Psychological Distress and Health Related Quality of Life between Smokers and Non-Smokers

The present research was conducted to explore the relationship between psychological distress and health related quality of life among direct smokers and second hand smokers. It was a correlation study in which cross-sectional research design was used. The total sample size was 200 which consist of hundred direct smokers and hundred second hand smokers. It was hypothesized that there is significant relationship between psychological distress and health related quality of life among direct smokers and secondhand smokers. It was also hypothesized that there is significant difference on psychological distress and health related quality of life between direct smokers and second hand smokers. Statistical Package of Social Sciences Version 20 (SPSS-20) was used to check these hypotheses. Results showed that there is significant negative relation between psychological distress and health related quality of life. Further, the results showed that there is significant difference on psychological distress between direct smokers and second hand smokers. This analysis further revealed that direct smokers have more psychological distress as compared to second hand smokers. In this study only one gender is taken as sample so in future researches both gender should be taken as sample. Key words; Psychological distress, Health related quality of life, Smoker

Turkey and the Balkan States: Justice and Development Party’s role in filling the void with Balkans

A century after the collapse of Ottoman empire, Turkey is trying to bridge the gaps again with the Balkans, some calling it a way of reviving the Ottoman empire, while as few see it as a way of making allies in the region to join European Union. There are many such narratives.  This paper will try to analyze how Turkey is trying to make its presence strong in Balkans, whether it is investing in their education, building religious monuments, or bringing stability and peace in the region. This paper will also focus on the growing relations between Turkey and Balkans during the ongoing governance of the Justice and Development Party (AKP)

Kautilya, the Indian Machiavelli; On War and diplomacy in Ancient India

In the contemporary times because of a little fluctuation in the global situation different variations have likewise occurred in act of diplomacy. Previously the emphasis was actually on hard power as a method of diplomatic preparation. However with establishment of the notion of soft power diplomatic practice became modernized in light of the fact that the idea of soft power gives a contrasting option to the discretionary emissaries to lead conciliatory practice without relating to candy and twig method. Despite India’s long history of reflection on interstate relations, Western assessments and theorizations continue to dominate the modern scholarship on India’s IR, with Indians mostly reacting to foreign assessments. This paper will elucidate various diplomatic views of Kautiya in the ancient India period that are still valuable for the Indian and world diplomacy. This paper will also try to shed light on Kautilya’s view on spies, agents and interstate relations

Management of Flexor Tendon Injuries in Hand

Peculiar anatomy of human hand with flexing fingers and opposing thumb give human beings clear edge over other existing living beings. We use hands for carrying out most of our daily activities. But at the same time this makes our hands vulnerable for getting traumatized. Hand injuries which involve underlying tendons make digits dysfunctional, which in turn affects overall precise functioning of hand. In this chapter we will briefly discuss related surgical anatomy of flexor tendons and associated structures, features of flexor tendon injuries at different zonal levels, surgical methods involved and different post-operative protocols used for management of these flexor tendon injuries

Middle Cerebral Artery Aneurysm Coiling without Assisted Techniques – A Good Alternative, Single Venture Experience

Objective:  To evaluate the result of a coiling of middle cerebral artery aneurysms without auxiliary techniques. Material and Methods:  This study was conducted from June 2010 to September 2019 in the Department of Neuroradiology, Punjab Institute of Neurosciences, Lahore. There were a total of 500 patients with unilateral and bilateral cerebral aneurysms at the MCA level that have been included in this study which comprise of both sexes. Results:  There was a total of 500 patients, which comprised of 200 (40%) men and 300 (60%) women. Their ages ranged from 22 to 65 years. The majority number of patients was in their fifth 180 (30%) and sixth decade 150 (30%) of life. In our study, a successful coiling was performed in 490 (98%) patients with minimal re-canalization of MCA aneurysms. In 10 (2%) procedure was unsuccessful due to vasospasm. Conclusion:  The conventional coiling in middle cerebral artery aneurysms can be effective and safe without auxiliary techniques

Thomas Hobbes’ views on Philosophy, State of Nature and International Relations

The state of nature of Hobbes is like a reflection of the depression of 1640s that prevailed in the United Kingdom. The basic concept that determines the state of nature is individuality. This phenomenon is the expression of individuality, the beginning of Renaissance but not of full competence, of expressing individuality, liberating oneself from doctrinal teachings and medieval conceptions. According to Hobbes, human beings are individuals who have the desire and choice to choose. The person's ability to use his will and preference determines his happiness or unhappiness. The emotions of feeling, fear, desire etc. which are the basic characteristics of human life, are not merely physical and factual phenomenon, but a moral phenomenon that becomes evident by loving, enjoying or disliking, desiring or avoiding oneself. For Hobbes, human life is competition and struggle. As a creature that thinks of the future, human beings are constantly struggling to secure their future ambitions. It is the basic survival condition of a person that wants to be sovereign. It is inevitable that people who are equal in terms of physical and mental force will fight everyone in natural condition. This paper tries to elucidate Thomas Hobbes’ understandings of the concepts of philosophy, state and state of nature. This article will further try to shed light on the Thomas Hobbes’s views on International Relations

Acute ischemic stroke treatment barriers in Pakistan

Worldwide stroke is the second most common cause of death and the third most common cause of disability (1). No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. There is only one published stroke prevalence study which was conducted in a community residing in Karachi, the prevalence was 4.8%, however the results of the study should be interpreted with caution as a non-validated questionnaire was used. (2). Another community-based survey suggested as estimated 21.8% prevalence of stroke in an urban slum of Karachi (3). These studies although published in local journals but do not highlight the aspects of stroke treatment and prevalence. While the incidence is decreasing in high-income countries, it is increasing in low-income countries such as Pakistan, where there is not even a single established comprehensive stroke center with fully equipped facilities to do endovascular treatment of AIS. Medical advances in stroke treatment have greatly improved survival rates and disability from stroke during the last decade, these advances include cerebral angiographic techniques to remove the blood clot from brain vessels called Mechanical Thrombectomy. The quality of care and equipment available to stroke victims makes a world of difference. That is why the public needs to have access to the stroke center. Neurointerventional Radiology training and practice in Pakistan is still in early phases, being practiced in few leading hospitals of the country but no separate accredited postgraduate training program still available

HYBRID BONE SCINTIGRAPHY IN GASTROINTESTINAL MALIGNANCIES – INSTITUTIONAL EXPERIENCE

Objective: Bone metastases in gastrointestinal (GI) malignancies are uncommon and known to be predominantly lytic thus rendering a limited role for conventional bone scintigraphy. The aim of the study is to review Tc99m MDP bone scans performed in patients with known GI malignancy and the utility of Single-photon emission computed tomography (SPECT)/CT in characterization of bone lesions.Methods: Retrospective review of bone scans was done from June 2014 to December 2016 in patients with known GI malignancy, using electronic Hospital Information System.Results: A total of 110 patients (60 males, 50 females; Age range: 22–84 years, Mean Age 51.4 years with SD of 14.8) had bone scan over a period of 30 months. The commonest indications for referral were suspected bone metastasis on other imaging modalities including [CT (n = 56), Magnetic resonance imaging (n = 10), Positron emission tomography/CT (n = 6)], musculoskeletal pain (n = 37), pathological fracture (n = 1), neurological symptoms (n = 1), hypercalcemia (n = 1) and others (n =14) including restaging workup etc. Metastatic lesions were identified in 32 (29%) patients whereas 78 (71%) patients had benign non-aggressive lesions leading to normal bone scans. Among 32 patients with osseous metastasis, 8 (25%) patients had unifocal lesion; axial skeleton (n = 2) appendicular skeleton (n = 6), 24 (75%) patients had multifocal lesions; axial skeleton (n = 6), appendicular skeleton (n = 6) and both axial + appendicular (n = 12). Four (12%) patients had concurrent visceral metastases. In our cohort, based on the location of primary tumour, the frequencies of osseous metastasis were; esophagus = 15 out of 43 (35%), gastric = 7 out of 18 (39 %), gastro-esophageal junction = 1 out of 8 (1.5%) and colorectal = 9 out of 40 (22.5). SPECT/CT was acquired in 29 out of 110 patients, which characterized metastatic lesions (n = 12) and benign looking non-aggressive entities (n =17). Overall, bone scan upstaged disease in 31% and down staged 15% patients.Conclusion: Bone metastases in GI malignancies, though uncommon, show an aggressive pattern, with axial and appendicular involvement, and can be readily identified with hybrid bone scintigraphy in symptomatic patients. Key words: Hybrid imaging, Tc99m MDP, bone metastases, gastrointestinal malignancie

Incidence, outcome and risk factors for sepsis- a two year retrospective study at surgical intensive care unit of a teaching hospital in Pakistan

Background: Sepsis is amongst the leading causes of admission to the intensive care units and is associated with a high mortality. However, data from developing countries is scarse. Aim of conducting this study was to determine the incidence, outcome and risk factors for sepsis on admission to surgical intensive care unit (SICU) of a teaching hospital in Pakistan. Methods: Two year retrospective observational study included all consecutive adult admissions to the surgical intensive care unit (SICU) of a University Hospital, from January 2012 to December 2013. Results: Two hundred and twenty-nine patients met the inclusion criteria. Average age of the patients was 46.35±18.23 years (16–85), mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 15.92±8.13 and males were 67.6%. Median length of ICU stay was 4 [IQR 5]. 43% patients fulfilled the criteria of sepsis at the time of admission to the SICU and incidence of severe sepsis/septic shock was 35%. Abdominal sepsis was the most frequent source of infection (57.5%). The overall intensive care unit mortality was 32.31% but the mortality of sepsis-group was 51.15% as compared to 17.7% of the non-sepsis group. Stepwise logistic regression model showed that increasing age, female gender, non-operative admission, admission under general surgery and co-morbidities like ischaemic heart disease and chronic kidney disease were significant predictors of sepsis. Conclusion: The incidence of sepsis and severe sepsis/septic shock, on admission to SICU is high and mortality of the sepsis group is nearly three times the mortality of the non-sepsis group