Eagle’s Syndrome: Presentation, Diagnosis, and Management

Objective: To study the presentation, diagnosis, and treatment options in Eagle’s Syndrome in a tertiary care hospital. Material and Methods: The study was conducted at the ENT department of District Headquarter Hospital, Rawalpindi from 1st January 2016 to 31st March 2019.  All the patients who presented in outpatient (OPD) of the ENT department with pain around the ear and throat and diagnosed as a case of Eagle’s syndrome were included in the study. All the data of gender, age, CT scan findings, pain score, and management were noted on a predesigned proforma. Percentages and frequencies were calculated for all the data by using SPSS 21 version. Results: A total of 12 patients were included in the study, with 5 (42%) females and 7 (58%) males. The patient’s age range was from 24 to 68 years. Sharp, sudden onset, nerve-like pain was the major symptom in all cases. The length of the styloid process in 6 patients was between 3-4 cm and in 6 patients between 4-5 cm on a 3-dimensional computerized tomography scan. 100% of patients were managed surgically. In Group A (50%) styloidectomy was done after tonsillectomy while in other Group B (50%) patients styloidectomy was done by tonsil sparing technique. The relief of pain was a little better in patients of Group B. Conclusion: Sudden onset, sharp, shooting pain in the jaw area, around-ear, and in the throat with no other co-morbid should be investigated for Eagle’s syndrome. 3 dimensional CT scan is the best modality to see the length of the styloid process. Styloidectomy with tonsil sparing technique is a little better than tonsillectomy and gives early and permanent relief from this painful condition

Relationship of working capital management and profitability of the firms - an application of unit root and co-integration test on the various corporate sectors of Pakistan stock exchange

The main purpose of this research is to find the impact and the long-run relationship of working capital, and profitability in different major sectors of Pakistan stock exchange; for this purpose eight sectors with 95 listed companies selected that can be representative of the Pakistani mindset and practices of the corporate world. For this reason, ROA used as the dependent variable and CCC, CR, QR, WCT ART, APD, ROCE, DR to check the long-run relationship with Firm Performance. OLS is not possible due to the trend in data. In this research unit root test and Penal Co-integration test used for finding the long-run relationship equilibrium. This research paper provides guidelines to corporate practitioners and academia to understand and focus on working capital to improve profitability in the organization. Findings revealed that different sectors have different characteristics of working capital in the long-run equilibrium. This research intends to give future direction for the researcher to develop theories of liquidity and working capital

Streptococcal pharyngitis: Delving deeper than the throat

Acute rhabdomyolysis and elevated transaminases during streptococcal pharyngitis are rare presentations. The proposed pathophysiological mechanisms include direct bacterial invasion and toxin generation. Physicians should be aware of the association between these infections and the above-mentioned complications to facilitate optimal treatment of these patients. We present the case of a 18-years-old gentleman with β-haemolytic streptococcal pharyngitis complicated by rhabdomyolysis and elevated liver function tests. Such high levels of creatine phosphokinase of 111856 IU/L and elevated liver function tests with aspartate aminotransferase (AST) of 1862 U/L and alanine aminotransferase (ALT) of 1003 U/L in streptococcal pharyngitis is rare to find in the literature. He was treated with aggressive intravenous hydration, antibiotics and hemodialysis. Key Words: Rhabdomyolysis, β-haemolytic Streptococci, Creatine phosphokinase, Liver function tests

Acute urinary retention: Should we call it a manifestation of appendicitis?

Acute urinary retention (AUR) is a fairly common presentation in the elderly; but interesting to be noted in a healthy young individual as a manifestation of acute appendicitis. We present a case of a 32-year gentleman with decreased urine output with mild tenderness at the supra-pubic region; which was later on, shifted to the right iliac fossa. Computed tomography of the abdomen showed acute appendicitis. Emergency physicians are challenged to recognize the uncommon presentation of acute appendicitis and need to be reminded of this common complaint as a rare presentation of it. This case also stresses on the repeated abdominal examinations to seek diagnostic clarity. Key Words: Appendicitis, Acute urinary retention, Repeat abdominal examination

An Empirical Insight into the Theory and Practices of Capital Budgeting in Pakistan

The study explores the different stages of the capital investment decision process and empirically investigates these stages’ mediating role. We have used firms, managers, and economic attributes as independent variables. Likewise, ROA, ROE, and EPS are used as proxies for measuring firm performance, which is the dependent variable. A survey was conducted through a self-developed questionnaire for non-financial listed firms of the Pakistan Stock Exchange (PSX). The questionnaire comprises of two parts. The first part is related to managers and firm attributes. The second part covers the nine steps of the Capex Appraisal Model (CAM). PLS-SEM was used to investigate the objectives of the study. Moreover, the results support the applicability of CAM in the corporate sector of Pakistan. For this purpose, 27 hypotheses were empirically tested, of which 21 were found to be significant. However, 6 hypotheses were not supported. The findings suggest that the “Capex Appraisal Model” is a useful approach for the corporate sector of Pakistan. Thus, firms should properly evaluate Capex decisions to enhance performance in the long run

Influence of Near Fault Earthquakes with Forward Directivity and Fling Step on Seismic Response of Steel Box-Girder Bridge

The existing bridge seismic design guidelines that rely on the ground acceleration in the far fault zone, ignore the potential impact of near fault forward directivity and fling-step effects on the bridge structures. In the current study probabilistic seismic damage evaluation of a continuous four-span box girder bridge under the impact of near-fault forward directivity and fling step effect is studied employing the fragility analysis. The incremental dynamic analysis is used to construct the fragility curves which shows a range of damage states from minor to collapse for the different damage metrics and for the considered peak ground acceleration varying between 0.1g and 1.2g. Damage metrics such displacement pier ductility, rotational pier ductility and displacement of girder are used to develop the fragility curves and the probabilistic seismic damage model. To evaluate the bridge vulnerability, a probabilistic seismic damage assessment is performed using an ensemble of forward directivity and an ensemble of fling-step comprising permanent ground offset. The suggested probability-based earthquake damage framework is anticipated to be a well-versed model able to estimate the seismic damages to the continuous box girder bridges while taking into account the variation of near fault earthquakes. The findings show that, even at low PGA values the forward directivity and the fling-step ground motions represent a significant risk to the bridge

Operational Risk Management in Corporate and Banking Sector of Pakistan

This paper is to examine the current status of operational risk management in Pakistan concerning corporate and banking sector and explore the reasons for the adoption or lack of adoption of integrated approach to operational risk management. It identifies the imperatives for implementation of comprehensive risk management solutions leading to enterprise risk management (ERM).The mode of research is qualitative. The paper shows that effective risk management can enhance organizational performance but appropriate infrastructure is not available in companies.  This paper highlights the fact that knowledge of risk management in corporate sectors of Pakistan is insufficient and sample companies hesitate to respond thinking that it may reflect inefficiencies and in banking sectors the concept of operational risk management can be seen up to some extent. Keywords: Operational risk management, corporate and banking, integrated approach, Enterprise risk management, organizational performanc

Precipitating Factors and The Outcome of Hepatic Encephalopathy in Liver Cirrhosis

Objective: To determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Study Design: Cross-sectional, analytical study. Place and Duration of Study: The Aga Khan University Hospital, from January 2005 to December 2007. Methodology: Consecutive patients admitted with different grades of HE were evaluated between January 2005 and December 2007. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p \u3c 0.05. Results: Of the 404 patients 252 (62%) were males. Hepatitis C virus was the cause of cirrhosis in 283 (70%); Child Turcotte Pugh (CTP) class C was present in 317 (78%) patients. On presentation, 17% patients had grade 1 HE while 44%, 29% and 10% had grades 2, 3 and 4 respectively. The most common precipitant of HE was spontaneous bacterial peritonitis in 83 (20.5%), constipation in 74 (18.3%) and urinary tract infection in 62 (15.3%). One hundred and forty (35%) patients had ³ 2 precipitating factors while no precipitant was noted in 50 (12%) patients. Mean hospital stay was 4±3 days. The lesser the number of precipitants, shorter was the length of stay (p \u3c 0.01) and lesser was the grade of HE (p=0.025). Complete reversal of HE was noted in 366 patients (91%) while the remaining had grade 1 HE on discharge. Nine (2.2%) patients died during the hospital stay. No mortality was noted in patients without precipitants. Conclusion: Patients presenting with ³ 2 precipitating factors and advanced grade of HE had a prolonged hospital stay. Moreover, patients without precipitants had better outcomes

Geochemical Signature of Mesozoic Volcanic and Granitic Rocks in Madina Regency Area, North Sumatra, Indonesia, and Its Tectonic Implication

Http://dx.doi.org/10.17014/ijog.vol4no2.20094Five samples consisting of two Permian-Triassic basalts, two Triassic-Jurassic granitic rocks, and a Miocene andesite were collected from the Madina Regency area in North Sumatra that is regionally situated on the West Sumatra Block. Previous authors have proposed three different scenarios for the geological setting of West Sumatra Permian Plutonic-Volcanic Belt, namely an island-arc, subduction related continental margin arc, and continental break-up. Petrographic analysis of the Mesozoic basaltic samples indicates that they are island-arcs in origin; however their trace element spider diagram patterns (Rock/MORB ratio) also show the character of back-arc marginal basin, besides the island-arc. Furthermore, their REE spider diagram patterns (Rock/ Chondrite ratio) clearly reveal that they were actually generated in a back-arc marginal basin tectonic setting. Meanwhile, the two Mesozoic granitic rocks and the Miocene andesite reflect the character of an active continental margin. Their spider diagram patterns show a significant enrichment on incompat- ible elements, usually derived from fluids of the subducted slab beneath the subduction zone. The high enrichment on Th makes their plots on Ta/Yb versus Th/Yb diagram are shifted to outside the active continental margin field. Although the volcanic-plutonic products represent different ages, their La/Ce ratio leads to a probability that they have been derived from the same magma sources. This study offers another different scenario for the geological setting of West Sumatra Permian Plutonic-Volcanic Belt, where the magmatic activities started in a back-arc marginal basin tectonic setting during the Permian-Triassic time and changed to an active continental margin during Triassic to Miocene. The data are collected through petrographic and chemical analyses for major, trace, and REE includ- ing literature studies