement that the person suffering from cancer should be informed about the diagnosis and disease progression. About 45% (95% C.I.: 39.03, 51.37%) of the study respondents had enhanced understanding about palliative care. Individuals under 40 years old, those with an education level of at least grade 10, children or relatives were found to have significantly more enhanced knowledge about palliative care. The majority believed that the patient should be informed about the diagnosis and should be facilitated to carry out routine activities and fulfill their wishes.Conclusion: Nearly half of the caregivers had enhanced understanding of the palliative care approach. They showed consistent understanding of two foundational aspects indicating correct knowledge across age groups, gender, education level, and relationship with the patient. Firstly, that palliative care should be offered to everyone suffering from a terminal illness and, secondly, that this approach encompasses not just physical, but also psychological and social needs of the patient and the family. These findings will help inform the establishment of a palliative care program that fills the gaps in comprehension and knowledge of caregivers

Impact of Training and Development on Organization Performance with Mediating Role of Intention to Quit as Human Resource Quality Cost

The study is focused on the analysis of the impact of the training and development efforts in the  Small  and Medium  Enterprises  of  Pakistan  on  the  intention  of  employees  to  leave  the organization  considering  it  as  an  expense  and  the  wastage  of  time  and  resources  by  the organization.  The  study  will  also  evaluate  the  ultimate  impact  of  the  intentions  of  the employees  on  the  performance  of  the  organization.  The salary  based  employees  of  the organizations  having  5 –  250  employees  have  been  selected  on  the  basis  of  stratified sampling  technique  for  the  data  collection  purposes.  Out  of 600  questionnaires  distributed, 290  were  returned  and  278  were  used  for  the  study.  The relationship of training and development and organization performance has been found to be positively mediated by the intention of employees to quit the organizations. The positive relationship might exist due to the  number  of  other  factors  like  inflation,  less  job  opportunities  existing  in  the  Pakistani context. The study will be highly significant for the practitioners in the SMEs, shifting their focus towards the increased training and development efforts

Synovial sarcoma of cervicodorsal spine: A case report

Synovial sarcoma is a soft-tissue sarcoma. Its involvement of the spine is extremely rare. We report a 40 year old male who presented with shoulder pain and progressive weakness in all four limbs for six months with a visible, slowly growing bulge in his upper back. On examination he had quadriparesis and diffuse sensory deficit. MRI of the cervical spine showed a large soft tissue mass, iso to hypointense, extending into the neural canal, compressing the cord. The mass had a few internal areas of contrast enhancement with extension into the right paraspinal regions involving the vertebral bodies. Sub-periosteal spine dissection was done. Tumour was primarily extradural, involving and extending from paraspinal soft tissues to the posterior arches, laminae and spinous processes of the verteberae, with their destruction. Gross radical removal of the visible mass was done, followed by three cycles of radiation therapy. Excisional biopsy showed synovial sarcoma TYPE II. In conclusion, synovial sarcomas should be kept in the differentials of a mass arising in spinal axis

To Know the Effectiveness of Disc Excision in the Treatment of Herniated Lumbar Intervertebral Disc

OBJECTIVES To evaluate the effectiveness of disc excision in the treatment of herniated lumbar intervertebral disc.METHODOLOGY METHODOLGY This study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar. A total of 62 patients had moderate to severe radicular pain due to Prolapsed intervertebral disc at L4/5 or L5/S1. All the enrolled patients were subjected to disc excision surgery. Postoperatively the patients were kept for 48 hours for observation and then discharged. All the patients were advised to come after 2 weeks for the follow-up to check effectiveness. RESULTS The mean age of patients was 34.59± 7.49 years. There were 64.5% male and 35.5% female. 53.2% of patients had L4-L5, 33.9% of patients had L5-S1 and 12.9% of patients had both L4–L5 and L5–S1 level disc herniation. 85.5% of patients had no pain, 8.1% had mild pain and 04.8% had moderate pain. Postoperatively 79.0% of patients were satisfied. CONCLUSION As compared to conservative care limited disc excision is safe, effective, and reliable in terms of pain. Disc excision technique provides immediate relief from radicular pain

Modeling user’s trust in M-commerce acceptance: A conceptual framework in context of Pakistan

With the emergence of Intern ate and world wide web traditional business got new opportunity to complete globally. Traditional bricks-and-mortar business became electronic business ( e-business) by utilizing information and communication technology (ICT) tools. A new term of Mobile Commerce (M-Commerce) has created tremendous spectrum of business opportunities for businesses. Although there has been large scale adoption of M-Commerce in developing economies, but little growth is observed in developing economies such as Pakistan. There are doubts that users of M-Commerce demonstrate a lack of enthusiasm, which may be due to lack of trustworthiness. Based on the well-known and widely used technology acceptance model (TAM), this research study provides the conceptual framework, underpinning the relationship of trust with adoption of M-Commerce in Pakistan. The aim of this paper is to study the role of trust and its relationship with the acceptance of M-Commerce in Pakistan