Assessing the Impact of Eucalyptus Plantation on Groundwater Availability in Pakistan

Eucalyptus tree was first planted in Pakistan in the 1980s under the project of Pakistan Forest Institute sponsored by United States Agency for International Development. It is not native to Pakistan's environment, so it has become a threat to the ecosystem. A mature Eucalyptus tree shape is like a shrub or tall tree. It is centered by the number of controversies like allelopathy, loss of soil fertility, the substitution of conventional forests and causing various hydro-ecological imbalances of an ecosystem. Eucalyptus tree consumes three times more water in arid and semi-arid environments, because of vapor pressure deficit. About 80% of Pakistan's area is present in the semi-arid and arid climate. Pakistan is facing a serious water shortage and rapid groundwater level depletion in many parts of the country. It is believed that species of Eucalyptus tree are extracting more groundwater than water recharge. Therefore, the present study is conducted to identify the adverse impacts of Eucalyptus plantation on the groundwater level of Lahore. Six parks in Lahore were selected as study sites, i.e., Gulshan-e-Iqbal Park, Bagh-e-Jinnah, Jillani Park, Nawaz Sharif Park, Jallo Park, and Johar Town Park. A total of 3,484 Eucalyptus trees were identified with different age groups. These trees belong to the species of Eucalyptus camaldulensis, Eucalyptus citriodora and Eucalyptus sideroxylone. The study reveals that since 1990, the groundwater level has significantly reduced in study sites. It is recommended that Eucalyptus trees may be replaced with other indigenous species so that the rate of groundwater depletion can be slowed down

Healthcare-associated infections among pediatric oncology patients in Pakistan: risk factors and outcome.

Introduction: Pediatric oncology Patients are at increased risk of contracting healthcare-associated infections (HAIs), which are responsible for increased morbidity and mortality rates as well as treatment costs. This study aimed to identify the frequency of HAIs among pediatric oncology Patients and their outcome. Methodology: Pediatric oncology Patients admitted between January 2009 and June 2010 in a pediatric ward at Aga Khan University Hospital, Karachi, Pakistan, who developed HAIs, were analyzed. Results: A total of 90 HAIs were identified in 32 Patients in 70 admissions. The HAI rate among pediatric oncology Patients was 3.1/100 admission episodes. Bloodstream infections (63 episodes, 90.0%) were the most common, followed by urinary tract infection (two episodes, 2.9%). Gram-positive infections were seen in 54 (60%) Patients, followed by Gram-negative infection in 34 (37.8%), and fungi in 2 (2.8%) cases. Coagulase negative staphylococci was the most common Gram-positive and Escherichia coli and Pseudomonas aeruginosa were most common Gram-negative infections. Mortality rate among pediatric oncology Patients who developed HAIs was 12.5% (4/32). Total parental nutrition use and length of stay longer than 30 days were the identified risk factors associated with increased mortality among pediatric oncology Patients who developed HAIs. Conclusion: We report an HAI rate among pediatric oncology Patients of 3.1/100 admission episodes with a mortality rate of 12.5% in Pakistan. Further studies should be done, especially in the developing world, to identify the risk factors associated with increased mortality among pediatric oncology Patients so that adequate measures can be taken to reduce the mortality among these Patients

Mortality patterns among critically ill children in a Pediatric Intensive Care Unit of a developing country

Background and Aim: Advances in biomedical technology have made medical treatment to be continued beyond a point, at which it does not confer an advantage but may increase the suffering of patients. In such cases, continuation of care may not always be useful, and this has given rise to the concept of limitation of life-sustaining treatment. Our aim was to study mortality patterns over a 6-year period in a Pediatric Intensive Care Unit (PICU) in a developing country and to compare the results with published data from other countries.Materials and Methods: Retrospective cohort study was conducted in a PICU of a tertiary care hospital in Pakistan. Data were drawn from the medical records of children aged 1-month - 16 years of age who died in PICU, from January 2007 to December 2012.Results: A total of 248 (from an admitted number of 1919) patients died over a period of 6 years with a mortality rate 12.9%. The median age of children who died was 2.8 years, of which 60.5% (n = 150) were males. The most common source of admission was from the emergency room (57.5%, n = 143). The most common cause of death was limitation of life-sustaining treatment (63.7%, n = 158) followed by failed cardiopulmonary resuscitation (28.2%, n = 70) and brain death (8.1%, n = 20). We also found an increasing trend of limitation of life-sustaining treatment do-not-resuscitate (DNR) over the 6-year reporting period.Conclusion: We found limitation of life support treatment (DNR + Withdrawal of Life support Treatment) to be the most common cause of death, and parents were always involved in the end-of-life care decision-making

Impact of Climate Change on Land use/Land cover of Chakwal District

Alterations in land use and land cover, either natural or anthropogenic can disturb the balance of fragile ecosystems. Climate change plays a unique role in governing the structure and state of land features and alters the structure of ecosystem as well as its services required by earth. Human health and environment are matter of concern due to changes induced by human in its natural environment (Jat et al., 2008). Human has an urge to remain near nature, for that they shift from dense urban areas to less dense areas (Western, 2001). So is the case of new housing societies where the land mafias intimate the people about new settlements (Zaman and Baloch, 2011), which are made by cutting the forests, removing trees and disturbing the ecosystem. For proper planning and management of natural resources, it is necessary to study the land cover and its associated changes (Asselman and Middelkoop, 1995). Modelling of changes within land cover to identify environmental trends on the local, national or regional level, have been realized in the scientific community (Nath et al., 2020). GIS/RS provides continuous change dynamics (Berlanga-Robles and Ruiz-Luna, 2011) of land cover/land use, i.e. by satellite monitoring (Ruiz-Ruano et al., 2016). The understanding of land cover changes is necessary for decision making (Lu et al., 2004) in the natural resource management (Seif et al., 2012). This study was carried out to identify the impact of changes in climate upon land use and land cover of Chakwal district from 1995 to 2020. Geospatial techniques were applied to estimate the differences in land features, using different time interval satellite datasets (Table 1). Six major classes of land features including, agriculture, bare land, built-up, forest, shrubs/grass and water were selected for this study, with respect to time

Multi-drug resistant gram negative infections and use of intravenous polymyxin B in critically ill children of developing country: Retrospective cohort study

Background: Patients in pediatric intensive care Units (PICU) are susceptible to infections with antibiotic resistant organisms which increase the morbidity, mortality and cost of care. To describe the clinical characteristics and mortality in patients with Multi-Drug Resistant (MDR) gram negative organisms. We also report safety of Polymyxin B use in these patients.Methods: Files of patients admitted in PICU of Aga Khan University Hospital, from January 2010 to December 2011, one month to 15 years of age were reviewed. Demographic and clinical features of patients with MDR gram negative infections, antibiotic susceptibility pattern of isolates, discharge disposition and adverse effects of Polymyxin B were recorded.Results: A total of 44.8/1000(36/803) admitted patients developed MDR gram negative infections, of which 47.2%(17/36) were male, with mean age of 3.4 yrs(+/-4.16). Acinetobacter Species (25.5%) was the most frequently isolated MDR organisms followed by Klebsiella Pneumoniae (17%). Sensitivity of isolates was 100% to Polymyxin B, followed by Imipenem (50%), and piperacillin/tazobactem (45%). The crude mortality rate of patients with MDR gram negative infections was 44.4% (16/36). Fourteen of 36 patients received Polymyxin B and 57.1%; (8/14) of them were cured. Nephrotoxicity was observed in 21.4% (3/14) cases, none of the patients showed signs of neuropathy.Conclusion: Our study highlights high rates of Carbapenem resistant gram negative isolates, leading to increasing use of Polymyxin B as the only drug to combat against these critically ill children. Therefore, we emphasizeon Stewardship of Antibiotics and continuous surveillance system as strategies in overall management of these critically ill children

Shock Pathophysiology: Classifications and Management

Shock is a pathological state in which there is an insufficiency in oxygen supply and demand. Ultimately, it results in global hypoperfusion and a resulting increase in anaerobic respiration causing lactic acidosis. Maintaining adequate oxygen delivery in the critical care setting is of primary importance in the management of a critically ill patient. When oxygen supply is inadequate, the body undergoes several physiological changes to maintain the oxygen delivery requirements and perfusion pressure. This stage is referred to as compensated shock, and early signs of shock may be appreciated during this stage. When compensatory mechanisms are inadequate and DO2 begins to fall beyond the critical point, shock has progressed to the uncompensated stage. During this stage, there is rapid deterioration of the patient due to prolonged hypoxia and anaerobic respiration. Multiple Organ Dysfunction Syndrome (MODS) is the development of potentially reversible physiological derangement involving two or more organ systems not involved in the causative disorder, which results in persisting states of shock, sepsis and hypoperfusion and a major cause of high mortality in the intensive care unit reaching a range of 11–54% in septic pediatric patients. The final stage of shock is irreversible shock, which is also referred to as refractory shock. This final stage of shock carries a 96–99% mortality rate

Abstract to publication conversion in pediatric critical care medicine in Pakistan

Background: To determine the rate of conversion of abstracts presented at conferences into full-text articles published in peer-reviewed journals in the field of pediatric critical care medicine (PCCM) in a developing country.Methods: We retrospectively reviewed PCCM abstracts from Pakistan presented at national and international pediatric and critical care conferences over 10 years (January 2010 to March 2020). Data included abstract characteristics, such as presentation (poster/oral), presenter (fellow/resident), time of meeting (month and year), type of meeting, study design and topic; and publication characteristics, such as journal name, time (month and year) and first author. The primary outcome was publication rate of PCCM abstracts presented in meetings and time (months) from presentation to publication.Results: A total of 79 PCCM abstracts were presented in 17 meetings during the study period. There were 65 poster presentations (82.28%), of which 63 (79.74%) were presented at international critical care conferences and all presenters were PCCM fellows. In total, 64 (81%) abstracts were descriptive observational studies (retrospective: 50, 63.29%) and prospective (14, 17.72%). Only one was an interventional randomized controlled trial. The publication rate of PCCM abstracts was 63.3% (50/79) and the mean time to publication was 12.39±13.61 months. The publication rate was significantly correlated to the year of publication (p \u3c0.001).Conclusion: The PCCM abstract publication rate and mean time from presentation to publication was 63.3% and 12.39±13.61 months, respectively, in a developing country