Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Stress level of parents of hearing impaired children

The study attempted to determine the effects upon the family system of having a child diagnosed with deafness or hearing impairment. The specific variables are the rating of father stress, rating of mother stress. If any difference exist between maternal and paternal level of stress variables. The intent of this study is to better define the stress of parents due to disability of their children. The researcher used the translated version of standardized questionnaire on resources and stress short form (QRS-F) was used developed by William friedrich (1989). It constituted of 35 items. The sample consisted of 350 parents comprises(175 fathers and 175 mothers) of hearing impaired children who were studying in 1-5 grade at government special education schools and centers in Gujranwala district. Key words: stress, hearing impaired, deafness, paternal stress, maternal   stres

Bridging Theory-Practice Gap: Connecting Feedback with Teaching Practicum

Incorporating theory into practice is not a simple but rather a dialectical and complex process of observing, scaffolding, reflecting, and coordinating prospective teachers (PT) at teaching practicum. It has been observed that interaction in the form of academic feedback between cooperative teachers (CT) and PTs is poor. The study explores the perception of CTs, PTs and UTs (University teachers) about feedback practices to bridge the theory-practice gap during teaching practicum in the preservice teacher education program (PTEP). It is an exploratory investigation applying the survey method and semi-structured interview to collect data from PTs, CTs, and UTs to answer the investigation inquiries about the role of feedback practices in bridging the theory- practice gap. Purposive and criterion sampling techniques were used, and 98 PTs, 30 CT,s and 15 UTs participated in the study. Findings reveal that CTs are working as mentors without professional training, recognition of their contributions, and professional incentives and contradictory findings by the PTs and CTs about the in-time, targeted, supportive oral-written feedback at teaching practicum

Diagnosing Cervical Lesions Through LLETZ – A Reliable and Effective Tool

Background: Cervical dysplasia is the most common gynecological disorder of modern era. It initiates around the squamocolumnar junction of the cervix commonly due to the infection of human papilloma virus. Large loop excision of transitional zone is globally a standard procedure of choice both for diagnosing and treating cervical dysplasia. Pap smear is a fast and easy assessment tool for detecting cervical lesions, but it is relatively unreliable. Methodology: Fifty patients of age group 35 to 65 years patients having normal looking cervix with abnormal pap smear or suspicious looking cervix with or without abnormal pap smear, were selected for the study after informed consent. The procedure for LLTEZ was performed under strict aseptic measures in the procedural room and the biopsy specimen was sent for histopathological examination. The pathological findings were presented as percentages. Results: 66% cervical biopsy specimens were suggestive of chronic cervicitis and 24% samples were suggestive of chronic cervicitis with squamous metaplasia. Mild dysplasia in 4% samples, moderate and severe dysplasia were seen in 2% samples. Conclusion: LLETZ is an efficient procedure to deal with cervical dysplasia. It must be recommended for the work-up of uncertain gynecological presentations. The expertise of professionals must be improved through training to obtain maximum benefits

A comprehensive review of sectorial contribution towards greenhouse gas emissions and progress in carbon capture and storage in Pakistan

The extreme amount of greenhouse gases (GHGs) being released into the atmosphere has proved to be a globally challenging phenomenon that leads to changes in the climate and global warming. The amount of GHGs in the atmosphere has escalated immensely, with a substantial growth of 5.8% in 2010; a similar increase was observed in Pakistan as well. In Pakistan, carbon dioxide (CO2) emissions stand at 54% of total GHG emissions whereas methane, nitrous oxide, carbon monoxide and volatile organic carbon contribute to emissions at 36%, 9%, 0.75% and 0.3%, respectively. One of the key reasons for climatic changes is GHG emission generation from human interventions and activities related to transportation, urban development, industrialization, energy sources, farming and agriculture, waste's improper management, land use and forestry. In 2011, Pakistan's entire GHG emissions were a whopping 347 Mt of CO2-eq, and by 2050, they are estimated to reach 4621 Mt CO2-eq. This review evaluates and assesses GHG emissions generating from various sectors in Pakistan, in a socio-scientific prospect that is caused by human activities and interventions in different economic sectors in Pakistan, endangering the environment across the country. Additionally, the review examines the current level of GHG emissions while accounting for China-Pakistan Economic Corridor-based emissions, abatement strategies including development of a state-of-the-art technique for carbon capture and storage/utilization technologies in Pakistan. (c) 2019 Society of Chemical Industry and John Wiley & Sons, Ltd

A comprehensive review of climate change impacts, adaptation, and mitigation on environmental and natural calamities in Pakistan

The devastations and damages caused by climate change are apparent across the globe, specifically in the South Asian region where vulnerabilities to climate change among residents are high and climate change adaptation and mitigation awareness are extremely low. Pakistan's low adaptive capacity due to high poverty rate, limited financial resources and shortage of physical resources, and continual extreme climatic events including varying temperature, continual flooding, melting glaciers, saturation of lakes, earthquakes, hurricanes, storms, avalanches, droughts, scarcity of water, pest diseases, human healthcare issues, and seasonal and lifestyle changes have persistently threatened the ecosystem, biodiversity, human communities, animal habitations, forests, lands, and oceans with a potential to cause further damages in the future. The likely effect of climate change on common residents of Pakistan with comparison to the world and their per capita impact of climate change are terribly high with local animal species such as lions, vultures, dolphins, and tortoise facing extinction regardless of generating and contributing diminutively to global GHG emissions. The findings of the review suggested that GHG emissions cause climate change which has impacted agriculture livestock and forestry, weather trends and patterns, food water and energy security, and society of Pakistan. This review is a sectorial evaluation of climate change mitigation and adaption approaches in Pakistan in the aforementioned sectors and its economic costs which were identified to be between 7 to 14 billion USD per annum. The research suggested that governmental interference is essential for sustainable development of the country through strict accountability of resources and regulation implemented in the past for generating state-of-the-art climate policy

Divisional disparities on climate change adaptation and mitigation in Punjab, Pakistan: local perceptions, vulnerabilities, and policy implications

Climate change is a global challenge faced by everyone, but the developing countries are highly vulnerable to variations in the environment. This research focuses on the Punjab province of Pakistan and evaluates the impacts and consequences of climate change on general public at local and divisional level. In order to cope with the impacts of climatic changes at all levels, especially divisional level, raising reliable awareness and dispersing actionable knowledge regarding mitigating and adapting measures is significantly important. Therefore, recognition of information gaps, improvements in the level of alertness, and development of preventive measures in each sector is imperative. The impacts of climate change are observed across the country through gradual increase in temperature, human health issues, pest diseases, droughts, floods, and irregular weather patterns leading to changes in lifestyles, and these issues are likely to continue in the future. The main cause of climate change in Punjab, Pakistan, can be attributed to excessive release of greenhouse gases (GHG) into the atmosphere due to human activities involving inefficient energy usage, rapid urban expansion, improper waste management, industrial development, increasing transportation, agricultural activities, and livestock mismanagement. The findings of this study revealed that transportation sector is the major source of GHG emissions in the country, followed by industrialization and waste, at national, as well as divisional, level. The extent of impacts of climate change at divisional level is distinguishable and displayed a direct relationship with climate, geography, variation of effects, and modes of production in various regions of Punjab. The study strategically investigated all nine divisions of the province for comprehensive understanding of climate change phenomenon, and the results indicated that nearly three-fourths of the respondents have never indulged in taking steps towards climate change mitigation and adaptation. The study adopted a mixed (qualitative and quantitative) approach where the findings can act as set of guidelines for governmental authorities in formulating, assisting in preparation, instructing, and guiding policies for climate change mitigation and adaptation at national, local, and divisional levels

Regional and sectoral assessment on climate-change in Pakistan: Social norms and indigenous perceptions on climate-change adaptation and mitigation in relation to global context

Climate change has extremely damaged the whole world, particularly South Asian countries because common residents in this region are considered highly vulnerable to climate change impacts whereas their common awareness to adapt and mitigate these impacts is very low. Pakistan is one of the most important South Asian countries and has been affected tremendously through several impacts namely; temperature rise, drought, pest-diseases, health issues, seasonal and lifestyle change and it has the potential to continue doing so in future. We conducted a survey to explore the adaptation and mitigation alertness to climate change among all provinces and areas (urban, peri-urban and rural) of Pakistan from general public since they are directly affected by climate change. In Pakistan, climate change is essentially caused by greenhouse gas (GHG) emissions and the foremost sources of rise in the GHG emissions are human activities, such as deforestation and emissions from various sectors; transportation, industrialization, urbanization, waste, agriculture livestock & forestry and energy usage. All of these have a significant impact on climate change in all areas and provinces. The study determines that all the areas in Pakistan played an increased role in climate change, but rural, peri-urban, and small cities turned out to be in worst situation due to lack of attention and ignorance. Datum produced from this study can pave a way for assisting in preparing, instructing, and guiding national and international decision makers in order to upgrade the levels of adaptation and mitigation policy making and its implementation in South Asia specially and at global scale generally. (C) 2018 Elsevier Ltd. All rights reserved

Molecular and genetic perspectives of cold tolerance in wheat

Environmental variation is the most crucial problem as it is causing food insecurity and negatively impacts food availability, utilization, assessment, and stability. Wheat is the largest and extensively cultivated staple food crop for fulfilling global food requirements. Abiotic stresses including salinity, heavy metal toxicity, drought, extreme temperatures, and oxidative stresses being the primary cause of productivity loss are a serious threat to agronomy. Cold stress is a foremost ecological constraint that is extremely influencing plant development, and yield. It is extremely hampering the propagative development of plant life. The structure and function of plant cells depend on the cell's immune system. The stresses due to cold, affect fluid in the plasma membrane and change it into crystals or a solid gel phase. Plants being sessile in nature have evolved progressive systems that permit them to acclimatize the cold stress at the physiological as well as molecular levels. The phenomenon of acclimatisation of plants to cold stress has been investigated for the last 10 years. Studying cold tolerance is critical for extending the adaptability zones of perennial grasses. In the present review, we have elaborated the current improvement of cold tolerance in plants from molecular and physiological viewpoints, such as hormones, the role of the posttranscriptional gene, micro RNAs, ICE-CBF-COR signaling route in cold acclimatization and how they are stimulating the expression of underlying genes encoding osmoregulatory elements and strategies to improve cold tolerance in wheat