HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan.

Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan.

A proactive approach to assess safety level of urban bus stops.

Road safety has emerged as a global concern, and bus stops are the major points of concern as they act as interfaces where pedestrians interact with transit vehicles. In order to achieve a safe and sustainable infrastructure at bus stops, it is necessary to assess safety level of bus stops and suggest safety improvement measures. The present work aims to investigate whether design and management deficiencies of bus stops have any effect on safety of passengers and pedestrians. It is also aimed to develop a pro-active approach for evaluating safety level of bus stops by identifying design and management deficiencies. The methodology includes (i) identification of unsafe acts and causal factors at bus stops, (ii) classification of causal factors under design and management deficiencies, (iii) estimation of weightage of causal factors, (iv) fuzzy evaluation of bus stops, (v) calculation of safety levels of bus stops, and (vi) validation of the methodology using crash data. While a combination of Fuzzy AHP and RIDIT analysis was used to estimate the weightage of causal factors, a fuzzy-scoring-based expert field investigation was carried out to assess design and management deficiencies of bus stops. The methodology was applied to evaluate the safety level of bus stops located along a major urban corridor in Kolkata, India.