Predictors and outcome of tetanus in newborns in slum areas of Karachi city: A case control study

Background: Tetanus in newborns, is an under-reported public health problem and a major cause of mortality in developing countries. This study aimed to determine the predictors and outcome of tetanus in newborn infants in the slums of Bin-Qasim town, Karachi, Pakistan.Methods: We conducted a case-control study at primary health care centers of slums of Bin-Qasim town, area located adjacent to Bin Qasim seaport in Karachi, from January 2003 to December 2013. Cases were infants aged ≤30 days with tetanus, as defined by the World Health Organization. Controls were newborn infants aged ≤30 days without Tetanus, who were referred for a checkup or minor illnesses. The case to control ratio was 1:2.Results: We analyzed 26 cases and 52 controls. The case fatality was 70.8%. We identified four independent predictors of Tetanus in newborns: maternal education (only religious education with no formal education OR 51.95; 95% CI 3.69-731), maternal non-vaccination (OR 24.55; 95% CI 1.01-131.77), lack of a skilled birth attendant (OR 44.00; 95% CI 2.30-840.99), and delivery at home (OR 11.54; 95% CI 1.01-131.77).Conclusions: We identified several potentially modifiable socio-demographic risk factors for Tetanus in newborns, including maternal education and immunization status, birth site, and lack of a skilled birth attendant. Prioritization of these risk factors could be useful for planning preventive and cost-effective measures

Variation Analysis of Acanthopagrus latus found in the costal belt of Lasbella by using Mitochondrial DNA, D- Loop region

Background: Fish is a major source of food and plays major role in the blue economy of Baluchistan, Pakistan. The Yellow fin Sea Bream (A. latus) is found in coastal belts and locally known as “Dhandya”. Variation analysis between fish species were studied, using mitochondrial DNA. To understand genetic diversity of fish, mitochondrial DNA D-loop provides a good source of information for the management as well as the selective breeding of the sea fauna.Methods: The current study was focus on variation analysis, phenotypic and genetic variation in A. latus fish found in different region of coastal belt of Baluchistan. A total of forty-five fish  A. latus from three different areas of Baluchistan (Gaddani, Dam, and Kund Malir) were collected aseptically. The Phenotypic study was done on the bases of their body shape, body color and color of the fins. Four different kinds of A. latus  were observed and named  as type  A, B, C and D. The genetic characteristics were studied by observing the mitochondrial DNA D-loop region.Results: For Mitochondrial DNA analysis, the blood samples were collected from the selected samples and processed for DNA extraction. Primer was designed and PCR was performed. PCR products were sequenced and analyzed for observing genetic variation in mitochondrial DNA of A. latus.Conclusion: The analysis revealed three genetic variations; two heterozygous variations at 32 and 172 nucleotide positions (Adenine substituted by Thymine and Thymine substituted by Guanine) and one homozygous variation at 72 nucleotide position (an insertion of a Thymine).Keywords: Acanthopagrus latus; Mitochondrial DNA; Fish; Polymerase Chain Reaction   

Malnutrition and poor oral health status are major risks among primary school children at Lasbela, Balochistan, Pakistan

Background: This survey was focusing on health and oral hygiene status of primary school children at Lasbela district considering the comparatively less developed and socio demographically deprived part of the Country. Methods: A cross sectional survey was conducted to determine the health status of primary school children in seven tehseels of district Lasbela, Balochistan after applying proportionate sampling technique from March 2015 to July 2015. Field teams visited assigned schools to screen children and collect health related data on predesigned and pre coded proforma. Results: Out of 200 schools, 196 schools found opened, while 2% of schools (04) remained closed. A total of 6363 students were clinically screened. About 45% of the school children had normal body mass index (BMI) and rest were falling in different categories of malnutrition. More than 19% had ear, nose and throat (ENT) problems and around 19% presented with clinical anemia. Less than 50% of children had scar of BCG vaccination and 4% informed about use of gutka/supari chewing (smokeless tobacco use). Conclusion: In conclusion, we estimated high prevalence of malnutrition, poor oral health including smokeless tobacco use, and low BCG coverage among primary school children at Lasbela. Current scenario suggests immediate and contextually focused interventions to confine existing public health risks and avoid future burden of disease

Simplified antibiotic regimens for the management of clinically diagnosed severe infections in newborns and young infants in first-level facilities in Karachi, Pakistan: study design for an outpatient randomized controlled equivalence trial.

BACKGROUND: Infection in young infants is a major cause of morbidity and mortality in low-middle income countries, with high neonatal mortality rates. Timely case management is lifesaving, but the current standard of hospitalization for parenteral antibiotic therapy is not always feasible. Alternative, simpler antibiotic regimens that could be used in outpatient settings have the potential to save thousands of lives. METHODS: This trial aims to determine whether 2 simplified antibiotic regimens are equivalent to the reference therapy with 7 days of once-daily (OD) intramuscular (IM) procaine penicillin and gentamicin for outpatient management of young infants with clinically presumed systemic bacterial infection treated in primary health-care clinics in 5 communities in Karachi, Pakistan. The reference regimen is close to the current recommendation of the hospital-based intravenous ampicillin and gentamicin therapy for neonatal sepsis. The 2 comparison arms are (1) IM gentamicin OD and oral amoxicillin twice daily for 7 days; and (2) IM penicillin and gentamicin OD for 2 days, followed by oral amoxicillin twice daily for 5 days; 2250 "evaluable" infants will be enrolled. The primary outcome of this trial is treatment failure (death, deterioration or lack of improvement) within 7 days of enrollment. Results are expected by early 2014. DISCUSSION: This trial will determine whether simplified antibiotic regimens with fewer injections in combination with high-dose amoxicillin are equivalent to 7 days of IM procaine penicillin and gentamicin in young infants with clinical severe infection. Results will have program and policy implications in countries with limited access to hospital care and high burden of neonatal deaths

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

انوار احمد کے افسانوں میں جبر کے موسموں کی عکاسی(سیاسی واقعات اور ماحول کے حوالے سے)

Dr. Anwar Ahmad wrote stories not only social topics but also on the political matters, especially about the ill effects of Martial Law doctrine Ayyub when and other Dictators. In a story about the people migrating out of home land he mentions that and remits their parents. Hardly there might be any aspect of life on which Dr. Anwar Ahmad has not written, may it be love, inanity, cruelty, religious misdeed or political irregularities

Fault Protection in Microgrid Using Wavelet Multiresolution Analysis and Data Mining

The protection problems in microgrid effect the reliability of the power system caused due to high distributed generator penetrations. Therefore, fault protection in microgrid is extremely important and needs to be resolved to enhance the robustness of the power system. This manuscript proposes a combined signal processing and data mining-based approach for microgrid fault protection. In this study, first the multiresolution decomposition of wavelet transform is employed to preprocess the voltage and current signals to compute the total harmonic distortion of the voltage and current. Then, the statistical indices of standard deviation, mean, and median of the total harmonic distortion and the negative sequence components of active and reactive power are used to collect the input data. After that, all the available data is provided to the random forest-based classifier to evaluate the efficiency of the proposed scheme in terms of the detection, identification, and classification of faults. This study used different aspects for data collection by simulating various fault and no-fault cases for both looped and radial configurations under grid-connected and islanded modes of operation. The simulations were performed on a standard medium voltage microgrid using MATLAB/SIMULINK, whereas the analysis for testing and training of the random forest were conducted in Python. It is recognized that the proposed method performed better than support vector machines and decision tree that are reported in the literature. The results further demonstrate that the proposed method can also detect simultaneous faults, and it is also effective against measurement noise

A Protection Technique for Microgrid Using Wavelet Packet Transform and Data Mining Classifier

In electrical power systems, the popularity of the microgrid is significantly increasing because of its remarkable advantages. However, the microgrid often exhibits protection problems and seriously affects the reliability of power system. Hence, a proper protection strategy is extremely necessary to solve the protection issues. Therefore, this manuscript proposes a protection strategy against the faults in microgrids using a wavelet packet transform and data mining classifier. MATLAB/SIMULINK and Python are used to investigate the proposed scheme performance. It was found that the proposed technique can detect and classify different types of faults for the islanded and grid-associated modes of the microgrid

Malnutrition and poor oral health status are major risks among primary school children at Lasbela, Balochistan, Pakistan

Abstract Background This survey was focusing on health and oral hygiene status of primary school children at Lasbela district considering the comparatively less developed and socio demographically deprived part of the Country. Methods A cross sectional survey was conducted to determine the health status of primary school children in seven tehseels of district Lasbela, Balochistan after applying proportionate sampling technique from March 2015 to July 2015. Field teams visited assigned schools to screen children and collect health related data on predesigned and pre coded proforma. Results Out of 200 schools, 196 schools found opened, while 2% of schools (04) remained closed. A total of 6363 students were clinically screened. About 45% of the school children had normal body mass index (BMI) and rest were falling in different categories of malnutrition. More than 19% had ear, nose and throat (ENT) problems and around 19% presented with clinical anemia. Less than 50% of children had scar of BCG vaccination and 4% informed about use of gutka/supari chewing (smokeless tobacco use). Conclusion In conclusion, we estimated high prevalence of malnutrition, poor oral health including smokeless tobacco use, and low BCG coverage among primary school children at Lasbela. Current scenario suggests immediate and contextually focused interventions to confine existing public health risks and avoid future burden of disease