Pakistan Institute Research Articles

UNDERSTANDING THE IMPLICATIONS OF TAXATION POLICY IN PAKISTAN: A CASE OF FAILED MULTI-STAKEHOLDER INITIATIVES

Pakistan has multifaceted taxation difficulties in tobacco control and administration. Tobacco taxation issues include industry pressures, blaming the unauthorized market, and revenue theft at the collecting point. To avoid tax evasion and produce taxes on a consistent basis, a simple taxation system is required and suggested by related stakeholders for the execution of policies. A huge amount of tax is collected from this sector by the revenue collection agencies adding big portion in national deposits. On the other hand, tobacco usage is responsible for greatly raising the economic burden, greater health expenditures, and indirect costs associated with premature death, disability owing to tobacco-related illnesses, and loss of productivity. Effective tobacco taxes minimize various externalities by reducing consumption, legal consumption patterns and prevalence, as well as contributing to a reduction in government spending on health care expenditures directly due to cigarette smoking diseases. The philosophy of tax administration and control is creating policy conflict between different public institutions in Pakistan. The revenue collecting institutions believe on lowering the tax rates to overcome the illicit tobacco manufacturing and sales while health institutes believes on coercive measures and high tax rates to avoid and control the tax consumption. This paper will discuss the policy conflict, control mechanism, institutes tax philosophy, tax mechanism, and best practices around the globe to avoid policy conflict and better governance.

High-resolution Ultrasonographic Diagnosis of Plantar Fasciitis: An Association of Magnetic Resonance Imaging and Ultrasound

Objective: To assess the role played by ultrasound in evaluating plantar fasciitis and associate the findings with Magnetic resonance imaging.
 Study Design: Case series.
 Place and Duration of Study: Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Nov 2020 to Apr 2021.
 Methodology: All the patients underwent ultrasonography and magnetic resonance imaging scanning. The study and control Groups consisted of 38 patients. 
 Results: Out of 38 patients, plantar fascia thickness in symptomatic feet was measured with ultrasound for both the Study and Control Groups. The Control Group had slightly thinner plantar fasciitis (1.1-2.4 mm, 1.7 ± 0.06 mm; p =0.03) compared to the Study Group (2.9-6.9 mm; 4.9±1.4 mm). In addition, this study compared other plantar fasciitis diagnostic signs on sonography with the magnetic resonance imaging findings. The diagnostic accuracy of plantar fascia pathological focal echogenicity, plantar fascia oedema, perifascial oedema, and plantar fascia rupture was 15(80.6%), 12(60.7%), 15(77.1%), and 13(68.6%) respectively. The diagnostic accuracy of ultrasonography was lower while evaluating for calcaneal spurs.
 Conclusion: The present study concluded that ultrasonography could be the basic initial diagnostic imaging modality to confirm clinically suspected cases of plantar fasciitis. However, magnetic resonance imaging could be the preferred diagnostic modality for suspected complex pathology and lack of clinical presentation.

Diagnostic Accuracy of Ultrasonography Versus Magnetic Resonance Imaging in the Detection of Endometrial Carcinoma Keeping Histopathology as Gold Standard

Objective: To calculate the diagnostic accuracy of Ultrasonography versus Magnetic Resonance Imaging in detecting endometrial carcinoma with histopathology kept as a gold standard.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Diagnostic Radiology, Pakistan Institute of Medical Sciences Hospital, Islamabad Pakistan, from Apr 2019 to Apr 2020.
 Methodology: This study included patients of perimenopausal and post-menopausal age groups with abnormal uterine bleeding having a high index of suspicion for endometrial malignancy referred from the Gynecology department for an ultrasound examination. Patients having high suspicion for malignancy or inconclusive evidence on ultrasound were considered for Magnetic Resonance Imaging(MRI). All of them were followed for histopathological reports after surgical exploration. Clinical, sonological and Magnetic Resonance Imaging (MRI) findings, along with histopathological diagnosis, were documented.
 Results: Mean age of the patients was 56.58±10.28. Of these eight patients, 8(21.1%) did not have carcinoma upon histopathology. The most common type of carcinoma was poorly differentiated endometrial adenocarcinoma. The diagnostic accuracy of ultrasound was found to be 47.35%, while that for Magnetic Resonance Imaging (MRI) was 71.05%. Sensitivity and specificity for Ultrasound versus Magnetic Resonance Imaging (MRI) were 53.33% versus 66.67% and 75% versus 87.50%, respectively. The mean endometrial thickness on ultrasound was 15.97±5.64 mm, while on MRI was 15.42±6.9 mm.
 Conclusion: Magnetic Resonance Imaging (MRI) is a more accurate and sensitive modality in detecting endometrial carcinoma in patients with abnormal uterine bleeding.

Diagnostic Accuracy of Elastography to Differentiate Between Benign and Malignant Lymph Nodes of Head and Neck Region taking Histopathology as the Gold Standard

Objective: To estimate the diagnostic accuracy of Elastography to distinguish between benign and malignant lymph nodes of the head and neck region; taking histopathology as the gold standard.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Radiology Department, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jul to Oct 2021.
 Methodology: Elastography, Color Doppler and B-mode ultrasound were used to examine fifty participants with enlarged cervical lymph nodes. Elastographic forms (1–5) were characterized based on the hard area in the cervical lymph nodes. In addition, the shear wave elastography of cervical lymph nodes was evaluated. Outcomes of diagnostic sono-elastographic parameters were matched with the histopathology of lymph nodes as a reference of standard.
 Results: The mean age of patients was 30.50±8.95 years. Out of 50 patients, 31(62%) were men, and 19(38%) were women. Out of 50 patients enrolled, 29(58%) showed benign lymph nodes, while 21(42%) showed malignant lymph nodes on elastography.All 50 patients underwent a biopsy for histopathology.
 Conclusion: Ultrasound elastography has high diagnostic accuracy in differentiating benign from malignant lymph nodes. Therefore, it can be used as a reliable and non-invasive modality for diagnosing lymphadenopathy in the cervical region.Keywords: Cervical, Elasticity imaging techniques, Elastography, Lymph nodes, Lymphadenopathy, Neck, Ultrasound

CREATING INCLUSIVE TVET INSTITUTIONS FOR HEARING IMPAIRED STUDENTS: INSIGHTS AND RECOMMENDATIONS

This study aimed to examine the perspectives of eleven participants, including teachers, parents, curriculum developers, and academic administrators in the Technical and Vocational Education and Training (TVET) sector, engaged in inclusive education and creating inclusive education strategies. More specifically, this study explored their perspectives on implementing inclusive education for students with hearing impairment (HI) in TVET institutions in Pakistan. Qualitative research using a focus group method was conducted to gather data. Focus group discussions revealed the need for counselling, awareness, attitude changes, instructional methods, and infrastructure to facilitate inclusive education. Creating inclusive learning environments required collaboration, personalised support, and accessible environments. It also stressed the difficulties and potential of inclusive education and urged for further study and implementation of solutions to improve student learning and well-being. Inclusive educational settings can help all students succeed. Infrastructure was examined in vocational institutions’ special needs support. Wheelchair accessibility and a safe learning environment were emphasised. They stressed the impact of the institutions’ environments on student attitudes, academic achievement, and social development. Inclusion was also discussed, emphasising the need for a community-oriented vocational skills approach customised to these individuals’ educational requirements. Keywords: Inclusive education, Hearing Impaired Students, TVET, Perceptions.

Role of Serum Lipid Profile; Indicator of Early Changes in Head and Neck Cancer Cells

Objective: The objective of this study was to investigate the role of serum lipid profile as an indicator of early changes in head and neck cancer cells and to assess the potential value of these changes in detecting neoplastic cell alterations at an early stage. Methodology: The Hospital-based case-control study was carried out on 48 patients with newly diagnosed Head & Neck malignancies, attending the Department of Otorhinolaryngology and Head and Neck Surgery Pakistan Institute of Medical Sciences Islamabad between July 2020 and December 2020. Forty-eight Age and sex-matched who did not have any renal, hepatic or cardiac dysfunction were taken as controls. Fasting blood samples were drawn and analyzed for lipid profile as recommended in the literature. Results: A significant change in plasma lipid profile with P values of Total Cholesterol (0.000), Triglyceride (0.004), and HDL (0.009) of <0.05 indicates that there is a statistically significant reduction of mean serum Total Cholesterol, Triglyceride, and HDL in subjects with head and neck cancer compared to the control group. Conclusion: The altered plasma lipid status observed in this study suggests its potential as a valuable signal for early alterations in neoplastic cells associated with head and neck malignancies. Furthermore, a comprehensive review focusing on cholesterol-carrying lipoprotein transportation and the efficacy of receptor systems may contribute to a better understanding of the underlying mechanisms controlling plasma cholesterol concentration in the context of cancer.

Effect of Induction of Early Meconium Evacuation using Glycerin Suppositories in Promoting Feeding Tolerance in Low Birth Weight Infants

Objective: To determine the effect of Induction of early meconium evacuation using glycerin suppository in promoting feeding tolerance in low birth weight infants. Methodology: This quasi-experimental study was conducted in the Department of Neonatology at Pakistan Institute of Medical Sciences (PIMS) in Islamabad. A total of 120 neonates were included in both groups of the study. The control group received standard treatment, while the intervention group received standard treatment along with glycerin suppository. The data was analyzed using SPSS version 26. The independent sample t-test was used to compare the time to achieve full feed and the time to achieve complete evacuation of meconium between the two groups. A p-value of 0.05 was considered significant. Results: The mean gestational age was 30.30±1.19 weeks. Out of 240, 127 (52.9%) neonates were male. All neonates included in the study have a very low birth weight range from 1 to 1.6 kg with a mean weight of 1.32±1.29 kg. The intervention group showed a significant low time to achieve full feed and low time to achieve complete evacuation of meconium 11.21±1.54 and 4.99±1.16 days as compared to the control group 12.73±1.46 and 5.97±1.1 days, with p value 0.000. Conclusion: Glycerin suppository helps to reduce the time to achieve full evacuation of meconium.

Comparison of Cranial Ultrasound and Computed Tomographic Scan Finding in Infants with Post Meningitis Complications

Objective: To compare the findings of cranial ultrasound and computed tomographic (CT) scans in infants with post-meningitis complications. Methodology: A prospective analysis of 124 consecutive term infants was conducted in the department of radiology at the Pakistan Institute of Medical Sciences, Islamabad from August 2021 to April 2022. Transfontanelle ultrasonography was performed with a two-dimensional Sonoace 1500 ultrasound scanner (Medison Inc, South Korea 1995) equipped with a 6.5 megahertz (MHz) curvilinear small head probe. Sagittal and coronal sections were scanned using standard techniques. We included all 124 confirm cases of meningitis came to our hospital in the period through consecutive non probability sampling, which fulfilled the required sample size to test the objective in our population. Results: The average age of the infants was 4 months, with 71 (57.3%) males and 53 (42.7%) were females. Ultrasonography results were confirmed by CT scans in all patients. The diagnostic accuracy of ultrasonography was found to be 32.14%. Seizures disorders were the most common complication observed in the study population. Conclusion: Using transfontanelle ultrasound, it is possible to diagnose lesions inside the infant's brain. Transfontanelle ultrasound scans are most often requested for hydrocephalus detection and for abnormal findings. Infants with post-meningitic complications commonly suffer seizures. In post meningitic complications, ultrasound can still be used as an early non-invasive diagnostic modality despite its low diagnostic accuracy. Improved collaboration between radiologists and pediatricians can lead to better outcomes and reduced mortality and morbidity in neonates and infants.

Comparison of Unstable Per-Trochanteric Fractures Fixed with Proximal Femoral Nail Versus Dynamic Hip Screw Using Harris Hip Score

Objective: To compare the frequency of a good functional outcome in unstable per-trochanteric fractures fixed with a dynamic hip screw and proximal femoral nail using the Harris Hip Score. Methodology: A comparative study was conducted at the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences, Islamabad, from June to December 2021. A total of 80 patients with per-trochanteric femur fractures were selected and divided into two groups based on the surgical procedure performed: dynamic hip screw or proximal femoral nail. A comprehensive history and thorough examination were performed for all patients during scheduled follow-up visits. Patients were called in for follow-up assessments at 1 month and 3 months to evaluate the functional outcomes using the Harris Hip Score. Results: The mean age of all patients was 58.73±6.78 years. At the 3-month follow-up, the mean Harris Hip Score was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (84.64±7.05 vs. 73.9±12.53; p = 0.005). The proportion of patients with good functional outcomes (Harris Hip Score ≥ 70 points) was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (97.5% vs. 72.5%, p = 0.002). Conclusion: In this study, the proximal femoral nail group demonstrated superior functional outcomes compared to the dynamic hip screw group. The use of proximal femoral nail fixation can provide better outcomes and facilitate an earlier return to pre-injury status for patients.

Maternal Hydration with Intravenous Versus Oral Therapy in the Correction of Isolated Oligohydramnios in the third Trimester of Pregnancy

Objective: To compare the effectiveness of oral hydration versus intravenous hydration therapy in correcting amniotic fluid volume in women presenting with isolated oligohydramnios in the third trimester.
 Methodology: A randomized controlled study was conducted at the Department of Obstetrics & Gynaecology, Pakistan Institute of Medical Sciences, Islamabad, over six months from March 2021 to September 2021. One hundred and twenty-six patients were enrolled, with 63 in each group. Patients with AFI < 5 cm in the third trimester, singleton pregnancies, and no associated maternal or fetal risk factors were included. Demographic data, AFI at baseline, and hydration details were collected. Patients were divided into two groups: one received oral rehydration solution (ORS) every 30 minutes, and the other received intravenous (IV) lactated Ringers solution over one week. APGAR scores at 1 & 5 minutes were compared between the two study groups using independent samples t-test. P value ≤0.05 was taken as significant.
 Results: Both groups were comparable in terms of demographic parameters and pre-intervention water intake. AFI increased significantly in both groups compared to baseline at various intervals and persisted even one week after the completion of the study. Urine specific gravity decreased significantly after one week in both groups. Birthweight and Apgar scores at 1 and 5 minutes were comparable in both groups.
 Conclusion: Both oral and intravenous hydration significantly increased amniotic fluid volume and were equally effective in correcting isolated oligohydramnios in the third trimester. Oral hydration is a non-invasive, cost-effective, and convenient alternative to intravenous hydration, offering potential benefits for pregnant women without the need for hospital admission or IV lines.

Pregabalin and Gabapentin's Effectiveness Safety in Treating Neuropathic Pain are Compared at Pakistan Institute of Medical Sciences in Islamabad

Background: Patients with neuropathic pain treated at a single clinic in Pakistan took part in this research study over six months to assess the efficacy and safety of pregabalin and gabapentin as potential treatments. Patients suffering from neuropathic pain and participating in the experiment were split into two groups, each receiving pregabalin or gabapentin according to a random assignment. Before being evaluated using the Visual Analogue Pain Scale (VAS), participants were first questioned about their demographics and the degree of their pain at the beginning of the study. Follow-up appointments were held one week, one month, three months, and six months after the first visit. According to the research results, both pregabalin and gabapentin helped reduce neuropathic pain; however, the effects of pregabalin on pain reduction were much more significant. It was determined that both drugs were safe to use, and none of the reported adverse effects were particularly severe. Both gabapentin and pregabalin were found to be effective drugs in relieving neuropathic pain by the researchers who conducted the study. Objectives: The primary objective of this study is to ascertain whether or not pregabalin and gabapentin are helpful in the treatment of neuropathic pain in patients who are receiving care at the Pakistan Institute of medical sciences Islamabad, Pakistan. The secondary objective of this research is to evaluate the effectiveness of pregabalin and gabapentin in reducing the amount of pain that participants in the study report feeling. The Visual Analogue Scale, often known as the VAS, will quantify the pain level experienced.

A randomized controlled trial to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among TB patients.

Background: The study was designed to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among tuberculosis patients in Pakistan. Methods: A randomized, controlled prospective study was carried out in a Pakistan Institute of Medical Sciences hospital tuberculosis (TB) control center. Participants who visited the TB center between September 2020 and December 2021 were randomly assigned to two clusters, the usual care group (UC group) vs. the intervention group (pharmaceutical care group), in a 1:1 ratio by a simple envelope technique. In the intervention group, a patient received centered care that encompassed informed decision-making, which can increase the quality of care and monitoring of adverse drug events. However, the control group received routine TB treatment at the hospital. The EuroQol-5D-3L instrument was used to assess the health-related quality of life (HRQoL) at the baseline and in the third and sixth months of the treatment time period. Results: A total of 503 patients were eligible, of which only 426 patients were included in this study. At the end of the study, n = 205 of the patients in the intervention group and n = 185 of those in the control group were analyzed. In the intervention group, the EQ-5D-3L health utility score improved significantly (p < 0.001) (from the baseline mean ± SD, 0.40 ± 0.36, to 6months of treatment, 0.89 ± 0.09, while in the control group from 0.42 ± 0.35 to 0.78 ± 0.27). In multivariate regression analysis, the variables that remained statistically associated (p < 0.001) with the HRQoL (unstandardized β [95% confidence interval]) of the control group were as follows: gender, female vs. male (-0.039 [-0.076 to -0.003]); body weight, less than 40kg vs. more than 40kg (-0.109 [-0.195 to -0.024]); patients with any comorbidity vs. without comorbidity (-0.136 [-0.252 to -0.020]); and smokers vs. non-smokers (-0.204 [-0.291 to -0.118]). The study did not find any statistically significant associations between the intervention group's variables and the HRQoL. Conclusion: Patient-centered care interventions led by pharmacists as part of care coordination enhanced the HRQoL for TB patients significantly. According to this study, clinical pharmacists should be included in the interdisciplinary clinical staff for TB patient management.

Adherence with standard guidelines among doctors involved in aerosol generating procedures to control COVID-19 transmission.

To review the strategies for controlling COVID-19 transmission among doctors involved in aerosol generating procedures. A cross-sectional study was conducted in Pakistan Institute of Medical Sciences, Islamabad from September to November 2020, using a 21-itemed initially piloted self-administered questionnaire designed on Google forms. It was shared with doctors involved in Aerosol generating medical procedures (AGMPs) by using social media applications. After the data was collected, it was analyzed using SPSS version 21. A total of 136 doctors participated in the study that included 59 female and 77 male participants. Our 67 (49.3%) participants screened their patients for signs and symptoms of COVID-19 before a routine checkup. The most common disinfectant used for reusable medical equipment by 62 (45.6%) respondents was alcohol swab, 57 (41.9%) did not disinfect reusable equipment and 17 (12.5%) used Dettol water spray. Majority of the doctors involved in AGMPS are not following the guidelines provided by international and national bodies. As such adherence to guidelines can help prevent COVID19 transmission in frontline doctors especially those involved in aerosol generating procedures.

Intention to adopt Islamic finance through the mediation of attitudes towards Islamic finance

Purpose This paper aims to explore the intention to adopt Islamic finance (ItIF) through the mediation of attitudes towards Islamic finance among microbusiness owners of Pakistan. Design/methodology/approach The study is co-relational and based on cross-sectional data. The authors gathered the data from microbusiness owners through a survey questionnaire. The authors used 236 valid cases to assume the outcomes. Findings The results through structural equation modeling reveal a significant positive effect of the perception of Shariah compliance (PoSC), knowledge of the Islamic financial system (KoIF), religious preferences (RP) and loyalty on ItIF. Furthermore, attitude towards Islamic finance (AtIF) is a potent factor in developing the relationship between PoSC, KoIF, RP, loyalty and ItIF. Practical implications The study’s findings would be helpful for planners and policymakers in developing policies that favourably enhance the attitudes and intentions among individuals towards Islamic financing. The results would inspire readers to go to Islamic finance and an interest-free financial system enriched with Shariah law or Islamic obligations. The study would provide implications for the financial institutions in Pakistan and the rest of the Muslim world. Originality/value The study offers an apparent thoughtfulness of the empirical evidence from microbusiness owners of Pakistan. The study would provide a plausible mediating contribution of AtIF.

Working in partnership in Pakistan: Lessons from launching a pedagogical partnership program

This case study presents an account of the implementation of the Pedagogical Partnership Program (PPP) at a leading university in Pakistan. The PPP was unique in two main ways: (a) it was the first of its kind in any higher education institution in Pakistan and (b) it was launched during COVID-19. The launch of the program during COVID offers insights into how partnerships can be a unique support system for students and faculty in difficult times. We share several lessons learned from our experiences leading the PPP and from the feedback we received on end-of-partnership reports. These lessons have been critical to how we continued to think about the evolution of the program and its impact on students and faculty/staff at Lahore University of Management Sciences (LUMS). Through our analysis, we aim to add a new contextual perspective on partnerships in South Asia as a developing area of the world for partnership initiatives.

The frequency and risk factors associated with the development of knee and hip osteoarthritis of the intact limb after unilateral lower limb amputation at PIPOS Bannu.

Objective: To determine the frequency and risk factors associated with the development of osteoarthritis of the knee and hip joints of the intact limbs after unilateral amputation of the lower extremities with PIPOS Bannu. Study Design: Cross Sectional. Setting: Pakistan Institute for Prosthetics and Orthotics (PIPOS). Period: June 2019 to November 2019. Material &amp; Methods: The presence of osteoarthritis (OA) was determined by a standardized questionnaire, primarily based on laboratory tests/physical examination. Participants were evaluated by experts who diagnosed symptomatic hip and knee OA using a structured questionnaire and standardized joint tests based on American College of Rheumatology (ACR) clinical standards. Individuals who tested positive were tested by a rheumatologist, who checked for the presence of clinical ACR criteria to confirm the diagnosis. Results: A total of 150 patients were included in the study. Data is analyzed by SPSS 21. The average age of the patients was 38.12 ± 14.82 years. Of the total of 150 patients, 131 (87.3%) were male and 19 (12.7%) were female. According to the degree of amputation, 79.3% (n = 119) patients were traumatic and 20.7% (n = 31) were non-traumatic limbs. The incidence of knee osteoarthritis is 9.3% (9.3% for men and 0.0% for women) and 4.0% for hip osteoarthritis (2.7% for men and 1.3% for women), both in hip and knee osteoarthritis. 2.7% (2.0% for men and 0.7% for women). Conclusion: According to this study, traumatic and non-traumatic lower limb amputees are more likely to develop knee and hip osteoarthritis in the intact lower limb. Demographics and patient characteristics are major risk factors for osteoarthritis.

Laparoscopic vs mini-incision open appendectomy in patients presenting with acute appendicitis.

Objective: To compare the outcome of laparoscopic vs mini incision open appendectomy for acute appendicitis. Study Design: Randomized Control study. Setting: Pakistan Institute of Medical Sciences, Hospital, Phase V, Hayatabad, Peshawar. Period: March 2022 to November 2022. Material &amp; Methods: A total of 96 patients were enrolled in the study, the patients were divided in to two groups using randomization using non probability consecutive sampling and 48 patients were allocated to each group. Group A patients underwent laparoscopic while group B patients underwent mini incision appendectomy. In both groups operative time, need for analgesics, postoperative pain score, hospital stay and postoperative wound infection was compared. Chi square test and Independent sample T test was used, a P value ≤ 0.05 was taken as significant. Results: The mean age of the patients in group A was 30.58±8.35 years and 28.52±5.79 years in group B. In group A 14.6% patients needed analgesics while in group B 31.2% patients. Regarding the hospital stay group A patients had a mean hospital stay of 25.85±1.53 hours and in group B the mean hospital stay was 29.58±3.76 hours. In group A the mean postoperative pain score was 2.17±0.97 and in group B the mean postoperative pain score was 2.88±0.81. Conclusion: Laparoscopic appendectomy has a lower average postoperative pain score, need for analgesics and shorter hospital length as compared to mini incision operative appendectomy.

Analyzing the Role of Liquidity and Credit Risk Management on the Performance of Financial Institutions: A Case of Emerging Economy

This research paper examines the impact of liquidity and credit risk management on the performance of Pakistan's financial institutions. The study employs quantitative research methodology to collect secondary data from the annual reports of fifteen commercial institutions for the years 2012-2021. The researchers analyzed the data through panel regression analysis. According to the findings of the study, liquidity and credit risk management have a significant and positive effect on the financial performance of Pakistani institutions. This study is innovative because it focuses on the Pakistani financial industry, which has not been extensively examined in the literature. This study also contributes to the existing literature on the impact of liquidity and credit risk management on banks' financial performance. This study focuses on only 15 institutions in Pakistan, limiting the generalizability of the results. Future research can increase the sample size to include more banks and also consider other variables that may influence the financial performance of Pakistani banks. The study's findings can provide policymakers, regulators, and financial institutions with valuable insights to enhance their liquidity and credit risk management practices.

Application of marketing principles for HEIs: A perspective of Pakistani universities

This study focuses on the application of marketing principles for higher education institutions (HEIs) in Pakistani universities. The study begins with a review of the current marketing practices in the higher education sector and analyzes the challenges faced by HEIs in attracting and retaining students. The research methodology includes a mix of qualitative and quantitative data collection techniques such as surveys and interviews with stakeholders. Based on the findings, marketing – recommendations are proposed that includes segmentation of target audiences, identification of unique selling propositions, development of communication channels, and implementation and evaluation of the marketing plan. It incorporates the use of digital marketing tools, such as search engine optimization and social media marketing, to increase HEIs's visibility and brand awareness. The final recommendations of the study suggest implementing certain marketing suggestions to ensure the successful execution of the marketing plan. These suggestions include the creation of a specialized marketing team, providing training to both staff and faculty members, and regularly monitoring and evaluating the efficacy of the marketing efforts. By implementing these marketing suggestions, HEIs can achieve its enrollment and revenue targets while also improving its image as a premier educational institution in Pakistan.

Current Practice of Physical Therapists: An evidence-based practice survey

Background: Patient/client management is comprehensive multidirectional process. It includes patient client examination, evaluation, diagnosis, prognosis, intervention and then discharge plans from supervised treatment to follow ups. The process of examination includes comprehensive history taking, performing systemic review and special tests and measures. Aim: To investigate Pakistani physiotherapists’ current practice, skills and understanding of evidence-based practice in order to improve the utilization of the evidence base in physiotherapy in the country. Methods: This observational cross section study was done in Pakistan Institute of Medical Sciences and Islamabad Medical and Dental College, Islamabad between January 2021 and March 2021. Physiotherapists(n=369) were contacted through non-probability convenience sampling technique. Respondents were contacted at clinical facilities in the twin cities of Pakistan. The content of the questionnaire was validated using the literature and the method of Lynn MR et al. The results were extracted, conclusion was drawn, suggestions and recommendations were made. Results: The participants mean age was 27.58±7.41 years. The male/female ratio was almost same. Approximately half of the respondents 50.4% were agreed about the role of EBP in practice.57% respondents were agreed that EBP removes the art from clinical practice. 58.5% respondents were agreed about benefit of EBP and EBP improves clinical outcomes and 53.4%respondents were agreed about help of EBP in decision making. Attitude and knowledge need analysis was positive but there found compromise in utilization of this evidence-based practice, while this study showed more utilization. Conclusion: Five steps of evidence-based practice were found being infrequently practiced. Physiotherapists had good to fair understanding of evidence-based practice. Physiotherapists had fair to poor appraisal skills. Keywords: Clinician practice; Data base; Evidence-based practice; Physical therapist; Practice guideline; Patient management.