Imran Khan has always confronted the proverbial question ‘will he make it?’ in whatever he has set out to do. That was the question when his team was losing in the earlier stages of the World Cup of 1992, but he was the proud recipient of the coveted trophy at the concluding ceremony. The same was the haunting question when he launched “Imran’s Tigers” to build a cancer hospital in memory of his mother. He succeeded in building the Shaukat Khanum Memorial Hospital — one of the most acclaimed institutions known for its professional expertise and its humanitarian consideration, as it treats more than 75 per cent of its patients free of cost. This question again haunted him when he announced plans to build a university in one of the most backward areas of the country. The university, an affiliate of the UK-based University of Bradford, is there for all to see in Mianwali, as it disseminates quality education in a variety of disciplines.
George Fulton, in his article of September 22 titled “Yes we Khan”, wrote that Imran’s persona and the party were interchangeable and this springs from the preconceived notion of seeing only the corrupt as political leaders. One concedes that the PTI has none of this breed, and indeed will never have. But Mr Fulton fails to see the many bright faces that adorn the party. They may not be the likes of those who have traditionally indulged in denuding this country of its countless riches and enormous potential. They are professionals who all have earned a name for their capabilities and capacities to deliver.
Mr Fulton erroneously calls Imran’s idealism as ‘naivety’. This is the approach that has worked and delivered for him in the most trying of circumstances. And why should it not deliver now? Just because his battle is now in the realm of politics, where Imran is confronted with a pack of vultures and opportunists who see him as a potent threat to their fiefdom? Should he change course just to get into power and end up doing nothing — like all the political entities have done before him? What then would be the difference between him and the corrupt lot that he opposes so vehemently and correctly? If Mr Fulton looks at his appraisal once more to understand the deepset malaise that afflicts Pakistan, he too would come to the conclusion that if one is to bring genuine change here compromise with criminals and marauders is not the way.
At this critical juncture of its history, Pakistan needs an honest and incorruptible leader who would be able to lead by example. A corrupt leader would lead only by way of corruption. We have a string of them here — leaders with billions stashed away paying a miserly Rs 5,000 as annual income tax, or nothing at all. Pakistan is reeling under the debris of such corruption bequeathed upon it by an endless stream of inept rulers. Do we want to continue heaping humiliation upon the country and its people?
Because of the lack of credibility of successive leaderships that have ruled Pakistan, it has lost face internationally. Its word is not trusted and its intentions doubted. To correct that, Pakistan must have a leadership that would spell confidence among the international community and promote the self-respect of the poor people of the country.
It is with his credibility that he would be able to gel this nation into a powerful tool to fight and defeat the forces of obscurantism. He is a person who believes in moving forward and has no skeletons in the cupboard to draw him back. His growing popularity has cast a spell of doom on all his opponents who are lined up outside his door seeking an alliance or a ‘deal’. Imran says no not because he is proud, or naïve, but because he has taken upon himself a challenge that would be insurmountable if he were to follow a policy of compromise. He is the harbinger of change that the people of this country have waited for. By Raoof HasanPublished in The Express Tribune, September 30th, 2011. http://tribune.com.pk/story/263169/in-defence-of-imran-khan/
On November 18, 1999, immediately after General Pervez Musharraf took over the helm of affairs in Pakistan, this columnist (Dr. Haider Mehdi) wrote a personal letter to him.
The following is an extract from that letter: Consider the enormous accuracy of the predication of the political-military fallouts made over a decade ago.
“…Americans have been conducting their relations with Pakistan with specifically designed agendas. In the first phase, Pakistan fought American political battles of anti-communism… this was followed by Zia’s years, in engaging the Soviet Union in armed intervention; and now the likelihood is that the Americans would want Pakistan to assist them in destabilizing the Taliban regime in Afghanistan. As we enter the next millennium, the American and European political obsession will be to destabilize Islamic countries (what they coin now as “extremism”)… It is beyond the scope of Pakistani politics to define whether the political regime in Afghanistan ought to be destabilized or not. But, there is a certainty about one thing: should Pakistan get involved with Afghanistan’s internal affairs andcarry out the American political agenda in its newest form, the long-range consequences for Pakistan will be disastrous.”
And the ultimate disaster has struck us. Read between the lines: Admiral Mike Mullen has declared war on Pakistan. Has he not?
A simple question: Is Pakistan in a state of war now? The simple answer is YES!
Another simple question: Is Pakistan prepared for this forthcoming eventuality of American aggression and direct military intervention on its soil? The simple answer is: NO!
Yet another simple question: What should Pakistan do to respond to the growing US militarythreat?
We need to make multiple coordinated military and civil maneuvers: Pakistan’s armed forces (Air Force, Navy and Army) should be immediately mobilized in “Red Alert.” We should let our adversaries know, in no uncertain terms, that so far, Pakistan has been patiently tolerant, in the interest of peace and political reconciliations, of the low-intensity war conducted against it, both covertly and overly for years by the Americans and their allies. But, in the wake of Admiral Mullen’s recent testimony in the US Senate, the political and military ground realities in Pakistan have completely changed. Pakistan will have a “zero tolerance” military policy against any US aggressive initiatives. The preemptive civil and military counter-effective strategic response to future US military designs on Pakistan (which seem to be in an advanced stage) is to make sure that the Obama administration fully comprehends that Pakistan’s future military engagement with US forces will turn the ongoing low-intensity war into a full-fledged military conflict, should the Americans decide on yet another aerial or ground offensive in any part of its territory. Pakistan’s high military command needs to tell the American President, in unequivocal terms, that Pakistan’s army is not for hire anymore; it will not fight US-West proxy wars nor will it engage itself in waging aggression against its own people on the behest of the US and its allies in thename of the so-called “war on terrorism.”
Let us play politics with America on the basis of our strengths rather than be coerced into submission by American political, military and financial aid threats: Let us remind the Obama administration that America still has 130,000 troops in land-locked Afghanistan whose present survival and future safe exit depends on Pakistan’s generosity of political conduct and goodwill – and if the US insists on playing fire with us, we will play fire with America. The Americans should have no doubt in their minds: we will block NATO supplies, shoot down the next drone that violates our airspace and respond to any US military aggression with our full might. We are equipped with military capability to confront any armed adventure against our nation – and thismilitary confrontation will not be a “zero sum game” – the political military odds will most certainly be tilted to our advantage.
So let us keep a humanitarian context in view: Let us invite the US to join us at a negotiation table, and let us talk peace. Let us help America in ending this vicious war that has been their making in the first place and let us give the Afghans their country back. We need to make Americans realize now that they are not fighting a specific insurgency but an entire Afghan nation; they are fighting the Afghan people! It is about time that the Taliban’s legitimate national aspirations be respected and their moral- political rights recognized in an independent Afghanistan. Let us make US-Nato leadership understand that even in a 100-year war, the Afghans will not allow foreign military presence in their country.
Let us make Americans understand that they have failed in their conceptualization of the 21stcentury global world and their capitalistic corporate strategic goals do not sit well with the present-day enlightened socio-political awareness of the masses. The American-Western dogma is dead: look at the economic failures, take stock of the continued free-market crises and failings in capitalistic democracies. Stop indulging in counter- revolutionary wars: there is no room in the present-day world, in the interest of the masses everywhere, to create more Afghanistans, Iraqs and Libyas. America, as the leader of the reactionary, neo-con and neo-imperialist axis, needs to be stopped now – if necessary, by force.
Barrack Obama needs to be told that, in the aftermath of General Mullen’s Senate testimony, Obama’s re-election bid for the second presidential term largely depends on Pakistan’s goodwill and favorable political conduct. Obama needs to take bold and valorous acts of political statesmanship to opt for instant peace in Afghanistan than to choose another instant war against Pakistan. And Pakistan can help Obama in attaining peace instantly at a negotiation table helped by the Haqqani network and coordinated by the Taliban – without which Barrack Obama will be part of an ugly American history in the year of our Lord, 2012.
And the final vital question: Is the Zardari-Gilani regime capable of delivering this important message and able to communicate Pakistan’s nationalistic point of view with required dignity, integrity, convincing arguments, conceptual strength and tactical diplomacy to Obama’s administration? I am afraid the simple reality is: NO.
Zardari-Gilani are Pervez Musharraf’s protégés incapable of comprehending the looming crisis over Pakistan – just as Musharraf, a decade ago, intentionally and consciously disregarded Pakistan’s national interests (which was brought to his attention in my letter of November 18, 1999) – all for the love of personal power!
So what needs to be done? An interim government – to deal with the political- military crisis coming our way in the next few weeks! Perhaps even in the following few days!
At GUJRANWALA, PTI chairman Imran Khan reiterated on Sunday that the country needed a brave leader, and the War on Terror was benefiting the government instead of the people.
Addressing a rally in Gujranwala, Khan said that the War on Terror had cost Pakistan $70 billion and resulted in the loss of over 35,000 lives. He said the US was blaming Pakistan for their own failure in Afghanistan.
Referring to President Asif Ali Zardari, Khan said that the nation needed strong leadership unlike the present one that is not standing up to the US, despite all their allegations in recent times.
Khan said the government should reject US aid.
He said that if his party came into power, they would first reject US aid and fight this war on their terms. He added that it was this aid that was giving the miiltants the perception that we were fighting the US War on Terror and hence attacked us.
Speaking on the floods, he said that the president went to flood hit areas for a ‘photo opportunity’ and then disappeared.
Khan said that while the president was busy travelling the world and “amassing wealth”, it was the army that was fighting the insurgency in the tribal areas, controlling the situation in Balochistan, and the rangers who were conducting operations in Karachi.
On Waziristan, he urged the nation to unite against any possible US operation in the area. The US has been pressuring Pakistan to conduct an operation in North Waziristan to clear it of militant hideouts.
Khan said that come election year the people should not vote for a “coward leader”, as Pakistan was a dignified nation.
Khan said he would make an important announcement in the coming days and give the nation good news soon.
It isn’t really all a conspiracy theory but I don’t mind if we begin with this premise. What has befuddled analysts as well as non-analysts in recent times is the question that what has America gained by its adventure in Afghanistan, which has also cost it over a trillion dollars?
Let’s detail some of these gains: Al Qaeda has undoubtedly been weakened and is no longer a significant force in the AfPak contiguity. The flip side, however, is that al Qaeda now has its tentacles spread on newer shores: in Yemen, the Arabian peninsula, Southeast Asia, the Maghreb and also various cells reported to be presented in Europe.
It all began with George W Bush’s “smoke ‘em out” determination. Of course, no one will deny the need to commiserate with the Americans on the dastardly 9/11 tragedy, but the invasion of Afghanistan only seems to have ended up spreading al Qaeda to other regions of the world. Instead of containing it, it has been transformed into a geographically diverse movement, and one cannot rule out that it will not plan or carry out further attacks. Furthermore, the result also has been an overly indebted American economy, the threat of another recession, a fracturing polity and, all in all, a humiliating drawdown of American stock in the world. Nations pay for a long time after their leaders make poor decisions and bad choices; in the case of superpowers this is even more acute.
The next sin, and an opportunity lost, was when Barack Obama chose to stay the route in Afghanistan. He shunned Iraq because he had a choice, but never got the nerve to dump Afghanistan. He may continue to explain that to his grandchildren with grand moral overtones and religion-draped patriotic zeal, but he will find it hard to explain to his Democratic Party Caucus, how he lost the magical superiority that he and his party had achieved in the 2008 elections. Perhaps he was too weak to answer the call of his conscience and do what he always knew was the right course, but he could not appear as a wimp to the American electorate.
That meant that the US would remain embroiled in Afghanistan. Let us assume that Afghanistan’s key strategic location as a saddle amidst energy-rich Central Asia, a deviant Iran, and a nuclear and religiously polarised Pakistan, was the underlying objective. It certainly would have been a laudatory objective worthy of both time and treasure for the lone superpower of the time. There are two ways for America to entrench itself in Afghanistan to achieve any of the above interests as well as to checkmate China and Russia from making forays into the mineral-rich region. One would have been to convert Afghanistan to an entity that would mirror America and create socio-political identities that would keep both in a natural embrace — a kind of America away from America. That was not to be though; initially the US diverted its focus back to Iraq, and then when attention went back to Afghanistan, a lot of time had elapsed and the US economy was unable to support two wars at the same time. That is when the counterinsurgency mission scaled itself down to counterterrorism. As such Afghanistan hasn’t morphed into a mini-America and has not developed socio-political linkages that would have given the US a natural parking slot and pervasive presence.
The next option, and that still is very much on the cards, is to sign a strategic agreement for a prolonged presence in the country. Under this, Afghanistan would have control and ownership of military bases that the US may occupy at any time of its choosing. That would clearly need a multi-partisan acquiescence in Afghanistan and a long surviving political structure that will continue to honour the agreement. So in case there is a future coalition government in that country with a Taliban presence, this arrangement, of the US having access to bases, may not materialise.
An extended formulation of the same concept, to enable America to revisit the region at the time of its choosing, is to leave enough turmoil behind for Washington to say that it believes that its vital interests, vis-à-vis energy-rich Central Asia and strategically important Iran and Pakistan would remain threatened, and hence it would be able to invite itself to justify a prolonged presence. Even Karzai isn’t game for the longer-term bases deal and is insisting that any such proposal be decided by a loya jirga.
Hence, America’s most credible way out of the quagmire it finds itself in, is to leave a sustaining chaos behind instead of a sustained peace and a political order that will keep creating conditions where US intervention may be necessary from time to time.
Enter the Haqqanis, and America’s wrath for both Pakistan and the Haqqanis. If the Haqqanis, as the more formidable militant group, can continue to cause this region and Afghanistan to be engulfed in conflict, that should foot the bill. What better if Pakistan, too, can be coerced into taking on the Haqqanis and create a wider zone of a continuing conflict. Perhaps that may put into perspective the outbursts from America’s military and political leaders, all pinning blame in recent days on Pakistan.
It was interesting to hear an American analyst say on an Indian television channel, that all of America’s and India’s “pains” could be removed if the Pakistani military were brought under civilian control. That’s insidious: not only would they like the military to take on the Haqqanis, they would like the politicians to push the military to take on the Haqqanis, and in doing so both would be at odds with each other. That way the turmoil would be just about perfect. Add to that what goes on in Balochistan and Karachi, and you have a coalescing set of conditions inviting foreign (read American) intervention on humanitarian grounds — to ward off a possible ethnic and/or civil war (the latter threatening the safety of Pakistan’s nuclear assets).
Of course, much of this is conjecture and some may call it a conspiracy theory. In any case, it awaits the test of time. Till that happens, however, it is worth remembering that what remains supreme are interests and that altruism in global politics is a misplaced notion.
Afghanistan drifts towards a closure, on floating wafts of time, on which travel events outside the control of the most powerful; directionless. Sadly, after half the world has fished in its troubled waters, abandonment is on the cards. US President Barack Obama remains unclear which way he is going, both as the guide to American policy and as a president. He has lost his way in the Washington maze, and in the absence of the commander-in-chief, everyone else is suddenly sprung into action — Pentagon, the FBI, the CIA, the State Department, Brennan et al. No, it isn’t the routine Washington functioning where separate voices provide differing nuances, but a superpower in serious disarray. It is important to say this since the super-power drives the agenda, especially so in Afghanistan. All others are bit players swishing on the fringes, at best muddying the already murky. Continue reading >>> http://goo.gl/s98wp
The Islamic Republic of Pakistan may have been one of the more resilient Asian countries in the wake of the global financial crisis, but since then the economy has been seriously weakened. The earthquake in 2005 did great damage to the country's infrastructure but the ruinous floods of 2010 have destroyed even more, with an estimated total economic impact of as much as US$43 billion.
The floods' aftermath has contributed further to public perception of inefficiency and to political unrest. The international community was slow to respond and the Pakistani government was blamed for sluggish and disorganized response to the floods. There were also allegations that local authorities and warlords conspired to divert funds. The wealthy, with better access to transportation and other facilities, suffered far less than the poor and the floods have exacerbated Pakistan's class divisions.
Overall, Pakistan has suffered for decades from internal policy disputes and low levels of foreign investment. Political and economic instability has caused the Pakistani rupee to be devalued and by 2010, inflation had risen to more than 13%. Recent lower oil prices and record remittances from workers abroad have helped stabilize foreign exchange reserves, but reconstruction of the country following the floods will severely strain Pakistan's limited resources.
High military spending absorbs a disproportionate percentage of the country's annual budget, justified by internal conflicts and Afghan Islamic extremism, tension with India over Kashmir, and nuclear rivalry with India. India and Pakistan exemplify the worst consequences of holding nuclear weapons. The great expense involved has a much greater impact on them than on richer nuclear weapon states, since both India and Pakistan have considerable poverty which would suggest the wiser allocation of resources for economic development.
Not all military spending comes from the country's own resources. The U.S. has provided direct and overt security aid to Pakistan since the September 11 attacks to a total of more than $20 billion. The U.S. has also trained Pakistani military forces and provided them with military equipment ,including tanks, missiles and helicopters. In spite of this, the government is set to announce a defense budget for 2011-2012 that will be just over a quarter of its expected tax revenues, though analysis suggests that the numbers understate the full costs of military spending.
Known military expenses have risen by 29 percent over the past two fiscal years, almost exactly in line with inflation, and after debt servicing, the government is left with only about 23.4 percent of actual tax revenues to run the rest of the government, invest in education and social services, restore infrastructure and ease the food crisis. The government will be heavily dependent on foreign aid over the next few years and it must come from other Muslim countries and the United Nations, as well as the US. This should help to prevent the widespread disaffection about US aid, its lack of success in buying goodwill and its disproportionate influence on Pakistani affairs.
So Pakistan needs new leadership to take the country out of this spiral down into further poverty and despair, which historically leads to anger and extremist violence. More spending on the military will not prevent violence; it will only make it worse.
A man who understands this well and is emerging as a powerful leader for a new Pakistan is Imran Khan, visionary, philanthropist and pious Muslim. Derided by his detractors for his colorful past as celebrity cricket player, Imran Khan has recently had another book published, which reveals a man of powerful insights and pragmatic solutions to Pakistan's internal problems. At the same time, he sees the need to restore Pakistan's international standing while tackling the immediate problems of over 15% unemployment. Pakistan's economy needs to be stabilized and made more immune to internal and external shocks. Job creation and poverty reduction are needed to get Pakistan out its current stagnation and Khan is very aware that young people in Pakistan, as all over the Middle East, are impatient for opportunity and change.
Imran Khan for president is a phrase that will be heard increasingly from now on, as corruption and political instability continue to erode confidence in the government. Reduction in business confidence, deterioration of economic growth, reduced public expenditures and poor delivery of public services are all undermining Pakistan's democracy. The domination of the military in politics and a disregard for the rule of law and order are destabilizing Pakistani society and encouraging the rise of militant Islamic political parties. If ever Pakistan needed a firm, wise, pragmatic and moral leader, it is now. The world will be watching Imran Khan's campaign for the Presidency with admiration for his courage and great hope for the future for the people of Pakistan.
Talking to politician and traders from Khyber Pakhtunkhwa, who joined the PTI here at the party Central Secretariat, Imran Khan said next few months were crucial, and a big change was about to take place on the national ...
KARACHI- Pakistan's opposition leader Imran Khan has said that the United States' war on terror is breeding extremism and terrorism and termed US drone attacks in the tribal regions a breach of country's sovereignty. ...
Dengue Fever is a major global health threat and a leading cause of mortality in the tropics and subtropics. It is caused by infection with any one of four serotypes of dengue virus transmitted by the bite of the Aedes mosquito. This mosquito species breeds around habitations and feeds during the day. As many as 100 million people are infected annually, of which about 25,000 die of the disease.
<<< The Aedes mosquito and its infamous black and white stripes.
Presentation
Once inoculated into the human body, dengue has an incubation period (during which the virus multiplies) of 3-14 days. Thereafter, in the typical form of the disease, a five- to seven-day acute fever ensues. Recovery is usually complete by 7-10 days.
It is important to appreciate that about half of all dengue infections go completely unnoticed. Some patients have isolated fever while others may produce the typical symptom complex of classic dengue fever (DF). Fever may be as high as 106°F. The fever presents in a nonspecific manner and may not be distinguishable from other infectious illnesses. The fever in DF is often preceded by chills, red speckles on the skin, and facial flushing. It typically begins on the third day of symptoms and lasts five to seven days. The other symptoms associated with DF include headache, which is usually generalised, pain in the back of the eye, nausea or vomiting and a rash that begins on day three and persists for about three days. DF can also be associated with muscle aches, joint pains and generalised fatigue. Abdominal pain when present can be a heralding sign of a more serious form of the disease, known as dengue hemorrhagic fever (DHF).
DHF is characterised by bleeding. This may be as mild as small amounts of oozing from the nose or gums or serious enough to present with copious bloody vomiting, an abnormally heavy period or excessive blood in the stool. Abdominal pain, excessive restlessness, confusion, decrease in body temperature, and a drop in the platelet count are indicators of imminent DHF.
Patients who have previously had DF (over half of which go unnoticed) are specifically at risk for development of DHF. It is also important to keep in mind that it is at the time when the fever is receding that DF patients are at greatest risk for DHF. This is the time to watch for the warning signs mentioned above and seek emergency care. If not properly taken care of, DHF complications (particularly gastrointestinal bleeding) can worsen and induce shock. This most severe and fatal form of dengue is known as Dengue Shock Syndrome (DSS). DSS is characterised by cold-clammy skin, a fast heart rate, decreased blood pressure, delirium, difficulty breathing and damage to the internal organs specifically the liver and kidney. DSS can lead to multiorgan failure and death.
Outcome
Most patients achieve a complete recovery from dengue. Even patients with DHF and DSS usually recover with proper resuscitation. Infection with one dengue serotype confers lifelong immunity against that particular serotype, but still leaves the individual susceptible to the other three serotypes. As mentioned above, a subsequent infection by a different serotype is a major risk factor for the development of DHF and, as a result, DSS.
Prevention
No vaccine is currently available to prevent contracting the dengue virus. Consequently, the most effective protective measures are those that avoid mosquito bites. Repellants and protective clothing are simple effective measures to take. Even better, eliminate mosquito breeding grounds: ensure no water is left standing in flower vases, old tires, etc. Since the Aedes is a day-biting mosquito, mosquito nets are not useful.
Diagnosis
DF is diagnosed clinically, based on the patient’s presenting symptoms and signs. A complete blood count might reveal a low white cell and platelet count. Serological testing and PCR are not only very costly but are unhelpful in the initial stages of the disease.
Treatment
Dengue fever is usually a self-limited illness, and only supportive care is required. No specific antiviral medication currently is available to treat dengue infections. Paracetamol should be used to manage the fever. Other agents including aspirin should be avoided, especially in children.
Patients may become dehydrated from fever, vomiting or lack of adequate dietary intake. Patients who are able to tolerate oral fluids should be encouraged to drink oral rehydration solution, fruit juice or water to prevent dehydration. Patients who improve can continue to be monitored in an outpatient setting. Patients who do not improve should be admitted to the hospital for hydration. Patients with dengue shock syndrome are treated in intensive/critical care units.
No specific diet is necessary for patients with dengue fever. Bed rest is advised.
Patients with known or suspected dengue fever should have their blood counts measured daily from the third day of illness until one to two days after the fever abates. Patients whose condition improves can continue to be monitored in an outpatient setting. Patients who do not improve should be admitted to the hospital for hydration.
When the patient’s fever is going away, watch for the warning signs mentioned above (taken from the CDC site here). If any of them appear, take the patient to the Emergency department of your nearest hospital immediately.
Platelets, or thrombocytes (from Greek θρόμβος, "clot" and κύτος, "cell"), are small, irregularly shaped clear cell fragments (i.e. cells that do not have a nucleus containing DNA), 2–3 µm in diameter, which are derived from fragmentation of precursor megakaryocytes. The average lifespan of a platelet is normally just 5 to 9 days. Platelets are a natural source of growth factors. They circulate in the blood of mammals and are involved in hemostasis, leading to the formation of blood clots. [Dengue fever reduces platelets level ]
~~~~~~~~~~~~~~~~~~~~~~~~
Less than 50,000 platelets count worrisome, says doctor
Humidity, Aedes-mosquito, fresh stagnant water and plus the virus compiles and forms Dengue Fever. The platelets count is the only option physicians deal with in the initial stages. Platelets count should not drop in the patients suffering from dengue, said Dr. Abdus Salam, Director Emergency Room of Shifa International Hospital while addressing an awareness session in Hospital. Less than 50,000 platelets count with bleeding is a worrisome situation for the doctors, as alarmed Dr Salam. If the patient’s platelets count is 10,000 with no bleeding; internal or external the patient is in out of the danger zone. The normal platelet count is 150,000 up to 450,000. Salam informed this scribe that the symptoms include fever, headache, muscle and joint pains and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs. Dr. Salam informed that only eight hours are required for the mosquito to breed from the development from an egg to larvae. He alarmed the audience to double check for rainwater stored at places as the monsoon continues.
~~~~~~~~~~~~~~~~~~~~~~~~~~
If the number of platelets is too low, excessive bleeding can occur. However, if the number of platelets is too high, blood clots can form (thrombosis), which may obstruct blood vessels and result in such events as a stroke, myocardial infarction, pulmonary embolism or the blockage of blood vessels to other parts of the body, such as the extremities of the arms or legs. An abnormality or disease of the platelets is called a thrombocytopathy, which could be either a low number of platelets (thrombocytopenia), a decrease in function of platelets (thrombasthenia), or an increase in the number of platelets (thrombocytosis). There are disorders that reduce the number of platelets, such as heparin-induced thrombocytopenia (HIT) or thrombotic thrombocytopenic purpura (TTP) that typically cause thromboses, or clots, instead of bleeding.
Platelets release a multitude of growth factors including Platelet-derived growth factor (PDGF), a potent chemotactic agent, and TGF beta, which stimulates the deposition of extracellular matrix. Both of these growth factors have been shown to play a significant role in the repair and regeneration of connective tissues. Other healing-associated growth factors produced by platelets include basic fibroblast growth factor, insulin-like growth factor 1, platelet-derived epidermal growth factor, and vascular endothelial growth factor. Local application of these factors in increased concentrations through Platelet-rich plasma (PRP) has been used as an adjunct to wound healing for several decades.
High and low counts
A normal platelet count in a healthy individual is between 150,000 and 450,000 per μl (microlitre) of blood ((150–450)×109/L). Ninety-five percent of healthy people will have platelet counts in this range. Some will have statistically abnormal platelet counts while having no demonstrable abnormality. However, if it is either very low or very high, the likelihood of an abnormality being present is higher.
Both thrombocytopenia and thrombocytosis may present with coagulation problems. In general, low platelet counts increase bleeding risks; however there are exceptions (such as immune-mediated heparin-induced thrombocytopenia or paroxysmal nocturnal hemoglobinuria). High counts may lead to thrombosis, although this is mainly when the elevated count is due to myeloproliferative disorder.
Transfusion is generally used only to correct unusually low platelet counts (typically below (1.0–1.5)×1010/L). Transfusion is contraindicated in thrombotic thrombocytopenic purpura (TTP), as it fuels the coagulopathy. In patients undergoing surgery, a level below 5×1010/L is associated with abnormal surgical bleeding, and regional anaesthetic procedures such as epidurals are avoided for levels below 80–100.
Normal platelet counts are not a guarantee of adequate function. In some states, the platelets, while being adequate in number, are dysfunctional. For instance, aspirin irreversibly disrupts platelet function by inhibiting cyclooxygenase-1 (COX1), and hence normal hemostasis. The resulting platelets are unable to produce new cyclooxygenase because they have no DNA. Normal platelet function will not return until the use of aspirin has ceased and enough of the affected platelets have been replaced by new ones, which can take over a week. Ibuprofen, another NSAID, does not have such a long duration effect, with platelet function usually returning within 24 hours,and taking ibuprofen before aspirin will prevent the irreversible effects of aspirin.[18] Uremia, a consequence of renal failure, leads to platelet dysfunction that may be ameliorated by the administration of desmopressin.
Medications
Oral agents often used to alter/suppress platelet function include aspirin, clopidogrel, cilostazol, ticlopidine, and prasugrel.
Intravenous agents often used to alter/suppress platelet function include: abciximab, eptifibatide, tirofiban.
In addition to platelet transfusion, hematopoetic agents such as Oprelvekin, Romiplostim, and Eltrombopag can be used to increase platelet counts.
THE 10th anniversary of 9/11 was a sombre occasion for reflection on the meaningless suffering and violence caused by Al Qaeda and its franchises as well as the subsequent military reaction by states across the globe.
This decade will be remembered for its long periods of unnecessary war, violence, torture and death. If all the tears caused by such abundant sorrow could be collected in one place, they would constitute a tragic river of regret, broken hopes and hearts.
Having worked for more than 18 months in Swat with trauma patients who were victims of personal tragedies during the Taliban rule and the military response thereafter, one has witnessed the heartrending effect on ordinary people.
The worst sufferers have been women and children, and there are many households in Swat today with widows as head of the family. They have not only to cope with the strain of living but also of having to raise families without breadwinners. One cannot allow this catastrophe to pass without reflection; one must answer why this has happened.
I am reminded of the lines by poet Joan Anglund who wrote, “Like a great dark bird, winging home, tragedy drops into the waiting nest, woven by our weaknesses”. One notes the many opportunities that arose. If these had been grasped at the right moment tragedies could have been prevented.
It is true that neither the US nor Pakistan were wise enough to deal with what Osama bin Laden had in mind. It was a systematic failure across the board in not knowing how to counter him. In the case of Pakistan we were complacent about not having rooted out the radicals after their dispersal from Tora Bora.
The 9/11 Commission Report said that it was clear to the US intelligence community that “Although Bin Laden was determined to strike in the US … [n]umerous precautions were taken overseas. Domestic agents were not effectively mobilised”. Even more telling was the commission’s finding that “None of measures adopted by the US government from 1998-2001 disturbed or even delayed the progress of the Al Qaeda plot … Across the government there were failures of imagination, policy,
capabilities and management”.
In the case of Pakistan, had Gen Musharraf been vigilant and honest, many lives across the world including in Pakistan could have been saved and we would have also avoided the embarrassment of the discovery of Bin Laden in Abbottabad. A preventive policy would have stopped or reduced the subsequent eruption of extremism within Pakistani society that is today devouring it.
Anthony Cordesman is not wrong in saying that, “Pakistan is passing through one of the most dangerous periods of instability in its history … [It] is approaching a perfect storm of threats, including rising extremism, a failing economy, chronic underdevelopment and an intensifying war, resulting in unprecedented political, economic and social turmoil”.
In order to gain American sympathies, the Pakistan government issued a sponsored advertisement in the Wall Street Journal on 9/11 claiming that Pakistan was the worst sufferer during the last decade in terms of losses and the number of persons, both civilian and military, killed in the war. However, to ask in the advertisement ‘Which country can do more for your peace?’ and then continue blatantly, ‘Can any other country do so? Only Pakistan’ is in bad taste. Nations make policies and sacrifices for their own strategic interests. This is no way to go about getting mileage by selling the shrouds of one’s citizens.
On another level, this statement clearly indicates Islamabad’s view that Pakistan is fighting America’s war, something that the majority of Pakistanis have been saying ever since Gen Musharraf tied Pakistan’s fate to the US.
Despite having more than 150,000 soldiers defending the country’s sovereignty against non-state threats in Fata and Malakand, we witness daily the shenanigans of mad men and psychopaths on the national media about other less important matters; it appears we have become deranged as a people.
In the absence of any sincere effort to curb the destruction of Karachi, as Pakistan’s principal city, we hear meaningless homilies by everyone. Everyday our level of governance drops many notches. It is as if we want the tragedy (of Karachi) to drop into the waiting nest as described by Anglund.
With the December 2014 deadline for the withdrawal of the US from Afghanistan drawing near, we should be working hard to ensure that we are not caught again in the cross-hairs of another civil war that would do permanent harm to Pakistan. This is a moment for political parties and institutions to gather and craft a unified Pakistani policy that provides a workable regional solution based on peace.
If our national leadership fails to find time to lead the fight against extremism then we will have only ourselves to blame if we are ensnared again in the Afghan quagmire.
The Pakistan government has proudly proclaimed the figures of sacrifices made for the US since Sept 11, 2001. There are 21,672 Pakistani civilians dead or injured. The army lost 2,795 soldiers while 8,671 were wounded. There were 3,486 bomb blasts and 283 suicide attacks. More than 3.5 million persons became internally displaced. The losses to assets are worth more than $68bn. However, it is doubtful whether such statements will shift US policy favourably towards Pakistan.
On the other hand, these losses, though substantial, pale in comparison to our failure of governance as seen in Karachi. If the pressure on Pakistan’s dwindling capacity increases then our institutions may soon become dysfunctional and that to my mind will be the ultimate price we may pay for the 9/11 decade.
All the political parties except the ruling Pakistan People’s Party (PPP) and the Pakistan Muslim League-Quaid (PML-Q) described Muttahida Qaumi Movement (MQM) chief’s video address on Friday a non-event and a waste of time.
Altaf Hussain, during almost four hours of address — the longest in Pakistan’s political history and shown live on all private channels — actually revealed nothing except for allegations without any proof that the Awami National Party (ANP) received money from the US to win general elections in 2008, the Pakistan Muslim League-Nawaz (PML-N) workers were heavily armed and the Jamaat-e-Islami (JI) was running an underground armed group called ‘Thunder Squad’.
All three named parties, however, scoffed at the allegations saying the accusations coming from the MQM chief were meanningless when everyone knows who started extortion rackets, ran death squads, grabbed lands and killed own supporters in Karachi if they dared to speak against the party leader.
PML-N leader Ahsan Iqbal said that Altaf wasted valuable time of the entire nation through his irrelevant tirade with no evidence and did not respond to the allegations made on oath by Dr Zulfiqar Mirza that really prompted him to address the people.
The ANP, for so long a coalition partner along with the MQM in Sindh and at the centre, said that the address was a sheer waste of time that had no substance whatsoever and Altaf appeared mentally sick.
“The MQM chief is feeling insecure and the noose around him is tightening in connection with the assassination of Dr Imran Farooq,” declared ANP Senator Zahid Khan when asked to comment on MQM leader’s outburst and his accusation that Asfandar Wali Khan received millions of dollars from the USA.
Not to anyone surprise Altaf did not utter a single word against the Pakistan People’s Party, President Asif Ali Zardari, whom he called brother, Prime Minister Yousuf Raza Gilani and former senior provincial minister Dr Zulfiqar Mirza, the man who opened the Pandora’s box and alleged that the MQM and Altaf were foreign agents and working for the disintegration of Pakistan.
When asked what was his comment on Altaf’s address, Dr Mirza told newsmen that it was an entertainment show with some song and dance number and never answered my accusations.
During his marathon address Altaf also criticised the judiciary claiming that it was powerless to get any of the dozens of verdicts implemented and urged the army and Inter Services Intelligence to stop the genocide of Urdu speaking population in Karachi.
JI Karachi chief Mohammed Hussain Mehanti told newsmen that MQM chief was confused and did not know what was he talking about and worth not even mentioning when all and sundry were aware of the party and its working.
In 1998, Osama bin Laden and Ayman Zawahiri declared war on the US, outlining a philosophy of the clash of civilizations which legitimised attacks on the West - both soldiers and civilians. In the US, a group of politicians, who were to become known as the Neocons, believed they too had a moral duty to change the world. Both groups found their opportunity in the attacks of 9/11 and the invasions of Afghanistan and Iraq. But both were to see their dreams perish with the increasing human cost of these wars and the reality that ideologies without popular support cannot change the world.
A review of the 10 years since the September 11, 2001, attacks for a country that has weathered more crises than most. by Asad Hashim. The last 10 years have been something less than kind to Pakistan.
Since it was famously told that it either stood with the United States in its "War on Terror" or faced being bombed "back to the Stone Age" in 2001, it has lost 35,000 citizens to "terror"-related attacks and violence, with 3,500 of those being security forces and military personnel who were either targeted by militant groups or were killed during military operations. To put that second number in context, it is 30 per cent higher than NATO military casualties in the war in Afghanistan in the same period.
It has endured countless attacks against both civilian targets (including mosques) and state personnel and infrastructure, peace deals with militant groups in its largely ungoverned tribal areas (invariably followed by the breakdown of said deals), the storming of a radical seminary in the capital by the army (the Lal Masjid episode of 2008), the emergence of a Pakistani-target centric militant network (the Tehreek-e-Taliban Pakistan), al-Qaeda's designation of it as its primary enemy worldwide, the imposition of Sharia law in Swat, and a subsequent military operation in the valley (as well as similar operations in South Waziristan (multiple times), Orakzai, Bajaur, Mohmand, Khyber, Kurram and Swat itself on an earlier occasion; elsewhere, the government used armed tribal "lashkars" to fight extremist groups). It has seen the killing of arguably the country's most nationally popular leader in a suicide-bombing-and-shooting attack at a political rally, more bombings against civilians, the assassinations of a provincial governor and a federal minister for opposing a controversial blasphemy law, the killing of a major Baloch separatist leader in a state military operation, an expanded US drone strike campaign since 2009 (killing an estimated at least 2,309 people, of whom at least 392 were civilians, and the killing of the world's most wanted man, Osama bin Laden, on the doorstep of the country's military academy in a covert strike by US special forces.
Economically, its Gross Domestic Product has grown by 22.5 per cent (in real terms) to $174.8m, with an accompanying rise in consumer inflation from 3.7 per cent to 13.7 per cent for the country's now 174 million citizens. It has had two major International Monetary Fund bailouts, seen annual economic growth of around seven per cent give way to economic stagnation due to an over-dependence on credit and foreign direct investment in the growth bubble, and a massive influx of US military and civilian aid, culminating in the Kerry Lugar Bill, under which Pakistan is to receive $7.5bn over five years in civilian-only aid.
Politically, the country has seen two parliamentary elections on either side of seven years of military rule, an unprecedented liberation of media freedoms, a popular mass movement for the reinstatement of its Supreme Court Chief Justice and the overthrow of said military ruler, the killing of the largest national party's leader and the subsequent ascendance of her widely unpopular husband to the country's presidency, a continuing movement for secession in the country's largest province (by area) and bitter political conflict, sometimes resulting in bouts of violence claiming hundreds of lives, as most recently seen in Karachi.
And all of this is before one gets to the natural disasters: two major earthquakes, a tropical cyclone and major flooding which, put together, killed more than 75,000 people (96 per cent of those in the 2005 Kashmir earthquake) and affected more than 20 million (the vast majority after the devastating floods in 2010).
The country lurches, then, from crisis to catastrophe and back again, stopping briefly at moments of opportunity.
Crises of duplicity
The armchair debate in Pakistan is often focused on how the country's support for the US-led "War on Terror" has led Pakistan into this delicate balance – realistically, however, when then-US Secretary of State Colin Powell told then-Pakistani President and General Pervez Musharraf that Pakistan was either an ally or a target, there was no real choice involved.
"I don't think Pakistan had a choice. In that climate, I don't think Pakistan could declare neutrality, and I don't think that anybody would have considered neutrality as credible for Pakistan," Dr Rasul Baksh Raees, a professor of political science at the Lahore University of Management Sciences (LUMS) and columnist, told Al Jazeera. "I don't think that Pakistan could really get through the crisis [if it had said no] ... Today, although it is wounded, it is still alive."
Dr Hasan Askari Rizvi, a political and defence analyst, agrees, pointing out that at the time, only Pakistan's Islamist political parties (the most prominent of whom, the Jamaat-e-Islami and Jamiat Ulema-e-Islam, have historically fared poorly in national elections) publicly opposed Pakistani co-operation with the United States.
"Mainstream political parties were not opposed to the decision," he told Al Jazeera. "It is only at a later stage that this confusion about what Pakistan should do increased [amongst the political leadership]".
"What 9/11 did was that it made the military, through General Musharraf, come out of alignment with the mullahs [clerics] and the militants" [GALLO/GETTY]
As the years progressed, however, and the war in Afghanistan continued well beyond initial expectations, the Pakistani position, as articulated by Musharraf, of co-operating at the wrong end of a gun began to change, as did citizens' perceptions.
"The roots of the violence [in Pakistan] can be traced back to the pre-9/11 period. What happened after 9/11 was that the different militant Islamic groups gradually turned against the Pakistani state and they increased their mutual coordination, all aimed at the Pakistani state," Rizvi says.
The Pakistani state, and society at large, meanwhile "could not really make up their mind about how they should deal with all kinds of militant Islamic groups, including the Taliban", he continues. Raees argues that the result has been a country that is "socially and psychologically fractured", where citizens feel a sense of "anxiety and insecurity" at the lack of clear answers regarding their lives.
"What was lost in [the US support for Musharraf] was democracy and democratisation. Because Musharraf always said that Pakistan was fighting America's war … it gave the Pakistanis the very real belief that they were a rental army, and you see that anger. It really enabled Pakistanis to conclude that the war that they were fighting against the Taliban was not their war," argues Carol Christine Fair, an assistant professor at Georgetown University's School of Foreign Service and an expert on the region.
The ambivalence comes in no small part from the fact that the Pakistani state has historically fostered groups such as Jaish-e-Muhammad and Lashkar-e-Taiba to further its foreign policy objectives in the region (mainly with regards to the dispute over Kashmir with India). While its compact with the United States may have exacerbated the rate of the problem, however, there was always going to be a moment for Pakistan when the suicide bombers came home to roost.
"What 9/11 did was that it made the military, through General Musharraf, come out of alignment with the mullahs [clerics] and the militants," explains Fair. "And [in response to that], some of the militants, like Jaish-e-Muhammad, said 'Screw you'."
Missed opportunities
"[The post-9/11 scene] was an opportunity for Pakistan to really change its foreign policy away from supporting militancy. […] Initially, the world community would have supported Pakistan if it saw this as a way of abandoning its proxy wars and groups," she argues. "Pakistan kind of squandered that opportunity to reverse its decades old dangerous foreign policy and of course this Pakistani Taliban phenomenon: well, there would be no Pakistani Taliban if there were no militants that Pakistan had supported over a number of years. And Pakistanis have paid a heavy price for this [in lives]. […]
"I don't think 9/11 was pivotal about the identity questions [that Pakistanis face] … those questions were already there. The fact is that well before 9/11 you had groups slaughtering members of the Ahmadiyya and Shia communities."
Today, while the Pakistani government has repeatedly said that it "owns" the war against extremists on its soil, it continues to differentiate between targets, based on its understanding of the strategic calculus at play.
"The Pakistani position is really riddled with hypocrisy and duplicity," says Fair, when speaking of tacit Pakistani support for groups such as Lashkar-e-Taiba (or its more peaceable front, the Islamic charity Jamaat-ud-Dawa) or the Haqqani network, which is fighting NATO forces in Afghanistan out of bases in North Waziristan, but refrains from attacking Pakistani targets. She quickly adds, however, that the same could be said of the US position, given how it has treated a country which was "pulling their weight more than other ally" in the early years of the war.
"If you analyse this issue, you run deep into a cultural, intellectual and social crisis and the crisis borders on duplicity and a total lack of integrity: you don't want to say it is your war, although it is. And you don't want to say that you are an American ally, but you are"
Dr Rasul Baksh Raees
"The problem was that as Pakistan became more important in the 'War on Terror', it became increasingly difficult to make Pakistan abide by promises that were made [regarding support for proxy groups]," she says.
"If you socially analyse this issue, you run deep into a cultural, intellectual and social crisis and the crisis borders on duplicity and a total lack of integrity: you don't want to say it is your war, although it is. And you don't want to say that you are an American ally, but you are," rails Raees.
Pakistan refuses to confront the Haqqani network and other Afghan Taliban leaders based on strategic calculations regarding their likelihood to figure in any post-war Afghanistan as a counterweight to the perception of a Northern Alliance-based government that is dominated by Indian influence, most analysts agree.
That still leaves its support for groups such as Jaish-e-Muhammad and Lashkar-e-Taiba, historically used by the state against India. Rizvi argues that such groups have by now "established strong roots in Pakistani society because of the tolerance shown by the Pakistani security forces. By now, a strict action against LeT or Jamaat ud Dawa or Jaish-e-Muhammad would mean fighting a war in the cities, which the Pakistan army would avoid. In other words, the military has lost the option of controlling them because of its own policies in the past".
He points to the Sipah-e-Sahaba Pakistan and the Lashkar-e-Jhangvi (both anti-Shia groups) as examples of groups that the state has no explicit use for externally, but which can nevertheless not be controlled domestically.
Rizvi says that going forward, Pakistan will likely continue to tolerate certain militant groups so that they can maintain influence with them, even if the Afghan Taliban would not necessarily be "directly amenable to Pakistani influence. They may listen to them, but they are not likely to act on their advice, because from their perspective Pakistan has betrayed them [by co-operating with the United States post-2001]".
Nevertheless, Pakistan does possess leverage over several Afghan groups, and over the Afghan economy in particular through its control of land trade routes into the country from the Arabian Sea, and Rizvi feels that Pakistan will operate those levers in order to ensure that it does not face unfriendly neighbours on both its eastern and western borders.
"I think that Pakistan has this mythical idea that when [the US withdraws], life will return to status quo. It's not going to happen. The whole region is going to be engulfed in further militancy and violence. Only part of it can be attributed to the US," says Fair, adding that the US has "put in a lot of structures that will make civil war [in Afghanistan] more likely", such as a police based on "local militias". She adds that Pakistan may have a particularly difficult time with the Afghan Taliban after the withdrawal, given that most of its commanders are now young men who grew up in refugee camps in Pakistan.
"These are kids who have become mid-level commanders who hate Pakistan and hate the ISI [Pakistan’s main intelligence agency]."
'Wounded, but still alive'
On the political front, meanwhile, wrangling continues between the democratic government and an activist judiciary, empowered by the mass movement to bring its chief justice back to the Supreme Court.
Nevertheless, the PPP-led coalition government, faced with crises on both the economic and security fronts, continues to totter, but not topple. Perhaps the only reason this government may well see out its term until 2013 (making it the only democratically elected and led government in Pakistan to do so in the country's 64 year history) is that no one else really wants to take the reins faced with such dire circumstances.
Ultimately, Pakistan's problems remain more deep-rooted than simply those of circumstance – or, in this case, a particular circumstance, which killed more than 3,000 people in cities on the other side of the globe. With space of political discourse ever narrowing, the challenges Pakistan faces are both existential and pragmatic: it needs to answer questions of identity whilst simultaneously paying its bills, feeding 174 million citizens and, in a both real and metaphorical sense, holding itself together.
A foreign policy that appears to be based on running with the hare and hunting with the hounds, however, indicates that when it comes to the international community, and particularly its immediate neighbours, it will likely continue to muddle through on the knife edge of stability.
