Pollen fertility estimation of some sub-tropical flora of Pakistan

A total of 46 species from 3 monocotyledon and 18 dicotyledonous families were investigated for percentage pollen fertility. The average fertility was 91.15% which showed the general stability of the flora in the study area. In the present research the highest 100% value was observed in Argyrolobium roseum (Camb.) Jaub. and Spach and the lowest 66.67% was observed in Spergularia arvensis L. The dominant families regarding number of species were: Brassicaceae having six species, whose average fertility was 91.82% and Papalionaceae having five species whose average fertility was 88.79%. The present studies showed that the flora of the area is a stable one.Key words: Pollen fertility, district tank, sub-tropical flora

Prevalence of Xerostomia in Diabetes Mellitus at lower Sindh.

Introduction: Xerostomia is a common problem in apparently normal as well as in ill individuals. Diabetes mellitus is a common endocrine disorder in which Xerostomia is complained frequently. Xerostomia contributes to altered eating habits and increase risk of dental caries and oral infection if there is inadequate blood glucose control. Factors affecting Xerostomia includes socioeconomic and medical condition, includes uncontrolled diabetes mellitus, presence of peripheral neuropathy, use of medications, gender and age. Objective: To document the prevalence of Xerostomia among diabetic patients. Methodology: This prospective, cross sectional study was conducted on known cases of Diabetes mellitus attending medical OPD at Muhammad Medical College, Mirpurkhas Sindh from March 2017 to August 2017. During this period 100 patients were included according to inclusion criteria. Demographic details were recorded. Fox questionnaire was filled in, the data collected was analyzed by SPSS version 22, and presented as number and percentage. Result:  Among100 patients; 37% were xerostomic and 63% were non xerostomic, age range of xerostomic was 50 ±7years and non xerostomic was 35 ±11 years. 21 females had Xerostomia and 29 had no Xerostomia .16 males were xerostomic, and 34 males were non xerostomic. Among xerostomic patients 15 were insulin dependent and 21 were non-insulin dependent. Where as in non xerostomic 22 were insulin dependent and 42 were non-insulin dependent. The mean duration of diabetes mellitus was 10 ±5 years in Xerostomic and it was 8 ±3 years in non xerostomic diabetes mellitus. Conclusion: Xerostomia is common in elderly diabetics and in females and is dependent on glycemic control and duration of diabetes. Key words: Xerostomia, Diabetes mellitus, Elderly and Duration of Diabetes Mellitus.&nbsp

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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Indo-Pakistan Relations During the 1971 War Era: Indo-Pakistan Relations During the 1971 War Era

Pakistan and India relations always stay on the zigzag way since the partition of the united India. The relations further gone worst during the era of 1971 while East-Pakistan and West-Pakistan’s situation gone worst. In this all game, initially, India played the hidden role which openly converted into the war between the Pakistan and India in 1971. This study shed light on the Pakistan and India relations during the said era and explores the relations between both the countries fell into hell and finally converted into war. This study highlight how the India and Pakistan conflict emerged, India’s involvement and direct engagement, naval hostilities, Attacks on Pakistan, Ground Operations, emergence of East-Pakistan and further relations gone worst

Ethnotaxonomical Approach in the Identification of Useful Medicinal Flora of Tehsil Pindigheb (District Attock) Pakistan

researchThe presented research investigated the use of folk remedies among the people of Tehsil Pindigheb, District Attock of Pakistan. During the ethnobotanical survey, we documented indigenous knowledge and collected plant specimens which included medicinal plants. Through questionnaire, ethnomedicinal data was collected from key informants and local inhabitants in randomly selected villages. One hundred plant species belonging to 44 families were recorded as medicinal flora of the area. Due to construction of new housing colonies, modern agricultural practices and cultural changes within the community, the use of traditional knowledge and medicinal plant species are threatened day by day in the area. This study will provide help in future conservation strategies

AFLP mediated genetic diversity of malvaceae species

AFLP (Amplified fragment length polymorphism) marker system is a reliable method in the evaluation of genetic diversity among different species. It was used to explore phenetic relationships and diversity within and between 13 Malvaceae species belonging to 5 different genera. The primary objective of the study was to evaluate the taxonomic potential, usefulness and applicability of AFLP marker system to reconstruct genetic relationships at interspecific and intergeneric level in Malvaceae. In total, 28 accessions comprising 13 species were included in the study but for assorted technical reasons five profiles remained incomplete or with ambiguous banding pattern. Therefore 23 accessions comprising 12 species were included in the final analysis. Two primer pairs produced a total of 73 bands, of which 70 were polymorphic. Neighbor Joining (NJ) tree showed that all 23 accessions were basically classified in three main clusters and several sub-clusters. The tree had well supported branches especially at the level of accessions and species. However, it also had poor bootsrap support at some intermediate and deeper branches. The informative value of the technique was evaluated by comparing the current results with earlier morphological and molecular investigations. Despite some poorly supported parts of the tree, most of the topologies established were in general congruence with earlier studies revealing that AFLP is a robust and reliable tool for DNA fingerprinting and detecting genetic relationships in Malvaceae at different taxonomic levels