Private Power Generation—Opportunities and Challenges

POWER INDUSTRY DYNAMICS The concept of modern world is imperfect without electricity. The development of modern gadgets in past two decades has made human living as reflection of a science fiction movie. The fiction like living’s axis in fact is electricity and without electricity every thing comes to a grinding halt. Though this picture is portrait of the developed world, yet everyone would agree that wherever electricity has reached, it has transformed everything into power reliant. Whether it is Pakistan or any third world country, the industry; the commerce; the banking system; the methods of teaching in educational institutions; hospitals; control systems of civil aviation and civic traffic systems; and the domestic living, everything revolves around electricity. Whenever there is any break in electricity supply, output of every segment of society drops down to its lowest ebb. Many segments such as process industry and hospitals require highly reliable power supply systems. Truly, electricity is no more a luxury available to rich only; it has now become a basic need. However, scientists have not yet fully succeed in overcoming the challenges posed by the dynamics of electricity. First of all their failure to store electricity on commercial scale has made it necessary to keep generating electricity all the time. However, managing the generation quantum to meet the varying intra-day and inter-day power demand at places which are hundreds of miles apart require dedicated and sophisticated transmission and distribution infrastructure. The problem accentuated in countries like Pakistan where the generation capacity reduces in winter due to lower availability of its hydro power plants and lower availability of gas for thermal generation plants. The transmission cum distribution infrastructure as well as installation cum operations of power generating plants is very capital intensive. Hence it is very difficult for the governments and / or power utilities to develop the generation capacity and the transmission cum distribution network all by itself

Critical appraisal of endometriosis management for pain and subfertility

Objective: To critically appraise current best available management of pain and subfertility ascribable to endometriosis.Methods: Medline and specialist computer databases were searched along with reference lists of known reviews and primary articles to identify cited articles not captured by electronic searches. We included all studies pertaining to treatment of pain and subfertility ascribable to endometriosis.Discussion: Medical and surgical management options for pain and subfertility are presented as Evidence-based inquiries for critically appraised topics. Each problem is presented as an answerable question followed by assessment of literature search for level of evidence. This is followed by critical appraisal of results. In the end, take-home answer to individual problem is presented in view of best available evidence.Conclusion: Evidence-based management of endometriosis provides realistic therapeutic goals and expectations for the clinicians and women experiencing pain and subfertility due to this disease. It also promotes efficient and effective use of medical and surgical options when required

Clinical features and outcome of surgery in 30 patients with acromegaly

Objective: To assess the surgical outcome of hypophysectomy in acromegalic patients, differences in response to surgery in micro and macroadenoma and the development of associated hormonal deficiency after surgery. Methods: Retrospective analysis of charts of acromegalic patients who were operated upon at Aga Khan University Hospital, Karachi, was done. Information regarding presentation, laboratory data, radiological assessment, details of surgery and postoperative outcome was recorded. Surgical outcome was classified depending on the degree of disease control after surgery as biochemical cure, remission and treatment failure. Results: Out of 30 patients, eighteen (60%) were males and 12 (40%) females with mean age at the time of diagnosis 35.6+/-10.4 years. The mean duration of symptoms was 3.2+/-2.4 years. Twenty-five patients had macroadenoma and five had microadenoma. Preoperative mean GH level was 42.4 ng/ml with range of 2.5 to 534 ng/ml. Following surgery, 13 had biochemical cure, 4 were in remission and 13 failed to respond. The outcome in microadenoma was better than in macroadenoma i.e. 100% vs. 32%. Preoperatively four patients had panhypopituitarism with additional six patients (20%) developing hypopituitarism postoperatively. Conclusion: Our study showed that acromegaly was seen at a much earlier age, outcome of surgery was comparable to other international studies and postoperative panhypopituitarism was seen in significant number of patients. The outcome in microadenoma was better than in macroadenoma but the number of patients seen with microadenoma was small

Clinical presentation of thyroid cancer patients in Pakistan--AKUH experience

Objective: To asses the clinical presentation of patients with thyroid cancer, their preferred diagnostic work-up and preferred surgical procedure. Methods: A retrospective chart review of patients that underwent partial or total thyroidectomy for thyroid cancer at AKUH between 1989 and 2002. SPSS was used to analyze data. Pearson\u27s chi square and likelihood ratios used to calculate tests of significance. Results: A total of 97 patients were included in this review. Solitary thyroid nodule was the initial presentation in three. Majority (58.7%) presented with neck swelling or enlarging goiter. One out of every 3 patients showed evidence of lymph node involvement and 20% had distant metastases. The aggressiveness of the disease did not correlate with age, sex or histological subtype. There was no correlation between the size of the tumor and presence of local or distant metastases. CONCLUSION: Thyroid cancer is a more aggressive disease in Pakistan, with majority of patients presenting with multinodular goiters, and a significant number have lymph node metastases. A higher degree of vigilance and a lower threshold for fine needle aspiration (FNA) is needed while evaluating patients with thyroid goiter

Uterine atony at a tertiary care hospital in Pakistan: A risk factor analysis

Objectives: To identify risk factors for uterine atony following assisted or unassisted vaginal delivery.Design: This hospital based case control study was done at The Aga Khan University Karachi, Pakistan. Cases were defined as all women with uterine atony within 24 hours of an assisted or unassisted vaginal delivery. Controls were based on women with normal assisted or unassisted vaginal delivery without uterine atony. Data abstracted form the medical records; adjusted odds ratios were estimated by multiple logistic regression.Results: Factors having a significant association with uterine atony were gestational diabetes mellitus (odds ratio 7.6, 95% CI 6.9-9.0, p = 0.003) and a prolonged second stage of labour in multiparas (odds ratio 4.0, 95% CI 3.1-5.0, p = 0.002). No associations were found with high parity, age, preeclampsia, augmentation of labour, antenatal anemia and a history of poor maternal or perinatal outcomes.Conclusions: Among previously documented risk factors for uterine atony, only a prolonged second stage of labour in multiparas was found to be significant in this study. Gestational diabetes mellitus, a previously undocumented factor, has also been identified as an independent risk factor. Multiparity and age were not found to be significant risk factors. The study underlines the importance of confirming these findings for better prevention and management of uterine atony

A comparison of severe pre-eclampsia/eclampsia in patients with and without HELLP syndrome

Background: The relationship of Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome with maternal and perinatal health and its presentation in Pakistani population is not known.Purpose: To determine the mode of presentation along with maternal and perinatal outcome of patients with HELLP syndrome.Methods: Case records of patients with severe hypertension in pregnancy who delivered between January 1, 1989 and December 31, 1994 at The Aga Khan University Hospital, Karachi. Out of 120 cases of severe pre-eclampsia/eclampsia, there were 36 cases of HELLP syndrome (Group-A). These were then compared with cases without HELLP syndrome (Group B) for their mode of presentation along with maternal and perinatal morbidity and mortality.Results: The overall incidence of HELLP syndrome was 0.4%. In the antepartum factors; unbooked status (66% vs 30%; p \u3c 0.05), diastolic B.P. \u3e 120 mmHg (61% vs 16%; p \u3c 0.05) DIC (13% vs 2%; p = 0.03), seizures (40% vs 16%, p = 0.01) and ARF (11% vs 1%, p = 0.07) were significantly raised. In the intrapartum factors there were no significant differences between the two groups in mode of delivery and complications of delivery. Neonatal outcomes did not differ significantly in the two groups.Conclusions: Women with severe hypertension in pregnancy manifesting with HELLP syndrome show a significantly greater frequency of developing DIC, seizures and acute renal failure. Therefore, their care necessitates intensive monitoring to preclude development of these complications

Effect of prepregnancy body mass index and gestational weight gain on birth weight

Objective: Nutritional status of women has been considered an important prognostic indicator of birth outcome. The study aims to show the effect of various prepregnancy Body Mass Index (BMI) categories and corresponding gestational weight gain on newborn birth weight.Methods: Two hundred women were included in the study. These women had regular antenatal visits and later delivered at The Aga Khan University Hospital (AKUH) between the period January 1, 1996 to December 31, 1997.Results: For women with prepregnancy BMI \u3c 19., mean birth weight of newborns was lower for those gaining \u3c 12.5 kg than those gaining \u3e 12.5 kg (P \u3c 0.001). Women who started their pregnancy with BMI 19.8-26 and gained weight above expected range gave birth to high birth weight babies (P = 0.009). Gestational weight gain did not have a significant association with birth weight for women having prepregnancy BMI \u3e 26.Conclusion: Efforts should be made to attain adequate prepregnancy weight to reduce the likelihood of low birth weight babies. Hence, special attention should be paid to women with low prepregnancy BMI

Family medicine postgraduate training in Pakistan

There is no organized system of postgraduate training for family medicine or general practice in Pakistan. This paper describes the status of primary health care delivery in Pakistan and the growth of family medicine throughout the world. It stresses the need for organized postgraduate training relevant to the needs of primary health care in Pakistan and describes efforts currently under-way in this regard at the Aga Khan University Medical Center (AKUMC) in collaboration with the College of Physicians and Surgeons of Pakista