Ultrasonographic Comparison of Previous Caesarean Scar Thickness in Second and Third Trimester of Current Pregnancy

Background: The rate of caesarean section is increasing in the world. With which there is an increase in complications of pregnancy. There is risk of the uterine rupture if there is trial of the normal delivery. The aim of study is to determine and compare previous caesarean scar thickness in second and third trimester of pregnancy. Objective(s): To determine previous caesarean scar thickness in second and third trimester of current pregnancy. Methodology: An analytical study was conducted in the Saima medical center Shalimar link road Lahore. Sixty-two patients were enrolled in this study with convenient sampling. Toshiba nemio 10 ultrasound machines with convex transducer frequency range 3.5 MHz.patients with placenta previa and twin gestation were excluded from this study. Transabdominal technique was used in this study. Data were collected through data collection sheets and was tabulated and analyzed using statistical package for the social sciences (SPSS)version 24(SPSS, IBM, Armonk, NY, United States of America) Microsoft excel. Results: A total of 62 patient were examined in the study. The age incidence of the cases in this study varied between 22 years to 36 years. The mean age of the patients in the study was 27. 2903.The mean gestational age was 27.47. The mean scar thickness at 24-28 weeks was3.3925. parity varied patient to patient.16(25.8%) females had para 2.23(37.1%) had para 3 and 16(25.8%) had para 4.3(4.8%) females had para 5 and 4(6.5%) had para 6. In the current study out of sixty-two patients 13(21%) were gravida1,24(38.7%) was gravid 2,17(27.4) were gravid 3,4(6.5%) gravid 4 and (6.5) gravid. A statistical significance difference found in mean scar thickness at 24-28 weeks of gestation and at 32-36 weeks of gestation-value = 0.000 < α = 0.05. Conclusion(s): ultrasound is the useful modality for determining scar thickness. The scar thickness of previous c section in the current pregnancy. Keywords: Analytical study, cesarean scar thickness DOI: 10.7176/JHMN/93-02 Publication date:September 30th 202

Impact of journalists’ Twitter use on their perceptions of job performance in the Pakistani context

Purpose –This study investigated factors affect the use of Twitter by Pakistani journalists and to what extent Twitter usage impact on their job performance. Design/methodology/approach –This study opted for a quantitative survey research design. The theoretical lens used in this study was the Theory of Planned Behavior (TPB), extended to include the impact of Twitter usage on job performance. A pilot-tested structured questionnaire was used to collect data from the journalists working in the mainstream media houses of Pakistan. Findings – The study’s findings revealed that the majority of the journalists leveraged the platform for tweeting and to read tweets. From the linear regression results, it was found that Twitter usage intention is influenced more by usefulness compared to perceived behaviour control, subjective norms and attitude. Moreover, the journalists’ behavioural intention was found to be a stronger predictor of Twitter usage compared to the other factors. Overall, the results denote that attitude, subjective norms, perceived behaviour controls, and behaviour intention significantly affect the journalists’ Twitter usage that improves their job performance. Originality/value – To the best of our knowledge, this is the first study conducted on Pakistani journalists’ Twitter usage and its impact on job performance by employing established theoretical lens

SEASONAL VARIATION AND RECENT STATUS OF TYPHOID FEVER IN A TERTIARY CARE HOSPITAL

ABSTRACT In many developing countries, typhoid fever is endemic. Early diagnosis is important for appropriate treatment on time

BPPO-Based Anion Exchange Membranes for Acid Recovery via Diffusion Dialysis

To reduce the environmental impact of acids present in various industrial wastes, improved and robust anion exchange membranes (AEMs) are highly desired. Moreover, they should exhibit high retention of salts, fast acid permeation and they should be able to operate with low energy input. In this work, AEMs are prepared using a facile solution-casting from brominated poly-(2,6-dimethyl-1,4-phenylene oxide) (BPPO) and increasing amounts of 2-phenylimidazole (PI). Neither quaternary ammonium salts, nor ionic liquids and silica-containing compounds are involved in the synthesis. The prepared membranes showed an ion exchange capacity of 1.1–1.8 mmol/g, a water uptake of 22%–47%, a linear expansion ratio of 1%–6% and a tensile strength of 0.83–10.20 MPa. These membranes have potential for recovering waste acid via diffusion dialysis, as the acid dialysis coefficient (UH) at room temperature for HCl is in the range of 0.006–0.018 m/h while the separation factor (S) is in the range of 16–28, which are higher than commercial DF-120B membranes (UH = 0.004 m/h, S = 24)

Exposure to low concentrations of heavy metals alone and in combination induces histopathological and genotoxic effects in fish (Labeo rohita)

Background: The terrestrial and agro-aquatic ecosystems are continuously at the pity of human's negative impacts. Extensive and indiscriminate application of agrochemicals like heavy metals, industrial wastes, germicides, drug residues and different feed additives has become serious threats to public health. The current experimental trial was executed to investigate genotoxic potential of different heavy metals in fresh water fish (Labeo rohita).Methods: A total of 120 active, healthy, free from  disease and internal parasites fish having three months of age were procured from local fish breeding center and were kept in glass aquarium having 100 liter water. After two weeks of acclimatization, fish were arbitrarily distributed and placed in different eight groups (A-H). Prior to start of experiment, acute toxicity of various heavy metals alone such as lead, cadmium, chromium and in combination (Pb +Cr), (Cr+Cd), (Cd+Pb) and (Pb+Cr+Cd) mixture were determined in-term of 96-h LC50 and lethal doses for Labeo rohita. After assessment of acute toxicity, all the fish were exposed to three sub-lethal concentrations (5, 7 and 9%) of heavy metals alone and in combinations for a period of 30 days in triplicate experiments.Results: Different clinical ailments like, increased surface breathing, loss of coordination, rapid opercular movement, erratic swimming, air gulping, jerking movement and tremors were noted in fish. Histopathological observations of gills of various fish exhibited severe microscopic alterations. Results on micronucleus assay exhibited increased frequency of formation of micronuclei in red blood cells, while comet assays showed significantly increased DNA damage in peripheral erythrocytes in-term of arbitrary units of comets, average percentile rate of damaged cell and genomic damage index.Conclusion: From the results of our experimental study, it can be concluded that fresh water fish are useful and reliable bio-indicators of heavy metal toxicity. Micronucleus and comet assays showed that heavy metals alone and in combination induced DNA damage in fish.Keywords: Labeo rohita; Heavy metals; Histopathology; Erythrocytes; DNA damag

Novel VPS13B Mutations in Three Large Pakistani Cohen Syndrome Families Suggests a Baloch Variant with Autistic-Like Features.

BackgroundCohen Syndrome (COH1) is a rare autosomal recessive disorder, principally identified by ocular, neural and muscular deficits. We identified three large consanguineous Pakistani families with intellectual disability and in some cases with autistic traits.MethodsClinical assessments were performed in order to allow comparison of clinical features with other VPS13B mutations. Homozygosity mapping followed by whole exome sequencing and Sanger sequencing strategies were used to identify disease-related mutations.ResultsWe identified two novel homozygous deletion mutations in VPS13B, firstly a 1 bp deletion, NM_017890.4:c.6879delT; p.Phe2293Leufs*24, and secondly a deletion of exons 37-40, which co-segregate with affected status. In addition to COH1-related traits, autistic features were reported in a number of family members, contrasting with the "friendly" demeanour often associated with COH1. The c.6879delT mutation is present in two families from different regions of the country, but both from the Baloch sub-ethnic group, and with a shared haplotype, indicating a founder effect among the Baloch population.ConclusionWe suspect that the c.6879delT mutation may be a common cause of COH1 and similar phenotypes among the Baloch population. Additionally, most of the individuals with the c.6879delT mutation in these two families also present with autistic like traits, and suggests that this variant may lead to a distinct autistic-like COH1 subgroup

Variable expressivity of FGF3 mutations associated with deafness and LAMM syndrome

<p>Abstract</p> <p>Background</p> <p>Recessive mutations of fibroblast growth factor 3 (FGF3) can cause LAMM syndrome (OMIM 610706), characterized by fully penetrant complete labyrinthine aplasia, microtia and microdontia.</p> <p>Methods</p> <p>We performed a prospective molecular genetic and clinical study of families segregating hearing loss linked to <it>FGF3 </it>mutations. Ten affected individuals from three large Pakistani families segregating <it>FGF3 </it>mutations were imaged with CT, MRI, or both to detect inner ear abnormalities. We also modeled the three dimensional structure of FGF3 to better understand the structural consequences of the three missense mutations.</p> <p>Results</p> <p>Two families segregated reported mutations (p.R104X and p.R95W) and one family segregated a novel mutation (p.R132GfsX26) of <it>FGF3</it>. All individuals homozygous for p.R104X or p.R132GfsX26 had fully penetrant features of LAMM syndrome. However, recessive p.R95W mutations were associated with nearly normal looking auricles and variable inner ear structural phenotypes, similar to that reported for a Somali family also segregating p.R95W. This suggests that the mild phenotype is not entirely due to genetic background. Molecular modeling result suggests a less drastic effect of p.R95W on FGF3 function compared with known missense mutations detected in fully penetrant LAMM syndrome. Since we detected significant intrafamilial variability of the inner ear structural phenotype in the family segregating p.R95W, we also sequenced <it>FGF10 </it>as a likely candidate for a modifier. However, we did not find any sequence variation, pointing out that a larger sample size will be needed to map and identify a modifier. We also observed a mild to moderate bilateral conductive hearing loss in three carriers of p.R95W, suggesting either a semi-dominant effect of this mutant allele of <it>FGF3</it>, otitis media, or a consequence of genetic background in these three family members.</p> <p>Conclusions</p> <p>We noted a less prominent dental and external ear phenotype in association with the homozygous p.R95W. Therefore, we conclude that the manifestations of recessive <it>FGF3 </it>mutations range from fully penetrant LAMM syndrome to deafness with residual inner ear structures and, by extension, with minimal syndromic features, an observation with implications for cochlear implantation candidacy.</p

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

Theoretical Perspectives and Current Challenges of Outcome-Based Education Framework

AbstractOutcome-Based education is a performance-based approach for the curriculum development, a future-oriented learner-centered ‘Empowerment Paradigm’ that empowers and endorses all learners with future success. It is an influential and tempting way of restructuring and reorganizing engineering education. Washington Accord, an International accreditation convention, an independent agreement between signatory organizations to provide an external accreditation to undergraduate engineering programs. The accredited engineering programs that qualify an engineer to enter into the practice of professional engineers are equally recognized and acknowledged by other signatory countries and responsible organizations Pakistan Engineering Council (PEC) is a full signatory to the Washington Accord and a regulatory organization for the accreditation of engineering programs in Pakistan. To keep up the permanent membership status, it is the requirement of PEC to implement Outcome-Based in engineering degree awarding institutes in Pakistan. The main aim of Outcome-Based education in engineering education is to empower engineering students with the essential characteristics required to switch themselves into the engineering profession as a global and professional engineer. The focus of current research is to explore the philosophical and theoretical underpinnings of Outcome-Based education. Moreover, to unveil the current challenges in the implementation of OBE framework in engineering education.

Impact of journalists’ Twitter use on their perceptions of job performance in the Pakistani context

Purpose –This study investigated factors affect the use of Twitter by Pakistani journalists and to what extent Twitter usage impact on their job performance. Design/methodology/approach –This study opted for a quantitative survey research design. The theoretical lens used in this study was the Theory of Planned Behavior (TPB), extended to include the impact of Twitter usage on job performance. A pilot-tested structured questionnaire was used to collect data from the journalists working in the mainstream media houses of Pakistan. Findings – The study’s findings revealed that the majority of the journalists leveraged the platform for tweeting and to read tweets. From the linear regression results, it was found that Twitter usage intention is influenced more by usefulness compared to perceived behaviour control, subjective norms and attitude. Moreover, the journalists’ behavioural intention was found to be a stronger predictor of Twitter usage compared to the other factors. Overall, the results denote that attitude, subjective norms, perceived behaviour controls, and behaviour intention significantly affect the journalists’ Twitter usage that improves their job performance. Originality/value – To the best of our knowledge, this is the first study conducted on Pakistani journalists’ Twitter usage and its impact on job performance by employing established theoretical lens