Pheochromocytoma associated with von Hippel-lindau disease in a Pakistani family

Objectives: The aim was to study the presentation, disease characteristics, operative outcome, and prognosis in patients with familial Pheochromocytoma associated with von Hippel-Lindau (VHL) disease.Materials and Methods: There were six patients belonging to two generations of a single family who developed features of VHL over a period of 13 years and were treated at our institute. Patients\u27 characteristics, that is, age, gender, presenting complaints and clinical signs, laboratory and biochemical evaluation, and the presence of associated conditions was gathered from medical records. The preoperative and postoperative radiological imaging and histopathological results were also collected.Results: Out of six cases, five were male, and one was female. The mean age at first presentation was 25 years (16-40). All patients presented with uncontrolled hypertension and were found to have Pheochromocytoma on workup. Three patients had unilateral adrenal tumor, and three had bilateral disease. None of the patients had extra-adrenal Pheochromocytoma. All patients were managed with adrenalectomy and had benign pathology. Two patients subsequently had craniotomy for excision of cerebellar hemangioma, and one patient had bilateral partial nephrectomy at the time of adrenalectomy. There was no peri- post-operative mortality and all patients are being followed by the surgeon(s) and endocrinologist.Conclusion: Pheochromocytoma can be a part of familial conditions including VHL. Other associated features should be suspected, investigated, and treated in these patients that can influence patients\u27 clinical course and prognosis. Family members should also be screened to achieve early diagnosis

Diaspora, Remittances and Dependence on Arab Countries: A Case of Pakistan

This paper has formulated a model by the name of DRADM i.e. Diaspora-Remittances-Arab Dependency Model while studying the literature pertinent to the modes of remittance, sectarianism and the Pakistani diaspora in the Middle-East. Pakistan is home of a large Shi’a population second only to Iran and this community regularly visits the holy shrines in Iran, Syria and Iraq forming a heartily connection with these countries. Contrarily, the Sunni Arab world hosts a huge number of Pakistani workers who send a significant part of their salaries back to Pakistan. These remittances act as a viable source of foreign exchange and help in balance of payments each year. Since the former group (Shi’a) is influenced by Iran and the latter (Sunni) by Saudi Arabia, Pakistan finds itself in a flux. In its bid to make a balance between Iran and Kingdom of Saudi Arabia (KSA), how Pakistan would manage its staggering economy with headship of Islamic military coalition, is a big question mark. With the help of published secondary data from governmental and other institutions this study examines the co-relation between remittances from Arab World and sectarianism (inside Pakistan and in Middle East) and its impact on the foreign policy of Pakistan

Riba Free Loan in Islamic Finance: Key to Social Development and Welfare

Worldwide Islamic financial institutions (IFIs) do not offer loan for avoiding interest/usury, confine their Shariah interpretations to a particular school of thought and offer products for rich people only. Loans are however demanded by the underdeveloped social actors in economy for welfare and development. As per Islam usury (Riba) free loan (Qard – e – Hassan or Dain) is a key to social development. Modern implicit and explicit shapes of master-servant relation among individuals and institutions are legal phenomena with diversified standards and patterns. As per Jaferia school of thought, Islam allows presetting Hadya (gift) in loans among master-servant. These options were utilized by our study for proposing a Pro-Hadya Riba Free Loan among master-servant. Such model of loaning can help stakeholders of Islamic finance improving the existing landscape from pro-commercial creed to pro - social development approach. It is further a potential replacement of fixed rate of interest/usury with Hadya. Such loan can be utilized for turning pension, gratuity, provident fund and other investment schemes Shariah based easily by taking advantage of master-servant setup. Findings and recommendations of this study contributes novel and further invites future research on its engineered model of loaning

Nephron sparing surgery for renal tumors-Comparison of off-clamp partial nephrectomy with hilar clamping

Background and objective: Open partial nephrectomy (PN) is still considered gold standard procedure for T1 localized renal tumors. Conventional technique involves clamping of the renal artery with or without vein however, renal ischemia produces a certain level of damage to the kidneys. This study aims to investigate potential effect of off-clamp vs. hilar clamping PN on renal function.Methods: This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution. A total of 90 partial nephrectomies were performed of which 65 cases were eligible for analysis. Non clamping technique was used in 43 while clamp was applied in 22 patients. Variables studied were patients\u27 demographics, clinical variables, the laterality, tumors size and location, R.E.N.A.L nephrometry score, blood loss, tumor histology and surgical margins. Patients\u27 renal function (serum creatinine and eGFR) were determined pre-operatively, at 3 and 12 months follow up. Data was analyzed on SPSS v. 22.Results: Both the groups were comparable with regards to pre-operative renal function. Mean radiological size of tumor was 4.71±1.31 and 3.81±1.0 (0.003) in two groups respectively. Mean R.E.N.A.L nephrometry score was 6.1±1.5 in off-clamp group compared to 7.05 ± 1.7 in clamp group (p=0.04). No statistically significant difference was found in operative duration, blood loss, positive surgical margins and intra/ peri-operative complications. At three months and one year, renal function was better preserved in non-clamp group compared to clamp group (p=0.001 and 0.007 respectively).Conclusion: Off clamp open partial nephrectomy is safe and feasible option leading to less decline in renal function

Consanguineous Marriages: Effects on Pregnancy Outcomes in Pakistan

Being a traditional and close-knit society, Pakistan has a substantial portion of the population who have consanguineous marriages. The purpose of this study is to investigate the socioeconomic and demographic factors behind consanguineous marriages and their effects on pregnancy outcomes. Secondary data of 13,558 married women, as provided in the Pakistan Demographic and Health Survey (2012-13), was utilised to conduct this research. The results demonstrate that women who are poor, uneducated and belong to the least developed regions of the country, are significantly more likely to be in consanguineous marriages. There is a higher prevalence of miscarriages, abortions and stillbirths in such marriages as compared to non-consanguineous ones. Therefore, there is a need to create public awareness on the adverse health impacts of consanguineous marriages. The scope of this article is related to the following SDG / SDGs.

Adrenalectomy for solitary metastasis of hepatocellular carcinoma post liver transplantation: case report and literature review

Abstract Liver transplantation (LT) is the treatment of choice for localized hepatocellular carcinoma (HCC) associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT. Surgical resection offers a unique opportunity for solitary metastasis. We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is discussed

Spatial Wind Speed Forecasting Using Artificial Neural Networks

Spatial interpolation is a commonly used technique to simulate wind speeds in areas which are devoid of such measuring devices. In this paper authors examine the applicability and efficiency of Artificial-Neural- Network (ANN) formalism aimed at interpolating wind speeds in space domain. Additionally, the effect of the correlation between the wind speed at target site and its correlated neighboring site is also examined in the present paper. Hourly wind speed data set comprising of wind speeds recorded from April 2016 to August 2018 provided by Energy Sector Management Assistance Program of World Bank is used for the study. The study is supported by including four different wind speed measuring stations in Pakistan, namely, Tando Ghulam Ali, Umer Kot, Sujawal and Sanghar. Best estimates from ANN model are obtained for Tando Ghulam Ali (MAPE= 7.37%) and worst estimates are observed forSanghar site (MAPE= 10.61%)

Brand Experience and Brand Loyalty: The Moderating Role of Brand Trust and the Mediating Role of Brand Love in Pakistani Smartphone Users

The current study looks at the relationships in the Pakistani smartphone market between brand experience, brand love, and brand loyalty. In addition, we also study brand trust\u27s moderating effect. The data was collected from 300 Pakistani smartphone users. Structural equation modelling (SEM) and PROCESS macro model 8 were used for data analysis. This research showed that the experience of a brand is a significant factor in determining both love and loyalty to that brand. The outcomes of the research indicated that there was a substantial relation between brand experiences and brand loyalty, with brand love serving as a mediating component in this relationship. We found that there was a statistically significant relationship between brand trust and brand experiences as well as brand loyalty. On the other hand, the association between brand experiences and brand love was tempered by confidence in the brand concerned. This pioneering study examines Pakistani smartphone users\u27 interests and behaviors and it also examines how brand trust mediates these variables

How to Retain the ‘Core- Employees’ Through HR Practices? An Empirical Study of Public & Private Sector Universities of Khyber Pakhtunkhwa (KP), Pakistan

This study investigates the influence and effectiveness of Human Resource Management Practices which will help organization to sustain the “core-employees”.  Employee retention is one of the challenges facing many business organizations today. This empirical study examined the current Human Resource Management practices in Higher education institution of Khyber Pakhtunkhwa. In particular, the study identifies those elements of HRM, which strongly influence the “Core-employees” to stay in the organization, because organizations inclination now days depend on upon knowledge base human capital and due to the emergence of new Public & Private sector universities in Khyber Pakhtunkhwa, most of the universities are facing employees turnover. In this study employee of both Public & Private sector universities of Khyber Pakhtunkhwa is targeted, in order to extract information regarding HRM practices that which factor significantly influence these core employees to stay in the organization. For this study One hundred and thirty participants were selected from thirteen Public and Private sectors universities of Khyber Pakhtunkhwa. Through stratified random sampling method. The constructs of the study were measured using five-point Likert rating scale. Keywords: Employees Retention, HRM Practices, Core employees, Reward and Recognition, Compensation

Riba Free Loan in Islamic Finance: Key to Social Development and Welfare

Worldwide Islamic financial institutions (IFIs) do not offer loan for avoiding interest/usury, confine their Shariah interpretations to a particular school of thought and offer products for rich people only. Loans are however demanded by the underdeveloped social actors in economy for welfare and development. As per Islam usury (Riba) free loan (Qard – e – Hassan or Dain) is a key to social development. Modern implicit and explicit shapes of master-servant relation among individuals and institutions are legal phenomena with diversified standards and patterns. As per Jaferia school of thought, Islam allows presetting Hadya (gift) in loans among master-servant. These options were utilized by our study for proposing a Pro-Hadya Riba Free Loan among master-servant. Such model of loaning can help stakeholders of Islamic finance improving the existing landscape from pro-commercial creed to pro - social development approach. It is further a potential replacement of fixed rate of interest/usury with Hadya. Such loan can be utilized for turning pension, gratuity, provident fund and other investment schemes Shariah based easily by taking advantage of master-servant setup. Findings and recommendations of this study contributes novel and further invites future research on its engineered model of loaning