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Home > Interferon Based Therapy of Chronic Hepatitis C Patients. a Case Study of Khyber Pakhtunkhwa.

Interferon Based Therapy of Chronic Hepatitis C Patients. a Case Study of Khyber Pakhtunkhwa.

Thesis Info

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Author

Sajid Ali

Program

PhD

Institute

University of Peshawar

City

Peshawar

Province

KPK

Country

Pakistan

Thesis Completing Year

2012

Thesis Completion Status

Completed

Subject

Natural Sciences

Language

English

Link

http://prr.hec.gov.pk/jspui/handle/123456789/198

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676726492300

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Hepatitis C is the inflammation of the Liver caused by Hepatitis C virus (HCV), the leading cause of the liver cirrhosis and hepatocellular carcinoma. About 3% of the people have been affected by HCV world wide and in Pakistan being an underdeveloped country; an estimated 10 million people have Hepatitis C infection (WHO). As hepatitis C infection is asymptomatic and due to untimely diagnosis it leads to severe liver diseases and anuualy a lot of affected individuals lose their lives. In order to cure the infection Food and Drug Agency (FDA) has approved the use of Interferon (IFN) as the treatment remedy. In Pakistan National Institute of Health (NIH) has also given the recommendation for the use of IFN as the therapeutic agent In KhyberPakhtunKhwa (KPK) mostly conventional IFN and Ribavirin combination therapy is considered due to the prevalence of responsive genotypes 2 and 3. Earlier no study has been conducted to sort out IFN response among chronic HCV patients in different districts of KPK province, therefore we attempted to find out response of conventional IFN combination therapy at districts level in KPK. Samples were collected from chronic HCV patients referred by clinician/laboratories of different regions of KPK. The samples were analyzed for screening by ICT (Immunochromatographic Technique) and ELISA (Enzyme Linked Immunosorbant Asaay) followed by confirmation through polymerase chain reaction (PCR). We have also done genotyping for some of the chronic HCV patients. PCR confirmed positive patients were given IFN and Ribavirin combination therapy keeping in mind the therapy exclusion criteria. The dose of IFN and Ribavirin was 3 Million Units thrice a week and 800-1200mg daily depending on the age of the patients, respectively. This therapy was continued for six months with repeated testing of ALT (Alanin Transaminase) and CBC (Complete Blood Count), during and after therapy. At the end of six months of therapy, PCR test was done for all course completed patients. Active HCV infection was present in 66.6% among 3075 anti-HCV positive patients while 33.3% anti-HCV positive patients were negative for HCV RNA. Rate of active iiHCV infection was comparatively more in districts Bunir (72%), Dir (70 %) and in Mardan (69%). While lower in districts Swabi (66%), Peshawar (64%) and Kohat (59%). HCV genotype analysis in chronic HCV patients of KPK revealed that the most abundant genotypes/subtypes among the patients analyzed were 2a followed by subtype 3a. Other common genotypes included the untypable type of the virus and genotype 3b. Response of IFN and Ribavirn combination therapy in the 1st trial among 174 PCR positive patients was 74.71% and the resistance was 25.28%. Among different districts, high end of treatment response (ETR) was shown by district Mardan patients population (89.18%), followed by Bunir (69.23%). While low response was present in case of district Peshawar (60%) and Federally Administered Triable Area (FATA) (55.55%). In the second trial of IFN therapy, out of total (341) selected patients for standard IFN- based therapy 81% showed ETR and 19% did not show response. Among the districts high ETR was shown by district Swabi (92%), followed by district Kohat (80%). Comparatively low response was present in case of district Bunir (71%). In genotype specific response of IFN based therapy, out of total 51 selected patients. Responsive genotypes among these were 2a followed by 3a. Response rate among different HCV genotypes were as, 2a HCV genotypes had high (77.72%) ETR, followed by 3a genotypes (72.22%). Comparatively low response was present in case of 3b and 1b genotypes (66.66%) and (33.33%) respectively. While untypable genotypes showed no response. Our results revealed that response of combination IFN therapy is good in some of the districts patients’ population. High ETR rate in these districts may be attributed to prevalence of responsive HCV genotypes 2 and 3. In case of non responsive genotypes some new effective remedies should be discovered. While untypable genotypes should be sequenced so as to adopt some new therapeutic agents against them.
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مولانا ابوالحسن علی فراہی اصلاحی

مولوی ابوالحسن علی فراہی اصلاحی
مولوی ابوالحسن علی فراہی اصلاحی ناظم مدرسۃ الاصلاح سرائے میر کئی ماہ سے بیمار تھے۔ علاج کے باوجود مرض بڑھتا گیا۔ بالاخر ۳۱؍ جنوری ۱۹۸۷؁ء کو وقت موعود آپہنچا اور رحلت کرگئے، اناﷲ و انا الیہ راجعون۔
وہ ترجمان القرآن مولانا حمیدالدین فراہیؒ کے حقیقی پوتے تھے، ان کی تعلیم مدرسۃ الاصلاح کے علاوہ شبلی نیشنل اسکول و کالج میں ہوئی تھی، گھر کے خوش حال تھے، اس لئے کوئی ملازمت کرنے کے بجائے زمین اور زمینداری کی دیکھ بھال کرتے رہے، لیکن قومی و ملی کاموں سے دلچسپی تھی، تقسیم کے زمانہ میں جمعیۃ علماء کانگریس کے پرجوش حامی تھے، تقسیم کے بعد صوبہ کانگریس کے ممبر بھی ہوئے، پھر پرانے کانگریسیوں کی طرح اس سے دل برداشتہ ہوکر لوک دل میں چلے گئے مگر اس سے بھی نباہ نہ کرسکے اور اب سیاسی جھمیلوں سے الگ ہوکر صرف مدرسۃ الاصلاح کی خدمت کے لئے وقف ہوگئے تھے، جس سے اپنے دادا کی یادگار ہونے کی بناء پر ہمیشہ بہت تعلق رکھا، پہلے اس کے نائب ناظم ہوئے اور اب کئی برس سے ناظم ہوگئے تھے۔
وہ جس اخلاص، ایثار و قربانی سے کسی معاوضہ کے بغیر مدرسہ کی خدمت انجام دے رہے تھے، اس کی مثال کسی دینی مدرسہ میں کم ہی ملے گی، ان کے دور میں مدرسہ میں کئی عمارتیں تعمیر ہوئی، بعض مفید کام بھی انجام پائے، یہاں ان کے دادا کی یاد میں دائرہ حمیدیہ قائم ہوا تھا جس کو متحرک بنانے کے بڑے خواہشمند تھے، مرحوم کو دارالمصنفین سے بھی گہرا لگاؤ تھا۔ ان کے دادا مولانا حمیدالدین فراہیؒ کی سرپرستی میں اس کا آغاز ہوا تھا، ان کے بعد ان کے چھوٹے بھائی مولوی حاجی رشید الدین فراہی کو بھی اس ادارہ سے بڑی دلچسپی اور ہمدردی رہی۔
مرحوم مرنجان مرنج شخص تھے، طبیعت...

ضرورة تبني الأدب الإسلامي في عصر المادة الحديث ودور الأديب المسلم في نشره

Our current Islamic literature must adapt the post modem literary trends so as to make it more readable and reader-friendly. It is this optimizing and modernizing trendstylistically that would enhance the worth and readability of Islamic literature. The present article is an effort to review the reader friendly formats for Islamic literature so that it may become more inspiring.

Modeling Dynamics of Dividend Policy, Capital Structure and Agency Cost: Evidence from Nonfinancial Sector of Pakistan

Capital structure of a business refers to its sources of finance. The value of a company is independent of its capital structure and the cost of equity for a leveraged firm is equal to the cost of equity for an unleveraged firm (Miller and Modigliani, 1961). All this prevails if there is no transaction or bankruptcy cost and there is perfect information. The pecking order theory of Myers (1984) ranks internal sources such as debt and equity which paves the way for expansion of the concept of capital structure. Many of the previous studies reveal rising debts to have positive effect on the growth of economic activities of the business. On account of rising growth the business is likely to be overvalued; the benefits of which are accrued to the management. When the management is after these benefits, this creates agency costs. Agency costs provide relevance of capital structure. Unless free cash flow is given back to investors, management has an incentive to destroy firm value through empire building and perks. Increasing leverage imposes financial discipline on management. The studies of Black (1976), Allen and Michaely (2003) and Baker (1999) provide room and gap to explore link of agency cost, capital structure and dividends. This study is an academic contribution to fill the gap. This study investigates significance of agency costs in relationship of capital structure and dividend policy of Pakistani nonfinancial sector. Type and size of the industries, performance of business enterprises possess significance in capital structure. Industry-specific qualitative variables, market capitalization, performance indicators, risk factors are also included in the model. Finding interactive effects of the agency costs, capital structure and dividend policies are an important contribution of the present study. The study finds significance of agency costs which determines dividend policy at variable proportion. Certain leading theories helped in providing the scope of this study. ‘Dividend Puzzle’ of Black (1976); growth prospects of the industry, earnings of the firm, and dividend policy of Lintner (1956); capital structure irrelevance of Miller and Modigliani (1961); dividend policy perspective of Brealey and Myers (1991) & Brigham and Gapenski (1991); significance of agency costs for the determination of dividends (Lloyd, et al., 1985; Alli, Khan, & Ramirez, 1993; Dempsey, Laber, & Rozeff, 1993) are a few to mention. Objectives of the study include understanding of the environment and features of Pakistani business enterprises; dividend policies of the listed companies of nonfinancial sector of Pakistan; understanding significance of agency cost using nonlinear and interactive approach; bringing together various advanced econometric methods as measuring source of relationship of variables; exploring empirical effects of three different sizes and nine different types of industries on the dividend policy; investigating homogeneity/heterogeneity of management style of the Pakistani business enterprises. The present study employs qualitative response variable models and the panel data models using the variable modeling technique consulting Amemiya (1981); Daniel & Yu, (2000); Gujarati & Sangeetha (2007) and Greene (2005). Findings of the study reveal interesting results. Pakistani management is relatively efficient in meeting regulatory requirements as compared to other countries of the South Asian region. The highest degree of bureaucratic culture in tax department is observed in Pakistan. The highest degree of problem is in the sectors related to the utilities which make very important component of infrastructure. Descriptive statistics reveal inconsistent overall performance of nonfinancial sector of Pakistan and that 2004, 2005 and 2006 are the years of better performance of Pakistani business enterprises. However, there is no significant difference of the level of uncertainty across the Pakistani industries. The results also show increasing probability of paying dividend with market capitalization, sales growth and ROA of companies; increasing impact of debt-equity ratio xiv(agency cost) on the probability of paying dividend and that leverage compels managers to act more in the interests of shareholders. Liquidity has the least relevance with the dividend policy of the Pakistani nonfinancial sector. There are significant chances of receiving dividends from engineering, paper, transport and communication industries. There are fewer chances of receiving dividends from cement, chemical, fuel, and energy. There are significant chances of receiving dividends from sugar and textile industries, though less than that of miscellaneous group. Findings of the estimated models show significance of industry-specific qualitative variables in the determination of dividend policy and performance of the business enterprises. An agency cost significantly raises the probability of paying dividends. Significance of the risk factor is not so high in the determination of dividend policy and performance of the corporate sector of Pakistan. Performance (ROA; sales growth) raises the probability of paying dividends. Medium and large companies look more inclined towards payment of dividends. Structural interaction of size and the leverage has no significance in this study. Negative interactive effect of the agency cost on the dividend policy of cement, sugar and textile show overvaluation as per Pecking Order theory. Identical findings are observed for ROA and ROE in respect of dividend policy. However, risk-related ROE has statistically insignificant role in dividend policy. Significant performance of Cement, Engineering, Sugar, Textile, Fuel & Energy, Paper & Board, Transport & Communication, in the Pakistani NFS has been found in the this study. The better business operations in the form of cash flows may be considered as source of better performance in terms of their profit efficiency. The performance of small firms in the industry is better in terms of profit margins as compared to medium and large firms on account of management efficiency. Finding interactive effects of the agency costs, capital structure and dividend policies are an important contribution of the present study. The study finds significance of agency costs which determines dividend policy at variable proportion. Application of nonlinear methods is another contribution of the study. The management must be careful while deciding about leverage. This study also considers dividend policy instead of dividend payout which remains controversial in Pakistani context. Leverage as control variable has potential to resolve ‘dividend puzzle’. Variable Proportional relationship of agency cost and dividend policy is an academic contribution of the study. The study also provides guidance for the investors as to the choice of industries for the purpose of investment. The study recommends application of Almon Distributed lag models if quarterly data for the Pakistani businesses were available. Dynamic Panel data models could be another option for the further studies. Behavioral financial analysis through survey data can be another option of future research. Testing of the assumptions of market perfection in the framework of M-M model is desired. The future research can be extended to South Asia, as a comparative study. ‘Dividend Puzzle’ can be resolved by optimal utilization of leverage because there is variable proportional relationship of leverage and dividend policy. ‘Agency Cost’ does have significance through interactive relationship of other capital structure, performance, size and types of industries. The study augments to the worth mentioning contribution of Michel (1979); Baker et al. (1985); Dempsey et al. (1993); Pandey (2003); Black (1976); Baker (1999) who missed the interactive effects.