Political Challenges and Security Issues in FATA and its impact on Economic Development

This research paper pertains to an in depth and profound analysis of both political reforms and change extended in FATA and build up systematically, it focuses on the historical background of the tribal areas, which has the centuries old customs and tradition. The system of judiciary, political, social, economic is based on these traditions. Efforts has been made to remain focus on the measures if taken, to integrate the tribal belt in Pakistan’s mainstream and this research paper also focus on the poor level of political administration, human rights, phenomenon and socio economic developments in this deprived and marginalized area of Pakistan. There is dire need of some major steps which must be initiated by the government of Pakistan on war footing to reform the system of education, health judiciary and other services sector. Tribal belt is far behind the rest of the country in all sectors of development. The advantages of modern politicoadministration must also be extended to FATA as in other parts of the country. The areas now forming FATA had seen perhaps more invasion than any other country/area in the world. It hold some of the most chequered and fascinating events of the history

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

using world health organisation near miss approach to assess preventable maternal morbidity and mortality at a tertiary care hospital

Objectives:  To determine frequency of severe maternal complications, maternal near-miss cases and maternal deaths in obstetric patients at a tertiary care hospital using WHO near miss approach. Study Design: Cross-sectional analytical study Place and duration of study: This was conducted at obstetrics unit of CMH Kharian from Jan 2019 – June 2019 Methodology: Inclusion criteria for baseline assessment was near miss approach which comprises of severe maternal complications, critical interventions  and life threatening conditions using WHO near miss approach 2009 for case identification. Demographic and reproductive profiles including age, parity, period of gestation, booking status, mode of delivery were calculated. Women with life threatening conditions including near miss and maternal mortality cases were calculated. Severe maternal outcome ratio, maternal near miss and maternal mortality ratio, mortality to near miss ratio and mortality index was calculated. Results: There were 1054 live births. Out of which 42 were near miss cases and 04 maternal deaths. Management based criteria identified 34(80%) followed by clinical 14(33%) and laboratory criteria 02(4.7%) respectively. Maternal mortality ratio was 379/100,000 and NMMR was 39 /1000 live births. Severe maternal outcome ratio was 43.6%.For near miss cases mortality index was 8.6.MNM:MD ratio was 10.5:1. Conclusion: The study concludes that a standardized near miss criterion makes audit and comparison of results in between hospitals and even countries having the same resources possible and reproducible. Particular advantage is its uniform approach which when correctly applied produces Continuous..

Political Challenges and Security Issues in FATA and its impact on Economic Development.

This research paper pertains to an in depth and profound analysis of both political reforms and change extended in FATA and build up systematically, it focuses on the historical background of the tribal areas, which has the centuries old customs and tradition. The system of judiciary, political, social, economic is based on these traditions. Efforts has been made to remain focus on the measures if taken, to integrate the tribal belt in Pakistan's mainstream and this research paper also focus on the poor level of political administration, human rights, phenomenon and socio economic developments in this deprived and marginalized area of Pakistan. There is dire need of some major steps which must be initiated by the government of Pakistan on war footing to reform the system of education, health judiciary and other services sector. Tribal belt is far behind the rest of the country in all sectors of development. The advantages of modern politico-administration must also be extended to FATA as in other parts of the country. The areas now forming FATA had seen perhaps more invasion than any other country/area in the world. It hold some of the most chequered and fascinating events of the history.14 Halama