Assessment of historical and projected changes in extreme temperatures of Balochistan, Pakistan using extreme value theory.

The fundamental consequences of global warming include an upsurge in the intensity and frequency of temperature extremes. This study provides an insight into historical trends and projected changes in extreme temperatures on annual and seasonal scales across "Balochistan, Pakistan". Historical trends are analyzed through the Mann Kendal test, and extreme temperatures (Tmax and Tmin) are evaluated using generalized extreme value (GEV) distribution for historical period (1991-2020) from the observational data and the two projected periods as near-future (2041-2070) and far-future (2071-2100) using a six-member bias-corrected ensemble of regional climate models (RCMs) projections from the coordinate regional downscaling experiment (CORDEX) based on the worst emission scenario (RCP8.5). The evaluation of historical temperature trends suggests that Tmax generally increase on yearly scale and give mixed signals on seasonal scale (winter, spring, summer, and autumn); however, Tmin trends gave mixed signals at both yearly and seasonal scale. Compared to the historical period, the return levels are generally expected to be higher for Tmax and Tmin during the both projection periods in the order as far-future > near-future > historical on yearly and seasonal basis; however, the changes in Tmin are more evident. Station-averaged anomalies of + 1.9 °C and + 3.6 °C were estimated in 100-year return levels for yearly Tmax for near-future and far-future, respectively, while the anomalies in Tmin were found to be + 3.5 °C and + 4.8 °C which suggest the intensified heatwaves but milder colder extreme in future. The findings provide guidance on improved quantification of changing frequencies and severity in temperature extremes and the associated impacts.

Assessment of changes in return levels of historical and projected high and low flows of upper Euphrates basin in Turkey using nonstationary models.

Owning to climate changes and other anthropogenic interventions, the frequency and return levels of extreme flows cannot be treated as stationary. This study quantifies the changes in return levels by fitting the stationary and nonstationary frequency distribution models for annual and seasonal high and low flows of upper Euphrates basin during historical and two projection periods. The projected flows of three selected sub-basins in the upper Euphrates were obtained using HBV-light hydrological model forced by projected daily precipitation and temperature driven from and the most representative regional climate model (RCM) for the study area within the CORDEX-Euro domain. During the historical period, analyses suggest that half of the stations exhibited an increase in return levels (up to 13.5% with GEV), while the remaining four sub-basins experience a decrease in the return levels (up to 27% with GEV). With few exceptions, most of the sub-basins experience an increase (up to 80% with GEV) in return levels of yearly low flows. With few exceptions, the return level of low flows for all seasons generally increases; however, directional variability for high flows is observed. The changes in return levels of yearly projected flows are consistent with historical results in indicating the direction of impact for both near future and far future periods. A decrease in return levels (up to 35% and 22%) in yearly high flows and an increase (up to 100% and 40%) during the near future and far future, respectively. It is projected that the floods of a given return level in the selected sub-basins are becoming milder across all three periods. However, some directional inconsistencies are noted in nonstationarity impact at seasonal scale through projection periods. On yearly basis, the decreasing high flow along with increasing low flow quantiles suggests that the range of extreme occurrences is shrinking. The nonstationarities in high flows as well as low flows should be incorporated in design and development of water resources schemes in the study area.

Duplication of gallbladder: a rare anomaly of biliary tract- A case report.

Incomplete duplication of gall bladder or vesica fellea divisa is one of the rare anomalies of gallbladder. Until now, 25 cases have been reported; of which four were proceeded with laparoscopic cholecystectomy. In our case, we diagnosed this nadir anomaly laparoscopically, posing a technical challenge since no radiological clue was observed beforehand. Successful laparoscopic resection of duplicated gall bladders was performed followed by Magnetic Resonance CholangioPancreaticography.

Liposarcoma of the spermatic cord.

A 43-years-old male patient presented through general practitioner with a complaint of right scrotal mass and was operated through inguinal approach. A 4 cm mass was excised and was found to be a liposarcoma of the spermatic cord upon histopathology, which is a diagnostic dilemma and very rare entity.

Outcome of open Tenckhoff catheter insertions: 5 years experience in a major tertiary centre in central Saudi Arabia.

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) has become a popular and established form of renal replacement therapy in patients with end-stage renal disease (ESRD). The objective of this study was to analyse the outcome of open Tenckhoff catheter insertions in patients with ESRD in term of catheter related complications. METHODS: From December 2006 to November 2011, 337 Tenckhoff catheters were placed in 305 patients with ESRD for CAPD, by general surgeons in King Saud Medical City, Riyadh, Saudi Arabia. Medical record of all these patients was reviewed retrospectively regarding the demography, causes of ESRD, catheter related complications, and their management. RESULTS: Mean age of the patients was 51.2 +/- 14.5 (range, 16-87 years). Majority of the patients were female 164 (53.7%). Forty three patients (14.1%) had previous abdominal surgery. Diabetic nephropathy was the commonest (51.4%) primary cause of ESRD. Ninety three insertions (27.5%) were associated with complications. Post insertion peritonitis was the commonest complication (9.2%) in our series, followed by mechanical dysfunction (8.6%). Fifty two catheters (15.4%) were removed because of different complications. Follow up ranged between 4-47 months with a mean of 21.4 +/- 11.2 months. CONCLUSIONS: Open surgical approach is simple, safe, and effective method of Tenckhoff catheter insertion with an acceptable complication rate, provided patients are adequately optimized and prepared for surgery.

Dermatofibrosarcoma: a rare neoplasm of skin.

A 25-year-old lady presented with a small pea-sized lesion on left side of her neck, anteriorly. There was no history of any other lesion on her body. She was medically fit otherwise. An excision was planned, after taking consent from her, which was performed under local anaesthesia as a day procedure. Her postoperative recovery was uneventful. Histopathology showed dermatofibrosarcoma protuberance which is an extremely rare skin tumour. She was further investigated for metastasis. Her CT scan of chest, abdomen and pelvis was performed which showed prominent thymus. Other than this finding, no other abnormality was found in CT scan.

Presentation of pulmonary tuberculosis at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Pulmonary tuberculosis (PTB) may be easily confused with other chest diseases during its initial presentation. This study was carried out to identify presenting clinical and laboratory features that differentiate PTB from other diseases and to correlate clinical features and laboratory findings. METHODS: This study was carried out at the Department of Pulmonology, Ayub Teaching Hospital Abbottabad, from September 1999 to December 2000. A total of 46 patients were included in the study after being clinically diagnosed as pulmonary tuberculosis. These patients were subjected to detailed history taking recording age, sex, weight, socioeconomic status and smoking habits. They were clinically evaluated and laboratory tests including Hemoglobin, ESR, TLC, DLC and sputum for AFB were done. They were put on standard antituberculous therapy and followed from 2 to 5 months to monitor treatment effect. Statistical analysis was performed by SPSS 8 computer program. RESULTS: A bimodal presentation (below age 30 years and above age 50 years), fever, productive cough, weight loss, night sweats and raised ESR were the most common findings in PTB patients. Sputum AFB smears were positive in 50% of diagnosed cases. No correlation was found between clinical and laboratory parameters in establishing a confident diagnosis of the disease. CONCLUSIONS: The study highlights the importance of further research to pinpoint stronger and more reliable criteria for diagnosis.