Background:Bear mauling is rarely reported in medical literature due to its rare occurrence. Present study was undertaken to describe the pattern and management of bear maul vascular injuries in Kashmir.Patients and Methods:Study of patients with bear maul vascular injury from 1st Jan 2004 to 31st Dec. 2008. Fifteen patients with bear maul vascular injury were studied. All patients of bear maul without vascular injury were excluded from the study.Results:Most of the patients were treated by reverse saphenous vein graft or end to end anastomosis. Most common complication was wound infection (20%) followed by graft occlusion (13.33%). There was no operative death.Conclusion:Bear attacks are very common in Kashmir. Vascular injury due to bear maul needs prompt resuscitation and revascularization. Results are very good provided timely intervention for revascularization is done.

No abstract

Purpose The fundamental purpose of this research is to compare Pakistan’s mineral policy instrument with that of leading developing minerals-based economies and to highlight the gaps. Mineral resources development can act as an engine for country growth and have the potential to transform economies and societies. The extent to which such transformation takes place varies depending upon the method of their use. Design/methodology/approach This paper conducts a gap analysis between Pakistan and leading developing minerals-based economies to identify key policy gaps. Two basic principles were kept in mind with the choice of countries: first, only developing countries were considered and, second, at least two countries had to be Islamic. Eight developing countries Chile, Mexico, Brazil, Peru, India, South Africa, Kazakhstan and Turkey were selected. Findings The most important finding of the exercise is that Pakistan’s mineral sector is lacking an enabling institutional, fiscal and regulatory framework for the optimal development of its mineral resources. Practical implication Pakistan’s mineral resources have the potential to expand its economy and benefit its citizens. For this to happen, Pakistan must first establish what beneficiation is realistically expected from its mineral resources and, second, formulate a mineral policy based on leading practices to attract mining investment and aim for a sector contribution to gross domestic product of 5 per cent. Originality/value This paper presents original work on how Pakistan should formulate its mineral policy to extract maximum benefit from its mineral resources.

Triple-A syndrome, also known as Allgrove syndrome, is an uncommon disorder which is inherited as an autosomal recessive disorder. About 100 cases have been described in literature. The three AAA comprises adrenal insufficiency secondary to adrenocorticotropic hormone (ACTH) resistance, achalasia cardia, and alacramia. We are reporting a case of a 10-year-old boy diagnosed as triple-A syndrome with ACTHresistant adrenal insufficiency, achalasia cardia, and alacrimia. He has alacramia since birth, and at the age of 7 years, he was diagnosed to have achalasia cardia. He developed the symptoms of adrenal insufficiency at the age of 9 years. Allgrove syndrome might be underreported in literature as the diagnosis requires high index of suspicion. In our patient, there was a delay of 3 years after the initial diagnosis of achalasia cardia. The diagnosis of Allgrove syndrrome should be considered in every child presenting with alacremia or achalasia cardia.

Background:Fibrocalculous pancreatic diabetes (FCPD) is a secondary form of diabetes, described from several tropical countries, including India. We described the existence of this entity in the subtropical region-the Kashmir valley of the Indian subcontinent and compared the clinical characteristics of these patients with type 2 diabetes mellitus (T2DM) patients.Aim:The present study aimed to compare the clinical characteristics of patients with FCPD and those with T2DM to identify the characteristics distinctive of FCPD.Materials and Methods:A total of 124 patients with FCPD were compared with 124 patients with T2DM matched for age and duration of diabetes. Biochemical parameters and microvascular and macrovascular complications were assessed in all patients. Multivariate regression analyses were performed to study the determinants of microvascular complications in both groups.Results:FCPD patients had significantly lower serum cholesterol, serum triglyceride, and serum calcium levels but higher glycosylated hemoglobin levels compared to T2DM patients. FCPD participants were significantly leaner. The prevalence of retinopathy, neuropathy, and nephropathy was similar between the two. Five T2DM patients had documented cardiovascular disease compared to one in FCPD patients (P < 0.05). Multiple logistic regression analysis revealed glycosylated hemoglobin and duration of diabetes to be significantly associated with retinopathy and nephropathy in T2DM. Among FCPD patients, glycosylated hemoglobin showed a strong association with retinopathy as well as nephropathy. BMI showed a significant negative association with nephropathy in FCPD patients. Age and age at onset showed a strong association with neuropathy in FCPD patients while the duration of diabetes showed the association with neuropathy (P = 0.015) in T2DM.Conclusion:There are several differences in the phenotype, biochemical parameters, and prevalence of diabetic complications between patients with FCPD and T2DM.