Appraisal of Groundwater Flow Simulation in the Sub- Himalayan Watershed of Pakistan

Numerical modeling of an aquifer is increasingly used as a power tool for monitoring and management of groundwater. This paper focuses on conceptualizing hydrogeological condition and establishing numerical simulation model using Visual MODFLOW to simulate the continuous depletion of groundwater in the southwestern part of the Soan watershed in Pakistan. An integrated groundwater modeling and management approach was adopted to provide suitable alternatives for water management in different hydro-environments. Geospatial techniques were employed for spatial database development, integration with a remote sensing (RS), and numerical groundwater flow modeling capabilities to simulate groundwater flow behavior. The calibration results indicated a reasonable agreement between the calculated and observed heads. The calibrated heads were used as initial conditions in the transient-state modeling. The modeling approach facilitated in identifying potential groundwater regime besides providing artificial recharge options for sustainable groundwater development

Propagation of Drought: From Meteorological Drought to Agricultural and Hydrological Drought

Drought is a hazard that occurs everywhere in the world (both in dry and in wet areas). Despite the controversy regarding drought changes in the last decades [1–3], increases in drought intensity are clearly identified in some areas [4] and it is believed that although increased heating from global warming may not directly cause droughts, it is expected that when droughts occur, they are likely to set in quicker and be more intense [5]. Throughout its history, China has frequently suffered from drought disasters due to its monsoon climate and was regularly hit hard by droughts over the last decades. Although little evidence of an expansion of the area affected by droughts was found in China over the last 50 years [6], severe droughts in southwestern China in 2010 and the middle/lower Yangtze Basin and Huaihe River Basin in 2011 have drawn more attention from the research community as well as from the public and governments alike on the impacts and problems brought on by drought. Poor performance by China’s emergency response management during recent major drought events highlights the necessity of improving both drought preparedness and emergency response skills

Comparison of first dorsal metacarpal artery flap done by consultants and residents and guidelines for improving outcome for beginners

Background: Thumb alone constitutes about 40% of hand function and trauma to distal part of thumb will thus affect the overall hand function. The goals of correction of traumatic deformities of distal thumb are to maintain adequate length and sensation along with giving a supple and stable soft tissue cover. Among other options, first dorsal metacarpal artery (FDMA) flap raised from the dorsum of the proximal part of index finger is a simple and widely used flap.Methods: We compared the results of FDMA flap done by residents (M.Ch trainees) and consultants in our institute. Residents operated upon a total of 12 patients and consultants operated upon 16 patients.Results: Among 12 patients operated by residents 3 flaps were lost and 2 flaps had marginal necrosis whereas among the patients operated by consultants 1 flap was lost and 1 had partial necrosis in distal part of the flap.Conclusions: Although there was no statistical difference between the operating time taken by trainees and consultant specialists but the complication rate is higher among the residents. Sticking with the basics of plastic surgery, FDMA flap is an excellent technique for thumb reconstruction and results are excellent as and when more experience is gained

Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

Background: Management of complicated wounds is a reconstructive challenge. A reconstructive surgeon has to be ready to face new challenges every day. Negative pressure wound therapy has revolutionized the management of complex wounds. We are presenting our experience with this wound care modality in the past 11 years.Methods: It was a prospective study conducted from January 2006 to December 2016 on patients having wounds of varied etiologies, who consented to participate in this study. Custom made low cost NPWT was used till definitive wound closure.Results: A total of 568 patients consented to participate in the study during these 11 years. No major complications were seen. Most of these were males (60.73%) in their 3rd and 4th decade. Trauma was the leading cause of wounds in 38.14%, followed by diabetic foot wounds in 21.5%. Ankle and foot was the most common site of wounds (30.92%) followed by leg (24.01%). A total of 322 small, 218 medium and 97 large size dressings were used. Most of the patients improved with the NPWT.  No major complications were seen.Conclusions: NPWT is safe, effective and has proved to be revolutionary in managing difficult wounds. With the use of customized low cost NPWT the benefit can be extended to underprivileged population in under developed nations too

Reconstruction of soft tissue defects in Fournier’s gangrene at a tertiary care centre

Background: Fournier’s gangrene is an acute and potentially lethal multi-bacterial necrotizing infection that primarily involves the scrotum but may extend beyond its confines to perineum and abdominal wall. The disease may result in sepsis and death if treatment is delayed. Management consists of timely diagnosis, aggressive debridement, broad-spectrum antibiotics followed by reconstruction which still remains a surgical challenge.Methods: It is a prospective study conducted from Jan 2006 to Dec 2015 on 29 patients of Fournier’s gangrene who were referred to the department of Plastic and Reconstructive Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, for reconstruction after initial debridement by general surgeon/urologist. The patient’s age, predisposing factors, site and the size of the defects, reconstructive options used and outcome were evaluated. Assessment of testicular function was done at 6 months by sperm count and morphology.Results: A total of 29 patients of Fournier’s gangrene consisting of 28 males and one female were included in the study. The mean age was 37 years and the most common comorbidity was diabetes mellitus in 18 patients (62%). Wounds were allowed to heal by secondary intension in 8 patients. Scrotal advancement flap was done in seven patients. Split thickness skin grafting (STSG) of extensive wounds was done in 11 patients and testes were placed in medial thigh subcutaneous pocket in one patient. Two elderly diabetic patients succumbed to sepsis and multi organ failure. Overall complication rate was 18.5%.Conclusions: Thorough debridement and early wound cover are essential in the management of Fournier’s gangrene for successful rehabilitation. Various reconstructive options are available with no conclusive evidence to support flap rather than skin graft and most of the procedures result in preservation of testicular function in the long term

Two stage flexor tendon reconstruction in hand: our experience

Background: Flexor tendon injuries in the digital flexor sheath area (zone II) are the most difficult to treat and remain a focus of both clinical attention and basic investigations. This prospective study was designed to evaluate the results of staged zone II flexor tendon repair.Methods: Seventy digits in thirty five patients were treated by Two Stage flexor tendon reconstruction and followed for an average of one and a half year. The procedure included placing a silicone catheter (cut to desire size) as an active implant and reconstruction of A2, A4 or both pulleys if damaged in first stage. During the second stage (performed three to eight months later), tendon graft replaced the silicone catheter in the pseudo sheath formed around the catheter. The proximal end of the transplanted tendon was fixed with flexor digitorum profundus tendon of respective finger using the Pulvertaft method, and the distal end of the graft was fixedwith the distal stump of respective flexor digitorum profundus tendon. Early controlled motion protocol was instituted in all cases.Results: As per Buck Gramcko scale total active motion obtained was Excellent in 70%, Good in 20%, Fair in 7.1%, and Poor in 2.9% of patients.Conclusions: Flexor tendon reconstruction using two stage tendon reconstructions is an effective way to restore digital tendon function in delayed zone II flexor tendon injuries

Closure of anterior palatal fistula using tongue flap: our experience

Background: Palatal fistula is one of the most common complications following cleft palate repair. It occurs mostly due to tip necrosis of palatal flaps. Small palatal fistulas are usually closed by transposition of adjacent tissues, however these local tissues are not sufficient for the closure of bigger fistulas. The tongue flap serves as a reliable and most easily obtainable local flap for closure of large sized palatal fistulas.Methods: This is a prospective study conducted from Aug 2006 to July 2015 in the department of Plastic & Reconstructive Surgery, SKIMS, Srinagar, Jammu Kashmir, India. A total of 25 patients with large anterior palatal fistula were treated using anteriorly based tongue flap. Patients were selected on the basis of size of fistula (> 1x1 cm), scarred local palatal tissue or history of fistula recurrence after previous attempts of closure using local palatal tissues.Results: In present study 25 patients of palatal fistula were treated using tongue flap. Eighty percent patients were in the age group of 3 to 5 years. Male-to-female ratio was 2:3. The largest dimension of treated fistula was 4x3 cm. There was partial dehiscence of flap suture line in two patients while remnant fistula was observed in three patients. None of our patients had flap necrosis.Conclusions: Tongue flap is an excellent and versatile option for closure of large palatal fistulas with high success rate and least morbidity

Production system and challenges of saline aquaculture in Punjab and Sindh provinces of Pakistan

IntroductionLack of data about saline aquaculture in Pakistan has curtailed informed policy and investment decision making resulting in undervaluation of and underinvestment in the sector. Therefore, saline aquaculture in Pakistan is today an underdeveloped sector despite its potential as an alternative livelihood for the country's rural farmers. This study represents one of the initial exploratory investigations into saline aquaculture systems in Pakistan, aiming to comprehend the existing sectoral landscape, production challenges, post-harvest constraints, and the associated capacity and investment needs.MethodsThe study employed purposive sampling to survey 121 low-income saline aquaculture farmers across five districts of Southern Punjab and Sindh provinces. The analysis was carried out using descriptive statistics.ResultsThe results revealed that the saline aquaculture sector is predominantly male-centric, with agricultural land utilized for both agriculture and aquaculture purposes. Ponds, which usually serve multiple functions, focus primarily on carp production, but adherence to good management practices remains limited. Farmers face various challenges, including the high costs of feed and seeds, freshwater scarcity, inadequate technical knowledge, and marketing issues.Discussion and conclusionThis study serves as a foundational assessment, addressing data and information gaps crucial for supporting the sustainable development of saline aquaculture in Pakistan. To facilitate such development, the study recommends initiating programs to strengthen technical skills in saline aquaculture, together with the establishment of hatcheries and breeding stations for saline-tolerant species, aiming to reduce dependence on freshwater species in saline pond environments