Job\u27s syndrome with an atypical presentation

Hyper Immunoglobulin E syndrome also called Job\u27s or Buckley Syndrome is a rare primary immunodeficiency disease characterized by elevated serum IgE levels (\u3e 2000 IU/ml), recurrent infections and eosinophilia. Other features include coarse facies and non-immunologic abnormalities of the dentition, bones, vasculature and connective tissues. We are reporting a case of a twenty four years old male with coarse facies who presented with severe pallor and upper gastrointestinal bleeding. Investigations revealed markedly elevated serum IgE levels (11,800 IU/ml), severe anaemia, esophageoduodenal erosions, Helicobacter pylori (H. pylori) gastritis and oro-esophageal candidiasis

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.Peer reviewe

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Prevalence of cryptosporidiosis in renal transplant recipients presenting with acute diarrhea at a single center in Pakistan

Background: Cryptosporidium is an intracellular protozoan organism which causes diarrhea, both in immunocompetent and immunocompromised hosts. Renal transplant recipients are prone to develop a variety of infections including protozoal infections. Objectives: The aim of this study was to determine the prevalence of cryptosporidiosis in our renal transplant recipients presenting with acute diarrhea. Patients and Methods: During six months of the study, 644 renal transplant recipients presented with acute diarrhea. Single stool sample was obtained for detailed analysis including gross and microscopic examination for red blood cells, pus cells, ova, cysts, and protozoa. The modified Ziehl-Neelsen (ZN) staining was done to identify the oocysts of cryptosporidia. Results: Out of 644 renal transplant patients, oocysts of cryptosporidia were identified in 343 patients (53%). Detailed stool analysis of these patients showed the presence of numerous pus cells in 27 (7.9%) patients, co-infection with giardia intestinalis cysts in 15 (4.3%), and entamoeba histolytica cysts in 10 (2.9%). In all, out of 343 patients, 43 (12.5%) had dual infection with bacteria and protozoa in addition to cryptosporidiosis. Conclusions: Cryptosporidium is an important pathogen causing acute diarrhea in renal transplant recipients in our set up. Stool examination is usually negative for pus cells. It is recommended that in all transplant recipients presenting with acute diarrhea modified ZN staining should be done to rule out cryptosporidiosis in highly endemic areas like Pakistan

Identifying critical factors towards building a viable sadaqa house model in Malaysia

While the Islamic banking and finance industry has grown rapidly since its inception in 1983, there remain gaps in terms of its reach and inclusiveness. The current model of Islamic banking tends to favour the more affluent segment of the society, to the exclusion of the poor, also known as the un-bankables. In view of this, there is an urgent need to develop an integrated model of Sadaqa House that can address this issue. This study intends to identify crucial factors towards developing a viable integrated model of Sadaqa House in Malaysia through a critical review of the literature. Four essential dimensions will be examined, namely: legal; Shari'ah; accounting; and financial aspects in order to arrive at a practical model of the Sadaqa House. The findings of this study are expected to provide vital inputs on the critical factors necessary to address the issues and challenges in materializing the idea of Sadaqa House in Malaysia

Alternative financing modes for higher learning institutions in Malaysia – Socially Responsible Investment (SRI) Sukuk & Social Impact Bonds (SIB)

Higher learning institutions (HLIs) in Malaysia consists of 20 public universities and more than 500 private HLIs catering for an increasing number of student enrolments. Funding for HLIs has become increasingly constrained as the budget for the education sector has been seeing cuts in recent years. This gives rise to the ever-increasing concern on the issue of self-sustainability of HLIs. It is not an issue unique to Malaysia per se, but it is a global phenomenon where HLIs around the world have faced challenges in achieving self-sustainability. Central to this issue is the challenge to find sources of funds needed to sustain HLIs’ operations and development. This issue has been gaining increasing prominence especially when funds and resources are becoming lesser and limited as a result of the slowing growth of the global economy. It has, therefore, become a necessity for HLIs to come out with innovative ways to raise funds and move towards becoming more self-sustainable sooner rather than later. Possible lessons can be learned from HLIs in the UK, US, and Australia where universities have enriched their source of finance including their involvement in the capital market to raise funds through bonds. Funds are also raised through university-industry linkages from private grants and PPP projects. In the context of Malaysia, this paper focuses on exploring alternative financing modes for HLIs through Socially Responsible Investment (SRI) Sukuk and Social Impact Bonds (SIBs). The methods utilized in this study are a critical review of the literature, case study analyses and interview sessions with experts. Based on the findings, the study recommended 2 SRI Sukuk models: firstly, in the situation where the proceeds are used for income-generating activities, while secondly for non-income generating activities. The returns and repayments of the Sukuk are dependent on key performance indicators (KPIs) being achieved. In both cases, it is recommended that the Sukuk be issued by a consortium consisting of a number of different universities in order to lower the cost of issuance and fund management, as well as efficiently utilizing resources. It is also recommended that the Sukuk is guaranteed by a third party, preferably by the government

Alternative financing modes for higher learning institutions in Malaysia: socially responsible investment Ṣukūk, social impact bonds, and public-private partnerships

Higher education in Malaysia is facing many challenges including rising costs, low repayment rates of the National Higher Education Fund (Perbadanan Tabung Pendidikan Tinggi Nasional, PTPTN), and the need to continuously improve educational quality. In addressing these challenges, the Malaysian Ministry of Higher Education (MOHE) has focused on efforts to achieve “financial sustainability” of higher learning institutions (HLIs) (Ministry of Education Malaysia, 2015). This effort is one of the ten main shifts outlined in the Malaysian Education Blueprint 2015-2025. To achieve this, the blueprint highlights three key initiatives: to link government funding to performance; to reform existing student financing mechanisms; and to encourage HLIs to diversify funding sources. This study is part of the effort to address the issue of achieving financial sustainability of HLIs. In doing so, the International Shari’ah Research Academy for Islamic Finance (ISRA), in collaboration with the Institute of Islamic Banking and Finance (IIiBF), International Islamic University Malaysia, embarked on a study exploring alternative financing modes for HLIs: sustainable and responsible investment (SRI) ṣukūk, social impact bonds (SIBs), and public-private partnerships (PPPs). The objectives of the study are as follows: (1) To explore models of Sharīʿah-compliant capital market social impact bonds (SIBs), sustainable and responsible investment (SRI) ṣukūk, and public-private partnerships (PPPs) fund-raising for HLIs. (2) To identify key critical success factors in developing alternative financing modes for HLIs. (3) To analyse the strengths and weaknesses of each model. (4) To propose the most suitable Islamic capital market model(s)/instrument(s) for adoption by HLIs and government in Malaysia to ensure the sustainability of HLIs. The study proposes two ṣukūk structures with payment-by-results mechanisms: SRI ṣukūk based on wakālah bi al-istithmār (wakālah ṣukūk), and temporary and permanent cash waqf ṣukūk (waqf ṣukūk). The issuance of the ṣukūk aims to become an alternative to a portion of government spending on higher education in the short run. The savings from unused spending can be set aside for investments and used for other higher education initiatives in the future. Furthermore, this may allow HLIs to become more empowered in terms of their autonomy and governance as they are not directly relying on government funds. The proceeds from the ṣukūk can be used for both operational (e.g., wages and bills) and developmental (e.g., new buildings and facilities) funding for the HLIs. The type of ṣukūk issued would depend on the HLIs needs as well as the resources that are available to them that may help support the purposes of the issuance. The study proposes the development of both ṣukūk under the Malaysian SRI ṣukūk framework as it has proven to be a comprehensive and robust framework that encourages new innovative issuances. Such issuances can promote and spur the growth of socially-motivated fundraising and the social financing segment, which is still nascent in the Malaysian market. In terms of both ṣukūk structures, the study proposes that guarantees be provided by the government and that tax incentives be provided for both the issuer and the investor. In particular, the funds used to invest in the ṣukūk should be treated similar to CSR funds, which have certain tax advantages such as tax deductions and exemptions as stipulated under the Malaysian Tax Act. For the wakālah ṣukūk, it is recommended that the capital be guaranteed by the government and that ṣukūk holders get returns depending on HLI performance or achievement of set KPIs. Returns can be structured either step-down or step-up depending on the appetite of investors, which can be determined through market research and roadshows. In the case of step-up, returns are provided parallel to performance or achievement of KPIs. The higher the success, the higher the returns, to a certain cap. This is a similar structure implemented for the return mechanism in social impact bonds (SIB). On the other hand, returns for step-down are opposite to performance. For example, if KPIs are achieved, returns are not provided; the investors may even waive a certain portion of their claim to their initial capital as a contribution towards the social cause. This is similar to the mechanism found in the first SRI ṣukūk in Malaysia, the Ihsan SRI Ṣukūk. For the cash waqf ṣukūk, there are two types of ṣukūk holders: temporary and permanent cash waqf ṣukūk. The permanent cash waqf ṣukūk holders do not get back their initial capital as their investment is fully utilised perpetually for the benefit of the beneficiaries. For the temporary cash ṣukūk holders, on the other hand, the return of their capital may depend on the performance or achievement of certain KPIs. This may also be structured as either a step-up or step-down return mechanism depending on the appetite of potential investors. For example, for step-up, if the KPIs are achieved, the temporary cash ṣukūk holders get back their capital. However, in the case of step-down, the temporary cash ṣukūk holders may fully or partially convert their investment into a permanent waqf depending on the degree of success in achieving the KPIs

Potential development of SRI sukuk models for higher learning institutions in Malaysia based on Wakalah and Waqf

Funding for Higher Learning Institutions (HLIs) in Malaysia has become increasingly constrained as the government faces increasing costs and global economic slowdown. Central to this issue is the challenge to raise the funds needed to sustain HLIs’ operations and development. It has therefore become a necessity for HLIs to come up with innovative ways to raise funds and move towards to becoming more self-sustainable. Malaysia can possibly learn from HLIs in the UK, US, and Australia where universities have managed to obtain funds through the capital market by issuing bonds. This paper focuses on exploring alternative financing modes for HLIs through Socially Responsible Investment (SRI) sukuk and Social Impact Bonds (SIBs). The methods utilized in this study are critical review of literature, case study analyses and interview sessions with experts. This study recommends two SRI sukuk models: firstly, in the situation where the proceeds are used for income generating activities, sukuk based on wakalah is proposed; while secondly for non-income generating activities, a cash-waqf sukuk with temporary and permanent features is suggested. In term of the structure of the sukuk, the returns and repayments of both sukuk are dependent on key performance indicators (KPIs) being achieved. In both cases, it is recommended that the sukuk be issued by a consortium consisting of a number of different universities in order to lower the cost of issuance and fund management, as well as efficiently utilizing resources. It is also recommended that the sukuk is guaranteed by a third party, preferably by the government

Microsoft Word - J3 - 62 final revised

A field trial was conducted at the Experimental Farms of Pir Meher Ali Shah Agriculture University, Rawalpindi during Rabi season, 2004 to study the effect of spatial arrangements and weeding techniques on weeds and yield of wheat. The experiment was laid out in randomized complete block design with two factors under split plot arrangement having three replications. The spatial arrangements were comprised of 15 cm, 22.5 cm and 30 cm apart rows and there were six weeding techniques viz. weeding check was included for comparison, hand weeding (weed free), chemical control (by application of Buctril Super @ 750 ml ha -1 ), bar-harrow 2-way, hoe and barharow 1-way. Hand weeding and chemical control with different spatial combinations showed significant effects on weed density, weed mortality percentage, weed biomass and grain yield. Spatial arrangement of 15 cm significantly decreased the weed biomass and enhanced grain yield. The interaction between weeding techniques with spatial arrangements was found significant for weed biomass and grain yield. The highest wheat crop yields of 5448 and 5970 kg ha -1 were achieved by using hand weeding and chemical control weeding techniques along with 15 cm spatial arrangement. These treatments caused significant increase of 133.93 % and 113.47% respectively over weedy check with 30 cm spacing