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

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

Diagnostic Accuracy of TCD/AC Ratio in Predicting Intrauterine Growth Retardation

Background: Fetal growth assessment is necessary for prediction of fetal health during pregnancy. Aim: To determine the diagnostic accuracy of transcerebellar diameter / abdominal circumference ratio in predicting intrauterine growth retardation after 20 weeks gestation taking birth weight as gold standard. Study design: Cross sectional study. Methodology: Present study was conducted at Department of Obstetrics &amp; Gynecology, Combined Military Hospital Kharian. Patients (n=80) with an age range of 18-40 years with singleton pregnancies at 20 weeks gestation were enrolled. All patients were assessed by ultrasound and TCD/AC ratio was calculated. All patients followed till birth and actual birth weight was obtained. All this information was recorded on Performa. Statistical analysis: Data was analyzed using SPSS version 26. Results were presented as frequency and percentage. Age was presented as mean± SD. Results: The mean age of patients was 28.61±5.72 years. The mean gestational age was 21.96±1.50 weeks. For prediction of IUGR, TCD/AC had sensitivity, specificity, PPV, NPV &amp; diagnostic accuracy of 85.29%, 91.3%, 87.88%, 89.36% &amp; 88.75%, respectively. Conclusion: It was concluded that TCD/AC ratio is an accurate diagnostic tool accuracy for prediction of IUGR during pregnancy. Keywords: Transcerebellar Diameter, Abdominal Circumference, Intrauterine Growth Retardation and Birth Weight.</jats:p

Importance of Intermittent Cardiotocographic Monitoring Prior to Misoprostol-Assisted Induction of Labour

Aim: To determine the importance of intermittent cardiotocographic monitoring during misoprostol-assisted induction of labour in pregnancies lasting weeks or more. Methods: This descriptive study was carried out in the Obstetrics and Gynecology department of Combined Military Hospital, Kharian Cantt for the duration from January 2022 to August 2022 among 130 primigravida patients underwent CTG before receiving transvaginal dose of misoprostol. Neonatal admissions, the mode of delivery, the Apgar score, and indications of induction were the variables examined. Results: Forty-two (70%) of the C-section patients had reassuring CTG and significantly low Apgar scores at 1 minute. Seven (8.5%) of the patients with thick meconium had non-reassuring CTG. Twelve neonates (9.2%) in total required resuscitation, 9 (75%) of whom had reassuring CTGs while 3(25%) had non-reassuring CTGs. The overall admission rate in NICU was 10%, and 38.5% of neonates that required resuscitation had non-reassuring CTG. Neonatal mortality was nil during the study time. Conclusions: Patients who had their labour induced with misoprostol had non-reassuring CTG among 50% of cases and had thick meconium stained liquor. Therefore, we can lower neonatal morbidity and mortality by early foetal impairment detection. Neonatal mortality was nil during the study time. Keywords: cardiotocography, induction, resuscitation, Apgar score and caesarean section</jats:p

Incidence And Risk Factors Of Maternal And Fetal Outcomes Among Patients Of Placenta Previa With And Without Placenta Accreta

Objective: The aim of the study was to evaluate maternal and fetal outcomes among patients of placenta previa (PP) with and without placenta accreta (PA). Methodology: All patients who underwent cesarean section for PP and PA were analyzed retrospectively at a tertiary care Combined Military Hospital Kharian, Pakistan, from February 2015 to March 2018. Maternal and neonatal data were obtained from medical records and the hospital database system. Results: PA was found in 37 patients from 111 patients of PP and 74 were without PA with the rate of approximately 2/1000 and 4/1000 respectively were included in the study. The mean age was 31.16±2.65 (range 22–37) years, mean gravidity of 3.69 ±1.40 (range 1 - 9), mean parity 2.57±1.01 (range 1–5), mean number of cesarean sections 2.10±0.66, (range 1-3) and a mean gestational age at the time of cesarean section was 35.65±2.46 (range 28–41) weeks. The maternal risk factors revealed marked differences between placenta previa with accreta and without accrete. The mean intraoperative blood loss in PA was 3,000ml, with a loss of 2,000ml occurring in 60%, and 3,000 ml in 21% of the PA cases. The mean pRBC transfusion was 4 units, while 17% received 6 units. Fetal growth restriction was not seen. A total of 12 neonates were admitted in NICU, with 03 neonatal deaths. There was no maternal death. Neonates born to women with placenta accreta had significantly lower birth weight, Apgar scores at 1 min and 12% required admission to NICU with 3 neonatal deaths. Conclusion: The advanced maternal age, past cesarean or uterine surgery, high parity as well as multiple gravidity were the risk factors for adverse fetal and maternal outcomes.</jats:p

A retrospective study of zoonotic tuberculosis among livestock farmers of Lahore district using one health approach

Objectives: Tuberculosis (TB) affects humans and animals regardless of species type, causing huge economic losses and deaths worldwide. However, the mechanisms and risk factors of zoonotic transmission are not well known in Pakistan. The current study aimed to identify the potential risk factors associated with TB in farmers and their animals, particularly exposure to infected animals in Lahore District, Pakistan. Materials and Methods: The study consisted of two components utilizing the concept of One Health. In the first component, a retrospective case-control study of human subjects (cases = 25, control = 25) was conducted from December 2021 to July 2022. In the second component, a cross-sectional analysis of the cattle owned by selected participants (TB cases and healthy controls) was completed in the Lahore district. A single intradermal tuberculin skin test was used to determine TB infection in cattle. Results: A total of 25 TB cases and 25 healthy controls were enrolled. Males in cases were found (OR = 0.01, 95% CI: 0.0002–0.29, p = 0.014) less likely to get TB, cases older than 35 years (OR = 1.13 (95% CI: 1.05–1.24, p = 0.004), unmarried cases (OR = 32.20, 95% CI: 2.92–819.03, p = 0.014), being a smoker (OR = 21.87, 95% CI: 2.80–395.82, p = 0.011), and keeping animals inside the home (OR = 9.92, 95% CI: 1.29–134.61, p = 0.047) were identified as significant predictors of TB in humans in the final multivariable logistic regression. Out of 175 tested animals, 3/65 animals belonging to the cases and 1/110 animals belonging to the controls were found positive. The animals belonging to the TB cases were (OR = 7.76, 95% CI; 0.79–76.02) more likely to have a positive Single Comparative Intradermal Tuberculin Test. The prevalence of bTB in animals belonging to the cases was 4.6% (95% CI, 1.26–12.58) compared to 0.9% (95% CI, 0.04–4.67) in animals of the control group. Conclusion: This study identified potential risk factors that could contribute to the complex wave of TB transmission between humans and animals. Our findings could provide data to inform policy-making and intervention strategies to reduce TB&apos;s burden in both populations. Embracing a holistic One Health perspective is imperative to effectively combat this shared health threat. [J Adv Vet Anim Res 2024; 11(4.000): 967-978

Morphoanatomical and Physiological Adaptations of Triticum aestivum L. against Allelopathic Extract of Trianthema portulacastrum L. (Horse purslane)

Weed infestation can be harmful to crop growth and cause severe losses in yield by absorbing nutrients and releasing inhibitory secondary metabolites and thus needs to be controlled for food security. The use of synthetic herbicides is one of the most widely applied methods, but its frequent usage is a serious threat to health and the environment and develops resistance in weeds. Allelopathy is an eco-friendly bio-control method, and Trianthema portulacastrum extracts are known to be effective against various weeds in the crop of Triticum aestivum (wheat), but their effect on the main crop (wheat) is still unknown. The pot experiment was carried out, and various concentrations (30, 60, and 100%) of root and shoot extracts of T. portulacastrum and a synthetic herbicide (Metafin Super) along with control (distilled water) were applied to the wheat plants. Various morphological, physiological, and anatomical parameters were recorded under natural conditions. The objective of this study was to explore the allelopathic impact of T. portulacastrum compared to the synthetic herbicide on the growth of wheat. This study displayed that various growth characteristics of wheat were significantly affected at p = 0.05 by root and shoot water extracts of T. portulacastrum but were less inhibitory as compared to the synthetic herbicide. This inhibition of the growth of wheat was coupled with a significant increase in total free amino acids, K ions, CAT (catalase), proline, epidermal and cortical thickness, and abaxial stomatal density. In addition, a reduction in growth parameters was correlated with a decrease in photosynthetic pigments. This study revealed that the use of T. portulacastrum extracts could be safer than synthetic herbicides for wheat plants and would be beneficial to control weeds in a wheat field