Spatial Environmental Criteria for Siting Industries

The paper presents the solution for identifying appropriate locations for industrial setup in Lahore districtusing GIS based multi-criteria decision analysis as decision support tool (DST). Several environmental indicators wereused in this study including air quality index, water quality index, landcover, and built-up/settlements. Thematic layerswere developed for these indicators followed by analysis in ArcGIS software’s model builder using various geoprocessing techniques. As a result the study area is divided into four types of zones (e.g., not suitable, less suitablemoderately suitable and suitable) depending on environmental criteria and industrial categorization. The results revealthat 52 % of district area goes to environmentally sensitive zone . In remaining areas possibility of setting industrieswith their pollution index is proposed. The areas are proposed considering the industry categories such as schedule Iindustries which are air emission industries and Schedule II industries which are effluent discharge industries as persectoral guidelines of Pakistan

Use of miltefosine in the treatment of visceral leishmaniasis in children at a tertiary care hospital of Karachi

Existing standard treatment options for visceral leishmaniasis are less than optimal. We report here the use of oral miltefosine in the treatment of two paediatric cases of visceral leishmaniasis at a tertiary care hospital in Karachi, Pakistan. One patient came from Balochistan while the second patient was from Northern Pakistan. Both presented with a prolonged history of fever, massive hepatosplenomegaly, anaemia and thrombocytopenia. Visceral leishmaniasis was diagnosed with bone marrow studies. Amphotericin B was first started in the first patient; however severe hypokalaemia and allergic reaction occurred. Oral miltefosine was then administered. The child showed clinical improvement with regards to signs of leishmania infection but succumbed to a nosocomial infection during the hospital stay. In the second patient, miltefosine was started in the first instance. He showed remarkable clinical improvement. At 2 months follow-up, the child showed adequate weight gain along with successful resolution of hepatosplenomegaly and fever. Miltefosine has the potential to be considered a first line therapy for visceral leishmaniasis in developing countries; however larger studies are warranted to validate the trends observed in this small case series

Practice of standard Cross Infection Protocol in Private Dental Clinics of Khyber Pakhtunkhwa, Pakistan: A cross-sectional study

Background: Infection control, which is considered to be the backbone of dentistry, has become a particularly essential piece of dental training because both the dentists and patients are at an expanded danger of cross-contamination. Dental clinical settings represent a high organic hazard of spreading a wide scope of microorganisms. The objective of this study is to gather information of different dentists regarding their practice of standard cross infection protocols and how can they improve the same in their private practices. Materials and Methods: This cross-sectional study was conducted in dental clinics of Khyber Pakhtunkhwa, KPK from January 2020 to July 2020 by distributing a questionnaire among dentists. It was a pre-designed questionnaire that was circulated in Google forms through Whatsapp and emails. The questionnaire was divided into 2 sections. Data was compiled and statistical tests were applied using the Statistical Package for Social Sciences SPSS® ver.23.0 Results: Regarding cross infection control measures, maximum dentists seem to have knowledge of cross infection control techniques. A significant difference was found (p= 0.05) between male & female dentists in disposing dental waste from clinical set up properly. A significant difference was also found between male & female dentists about rubber dam isolation (p=0.02). Conclusion: The result of this study showed that practice of dentists in KPK is not up to standard protocols of cross infection control. In this way, the need of great importance is to authorize and execute better proportions of infection control to improve dental practice in KPK. Key words: Infection control, Dental practice, Sterilizatio

Conservative Bridge Preparation By Using Natural Tooth As A Pontic With Ribbond Fiber: A Case Report At IIDH Islamabad

Summary: Traumatic damage to anterior teeth is a common form of dental injury, particularly in younger people. The abutment teeth only need to be slightly prepared for the conservative bridge preparation, as the name suggests. The final prosthesis can be fixed to the adjacent natural teeth in no time. This case reports a chair-side conservative and esthetic restoration in a 19-year-old girl who came with grade 3 mobility in her upper left central incisor by using her natural tooth as a pontic with ribbond fibre. Keywords: Conservative, Dental trauma, Ribbond fiber

A Generalized Class of Circular Designs Strongly Balanced for Neighbor Effects

Minimal strongly balanced neighbor designs are useful (i) to minimize the bias due to neighbor effects economically, and (ii) to estimate the direct effect and neighbor effects independently. Such designs can easily be obtained for v odd and are available in literature. In this article, A generalized class of minimal circular designs strongly balanced for neighbor effects in blocks of equal and two different sizes have been constructed in which only v/2 unordered pairs of treatments do not appear as neighbors, where v is the number of treatments

Some New Constructors of Circular Strongly Generalized Neighbor Designs

Minimal strongly balanced neighbor designs are well known designs to balance the neighbor effects at low cost as well as to estimate the direct effects and neighbor effects independently for v odd, where v is number of treatments to be compared. Minimal strongly generalized neighbor designs are used to minimize the bias due to neighbor effects for v even. In this article, constructors are developed to construct two useful classes of minimal circular strongly generalized neighbor designs

A Comparative Evaluation Of Premedication With Flurbiprofen And Prednisolone On Post Endodontic Pain In Teeth With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial

Background: Root canal treatment is an endodontic procedure that encompasses cleaning & shaping i.e. preparation of root canals followed by obturation of the prepared canals. Pain is a very common sensation that occurs few hours after root canal treatment (RCT). Objective: To evaluate and compare the efficacy of premedication with flurbiprofen and prednisolone on post-endodontic pain in teeth with symptomatic irreversible pulpitis. Materials and Methods: It is a randomized control trial study conducted in the department of Operative Dentistry & Endodontics, Sardar Begum Dental College, & Hospital Peshawar. Patients were randomly allocated into two groups i.e. A and B using coin flip technique. Thirty minutes before starting the endodontic therapy, single pretreatment dose of Flurbiprofen (100mg) was given to patients in Group A and Prednisolone (30mg) to patients in Group B. Patients’ pain intensity experience was measured using the visual analog scale (VAS) after root canal treatment. They were instructed to complete a pain diary at specific intervals (i.e. at 6, 12 and 24 hours after the commencement of treatment) in order to determine efficacy in both groups. Results: As per efficacy in both groups, in Group A, 44 (55%) showed effective results whereas in Group B, only 20 (25%) patients showed effective results. Conclusion: Single pretreatment dose of flurbiprofen has a more sustained effect in reducing post-endodontic pain as compared to prednisolone

Evaluation the effectiveness of abridged IMNCI (7-Day) course v standard (11-Day) course in Pakistan

Background: The conventional IMCI training for healthcare providers is delivered in 11 days, which can be expensive and disruptive to the normal clinical routines of the providers. An equally effective, shorter training course may address these challenges.Methods: We conducted a quasi-experimental study in two provinces (Sindh and Punjab) of Pakistan. 104 healthcare providers were conveniently selected to receive either the abridged (7-day) or the standard (11-day) training. Knowledge and clinical skills of the participants were assessed before, immediately on conclusion of, and six months after the training.Results: The improvement in mean knowledge scores of the 7-day and 11-day training groups was 31.6 (95% CI 24.3, 38.8) and 29.4 (95% CI 23.9, 34.9) respectively, p = 0.630 while the improvement in mean clinical skills scores of the 7-day and 11-day training groups was 23.8 (95% CI: 19.3, 28.2) and 23.0 (95% CI 18.9, 27.0) respectively, p = 0.784. The decline in mean knowledge scores six months after the training was - 12.4 (95% CI - 18.5, - 6.4) and - 6.4 (95% CI - 10.5, - 2.3) in the 7-day and 11-day groups respectively, p = 0.094. The decline in mean clinical skills scores six months after the training was - 6.3 (95% CI - 11.3, - 1.3) in the 7-day training group and - 9.1 (95% CI - 11.5, - 6.6) in the 11-day group, p = 0.308.Conclusion: An abridged IMNCI training is equally effective as the standard training. However, training for certain illnesses may be better delivered by the standard course

Nash-wo-Numa (childhood growth & development) study protocol: Factors that impact linear growth in children 9 to 15 years of age in Matiari, Pakistan

Introduction: Adolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation to linear growth and mental health. Data on the global burden of stunting after 5 years of age are limited, but estimates suggest up to 50 per cent of all adolescents in some LMIC are stunted. Additionally, many LMIC lack robust mental health care delivery systems. Pakistan has one of the world\u27s largest populations of adolescents (10 to 19 years) at approximately 40 million. The Nash-wo-Numa study\u27s primary objective is to assess the prevalence and risk factors for stunting among early adolescents in rural Pakistan. The study also aims to determine the prevalence of poor mental health and identify factors associated with common mental health concerns during the childhood to adulthood transition.Methods: This cross-sectional study will include girls (n= 738) 9.0 to 14.9 years of age and boys (n=687) 10.0 to 15.9 years of age who live in the rural district of Matiari, Pakistan. Participants will be assessed for anthropometrical measures, puberty development, nutritional biomarkers as well as symptoms of depression, anxiety and trauma using validated scales.Ethics and Dissemination: The proposed study aims to complete the picture of child and adolescent health concerning linear growth and mental health by including puberty indicators. Ethics approval has been granted by the Ethics Review Committee at the Aga Khan University, Karachi, Pakistan, #5251-WCH-ERC-18 and Research Ethics Board at SickKids Hospital, Toronto, Canada, #:1000060684. Study results will be presented at relevant conferences and published in peer-reviewed journals

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