DOES BRAND EXTENSION IMPACT PARENT BRAND: A CASE OF JOHNSON, UK

Purpose of study: The main purpose of this study is to check the impact of brand extensions on brand image. For this purpose Johnson is selected as parent brand for current research. The targeted brand extensions are Johnson shampoo, Johnson’s isotonic drinks, Johnson’s sports wear and Johnson’s suntan lotion. Research Methodology: sample was selected from Bradford, UK. Sample consists of graduate students including males as well as female. Total sample size is 60 and data was collected through self administered questionnaires. For each brand 15 respondents were selected. Convenient sampling was selected as sampling technique. Results: Results show that Johnson’s have high brand awareness and perceived quality. While there is negative correlation results for brand fit on brand image for those product extensions which are not in same brand category i.e. Johnson’s sportswear and Johnson’s isotonic drinks. Conclusion: It is concluded from study results that launching new product in same parent brand category have high chance of success while in different category is risk.Brand Extension, Brand Fit, Johnson, Product extensions, marketing.

Anatomical variations of nose and para-nasal sinuses; CT scan review

Objective: To determine the frequency of anatomic variations on computed tomography scan of para-nasal sinuses.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised computed tomography scans of 77 patients who had presented between October 2007 and March 2011. All the scans were reviewed using Picture Archiving Communication System computer software. The scans were reviewed for the presence of deviated nasal septum, paradoxical middle turbinate, Haller cell, Onodi cell, and pneumatisation of the middle turbinate and uncinate process.Results: The mean age of the patients was 31±13.15 years. One or more types of anatomical variants were observed in 40 (51.9%) of the patients; the most frequent being the deviated nasal septum 20 (26%) and the Concha bullosa 14 (18.2%).Conclusion: Considering the wide range of variations in the anatomy, each and every para-nasal sinus case should be planned individually and carefully to avoid dreadful complications and maximise patients’ benefit

Under recognized entity: chronic inflammatory demyelinating polyneuropathy with lupus

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired, autoimmune peripheral neuropathy. It has an insidious disease progression resulting in a debilitating illness. It is a well known neurological disorder. The causative factors are elucidating and it is generally considered idiopathic. However, its’ associations with various systemic disorders is well established albeit under recognized, especially with lupus as evident by few of the case reports/ series published in the recent past. The aim of this report is to highlight this neglected but important aspect of clinical neurology in common practice

Potential of Greywater Reuse and Its Effects on Potable Water Demand Management and Downstream Sewer Network

The UAE’s water demand is rapidly increasing because of population growth, infrastructure development, expansion of agricultural practices and for the desert greening policies. These circumstances force the country to depend on expansive desalinated water and made the country second largest desalination water producer in the world. It is essential to reduce the current water consumption rates by using efficient methods and conservation techniques. Greywater reuse is an effective and promising alternate to cope with this challenge. The study aimed to reduce the water consumption in the Emirate of Abu Dhabi by investigating the potential of greywater reuse. A field survey was carried out in a case study area in Al Ain which comprises of 100 traditional villa type houses. Each house occupies a plot area of 2050 m2 and approximately two thirds of each plot is used for gardening and plantation. It was found that about 94% of residents in the area comprises are using municipal water for home gardening. Analyses of water consumption data showed that about 80% of supplied water is used for outdoor activities and only 20% for indoor uses that goes to the sewer network. Statistical analysis of water consumption explored that the consumption is independent of family size. The EPANET software was used for hydraulic modelling of the existing water network. The simulation results specified that the recapture of greywater has positive impacts on the hydraulic performances of the water network. It was shown that greywater reuse has several advantages such as reduction of water demand by 10%, reduction of desalination plants’ operation and maintenance cost, reduction is emission of greenhouse gases and energy uses. On the contrary, in addition to health risks from greywater, recapture of greywater may reduce the sewer flow and thereby increase the retention time of sludge in the sewer line. Outcomes of the study support that the Abu Dhabi Emirate has a great potential of greywater reuse and about 86% of residents agreed to reuse it for their home gardens. However, for the installation of greywater scheme, residents expressed their interest on financial rebate from the government

Social determinants of Health and Alcohol consumption in the UK

  Addressing the social determinants of health (SDH) and health inequities are essential for successfully combating alcohol-related harm. In U.K, excessive consumption of alcohol is a huge public health concern. An estimated 9 million adults drink at level that increase the risk of harm to their health; 1.6 million adults in England have some degree of alcohol dependence; and of these some 250,000 are believed to be moderately or severely dependent and may benefit from intensive specialist treatment. To be able to devise effective action, it is essential to comprehend these inequities in the healthcare system. Health inequities are not solely related to access to health care services; there are many other determinants related to living and working conditions, as well as the overall macro-policies prevailing in a country. The key intention of this review was to critically analyse the degree to which social determinants have impacted on excess alcohol consumption. A comprehensive approach to reduce inequities in alcohol-related harm requires action that includes mix of long- and short-term impacts, addressing the consequences and the root causes of inequities, and acting on both individuals and environments. Whereas, consequences of harmful alcohol use are more severe for those already experiencing social exclusion. We suggest that (1) the effective legislation, (2) modifying marketing strategies, (3) enhancing cooperation with regional organizations, (4) more effectively implementing existing regulation and (5) consulting expert will enhance SDH for this vulnerable population

Reformation of Criminal Justice System of Pakistan

This paper analyzes the loopholes and faults in the Criminal Justice System of Pakistan (CJSP), which is under rising criticism for its ineffectiveness and has been ranked at 108th of the total 139 countries of the world in the Rule of Law Index, 2021. The poor and defective investigation by the police, without any effective prosecutorial or judicial supervision over the process of investigation, is mainly responsible for crippling the CJSP adversarial system, which needs to be reformed to make it effective. A comparative analysis will show that Latin American countries such as Chile, Argentina, México and Colombia have moved from an inquisitorial to an accusatorial system, claiming that this is the best way to protect fundamental rights and to reduce the ever-increasing impunity in these countries. By applying a comparative approach, it shows that both inquisitorial and adversarial system of justice have systematic weaknesses and strengths in their composition. This certainly has motivated the International Criminal Court (ICC), China, Spain, Italy and many other countries to develop an Adquisitorial System-mixed inquisitorial/adversarial system- to get the benefit of best practices of both the systems. The Pakistan case, in relation to the Latin American one, shows that what is important is not to analyze the system in the abstract, but to determine which one solves in a better way the problem a judicial system has: in Pakistan, law and order, given the limitations of police action; in Latin America, the protection of fundamental rights during the criminal process. The case in Pakistan shows that the problems the judicial system is facing can be solved by appealing to a combination of inquisitorial and accusatorial features. This paper concludes suggesting that the existing investigation phase of the CJSP should be transformed, by legal transplant, to an inquisitorial pre-trial investigation process, with necessary modifications, led by the investigative judge while the trial phase remains to be adversarial

Multiple sclerosis in Pakistan and need for Multiple sclerosis registry

Multiple sclerosis(MS) is an acquired chronic demyelinating disease of central nervous system is a leading cause of non-traumatic disability in young with significant socioeconomic impact. The aim of this study was to provide a comprehensive review of all available data of MS in Pakistan

Effect of montelukast on the symptom severity score of allergic rhinitis

Introduction: Rhinitis is a common respiratory disorder that can be broadly defined as an inflammation of nasal mucosa. Allergic rhinitis is the most common form of chronic rhinitis characterized by one or more symptoms including sneezing, nasal itching, nasal congestion, postnasal drip, and rhinorrhea. Montelukast is an antagonist to the leukotriene receptor. It is non-sedating, dosed once daily, and has a safety profile similar in adults and children, with approval down to six months of age. The purpose of the study was to see the improvement in the severity of symptoms of the patients with allergic rhinitis treated with montelukast.Methods: The symptom severity score for allergic rhinitis was calculated by asking the patient to evaluate the severity of individual symptoms (sneezing, nasal congestion, rhinorrhea, and postnasal drip) against the 4-point scoring scale over the last 24 hours. After explaining the scoring system to the patient, a proforma was filled before starting the treatment. A dose of 10 mg of montelukast once daily was prescribed. On the follow-up visit after four weeks of therapy, compliance was ensured and then the symptom severity score was recorded again on the proforma. The total nasal symptom severity score (TNSSS) was calculated as a sum of all four nasal symptoms. Pre- and post-treatment mean of TNSSS was compared using a t-test. P-value of less than 0.05 was considered significant.Results: A total of 140 patients were included in the study. The mean age was 30 years. The minimum age was 15 years and the maximum age was 45 years. There were 93 males and 47 females. The difference between pre- and post-mean values of TNSSS was 5.82. Both pre- and post-mean of TNSSS were compared using the t-test, and P-value was significant, i.e., \u3c0.005.Conclusions: The common symptoms of allergic rhinitis evaluated in the study showed improvement in response to the treatment with montelukast. The improvement in symptom severity score was maximum in sneezing and least in rhinorrhea. In light of recent developments on neuropsychiatric adverse effects and FDA warnings, caution needs to be exercised to reserve the use of montelukast for the selected patients

Effect of Dexmedetomidine on Postoperative Delirium Incidence measured with the Intensive Care Delirium Screening Checklist in high-risk Patients

Das postoperative Delir (POD) zeigt eine hohe Inzidenz und ist mit einer hohen Mortalität, Morbidität sowie einem längeren Krankenhausaufenthalt und damit einhergehend volkswirtschaftlichen Nachteilen verbunden. Die Risikofaktoren sind vielfältig und zum Teil gut untersucht. Der Einsatz von Dexmedetomidin zur Reduktion des intraoperativen Stresses sowie Einsparung von Narkotika ist aktueller Forschungsgegenstand der postoperativen Delirprophylaxe. Bisher untersuchte keine dieser Studien den Effekt von Dexmedetomidin bei Probanden mit großen viszeralchirurgischen Eingriffen, gemessen mit Intensive Care Delirium Screening Checklist (ICDSC). Die Vorteile der ICDSC im Vergleich zur etablierten Confusion Assessment Method for Intensive Care Unit (CAM-ICU) ist die Messung der Delirschwere und damit auch die Erfassung von subsyndromalem Delir. Vor diesem Hintergrund war das Ziel dieser Arbeit den Effekt von peri- und postoperativer intravenöser Gabe von dem Verum (Dexmedetomidin) oder dem Placebo (isotone Kochsalzlösung) auf die POD Inzidenz gemessen mit der ICDSC bei viszeralchirurgischen Hochrisikopatienten zu untersuchen. Im Rahmen einer doppelblinden randomisierten placebokontrollierten Arzneimittelstudie wurden Probanden in der Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin am Campus Virchow - Klinikum und am Campus Charité Mitte der Universitätsmedizin Charité rekrutiert. Insgesamt konnten 63 Probanden in die Studie eingeschlossen werden, wovon 3 Probanden die randomisierte Intervention nicht erhielten. In der vorliegenden Arbeit erfolgte die statistische Auswertung der postoperativen Delirinzidenz und der Delirschwere von n = 46 viszeralchirurgischen Probanden. Diese sekundären Endpunkte wurden mittels der ICDSC erhoben. Die potenzielle delirprotektive Wirkung von Dexmedetomidin zwischen viszeralchirurgischen und kardiochirurgischen Probanden konnte aufgrund der kleinen Stichprobe der kardiochirurgischen Gruppe nicht untersucht werden. Daher wurde auf eine Analyse der kardiochirurgischen Probanden mit n=14 verzichtet. Ohne signifikante Unterschiede in den Baseline - Charakteristika waren die Populationen in der Verum- und Placebogruppe gut miteinander vergleichbar. Es konnte dabei primär keine signifikante Reduktion (p = 0,223) der postoperativen Delirinzidenz bis zum Ende des Aufenthalts auf der Intensivstation, gemessen mit der ICDSC, in der Gruppe der viszeralchirurgischen Probanden gezeigt werden. Mit einer absoluten Risikoreduktion von 12,1% und einer relativen Risikoreduktion von 73% profitierte diese Gruppe jedoch im Vergleich zur Placebogruppe durch das Medikament. Auch hinsichtlich der 3-Monats-Mortalität profitierte die Dexmedetomidingruppe in dem beobachteten Zeitraum, allerdings ohne statistische Signifikanz. Eine Verkürzung der Verweildauer konnte jedoch durch den Einsatz des Medikaments nicht erzielt werden.Postoperative delirium (POD) shows a high incidence and is associated with high mortality, morbidity, as well as prolonged hospital stay and associated negative economic disadvantages. The risk factors are multiple, and some are well studied. The use of dexmedetomidine, to reduce intraoperative stress as well as saving narcotics, is subject of current research in postoperative delirium prophylaxis. However, none of these studies examined the effect of dexmedetomidine in patients undergoing major visceral surgery as measured by Intensive Care Delirium Screening Checklist (ICDSC). The advantages of ICDSC compared to the established Confusion Assessment Method for Intensive Care Unit (CAM-ICU) is the measurement of delirium severity and therefore the detection of subsyndromal delirium. The aim of this work was to investigate the effect of peri- and postoperative intravenous administration of the verum (dexmedetomidine) or the placebo (isotonic saline) on POD incidence measured with the ICDSC in high-risk visceral surgery patients. In a double-blind randomized placebo-controlled trial, patients were recruited in the Department of Anesthesiology and Operative Intensive Care Medicine at Campus Virchow – Klinikum and Campus Charité Mitte of the Charité Universitätsmedizin- Berlin. A total of 63 patients were included in the study, 3 of whom did not receive the randomised intervention. In the present study, statistical analysis of postoperative delirium incidence and delirium severity was performed in n = 46 visceral surgery subjects. These secondary endpoints were assessed using the ICDSC. The potential delirium-protective effect of dexmedetomidine between visceral surgery and cardiac surgery patients could not be investigated due to the small sample size of the cardiac surgery group. Therefore, no analysis of the cardiac surgery patients with n=14 was performed. With no significant differences in baseline characteristics, the populations in the verum and placebo groups were well comparable. Primarily, no significant reduction (p = 0.223) of the postoperative delirium incidence until the end of the stay in the ICU, measured with the ICDSC, could be shown in the group of visceral surgery patients. However, with an absolute risk reduction of 12.1% and a relative risk reduction of 73%, this group benefited from the drug compared to the placebo group. The dexmedetomidine group also benefited in terms of 3-month mortality during the observed period, although without statistical significance. However, a reduction in length of stay could not be achieved by the drug

Otosclerosis: Experience with stapes surgery

Introduction: Otosclerosis is a disorder in which the footplate of the stapes is replaced by an abnormal bone, thereby affecting sound transmission to the inner ear at the level of the oval window. The solution to this condition is to reestablish this mechanism back to normal via the ossicular chain to the inner ear. The aim of stapes surgery is to improve the hearing level to thresholds appropriate enough to obviate the need for hearing aid. The hearing improvement achieved after surgery often lasts for many years. The purpose of the current study was to review our experience and find out the rate of success related to hearing outcomes after stapedotomy.Methods: The patients who were operated for otosclerosis between January 2000 and December 2010 at Aga Khan University Hospital, Karachi, Pakistan were included in the study. The charts were reviewed to collect clinical data regarding stapes surgery. The values of speech reception threshold (SRT) were recorded, and the preoperative and postoperative means were compared with a t-test. The bone conduction (BC) and air conduction (AC) thresholds were evaluated at 0.5 kHz, 1.0 kHz, 2.0 kHz, and 3.0 kHz. The preoperative and postoperative means of air-bone gap (AB-gap) were compared with a t-test. The descriptive frequency was calculated to evaluate postoperative AB-gap in individual patients; patients were grouped with a difference of 10 dB of AB-gap. The SPSS Statistics software (IBM, Armonk, NY) was used for statistical analysis.Results: A total of 46 patients were included in the study. There were 15 males and 31 females. The mean age was 35 years (range: 20-56). Thirty-three patients had bilateral otosclerosis; two patients had surgery for both ears, taking the total number of ears operated to 48. The mean preoperative AB-gap was 39, while the mean postoperative AB-gap was 11. The means were compared with a t-test and a p-value of \u3c0.05 was considered significant. The means of preoperative and postoperative SRT were 56.25 and 24.27 respectively. Both means were compared with a t-test, and a p-value of \u3c0.05 was considred significant. Postoperatively, 34 ears had AB-gap of 10 dB (70.8%), 11 (22.9%) had within 20 dB, and three (6.3%) had within 30 dB.Conclusions: The success rate related to hearing outcomes in patients operated for otosclerosis was excellent and comparable to that found in the current literature. The wide AB-gap noticed in the majority of our patients may represent a delayed presentation to otolaryngologists, which requires further evaluation