A PROSPECTIVE STUDY COMPARING TUBELESS MINI-PERCUTANEOUS NEPHROLITHOTOMY TO RETROGRADE INTRARENAL SURGERY FOR ≤2 CM RENAL STONES.

Objective: The present study aims to assess the safety and efficacy of tubeless mini-PCNL and RIRS in the management of renal stones of ⩽2 cm size. Patients and methods: This was a prospective study in 80 patients with renal stones of ⩽2 cm and were divided into two equal groups of patients choice: Group 1 were managed by tubeless mini-PCNL and Group 2 by RIRS using flexible ureteroscopy and laser. Intraoperative events like duration of surgery, stone clearance and complications were noted. Postoperative parameters taken into account were pain score, parenteral analgesic requirements, bleeding, need for blood transfusion, fever, hospital stay, cost of the procedure and number of days taken to return to normal work. Results: Both groups were comparable for preoperative parameters. Mean duration of surgery in group 1 and group 2 was 68.88 ± 7.20 minutes and 92.25 ± 14.62 minutes respectively (p<0.00001). The mean haemoglobin fall in group 1 and group 2 was 0.47±0.24 g/dl and in group 2 was 0.28±0.18 g/dl respectively (p=0.00013). In group 2, residual stones were present in 4 patients (on follow-up at 3 weeks), while in group 1 there was no residual stones. The cost of the treatment was more in the RIRS group with statistically significant difference (p<0.005). Conclusion: In a urological setup where LASER and flexible ureteroscope are not available, tubeless mini PCNL is a safe, efficacious and cost-effective option for the management of smaller (⩽ 2 cm) stones compared to RIRS procedure. Recommendations: Mini PCNL and RIRS are safe and feasible surgical options to manage ⩽ 2 cm renal stones. We recommend tubeless mini PCNL in a setup where LASER and flexible ureteroscope are not available

PHYSICAL AND INDEX PROPERTIES OF LATE PRECAMBRIAN AND CAMBRIAN SALT RANGE ROCKS OF PUNJAB

Thirteen rock types including Sandstone, Siltstone, Dolomite, Shale, Gypsum and Rock Salt collected from five different formations of Salt Range area of Pakistan were tested to assess their physical and index properties. Specific gravity, dry and wet unit weights, moisture contents, porosity, water absorption and slake durability index were determined. Results indicate that most of the rocks have their specific gravity and unit weight values in the standard range. Higher durability indices and low water absorption values of sandstones and dolomite make them suitable for construction materials. While higher porosity of Baghanwala sandstone, lower and upper Khewra sandstone indicates their potential as hydrocarbon bearing reservoir and at the same time make them an ideal candidate for greenhouse gases sequestration in the subsurface.&nbsp

Determinants of Farmers’ Awareness and Adoption of Extension Recommended Wheat Varieties in the Rainfed Areas of Pakistan

Scientific evidence suggests that there is room for eradicating poverty and hunger by increasing food production through the adoption of modern agricultural practices by farmers. This study aimed, first, to explore the relationship between the farmers’ awareness and adoption of improved wheat varieties. Second, it aimed to find the key factors that govern the farmers’ awareness and adoption of extension-recommended innovations in the rainfed cropping system of the Khyber Pakhtunkhwa, Pakistan. Data were collected from 395 respondents. A binary logit model was used to analyze the effect of the farmers’ socioeconomic and farm-specific characteristics on their awareness and adoption of the extension-suggested wheat varieties. Moreover, qualitative data from 40 key informants were collected for in-depth analysis. The results show a strong association between the farmers’ awareness of a technology (improved wheat varieties) and its adoption. The results of the logit model show that their extension contacts, income from agriculture, and access to credit positively affected the farmers’ awareness, whereas their education and household sizes negatively affected their awareness. Moreover, the factors that positively influenced the farmers’ decision to adopt the technology included the extension contact, the confidence in the extension, the risk-bearing attitude, and the credit access, whereas the household size and education negatively affected it. The results of the key informant interviews reveal that the high incidence of poverty, the low soil fertility, the farmers’ inability to make effective decisions, the lack of accurate weather predictability in the rainfed farming system, the lack of government interest, and the asymmetric information in the inputs markets contributed to the farmers’ low levels of awareness and to their poor adoption of improved agricultural technologies. These results indicate that any intervention aimed at the awareness and adoption by farmers of improved technologies, such as new wheat varieties, should recognize the heterogeneity in the farmers’ socioeconomic and farm-specific characteristics

Agricultural Market Competitiveness in the Context of Climate Change: A Systematic Review

Climate change poses a significant threat to food security, poverty alleviation, and the economic growth generated by agriculture. In 2020, it is anticipated that the massive impacts of climate change, warfare, pests, and spreading infectious diseases will jeopardize food production, damage the supply chains, and over-stretch people’s ability to obtain nutritious foods at affordable/reasonable prices, threatening agricultural markets’ competitiveness. The study compiles information on climate change, competitiveness, and literature that links these phenomena to agricultural market competitiveness. The objective is to investigate the peer-reviewed and gray literature on the subject and explore the link between climate change and agricultural market competitiveness. Moreover, this study aims to find an appropriate technique to validate this assumed relationship. The findings indicate that there is currently no comprehensive measure/composite index for assessing the agricultural sector’s global competitiveness. The majority of used indicators of agricultural competitiveness do not account for the effects of climate change on agricultural market competitiveness. The study concludes by outlining implications/justifications for developing a global agricultural competitiveness index incorporating climate change impacts. The index is essential to maximize the potential of agricultural markets for optimizing the agricultural sectors’ competitiveness, and also to ensure global food security

Adult Bochdalek Hernia with Organo-Axial Gastric Volvulus: Misdiagnosed as Hydropneumothorax

Bochdalek hernia (BH) in an adult may manifest clinically with a myriad of abdominal or chest symptoms or a combination of them. Diagnosis of an adult BH is usually delayed in view of rarity of the lesion and its varied presentation. A 30-year-old adult gentleman presented to us with a left thoracostomy which was draining pus and ingested food particles. The tube thoracostomy had been performed in another hospital for an apparent left hydropneumothorax before he arrived in our hospital. Computed tomography of Chest and abdomen revealed a left diaphragmatic defect with herniation of stomach, spleen and omentum into the chest with organo-axial volvulus of the stomach. A thoracostomy tube was seen to be traversing through the stomach with its tip located close to the left pulmonary artery. The patient underwent left thoraco-abdominal exploration with dissection and reposition of the hernial contents in the abdominal cavity. The gastric perforations and the diaphragmatic defect were repaired. This case reiterates a well-known fact that an adult type BH must find a place in the differential diagnosis of a hydropneumothorax. Though the adult BH is a rare diagnosis, unawareness or reluctance to consider the possibility of adult BH may prolong the suffering of the patient as it happened in our patient who had iatrogenic perforation of the stomach due to tube thoracostomy

Satisfaction of Tuberculosis Patients with Directly Observed Treatment Strategy under Pakistan Health Care Policy: A Mixed-Method Study

(1) Background: Patients’ satisfaction is based on the perceived health care services of individuals and is influenced by the level of care provided by the health care system. It is often based on the patients’ expectations of care and self-assessment of their experiences. The success of the Directly Observed Treatment Strategy (DOTS) also depends on the quality of health care provided at the Tuberculosis (TB) centers, which can be evaluated by satisfaction levels of the patients. (2) Methods: A tuberculosis facility-based cross-sectional study was carried out in Khyber Pakhtunkhwa province in Pakistan. A mixed-method approach was adopted for data collection. An interviewer-administered questionnaire was used for quantitative data collection from 269 patients who were registered at 11 TB centers and private clinics. Qualitative data were collected through 20 in-depth interviews, 15 key informant interviews, and a focus-group discussion. Binary logistic regression was employed for analysis of the data. (3) Results: More than half of the respondents (63.94%) were satisfied with the DOTS strategy. A high percentage of patients were dissatisfied with the availability of safe water, waiting space for patients, waiting time, privacy, and the processing of appointments. Results from the binary logistic regression showed that gender (AOR = 2.21, CI 1.07–4.58, p = 0.033), marital status (AOR = 3.12, CI 1.45–6.73, p = 0.004), employment status (AOR = 5.22, CI 2.44–1.21, p = 0.000), home ownership (AOR = 3.82, CI 1.94–7.54, p = 0.000), literacy (AOR = 2.17, CI 1.11–4.25, p = 0.023), households’ main occupation (AOR = 4.42, CI 1.12–17.38, p = 0.033), and level of income (AOR = 2.39, CI 1.13–5.04, p = 0.023) were the significant factors affecting satisfaction levels of the patients. (4) Conclusion: There are a number of areas that need improvement for successful TB eradication. Significant work is required to improve the quality of TB care in these specific areas from the patients’ perspective. For instance, female health workers’ involvement in the DOTS program can solve the problems of female respondents in rural areas. Improving the infrastructure facilities at the TB centers, allocation of doctors and nurses at the rural health centers would result in positive outcomes of the DOTS in Pakistan as well as in other developing countries