Evaluation of Ground Water Quality for Irrigation Purpose of the Areas of District Bahawalnagar, Pakistan

Water is life line for all living creation including human beings. Economy of Pakistan is agricultural based and it mainly dependent on canal supplies. Before the introduction of irrigation system the water table was sufficiently deep but due to lack of drainage facilities and improper management practices, adopting by the farmers, the water table came up resulting water logging & salinity problems. Indus basin abundant resources of ground water, the quality of which various from sweets to very saline in different tracts. However a thin layer of good quality is present almost everywhere, where exists an immense potential for the use of these water resources for agriculture, municipal and industrial use. Keeping in this view a detailed study was carried out to provide guidelines to farmers and researches for better crop production by adopting water management practices. Total 23600 water samples were collected from all the five tehsils of district Bahawalnagar during the year July 2003 to June 2010. These samples were analyzed and categorized according to suitability criteria of water quality evaluation. 38.64 percent water samples were found fit, 7.65 percent were marginally fit and 53.7 percent water samples were found unfit for irrigation purpose. Majority of water samples were found hazardous for irrigation purpose. Almost all the area has highly saline water, which is affected yield of various crops. Keywords: EC, SAR, RSC, Ground water, Bahawalnagar, Pakistan

Torsional Behavior of Hybrid Reinforced Concrete Box Girders Composed of Conventional Concrete and Modified Reactive Powder Concrete

This paper investigates experimentally the torsional behavior of hybrid reinforced concrete box beams composed of conventional concrete at side walls and modified reactive powder concrete at top and bottom flanges. Hybrid reinforced concrete members is used extensively to deal with the members strength requirements related to flexural, shear and torsion in structural systems. The torsion failure is an undesirable failure because it's occurred in a brittle nature, it is necessary to avoid this type of failure in the earthquake areas. Three reinforced concrete box beams with dimensions (300x300x1200) mm of (width x height x length) respectively and interior hollow dimensions (140x140)mm were cast and tested to failure by using two opposite cantilevers arms which contribute in transferring the torque to the central part of the box beam. One of the beams was poured with conventional concrete, second beam with modified reactive powder concrete and third beam was poured as a hybrid member. Experimental data on ultimate capacity, cracking torsional loads, failure pattern and twisting angle for each of the box beams were gained. The experimental results show that the ultimate torsional strength value of hybrid box beam higher than conventional concrete beam by about (58) % and lower than modified reactive powder concrete specimen by about (40.75)%. Keywords: Hybrid reinforced concrete, conventional concrete, modified reactive powder concrete and torsion

Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: A meta-analysis of studies from developing countries

Background:Hypertension in pregnancy stand alone or with proteinuria is one of the leading causes of maternal mortality and morbidity in the world. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy though the effect varies based on baseline calcium intake and pre-existing risk factors. The Purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal mortality in developing countries.Methods: A literature search was carried out on PubMed, Cochrane Library and WHO regional databases. Data were extracted into a standardized excel sheet. Identified studies were graded based on strengths and limitations of studies. All the included studies were from developing countries. Meta-analyses were generated where data were available from more than one study for an outcome. Primary outcomes were maternal mortality, eclampsia, pre-eclampsia, and severe preeclampsia. Neonatal outcomes like neonatal mortality, preterm birth, small for gestational age and low birth weight were also evaluated. We followed standardized guidelines of Child Health Epidemiology Reference Group (CHERG) to generate estimates of effectiveness of calcium supplementation during pregnancy in reducing maternal and neonatal mortality in developing countries, for inclusion in the Lives Saved Tool (LiST).Results: Data from 10 randomized controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy was associated with a significant reduction of 45% in risk of gestational hypertension [Relative risk (RR) 0.55, 95 % confidence interval (CI) 0.36-0.85] and 59% in the risk of preeclampsia [RR 0.41, 95 % CI 0.24-0.69] in developing countries. Calcium supplementation during pregnancy was also associated with a significant reduction in neonatal mortality [RR 0.70, 95 % CI 0.56-0.88] and risk of pre-term birth [RR 0.88, 95 % CI 0.78-0.99]. Recommendations for LiST for reduction in maternal mortality were based on risk reduction in gestational hypertensive related severe morbidity/mortality [RR 0.80, 95% CI 0.70-0.91] and that for neonatal mortality were based on risk reduction in all-cause neonatal mortality [RR 0.70, 95% CI 0.56-0.88].Conclusion: Calcium supplementation during pregnancy is associated with a reduction in risk of gestational hypertension, pre-eclampsia neonatal mortality and pre-term birth in developing countries

Irrigation Water Quality Assessment and Salinity Management Strategies in Bahawalpur Division, Pakistan

Economy of Pakistan is agricultural based and it mainly dependent on canal supplies. Due to rapid population growth, there has been a dramatic increase in the intensity of ground water exploitation leading to decline water table and deteriorate ground water quality. Tube well water is one of the most common resources to support the irrigation in situation of canal water scarcity. Considering the importance of tube well water, present study was conducted for the quality assessment of tube well water to provide guidelines to farmer and researches for better crop production by adopting water management strategies. Total 1400 water samples were collected from Bahawalpur division during the year 2017. These samples were analyzed and categorized according to suitability criteria of water quality evaluation. 38.64 percent water samples were found fit, 7.65 percent were marginally fit and 53.7 percent water samples were found unfit for irrigation purpose. Majority of water samples were found hazardous for irrigation purpose. There is need to analyze the existing water resources and recommending comprehensive conservation and management strategies in view of catering the planning requirements for the future. Keywords: Salinity, Sodicity, Ground water, Bahawalpur, Pakistan

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

<p>Abstract</p> <p>Background</p> <p>There is a strong association between stillbirth and fetal growth restriction. Early detection and management of IUGR can lead to reduce related morbidity and mortality. In this paper we have reviewed effectiveness of fetal movement monitoring and Doppler velocimetry for the detection and surveillance of high risk pregnancies and the effect of this on prevention of stillbirths. We have also reviewed effect of maternal body mass index (BMI) screening, symphysial-fundal height measurement and targeted ultrasound in detection and triage of IUGR in the community.</p> <p>Methods</p> <p>We systematically reviewed all published literature to identify studies related to our interventions. We searched PubMed, Cochrane Library, and all World Health Organization Regional Databases and included publications in any language. Quality of available evidence was assessed using GRADE criteria. Recommendations were made for the Lives Saved Tool (LiST) based on rules developed by the Child Health Epidemiology Group. Given the paucity of evidence related to the effect of detection and management of IUGR on stillbirths, we undertook Delphi based evaluation from experts in the field.</p> <p>Results</p> <p>There was insufficient evidence to recommend against or in favor of routine use of fetal movement monitoring for fetal well being. (1) Detection and triage of IUGR with the help of (1a) maternal BMI screening, (1b) symphysial-fundal height measurement and (1c) targeted ultrasound can be an effective method of reducing IUGR related perinatal morbidity and mortality. Pooled results from sixteen studies shows that Doppler velocimetry of umbilical and fetal arteries in ‘high risk’ pregnancies, coupled with the appropriate intervention, can reduce perinatal mortality by 29 % [RR 0.71, 95 % CI 0.52-0.98]. Pooled results for impact on stillbirth showed a reduction of 35 % [RR 0.65, 95 % CI 0.41-1.04]; however, the results did not reach the conventional limits of statistical significance. This intervention could be potentially recommended for high income settings or middle income countries with improving rates and standards of facility based care. Based on the Delphi, a combination of screening with maternal BMI, Symphysis fundal height and targeted ultrasound followed by the appropriate management could potentially reduce antepartum and intrapartum stillbirth by 20% respectively. This estimate is presently being recommended for inclusion in the LiST.</p> <p>Conclusion</p> <p>There is insufficient evidence to recommend in favor or against fetal movement counting for routine use for testing fetal well being. Doppler velocimetry of umbilical and fetal arteries and appropriate intervention is associated with 29 % (95 % CI 2% to 48 %) reduction in perinatal mortality. Expert opinion suggests that detection and management of IUGR with the help of maternal BMI, symphysial-fundal height measurement and targeted ultrasound could be effective in reducing IUGR related stillbirths by 20%.</p

Do the quadriceps and hamstring muscles have an effect on patella stability in trochlear dysplasia?

Introduction: Trochlear dysplasia (TD) is a condition that is characterized by the presence of either a flat or convex trochlear, which impedes the stability of the patellofemoral joint (PFJ). The PFJ function is dependent on many different structures that surround the knee joint. The aim of this study was to analyse all the muscle components around the PFJ and identify whether gross muscle imbalance could contribute to the stability of the patella in TD. Material and methods: The average cross-sectional area (CSA) and cross-sectional area ratio (CSAR) of each muscle of the thigh region in subtypes of TD was evaluated and compared to normal knee joints. Ninety-eight patients (196 knees in total) were included in the study. Results: Of the 196 knee joints that were reviewed, 10 cases were found to be normal. In total, 186 cases were positive for TD. The majority consisted of type C. The hamstring muscles showed variable results. The vastus medialis muscle was larger in comparison to the vastus lateralis muscle over all the different TD subtypes; however, no statistical significance was identified. There was a marked statistical significance between the quadriceps and hamstring muscles, especially when comparing this to the normal knees within our cohort. Conclusions: This study revealed no significant difference in the effect of the thigh muscle CSA on the stability of the PFJ in TD. Further research is required to establish the roles of the different muscles around PFJ in the prevention of TD dislocation

Perioperative hemostatic management of patients with type A aortic dissection.

Coagulopathy is common in patients undergoing thoracic aortic repair for Stanford type A aortic dissection. Non-critical administration of blood products may adversely affect the outcome. It is therefore important to be familiar with the pathologic conditions that lead to coagulopathy in complex cardiac surgery. Adequate care of these patients includes the collection of the medical history regarding the use of antithrombotic and anticoagulant drugs, and a sophisticated diagnosis of the coagulopathy with viscoelastic testing and subsequently adapted coagulation therapy with labile and stable blood products. In addition to the above-mentioned measures, intraoperative blood conservation measures as well as good interdisciplinary coordination and communication contribute to a successful hemostatic management strategy

Mid-term outcomes of an alternative remodelling technique for aortic root replacement without coronary ostial mobilisation or reimplantation

BackgroundWe compare the early and late outcomes of a modified aortic root remodelling (ARR) technique for aortic root replacement without mobilisation or reimplantation of the coronary ostia, with those of the modified Bentall-de Bono procedure.MethodsA retrospective observational study was performed comprising 181 consecutive patients who underwent aortic root replacement with a modified Bentall-de Bono procedure (104 patients) or ARR (77 patients) between January 2013 and December 2019. Primary endpoints included hospital mortality and late survival. Secondary endpoints included incidence of post-operative complications and freedom from late re-operation.ResultsARR procedures were performed with shorter cross-clamp times and comparable cardiopulmonary bypass times to modified Bentall-de Bono procedures. The incidence of early post-complications was comparable between groups. 30-day mortality was numerically lower with ARR than the modified Bentall-de Bono procedure. Over 7-year follow-up, 4 patients (3.8%) required repeat aortic surgery after a modified Bentall-de Bono procedure, and none after ARR. Long-term mortality after ARR and after modified Bentall-de Bono procedures was 17.1% and 22.7%, respectively. The cumulative incidence of reintervention on the aortic root/valve was 3.2% after a modified Bentall-de Bono procedure and 0% after ARR. When adjusted for other independent risk factors, late mortality was not influenced by the procedure performed, although competing risk adjusted for age showed that the modified Bentall-de Bono procedure was associated with an increased risk of aortic root/aortic valve re-operation.ConclusionsThe modified ARR technique is associated with reduced myocardial ischaemia time, lower post-operative mortality and aortic re-intervention rates compared to a modified Bentall-de Bono procedure. It may be considered a safe and feasible procedure for aortic root/ascending aortic replacement offering good long-term outcomes.Peer reviewe

Balancing science and public policy in Pakistan\u27s COVID-19 response

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan\u27s response to COVID-19 has been under scrutiny for its granularity, reach and impact.Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case introduction from pilgrims returning from the Islamic Republic of Iran, followed by widespread community transmission. The National Command and Operations Centre, established through civilian and military partnership, was critical in fast tracking logistics, information gathering, real-time reporting and smart lockdowns, coupled with a massive cash support programme targeting the poorest sections of society. Cases peaked in June 2020 but the health system was able to cope with the excess workload. Since then, although testing rates remain low (\u3e 300 000 cases confirmed to date), case fatality rates have stabilized, and with 6300 deaths, Pakistan seems to have flattened the COVID-19 curve.Conclusion: Despite notable successes in controlling the pandemic, several weaknesses remain and there are risks of rebound as the economy and educational systems reopen. There is continued need for strong technical and programmatic oversight, linked to civic society engagement and working with religious scholars to ensure nonpharmacological intervention compliance

Balancing science and public policy in Pakistan\u27s COVID-19 response

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan\u27s response to COVID-19 has been under scrutiny for its granularity, reach and impact.Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case introduction from pilgrims returning from the Islamic Republic of Iran, followed by widespread community transmission. The National Command and Operations Centre, established through civilian and military partnership, was critical in fast tracking logistics, information gathering, real-time reporting and smart lockdowns, coupled with a massive cash support programme targeting the poorest sections of society. Cases peaked in June 2020 but the health system was able to cope with the excess workload. Since then, although testing rates remain low (\u3e 300 000 cases confirmed to date), case fatality rates have stabilized, and with 6300 deaths, Pakistan seems to have flattened the COVID-19 curve.Conclusion: Despite notable successes in controlling the pandemic, several weaknesses remain and there are risks of rebound as the economy and educational systems reopen. There is continued need for strong technical and programmatic oversight, linked to civic society engagement and working with religious scholars to ensure nonpharmacological intervention compliance