Macroeconomic Determinants of Urbanization in Pakistan

Urbanization refers to the migration of rural people to urban centers in search of better jobs. Urbanization and growth go together; no country has ever reached middle-income status without a significant population shift into cities. Urbanization has strong association with unemployment, economic growth, poverty, infrastructure, crimes, health, socio-economic conditions and education. In 2050, most of the urban population of the world will be concentrated in Asia (52%) and in Africa (21%). A simple and modest model provided reasonable results. Increase in literacy is a decisive factor that has significant impact on increasing urban population. Per capita GDP growth also positively influences the urban population. Age-structure is too an important determinant of migration and urbanization. It is an open secret that generally young persons have gone abroad. Specification and diagnostics test supported the model which reveals appropriateness and statistical soundness of the model. Serious heed is paid to delimitation of cities to make them manageable and governable. Agriculture is provided sufficient resources to discourage migration to cities

Congenital Pouch Colon: A Preliminary Report from Pakistan

Background: Congenital pouch colon (CPC) is a rare entity in patients of anorectal malformations (ARM) requiring special consideration as to the management. This study is aimed at evaluating the presentation, management, and the outcome of initial surgery in patients with CPC. Materials & Methods: This retrospective study was conducted in the department of Pediatric Surgery of our institute during May 2007- May 2010. The Information about the demography, clinical features, investigations, management, and the outcome of initial surgery was retrieved and analyzed. Results: There were 21 patients of CPC managed during the study period. Sixteen (76%) were males and five (24%) females (M:F 3.2:1). Mean age of presentation was 4.8 days with a range of 12 hours to 45 days. In 18 (85.7%) patients, CPC was found with high ARMs, whereas, in 3 (14.3%) patients it was associated with low ARMs. Imperforate anus with moderate to massive abdominal distension was the presentation in 16 (76%) patients. Abdominal radiographs helped in preoperative diagnosis in 8 patients. Two patients had pneumoperitoneum on abdominal radiographs. At operation, type I CPC was found in 9 (42.8%) patients, type II in 5 (23.8%), type III in 2 (9.5%) patients, and type IV CPC in 5 (23.8%) patients. In 11 (52.4%) patients, pouch was emptied and retained with proximal enterostomy. In 7 (33.3%) patients, end enterostomy with pouch excision was done. In two patients, a window colostomy was formed. In one patient, pouch was disconnected from the normal bowel and Hartmann’s pouch with end ileostomy was formed. There were 2 (9.5%) deaths in our series.Conclusion: CPC is a rare malformation. Massive abdominal distension with imperforate anus is the common presentation. Optimum management can reduce the morbidity and mortality

Autologous serum eye drops for treatment of dry eye syndrome

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Occipital Encephalocele and Review of Literature

Encephalocele is a rare congenital malformation of the central nervous system. It is defined as a congenital herniation of the intracranial compartments through a long defect and contains various rudimentary cerebral tissue components or sometimes only cerebrospinal fluid. They are located at midline of parietal or occipital region when the defect is small. Usually only the meninges herniate and the anomaly is cranial Meningocele or cranium bifidum with Meningocele. We present 47 cases of encephalocele, mostly occipital encephalocele, operated during last 5 years in our hospital at the department of Neurosurgery SZH, RYK. This is a retrospective study.Material and Methods: Between January 2008 and December 2013. Forty seven cases of encephalocele have been treated at our department. They were diagnosed on the basis of clinical findings and CT scan was done in all patients. All patients were operated and diagnosis was confirmed at peroperatively. Demographic, clinical, radiological and operative data were reviewed from hospital charts.Results: The total number of patients was 47, out of which 23 were male and 24 were female. Neurosurgical data of patients with encephalocele over the five years and three months from January 2008 to April 2014 were retrospectively studied. The average age of the patients at the time presentation was 10 months and seven days.Conclusion: Encephalocele is a relatively uncommon neurosurgical entity largely seen in the pediatric population. Treatment of this condition can be rewarding if properly managed early. Occipital, parietal, frontal, and frontonasal types may be approached without opening the cranium, while sincipital and basal encephalocele usually require craniotomy. In this series we present our experience in the operative management of encepha-locele with good outcome and also share our recommendation in technical consideration for surgical approaches

PSYCHOSOCIAL ILLNESS IN CHILDREN WITH THALASSEMIA: A CASE-CONTROL STUDY

INTRODUCTION: Thalassemia is the most common hemolytic autosomal recessive disorder. Pakistan has significant number of thalassemic children .The children with chronic disorders like thalassemia are prone to develop psychosocial illness including depression, anxiety, intellectual and behavioral issues.  OBJECTIVE: To assess the psychosocial illness in children with thalassemia and to compare these problems in children with and without Thalassemia   PLACE & DURATION: The Children’s Hospital and the institute of child health, Multan. From January to September 2021.  STUDY DESIGN: Case-control  MATERIAL AND METHOD:   In this study 50 children with Thalassemia and 50 normal children were enrolled as case & control according to inclusion and exclusion criteria. After approval from institutional ethical committee, detailed history ,Socioeconomic status, educational status of parent and child, age of diagnosis of disease, and whether thalassemia is well controlled or not and complications were noted. A Pediatric Symptom Checklist was used for psychosocial problems in all children. Data was analyzed by using SPSS version 22. Mean and standard deviation for quantitative data, while frequencies and percent for qualitative data was calculated. P-value was calculated by Chi square test. Prevalence ratio (ODDS ratio) with 95%confidence interval of all variables were calculated.  RESULTS: Out of 100 patients 50 were in case group (Thalassemia) and 50 control (non-thalassemic.Male female ratio was 1.2:1. 60 %( n=30) cases, 78 %( n=39) control patients were age ranges between 5 to 10 years. Educational level of parents of 40%(n=20),and 56%(n=28) was below matric,42%(n=21) and 90%(n=45) patients were going to school in case and control group respectively.82%(n=41) patients belonged to low socioeconomical status in each group. Regarding characteristics of thalassemia 74 %( n=37) patients were diagnosed within 1st year of life, while 26 %( n=13) after 1st year.64 %( n=32) had well controlled and 36 %( n=18) poor controlled disease. 20%(n=10) had developed Diabetes mellitus,2%(n=1) heart failure,74%(37) growth failure,76%(n=38) hemolytic facial features and 72%(n=36)skin discoloration. Psychosocial problems were statistically significant in children with Thalassemia as compared to healthy ones (p-value<0.001).Poorly controlled thalassemia and complications of heart and growth failure were found statistically significant risk factors.  CONCLUSION: Psychosocial problems are common in children with thalassemia as compared to healthy ones. So these patients must be referred for detailed psychological evaluation and management along with medical treatment.

Surgical Outcome of Cerebellopontine (CP) Angle Tumors

Objective: The purpose of this study is to evaluate the clinical characteristics and surgical outcome of CP angle tumors.Material and Methods: This is a retrospective study of 10 cases admitted in the Department of Neurosurgery, Shaikh Zayed Hospital, Rahim Yar Khan during the last 8 years. The predominating symptoms here related to the seventh and eighth cranial nerves and headache.Results: Study included 10 cases of CPA Tumour clinical presentation was hearing loss, tinnitus, abnormal bala-nce, headache, facial numbness and buccal numbness, ataxia and trigeminal neuralgia. We had 10 patients, came with above clinical presentations. All cases were operated through retromastoid sub-occipital craniectomy. VP shunt was inserted in 1 case. Histopathology report was four patients vestibular schwanoma three tentorial meni-ngioma, two epidermoid cyst and one patient had choroid plexuses papilloma.Complications: One patient developed meningitis due to cerebrospinal Fluid leakage at operative site. Lumber drain was placed to control leakage and infection was controlled by aggressive treatment. There was no mortality in our study. One patient developed recurrence of epidermoid cyst at the same site after seven and half years. None of the patients developed further cranial nerve deficit as compare to preoperative deficit. The maximum period of follow-up of one patient was seven and half year.Conclusion: It is concluded from this study that the retrosigmoid corridor is the safe surgical approach for CPA tumors. In case of CP angle epidermoid, there was no recurrence symptoms on the immediate follow-up. At ope-ration, the root entry zone of TN should be examined for evidence of additional vascular compressio

A social norms approach to changing school children’s perceptions of tobacco usage

Purpose: Over 200,000 young people in the UK embark on a smoking career annually, thus continued effort is required to understand the types of interventions that are most effective in changing perceptions about smoking amongst teenagers. Several authors have proposed the use of Social Norms programmes, where correcting misconceptions of what is considered normal behaviour lead to improved behaviours. There are a limited number of studies showing the effectiveness of such programmes for changing teenagers’ perception of smoking habits, and hence this paper reports on the results from one of the largest Social Norms programmes that used a variety of interventions aimed at improving teenagers’ perceptions of smoking. Design/methodology/approach: A range of interventions was adopted for 57 programmes in Year 9 students, ranging from more passive interventions such as posters and banners to more active interventions such as student apps and enterprise days. Each programme consisted of a baseline survey followed by interventions and a repeat survey to calculate changes in perception. A clustering algorithm was also used to reveal the impact of combinations of interventions. Findings: The study reveals three main findings: (i) the use of social norms is an effective means of changing perceptions (ii) the level of interventions and change in perceptions are positively correlated and (iii) that the most effective combinations of interventions include the use of interactive feedback assemblies, enterprise days, parent and student apps and newsletters to parents. Originality/value: The paper presents results from one of the largest social norm programmes aimed at improving young people’s perceptions and is the first to use clustering methods to reveal the impact of combinations of intervention

Jejunal Intussusception: A Rare Manifestation of a Primary Thyroid Non-Hodgkin Lymphoma

Primary thyroid lymphoma (PTL) is an uncommon malignancy of the thyroid gland, with most lymphomas of the thyroid being almost exclusively of the non-Hodgkin\u27s B cell variety. PTL requires a prompt diagnosis because of its ability to cause progressive compression symptoms, and its unusual presentation can make the diagnosis very challenging. Herein, we present a case of PTL in a young woman with an uncommon initial presentation and discuss the complications she faced during the surgery, as well as postoperatively, due to the compression of the trachea by the thyroid mass