The Role of Radiology (X-Ray versus Computed Tomography) in Medicolegal Cases Presented at a Tertiary Care Hospital in Pakistan

Objectives:  A prospective observational study was aimed to assess the role of plain radiographs and computed tomography in detecting head injuries presented at the medicolegal office at the Forensics and Radiology Departments, Gambat Medical Hospital, Sindh. Material and Methods:  All cases referred from the Medicolegal Office (MLO) with head injury were included. All victims underwent X-ray head and computed tomography skull was done with 1 or 1.5 cm thick axial sections without administration of intravenous contrast. The radiological reports of X-ray head and CT scans were documented and comparatively evaluated. Results:  Mean age was 38.63 ± 3.91 years. In 51 (45.13%) cases, X-ray was able to detect skull fracture, while CT scan detected 64(56.64%) skull fractures. There were 54 (84.3%) true positives, 3 (2.6%) false positives, 10(8.8%) false negatives, and 40 (40.7%) true negatives. The accuracy of X-ray to detect skull fracture was 88.50%. Conclusion:  X-ray had a sensitivity and specificity of 84.38% and 93.88%, respectively. It is a reliable tool to detect skull fractures in victims of assault in comparison with CT scans. X-ray is also associated with low dose radiation exposure as compared with CT scan which delivers 70 times more exposure than the former

Validation of verbal autopsy tool for ascertaining the causes of stillbirth

Objective: To assess performance of the WHO revised verbal autopsy tool for ascertaining the causes of still birth in comparison with reference standard cause of death ascertained by standardized clinical and supportive data.Methods: All stillbirths at a tertiary hospital in Karachi, Pakistan were prospectively recruited into study from August 2006- February 2008. The reference standard cause of death was established by two senior obstetricians within 48 hours using the ICD coding system. Verbal autopsy interviews using modified WHO tool were conducted by trained health workers within 2- 6 weeks of still birth and the cause of death was assigned by second panel of obstetricians. The performance was assessed in terms of sensitivity, specificity and Kappa.Results: There were 204 still births. Of these, 80.8% of antepartum and 50.5% of intrapartum deaths were correctly diagnosed by verbal autopsy. Sensitivity of verbal autopsy was highest 68.4%, (95%CI: 46-84.6) for congenital malformation followed by obstetric complication 57.6%, (95%CI: 25-84.2). The specificity for all major causes was greater than 90%. The level of agreement was high (kappa=0.72) for anomalies and moderate (k=0.4) for all major causes of still birth, except asphyxia.Conclusion: Our results suggest that verbal autopsy has reasonable validity in identifying and discriminating between causes of stillbirth in Pakistan. On the basis of these findings, we feel it has a place in resource constrained areas to inform strategic planning and mobilization of resources to attain Millennium Development Goal

Vegetation conditions in various plant communities and their performance in district Tharparkar, Sindh, Pakistan

Six villages were registered for the experimental purpose/plantation where more than 25,000 plants were planted to develop range forest. These plants were developed at Marvi nursery PARC-Arid Zone Research Institute, Umerkot and some were purchased from private nursery situated at Mirpurkhas. Results revealed that maximum plants mortality rate was found at village Ratnore and lowest mortality of plants was observed at Mithrio Charan. Plants damaged due to unknown reason (natural), termite attack and diseases. In various locations most of plants were affected by termites than others biotic and abiotic factors. The most influenced plant was Prosopis cinerera. Maximum plants survived numbers of grafted ber was found at village Ratnore, the biomass production of green and dry grasses was taken after harvesting. A highest green grass weight 21812.58 kg and dry 3439.83 kg were observed from elephant grass stock and lowest green weight 5001.92 kg from Gatten grass and dry weight 477.57 kg per acre were recorded from Rhode grass 1 (Sabri). Gatten grass and Rhode grass 1 (Sabri) were found lower weight. All these seven grasses showed excellent performance except Elephant grass and Gatten grass. These two grasses needed more water as compared to remaining five species. These grasses when fed by goats their milk production was increased and goats like to feed these grasses. The pictures of these grasses showed their appearance and health irrigated by underground brackish water with more than 2200 ppm

Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project

Background: Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur. Method/Design: This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization. Discussion: Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health syste

Human knockouts and phenotypic analysis in a cohort with a high rate of consanguinity

A major goal of biomedicine is to understand the function of every gene in the human genome. Loss-of-function mutations can disrupt both copies of a given gene in humans and phenotypic analysis of such 'human knockouts' can provide insight into gene function. Consanguineous unions are more likely to result in offspring carrying homozygous loss-of-function mutations. In Pakistan, consanguinity rates are notably high. Here we sequence the protein-coding regions of 10,503 adult participants in the Pakistan Risk of Myocardial Infarction Study (PROMIS), designed to understand the determinants of cardiometabolic diseases in individuals from South Asia. We identified individuals carrying homozygous predicted loss-of-function (pLoF) mutations, and performed phenotypic analysis involving more than 200 biochemical and disease traits. We enumerated 49,138 rare (<1% minor allele frequency) pLoF mutations. These pLoF mutations are estimated to knock out 1,317 genes, each in at least one participant. Homozygosity for pLoF mutations at PLA2G7 was associated with absent enzymatic activity of soluble lipoprotein-associated phospholipase A2; at CYP2F1, with higher plasma interleukin-8 concentrations; at TREH, with lower concentrations of apoB-containing lipoprotein subfractions; at either A3GALT2 or NRG4, with markedly reduced plasma insulin C-peptide concentrations; and at SLC9A3R1, with mediators of calcium and phosphate signalling. Heterozygous deficiency of APOC3 has been shown to protect against coronary heart disease; we identified APOC3 homozygous pLoF carriers in our cohort. We recruited these human knockouts and challenged them with an oral fat load. Compared with family members lacking the mutation, individuals with APOC3 knocked out displayed marked blunting of the usual post-prandial rise in plasma triglycerides. Overall, these observations provide a roadmap for a 'human knockout project', a systematic effort to understand the phenotypic consequences of complete disruption of genes in humans.D.S. is supported by grants from the National Institutes of Health, the Fogarty International, the Wellcome Trust, the British Heart Foundation, and Pfizer. P.N. is supported by the John S. LaDue Memorial Fellowship in Cardiology from Harvard Medical School. H.-H.W. is supported by a grant from the Samsung Medical Center, Korea (SMO116163). S.K. is supported by the Ofer and Shelly Nemirovsky MGH Research Scholar Award and by grants from the National Institutes of Health (R01HL107816), the Donovan Family Foundation, and Fondation Leducq. Exome sequencing was supported by a grant from the NHGRI (5U54HG003067-11) to S.G. and E.S.L. D.G.M. is supported by a grant from the National Institutes of Health (R01GM104371). J.D. holds a British Heart Foundation Chair, European Research Council Senior Investigator Award, and NIHR Senior Investigator Award. The Cardiovascular Epidemiology Unit at the University of Cambridge, which supported the field work and genotyping of PROMIS, is funded by the UK Medical Research Council, British Heart Foundation, and NIHR Cambridge Biomedical Research Centre ... Fieldwork in the PROMIS study has been supported through funds available to investigators at the Center for Non-Communicable Diseases, Pakistan and the University of Cambridge, UK

Challenges and opportunities in conducting research in developing countries

Developing countries disproportionally suffer from mortality and morbidity especially for children. Research leading to scientific progress in understanding causes of death has resulted in reduction in child morbidity and mortality in developed nations. However due to resource limitations, human and otherwise, in developing countries the progress towards achieving development goals, has been minimal. The collaborations and partnerships between developed and developing nations provides multiple opportunities for research and thereby learning, leading to reduction in child mortality. The scientists in both developed and developing nations need to understand the challenges that may occur while conducting research. In this paper we provide a framework for the researchers in both developing and developed nations to try to understand and develop research agenda and ideas that could not only address child health problems in developing countries but could also result in the progress of science benefitting the world at large

Modified Smoothing Algorithm for Tracking Multiple Maneuvering Targets in Clutter

This research work extends the fixed interval smoothing based on the joint integrated track splitting (FIsJITS) filter in the multi-maneuvering-targets (MMT) tracking environment. We contribute to tackling unknown dynamics of the multi-maneuvering-targets (MMT) using the standard kinematic model. This work is referred to as smoothing MMT using the JITS (MMT-sJITS). The existing FIsJITS algorithm is computationally more complex to solve for the MMT situation because it enumerates a substantial number of measurement-to-track assignments and calculates their posteriori probabilities globally. The MMT-sJITS updates a current target track by assuming the joint (common) measurements detected by neighbor tracks are modified clutters (or pretended spurious measurements). Thus, target measurement concealed by a joint measurement is optimally estimated based on measurement density of the modified clutter. This reduces computational complexity and provides improved tracking performance. The MMT-sJITS generates forward tracks and backward tracks using the measurements collected by a sensor such as a radar. The forward and backward multi-tracks state predictions are fused to obtain priori smoothing multi-track state prediction, as well as their component existence probabilities. This calculates the smoothing estimate required to compute the forward JITS state estimate, which reinforces the MMT tracking efficiently. Monte Carlo simulation is used to verify best false-track discrimination (FTD) analysis in comparison with existing multi-targets tracking algorithms

A cross sectional survey of newborn care practices in rural Sindh, Pakistan: implications for research and policy

INTRODUCTION: Of annual four million neonatal deaths, majority in the developing world, approximately three-quarters die within the first week of life. Pakistan has one of the highest newborn mortality rates. STUDY DESIGN: We conducted a cross sectional study to assess knowledge, attitudes and practices of women of reproductive age in rural Pakistan. RESULTS: Of 1490 mothers interviewed, prevalence of newborn care practices ranged between 32% (early bathing of newborn) and 69% (use of traditional cord applications). Uptake of antenatal care services was identified as a strong predictor of good newborn care after controlling for skilled birth attendance, socio-economic status, age of mother and sex of infant (OR = 1.26; 95% CI: 1.00–1.57). CONCLUSIONS: The association of uptake of antenatal care services with good newborn care highlights the necessity to improve coverage of services with the integration of counseling about newborn care in order to reduce the burden of neonatal morbidity and mortality

Rheological modeling and microstructural evaluation of oily sludge modified bitumen

The disposal of oily sludge (OS) and depletion of crude oil reservoirs has become a global problem for the petroleum industries. The rising cost of bituminous materials is also attributed to the depletion of crude oil reservoirs. Incorporating OS in the production of bitumen can reduce waste generation, thereby ensuring sustainability in petroleum industries. This study carried out a series of physicochemical, rheological and morphological tests to examine the suitability of OS as a bitumen modifier. OS and binders were subjected to Fourier transform infrared spectroscopy (FTIR) and atomic force microscopy (AFM) to characterize their morphological and chemical configuration. Using a dynamic shear rheometer (DSR) and response surface methodology (RSM), the performance characteristics of binders were analyzed and modeled. FTIR showed the identical functional groups responsible for the compatibility of OS and bitumen. Fit statistics and diagnostic graphs showed the significance and adequacy of the quadratic model for rutting and fatigue factors. Response surface plots showed that OS improved the fatigue resistance of bitumen. The OS up to 8 % addition improves fatigue resistance while keeping the performance grade (PG) identical to that of base bitumen