Stroke rehabilitation in pakistan: what we know and what we need to do?

Stroke is one of the leading causes of adult neurological disability all around the globe. There have been some remarkable improvements in the acute management of stroke. These include the use of thrombolysis, development of radiological investigations including computerized tomographic scan and magnetic resonance imaging and establishment of acute stroke units. There have been some promising advances the field of stroke rehabilitation as well in the last three decades

H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in Dyspeptic Patients

Introduction: There are several invasive and non-invasive techniques used to diagnose H. pylori infection, each having its own advantages and disadvantages. Invasive methods require biopsy samples from stomach and duodenum and can be tested by various methods such as histology, Rapid urease test (RUT), microbiological culture and Polymerase chain reaction (PCR) whereas non-invasive tests include stool antigen test, serology and Urea breath test Objectives: To determine the diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients (18-65 years). Materials & Methods: Descriptive, cross-sectional study was conducting during 30th April 2019 to 30th October 2019 in Gastroenterology Unit, Holy Family Hospital, Rawalpindi. A total of 85 patients irrespective of gender having age 18-65 years having symptoms of dyspepsia were included. Patients having gall stones, celiac disease, pancreatic disease, Diabetes Mellitus, thyroid disease and any other patients on PPI or H2 receptors. Patients with history of alcoholism, diagnosed cases of H. Pylori infection or treatment history of H Pylori. Patients diagnosed for pancreatitis, cholecystitis, Hepatitis B or C Virus positive cases of Chronic Liver Diseases, HIV, malignancy or Ischemic Heart Disease or being pregnant were excluded. H. Pylori on Fecal Antigen Detection and endoscopic biopsy were noted. Results: Fecal Antigen Detection found that 42 were True Positive and 04 were False Positive. Among 39, Fecal Antigen negative patients, 04 (False Negative) had H. Pylori on endoscopic biopsy whereas 35 (True Negative) had no H. Pylori involvement on endoscopic biopsy (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients was 91.30%, 89.74%, 91.30%, 89.74% and 90.59% respectively. Conclusion: This study concluded that diagnostic accuracy of H. Pylori Fecal Antigen Detection in dyspeptic Patients is quite high. Keywords: helicobacter pylori, Fecal Antigen Detection, endoscopic biopsy.   &nbsp

H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in Dyspeptic Patients

Introduction: There are several invasive and non-invasive techniques used to diagnose H. pylori infection, each having its own advantages and disadvantages. Invasive methods require biopsy samples from stomach and duodenum and can be tested by various methods such as histology, Rapid urease test (RUT), microbiological culture and Polymerase chain reaction (PCR) whereas non-invasive tests include stool antigen test, serology and Urea breath test Objectives: To determine the diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients (18-65 years). Materials & Methods: Descriptive, cross-sectional study was conducting during 30th April 2019 to 30th October 2019 in Gastroenterology Unit, Holy Family Hospital, Rawalpindi. A total of 85 patients irrespective of gender having age 18-65 years having symptoms of dyspepsia were included. Patients having gall stones, celiac disease, pancreatic disease, Diabetes Mellitus, thyroid disease and any other patients on PPI or H2 receptors. Patients with history of alcoholism, diagnosed cases of H. Pylori infection or treatment history of H Pylori. Patients diagnosed for pancreatitis, cholecystitis, Hepatitis B or C Virus positive cases of Chronic Liver Diseases, HIV, malignancy or Ischemic Heart Disease or being pregnant were excluded. H. Pylori on Fecal Antigen Detection and endoscopic biopsy were noted. Results: Fecal Antigen Detection found that 42 were True Positive and 04 were False Positive. Among 39, Fecal Antigen negative patients, 04 (False Negative) had H. Pylori on endoscopic biopsy whereas 35 (True Negative) had no H. Pylori involvement on endoscopic biopsy (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients was 91.30%, 89.74%, 91.30%, 89.74% and 90.59% respectively. Conclusion: This study concluded that diagnostic accuracy of H. Pylori Fecal Antigen Detection in dyspeptic Patients is quite high. Keywords: helicobacter pylori, Fecal Antigen Detection, endoscopic biopsy.   &nbsp

Comparison of oxybutynin and tolterodine in treatment of detrusor overactivity associated with upper motor neuron lesions, based on changes in urodynamic parameters

To compare efficacy of oxybutynin and tolterodine in managing Detrusor Overactivity (DO) in Pakistani patients with different upper motor neuron lesions. Methods: A randomized controlled trial was carried out at Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from January to August 2015 including individuals with a diagnosis of DO as a result of upper motor neuron lesions. Maximal detrusor pressure (MDP) and maximal cystometric capacity (MCC) were measured at baseline and at four months post-treatment. Group-A was treated with tolterodine and group-B with oxybutynin. Results: A total of 60 individuals (mean age: 43.9 ± 15 years) were included. Majority (83.3%) were male and had spinal cord injury as the commonest etiology (56.7%). Group-A had a mean pre-treatment MCC of 188.3 ± 48.2 ml, and a mean post-treatment MCC of 281.5 ± 49.1 ml (p\u3c 0.001). The mean pre-treatment MDP was 83.6 ± 9.5 cm of H2O, and the mean post-treatment value was 40.9 ± 10.2 cm of H2O (p\u3c 0.001). Group-B had a mean pre-treatment MCC of 209.8 ± 60.5 ml, and mean post-treatment MCC of 308.7 ± 65 ml (p\u3c 0.001). The mean pre-treatment MDP was 80.7 ± 10.6 cm of H2O, and the mean post-treatment value was 40.7 ± 10.1 cm of H2O (p\u3c 0.001). The difference in mean reduction in MCC and MDP produced by tolterodine and oxybutynin was statistically insignificant. Conclusions: Both oxybutynin and tolterodine showed similar efficacy in the treatment of DO based on measurable urodynamic outcomes

Migration research issues in Asia

Abstract: Purpose: The aim of this study is to highlight the issues confronted during research on migration from Asian perspectives. In addition, the study aims to convince the research dimensions to be in line with the issues of the current environment. Approach: A quantitative approach is perceived to be an ideal technique to be employed for this research study since most of the data has been acquired from the secondary work done by different research fellows on the subject. Descriptive analysis has been presented on the work earlier done and also focused on the gap for the incumbent studies. Findings: Intense migration occurred over the last three decade in Asia, this article’s area of concern on research conduction of international labor in Asia. This article covers research carried out in the late twenty-first century. The rising implication called for highlighting the Asian migration phenomena. The rising implication called for highlighting the Asian migration phenomena. It is evident by present work on the literature on migration, the development of research, and the development of research networks in the region. It is suggested that increased efforts should focus on the establishment of a link between internal and international migration in spite of more work on migration phenomena in the region. Conclusion: It is concluded that migration in Asia is a significant phenomenon, and if it continues, will hurt the associated nations due to brain drain

Formal and Executable Specification of Random Waypoint Mobility Model Using Timed Coloured Petri Nets for WMN

The wireless mesh network (WMN) is an emerging and cost-effective alternative paradigm for the next generation wireless networks in many diverse applications. In the performance evaluation of routing protocol for the WMN, it is essential that it should be evaluated under realistic conditions. The usefulness of specific mobility protocol can be determined by selection of mobility model. This paper introduces a coloured Petri nets (CP-nets) based formal model for implementation, simulation, and analysis of most widely used random waypoint (RWP) mobility model for WMNs. The formal semantics of hierarchical timed CP-nets allow us to investigate the terminating behavior of the transitions using state space analysis techniques. The proposed implementation improves the RWP mobility model by removing the “border effect” and resolves the “speed decay” problem

Firm Size as Moderator to Leverage-Performance Relation: An Emerging Market Review

Present study explored leverage-performance relation while the moderating firm size in developing countries like Pakistan. Data is collected for 304 Pakistani non-financial firms for the period of 2005-2013. It is found that overall leverage-performance relation is negative for all types of firms. However, such losses are more prominent for small size firms. Results also showed that the leverage-performance relation is nonlinear for medium and large size firms.However, in practice these firms are not targeting optimal level and over-leveraging that ultimately decrease their profits.So, financial managers of small size firms should avoid debt financing while for large and medium size firms,managers need to adjust their debt ratio toits optimal level. Keywords: Leverage, Performance, Capital Structure, Moderation, Firm Size JEL code: G32

Surgical Outcome of Endoscopic Third Ventriculostomy in Patients Having High ETV Success Score: One-Year Experience at a Tertiary Care Hospital

Background & Objective:  Endoscopic third Ventriculostomy (ETV) is an accepted alternative to VP shunt in patients with obstructive hydrocephalus. We will share our experience and outcome. Materials & Methods:  Thirty consecutive ETV cases performed by a single surgeon during 1 year in patients with an ETV success score of 60 or higher were included in this study. Patients’ demographics, outcomes, and complications are reported. Results:  (60%) were male and 12 (40%) were female. The mean age in our study was 6.1 years ± 9 (mean ± SD). Posterior fossa tumor was the most common etiology in our series (46.6%) followed by aqueductal stenosis (23.3%). Eighty percent of our patients did not experience an ETV failure. The complication rate was 20%. Inadequate ventriculostomy in 6.6% of the patients was the commonest complication. Conclusion:  ETV is safe and effective in patients with high ETV success scores