Challenges of sustainable wastewater management in Pakistan : a case study of Faisalabad

For several decades, achieving global development goals that reflect community needs has been the focus of development and conservation approaches; currently, special attention has been paid to water- and sanitation-related goals. Sustainable wastewater management, a target under the Sustainable Development Goals (SDG 6, 6.3) has fostered a debate on its complex role in sustainable development. Exploring the gaps between the real situation and the proposed one regarding sustainable wastewater management (zero pollution) would guide the developing world towards the right steps for improvements in the water and sanitation sector. Gaps exist in the literature about sustainable wastewater management, particularly with reference to developing countries. Against this background, the aim of this study was to investigate the challenges in sustainable wastewater management in Pakistan, more specifically in Faisalabad. These challenges, which require the attention of policymakers in Pakistan, include the following: untreated dumping of wastewater (domestic or industrial); overexploitation of groundwater; lacking clean drinking water and sanitation facilities; a weak legal framework to prosecute polluters; governance challenges in administrative agencies; and public health concerns. The study was conducted in urban and peri-urban areas of Faisalabad, Pakistan. Faisalabad is located in a semiarid region and is facing water scarcity issues. Industrial development, particularly in the textile sector, and rapid urbanization within this region, are posing threats to groundwater sources (due to intensive pumping), surface water sources (due to untreated dumping of wastewater), human health, and the environment (due to untreated reuse of wastewater). While these problems are widely recognized, there are major knowledge gaps on how to address them so as to ensure a sustainable wastewater management. The case study examines four main aspects of wastewater management: the interaction of wastewater with human health and the environment, existing formal rules for wastewater management, the institutional framework that governs wastewater management, and future development schemes and policies for better management. The first objective of the study was to evaluate the influence of poor wastewater management on the community and natural resources (at the micro-level). For this purpose, wastewater-irrigated areas were selected. The second goal was to evaluate gaps in the legal framework of wastewater management in Faisalabad. Identifying the challenges in urban wastewater management in Faisalabad was the third objective. The last objective was to review the current and potential future policy interventions within the context of the study area. Applying a case study design, this in-depth study explored the role of all stakeholders (administrative departments, individuals, industrialist, wastewater irrigators, etc.) linked with wastewater management. A multiphase data collection approach using mixed methods was used for the in-depth investigation. A framework was developed, which enabled the researcher to evaluate the current state of wastewater management and to identify the gaps to achieve sustainable wastewater management. The first phase of data collection comprised a household survey and a chemical analysis of soil, irrigation water and groundwater across three categories of different sources of irrigation water: industrial wastewater, domestic wastewater, and canal water. Data was collected in the peri-urban areas of Faisalabad. The household survey data were analyzed using descriptive analysis, statistical comparative analysis, and econometric analysis techniques. For the review of the current legal framework, desk research was carried out with the aim to critically analyze regulations, based on secondary sources. The second phase of data collection incorporated qualitative data collection tools, specifically in-depth interviews, focus group discussions, and a participatory mapping tool called net-mapping. These data collected from diverse stakeholders were evaluated using a content analysis approach to explore and identify the challenges in wastewater management. The institutional analysis was based on a conceptual framework, which was derived from the Institutional Analysis and Development (IAD) Framework. In addition to institutional analysis, historical developments of institutions (historical institutionalism approach) and their governance failures (discourse analysis of newspaper articles) were also analyzed. Finally, on this basis, possible policies to improve the current situation of wastewater management in Faisalabad were derived. The review of secondary data of wastewater management in Faisalabad showed that only 20 percent of the wastewater generated in Faisalabad was treated. A single treatment plant treated only domestic wastewater. The study showed that mostfarmers preferred to apply untreated domestic wastewater because the treated wastewater was more saline and had less organic content as compared to untreated domestic wastewater. During the last decade, without any drastic change in demographics and industries in Faisalabad, the volume of generated wastewater doubled. Most industry plants dilute their effluents by adding saline groundwater to their effluents before dumping it to drains. Evidence showed that wastewater reuse and dumping of untreated wastewater in Faisalabad increased. The evidence indicates that, despite all efforts to resolve the problem, wastewater management (generation, collection, treatment, and reuse) in Faisalabad has deteriorated in recent years. The results from the household survey across three categories of water (industrial wastewater, domestic wastewater, and canal water) in Faisalabad confirmed the problematic use of untreated wastewater for irrigation and its impact on human health and the environment. Irrigation with domestic wastewater was associated with a higher income and therefore contributed to food security, which underlines the farmers preference for this type of water. On the contrary, industrial wastewater negatively affected farm households. Thus, the results showed that there is a demand to reuse wastewater in agriculture, which needs proper management to reduce the risks involved. It was concluded that policies required for each site will be different depending on the quality of the wastewater and local conditions of the sites. No single model is fit for all conditions. The review of the current legislation led to the identification of several gaps, which favored violators or rules and polluters. Although sustainable wastewater management had been addressed through scattered clauses in various pieces of formal legislation, rules were not comprehensively legislated or enforced. The study showed that the difficulty in timely testing disposed wastewater and the lengthy legal process made proper law enforcement practically impossible. Therefore, violators used these implementation gaps to avoid fines and punishments. Local awareness and presence of a local pressure groups at the time of legislation could have reduced gaps in legislation and in law enforcement. Using governance and evaluative criteria (derived from the IAD framework), social and governance challenges regarding wastewater management in Faisalabad were comprehensively assessed. Furthermore, the historical institutionalism approach helped to identify the in-built challenges of administrative institutions. The most important challenge identified in the study was the low capacity of implementing agencies due to human, technical, and financial limitations. Moreover, the urban planning of Faisalabad completely failed during the previous decades, which resulted in scattered industrial clusters throughout the residential areas. Such poor planning restricted proper management, treatment, and reuse of effluents. In addition, the institutional analysis showed that the public organizations and agencies had weak administrative linkages among each other. The study also indicated that a problematic institutional environment, including nepotism and interference in office affairs, influenced how the public organizations operated. It was concluded that a comprehensive strategy is needed for improved wastewater management, which needs to address simultaneously issues of institutional and technical feasibility, economics, social acceptability and environmental sustainability. Future studies could further explore such comprehensive strategies within the context of developing countries.Seit mehreren Jahrzehnten steht die Erreichung globaler Entwicklungsziele, die den Bedürfnissen der Gemeinschaft entsprechen, im Mittelpunkt der Entwicklungs- und Erhaltungsansätze; derzeit wird den wasser- und sanitärbezogenen Zielen besondere Aufmerksamkeit geschenkt. Die nachhaltige Abwasserentsorgung, ein Ziel im Rahmen der Ziele für nachhaltige Entwicklung (SDG 6, 6.3), hat eine Debatte über ihre komplexe Rolle bei der nachhaltigen Entwicklung angeregt. Die Untersuchung der Lücken zwischen der tatsächlichen und der vorgeschlagenen Situation in Bezug auf eine nachhaltige Abwasserentsorgung (Null-Verschmutzung) würde die Entwicklungsländer zu den richtigen Schritten zur Verbesserung des Wasser- und Abwassersektors führen. In der Literatur gibt es Lücken in der nachhaltigen Abwasserentsorgung, insbesondere in Bezug auf Entwicklungsländer. Vor diesem Hintergrund war es das Ziel dieser Studie, die Herausforderungen einer nachhaltigen Abwasserentsorgung in Pakistan, insbesondere in Faisalabad, zu untersuchen. Zu diesen Herausforderungen, die die Aufmerksamkeit der politischen Entscheidungsträger in Pakistan erfordern, gehören unter anderem: unbehandelte Einleitung von Abwasser (ob in Haushalten oder in der Industrie); Übernutzung des Grundwassers; Mangel an sauberem Trinkwasser und sanitären Einrichtungen; ein schwacher Rechtsrahmen für die Verfolgung von Verursachern; Herausforderungen für die Verwaltung von Verwaltungsbehörden und Belange der öffentlichen Gesundheit. Die Studie wurde in städtischen und peripheren Gebieten von Faisalabad, Pakistan, durchgeführt. Faisalabad liegt in einer semiariden Region und ist mit Wasserknappheit konfrontiert. Die industrielle Entwicklung, insbesondere im Textilsektor, und die rasante Urbanisierung in dieser Region stellen eine Bedrohung für die Grundwasserquellen (durch intensives Pumpen), die Oberflächenwasserquellen (durch unbehandeltes Einleiten von Abwasser), die menschliche Gesundheit und die Umwelt (durch unbehandelte Wiederverwendung von Abwasser) dar. Obwohl diese Probleme allgemein anerkannt sind, gibt es große Wissenslücken, wie man sie angehen kann, um eine nachhaltige Abwasserbewirtschaftung zu gewährleisten. Die Fallstudie untersucht vier Hauptaspekte der Abwasserentsorgung: die Wechselwirkung von Abwasser mit der menschlichen Gesundheit und der Umwelt, bestehende formelle Regeln für die Abwasserentsorgung, den institutionellen Rahmen, der die Abwasserentsorgung regelt, sowie künftige Entwicklungsprogramme und -strategien für eine bessere Bewirtschaftung. Das erste Ziel der Studie war es, den Einfluss einer schlechten Abwasserentsorgung auf die Gemeinschaft und die natürlichen Ressourcen (auf der Mikroebene) zu bewerten. Zu diesem Zweck wurden abwasserbewässerte Bereiche ausgewählt. Das zweite Ziel war die Bewertung von Lücken im rechtlichen Rahmen der Abwasserwirtschaft in Faisalabad. Die Identifizierung der Herausforderungen in der städtischen Abwasserentsorgung in Faisalabad war das dritte Ziel. Das letzte Ziel war es, die aktuellen und potenziellen zukünftigen politischen Interventionen im Rahmen des Untersuchungsgebietes zu überprüfen. Anhand eines Fallstudienentwurfs untersuchte diese eingehende Studie die Rolle aller Beteiligten (Verwaltungsabteilungen, Einzelpersonen, Industrielle, Abwasserbewässerer usw.) im Zusammenhang mit der Abwasserwirtschaft. Für die eingehende Untersuchung wurde ein mehrstufiger Datenerfassungsansatz mit gemischten Methoden verwendet. Es wurde ein Rahmen entwickelt, der es dem Forscher ermöglicht, den aktuellen Stand der Abwasserbewirtschaftung zu bewerten und die Lücken für eine nachhaltige Abwasserbewirtschaftung zu identifizieren. Die erste Phase der Datenerhebung umfasste eine Haushaltserhebung und eine chemische Analyse von Boden, Bewässerungswasser und Grundwasser über drei Kategorien von verschiedenen Quellen von Bewässerungswasser: Industrieabwasser, Haushaltsabwasser und Kanalwasser. Die Daten wurden in den Randgebieten von Faisalabad erhoben. Die Daten der Haushaltsumfrage wurden mit Hilfe von deskriptiver Analyse, statistisch vergleichender Analyse und ökonometrischer Analysetechnik analysiert. Für die Überprüfung des aktuellen Rechtsrahmens wurde Desk Research mit dem Ziel durchgeführt, Vorschriften auf der Grundlage von Sekundärquellen kritisch zu analysieren. Die zweite Phase der Datenerhebung beinhaltete qualitative Datenerfassungsinstrumente, insbesondere Tiefeninterviews, Fokusgruppen-Diskussionen und ein partizipatives Mapping-Tool namens Net-Mapping. Diese Daten, die von verschiedenen Interessengruppen gesammelt wurden, wurden mit Hilfe eines Inhaltsanalyseansatzes ausgewertet, um die Herausforderungen in der Abwasserwirtschaft zu erforschen und zu identifizieren. Die institutionelle Analyse basierte auf einem konzeptionellen Rahmen, der aus dem Institutional Analysis and Development (IAD) Framework abgeleitet wurde. Neben der institutionellen Analyse wurden auch historische Entwicklungen von Institutionen (historischer Institutionalismusansatz) und deren Governance-Fehler (Diskursanalyse von Zeitungsartikeln) analysiert. Schließlich wurden auf dieser Grundlage mögliche Maßnahmen zur Verbesserung der aktuellen Situation der Abwasserwirtschaft in Faisalabad abgeleitet. Die Überprüfung der Sekundärdaten der Abwasserwirtschaft in Faisalabad ergab, dass nur 20 Prozent des in Faisalabad anfallenden Abwassers behandelt wurden. Eine einzige Kläranlage behandelte nur häusliches Abwasser. Die Studie zeigte, dass die meisten Landwirte es vorzogen, unbehandeltes häusliches Abwasser einzusetzen, da das behandelte Abwasser salzhaltiger und organischer als unbehandeltes häusliches Abwasser war. In den letzten zehn Jahren hat sich die Menge des anfallenden Abwassers ohne drastischen demographischen und industriellen Wandel in Faisalabad verdoppelt. Die meisten Industrieanlagen verdünnen ihre Abwässer, indem sie salzhaltiges Grundwasser zu ihren Abwässern hinzufügen, bevor sie es in die Kanalisation gelangen lassen. Es zeigte sich, dass die Wiederverwendung von Abwasser und die Einleitung von unbehandeltem Abwasser in Faisalabad zunahmen. Die Belege deuten darauf hin, dass sich die Abwasserbewirtschaftung (Erzeugung, Sammlung, Behandlung und Wiederverwendung) in Faisalabad trotz aller Bemühungen zur Lösung des Problems in den letzten Jahren verschlechtert hat. Die Ergebnisse der Haushaltsumfrage über drei Wasserkategorien (Industrieabwässer, Haushaltsabwässer und Kanalwasser) in Faisalabad bestätigten die problematische Verwendung von unbehandeltem Abwasser zur Bewässerung und seine Auswirkungen auf die menschliche Gesundheit und die Umwelt. Die Bewässerung mit häuslichem Abwasser war mit einem höheren Einkommen verbunden und trug somit zur Ernährungssicherheit bei, was die Präferenz der Bauern für diese Art von Wasser unterstreicht. Im Gegenteil, Industrieabwässer belasteten die landwirtschaftlichen Haushalte. So zeigten die Ergebnisse, dass es einen Bedarf an Wiederverwendung von Abwasser in der Landwirtschaft gibt, die ein angemessenes Management benötigt, um die damit verbundenen Risiken zu reduzieren. Es wurde der Schluss gezogen, dass die für jeden Standort erforderlichen Maßnahmen je nach Qualität des Abwassers und den örtlichen Gegebenheiten der Standorte unterschiedlich sein werden. Kein einziges Modell ist für alle Bedingungen geeignet. Die Überprüfung der aktuellen Gesetzgebung führte zur Identifizierung mehrerer Lücken, die Verletzer oder Regeln und Verursacher begünstigten. Obwohl eine nachhaltige Abwasserentsorgung durch verstreute Klauseln in verschiedenen formalen Gesetzen angesprochen wurde, wurden die Vorschriften nicht umfassend gesetzlich geregelt oder durchgesetzt. Die Studie zeigte, dass die Schwierigkeit, das entsorgte Abwasser rechtzeitig zu testen, und das langwierige Rechtsverfahren eine ordnungsgemäße Strafverfolgung praktisch unmöglich machten. Daher nutzten Verletzer diese Umsetzungslücken, um Bußgelder und Strafen zu vermeiden. Das lokale Bewusstsein und die Präsenz einer lokalen Interessengruppe zum Zeitpunkt der Gesetzgebung hätten Lücken in der Gesetzgebung und in der Strafverfolgung schließen können. Anhand von Governance- und Bewertungskriterien (abgeleitet aus dem IAD-Rahmen) wurden soziale und Governance-Herausforderungen in Bezug auf die Abwasserbewirtschaftung in Faisalabad umfassend bewertet. Darüber hinaus trug der Ansatz des historischen Institutionalismus dazu bei, die eingebauten Herausforderungen der Verwaltungseinrichtungen zu identifizieren. Die wichtigste Herausforderung, die in der Studie identifiziert wurde, war die geringe Kapazität der Durchführungseinrichtungen aufgrund menschlicher, technischer und finanzieller Einschränkungen. Darüber hinaus scheiterte die Stadtplanung von Faisalabad in den vergangenen Jahrzehnten völlig, was zu verstreuten Industrieclustern in den Wohngebieten führte. Eine solche schlechte Planung schränkte die ordnungsgemäße Verwaltung, Behandlung und Wiederverwendung von Abwässern ein. Darüber hinaus zeigte die institutionelle Analyse, dass die öffentlichen Organisationen und Agenturen schwache administrative Verflechtungen untereinander aufweisen. Die Studie zeigte auch, dass ein problematisches institutionelles Umfeld, einschließlich Vetternwirtschaft und Einmischung in Büroangelegenheiten, die Funktionsweise der öffentlichen Organisationen beeinflusst. Es wurde festgestellt, dass eine umfassende Strategie für eine verbesserte Abwasserentsorgung erforderlich ist, die gleichzeitig Fragen der institutionellen und technischen Durchführbarkeit, der Ökonomie, der sozialen Akzeptanz und der ökologischen Nachhaltigkeit angehen muss. Zukünftige Studien könnten solche umfassenden Strategien im Kontext der Entwicklungsländer weiter untersuchen

Document analysis by means of data mining techniques

The huge amount of textual data produced everyday by scientists, journalists and Web users, allows investigating many different aspects of information stored in the published documents. Data mining and information retrieval techniques are exploited to manage and extract information from huge amount of unstructured textual data. Text mining also known as text data mining is the processing of extracting high quality information (focusing relevance, novelty and interestingness) from text by identifying patterns etc. Text mining typically involves the process of structuring input text by means of parsing and other linguistic features or sometimes by removing extra data and then finding patterns from structured data. Patterns are then evaluated at last and interpretation of output is performed to accomplish the desired task. Recently, text mining has got attention in several fields such as in security (involves analysis of Internet news), for commercial (for search and indexing purposes) and in academic departments (such as answering query). Beyond searching the documents consisting the words given in a user query, text mining may provide direct answer to user by semantic web for content based (content meaning and its context). It can also act as intelligence analyst and can also be used in some email spam filters for filtering out unwanted material. Text mining usually includes tasks such as clustering, categorization, sentiment analysis, entity recognition, entity relation modeling and document summarization. In particular, summarization approaches are suitable for identifying relevant sentences that describe the main concepts presented in a document dataset. Furthermore, the knowledge existed in the most informative sentences can be employed to improve the understanding of user and/or community interests. Different approaches have been proposed to extract summaries from unstructured text documents. Some of them are based on the statistical analysis of linguistic features by means of supervised machine learning or data mining methods, such as Hidden Markov models, neural networks and Naive Bayes methods. An appealing research field is the extraction of summaries tailored to the major user interests. In this context, the problem of extracting useful information according to domain knowledge related to the user interests is a challenging task. The main topics have been to study and design of novel data representations and data mining algorithms useful for managing and extracting knowledge from unstructured documents. This thesis describes an effort to investigate the application of data mining approaches, firmly established in the subject of transactional data (e.g., frequent itemset mining), to textual documents. Frequent itemset mining is a widely exploratory technique to discover hidden correlations that frequently occur in the source data. Although its application to transactional data is well-established, the usage of frequent itemsets in textual document summarization has never been investigated so far. A work is carried on exploiting frequent itemsets for the purpose of multi-document summarization so a novel multi-document summarizer, namely ItemSum (Itemset-based Summarizer) is presented, that is based on an itemset-based model, i.e., a framework comprise of frequent itemsets, taken out from the document collection. Highly representative and not redundant sentences are selected for generating summary by considering both sentence coverage, with respect to a sentence relevance score, based on tf-idf statistics, and a concise and highly informative itemset-based model. To evaluate the ItemSum performance a suite of experiments on a collection of news articles has been performed. Obtained results show that ItemSum significantly outperforms mostly used previous summarizers in terms of precision, recall, and F-measure. We also validated our approach against a large number of approaches on the DUC’04 document collection. Performance comparisons, in terms of precision, recall, and F-measure, have been performed by means of the ROUGE toolkit. In most cases, ItemSum significantly outperforms the considered competitors. Furthermore, the impact of both the main algorithm parameters and the adopted model coverage strategy on the summarization performance are investigated as well. In some cases, the soundness and readability of the generated summaries are unsatisfactory, because the summaries do not cover in an effective way all the semantically relevant data facets. A step beyond towards the generation of more accurate summaries has been made by semantics-based summarizers. Such approaches combine the use of general-purpose summarization strategies with ad-hoc linguistic analysis. The key idea is to also consider the semantics behind the document content to overcome the limitations of general-purpose strategies in differentiating between sentences based on their actual meaning and context. Most of the previously proposed approaches perform the semantics-based analysis as a preprocessing step that precedes the main summarization process. Therefore, the generated summaries could not entirely reflect the actual meaning and context of the key document sentences. In contrast, we aim at tightly integrating the ontology-based document analysis into the summarization process in order to take the semantic meaning of the document content into account during the sentence evaluation and selection processes. With this in mind, we propose a new multi-document summarizer, namely Yago-based Summarizer, that integrates an established ontology-based entity recognition and disambiguation step. Named Entity Recognition from Yago ontology is being used for the task of text summarization. The Named Entity Recognition (NER) task is concerned with marking occurrences of a specific object being mentioned. These mentions are then classified into a set of predefined categories. Standard categories include “person”, “location”, “geo-political organization”, “facility”, “organization”, and “time”. The use of NER in text summarization improved the summarization process by increasing the rank of informative sentences. To demonstrate the effectiveness of the proposed approach, we compared its performance on the DUC’04 benchmark document collections with that of a large number of state-of-the-art summarizers. Furthermore, we also performed a qualitative evaluation of the soundness and readability of the generated summaries and a comparison with the results that were produced by the most effective summarizers. A parallel effort has been devoted to integrating semantics-based models and the knowledge acquired from social networks into a document summarization model named as SociONewSum. The effort addresses the sentence-based generic multi-document summarization problem, which can be formulated as follows: given a collection of news articles ranging over the same topic, the goal is to extract a concise yet informative summary, which consists of most salient document sentences. An established ontological model has been used to improve summarization performance by integrating a textual entity recognition and disambiguation step. Furthermore, the analysis of the user-generated content coming from Twitter has been exploited to discover current social trends and improve the appealing of the generated summaries. An experimental evaluation of the SociONewSum performance was conducted on real English-written news article collections and Twitter posts. The achieved results demonstrate the effectiveness of the proposed summarizer, in terms of different ROUGE scores, compared to state-of-the-art open source summarizers as well as to a baseline version of the SociONewSum summarizer that does not perform any UGC analysis. Furthermore, the readability of the generated summaries has also been analyzed

Frequency of caesarean section in diabetic vs. non diabetic females undergoing induction of labour at term

Introduction: Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance recognized during pregnancy. Gestational diabetes is associated with adverse maternal and fetal outcome. Majority of patients with diabetes had induction of labour at term (≥37weeks) to prevent maternal and fetal morbidity especially shoulder dystocia, macrosomia and intrauterine fetal death at term Objectives: To find frequency of gestational diabetes (GDM) in patients undergoing induction of labour. To compare the frequency of caesarean section in diabetic (GDM) and non-diabetic females undergoing induction of labour Methodology: Study Type; It was a descriptive case series conducted at the department of Obstetrics and Gynecology, Shalamar Hospital Lahore. Duration of study was six months after approval from IRB. Sample size; Sample size of 214 cases undergoing induction of labour at term during study period; calculated with 95%confidence level and 3.4% margin of error and taking expected percentage of GDM is 6.9%. Sampling Technique; purposive sampling Methodology: 214 females who will fulfill the inclusion criteria were enrolled in the study from labour room of Department of Obstetrics and Gynecology, Shalamar Hospital Lahore. Induction of labour done with tab prostin 3mg single dose and patients having gestational diabetes were identified and frequency of caesarean section in Diabetic and non-diabetic calculated. Results: In current study, mean age of the patients was 27.8±4.4 years. Mean gestational age was 37.1±3.8 weeks and mean BMI was 28.6±4.1 kg/m2. Primigravida were 88 (41.1%) and multigravidas were 126 (58.9%). Gestational diabetes was found to be in 36 patients (16.8%). Caesarean section was performed in 77 patients (36%). Comparison of frequency of cesarean section in diabetic (GDM) and non-diabetic females undergoing induction of labour revealed majority of the caesarean sections performed in GDM patients (p=0.007). Conclusion In conclusion, our study found a higher incidence of cesarean section than normal delivery in pregnant women with gestational diabetes. Major factors for operational delivery in GDM population included: advanced maternal age and high BMI value

Comparison of neonatal respiratory morbidity in neonates delivered at term by elective caesarean section with and without antenatal Corticosteroid

Introduction:Performing elective caesarean section prior to 39 completed weeks,it can lead to breathing problems in neonates as compare to those, who are born through caesarean section without antenatal Corticosteroid. WHO recommends the administration of intramuscular corticosteroids either dexamethasone or betamethason (total 24mg in divided doses) in the antenatal period, when there is a risk of preterm birth. The advantages and disadvantages of a similar regimen given after 37 weeksof pregnancy prior to elective caesarean section (LSCS) to prevent respiratory morbidity in a newborn is yet a topic of discussion.In Pakistan still,many clinicians are doing caesarean section at 37 or 38 weeks without antenatal Corticosteroids. The rationale is to emphasize the use of steroidsbefore caesareanat 39 weeks. Objective:To compare neonatal respiratory distress in neonates delivered between 37 --38+6 weeks of gestation by elective caesarean section with and without antenatal Corticosteroid. Study design:Randomized controlled trial. Setting:Department of Gynae & Obstetrics, unit 2, Shalamar Hospital, Lahore. Duration:Six months from 12th September 2018 to 12th March 2019. Materials and Methods:The study included women who were, planned for elective LSCS at 37-38+6 weeks, divided into two groups .The sample size was 140 (70 in each group),recruited by non-probability consécutive sampling. Inclusion criteria were singleton pregnancy, at 37 to 38+6 weeks for elective LSCS due to indications like primi breech, previous caesarian scar/scars, and maternal wish. All eligible participants were allocated to one of the following groups. Group (A) received an injection of dexamethasone 48 to 72 hours before elective LSCS. Group (B), did not receive an injection of dexamethasone. The outcome to be measuredinthis study were the Apgar score at 1& 5 minutes, the incidence of transient tachpnea of the neonate (TTN) and respiratory distress syndrome (RDS) in newborns,and the need for mechanical ventilation among neonates from two different groups. The data was collected and analyzed by SPSS version 20.Descriptive statistic were applied to calculate the mean and SD for age, gestation age & BMI. Student T-test was used to compare the continuous outcome measures. Neonatal respiratory morbidity was compared in two groups by using the chi-square test at the level of significance of 0.05.Results:Mean age in Group-A was 28.12± 5.6 and in Group-B was 28.97± 6.3 years. There was no statistically significant difference in these groups in termsof Body mass index, gestational age at the time of delivery, age of mother, birth weight, Apgar score at 1 and 5 min,and indications for cesarean section. Neonatal respiratory morbidity was higher in Group-B as compared to Group-A (30% vs.12.9%)p-value-0.013. Conclusion:Antenatal dexamethasone administration significantly reduces the respiratory morbidity among neonates delivered at 37 to 38+6by elective cesarean section. But further studies are required to assess the beneficial role of dexamethasone in the reduction of neonatal respiratory morbidity with a large sample size.Keywords:Neonatal respiratory morbidity, transient tachypnea of newborn, elective caesarean section, antenatal corticosteroids

Coinfection with Lichtheimia corymbifera and Aspergillus flavus in an Immune-Competent Patient Mimicking as Pulmonary-Renal Syndrome

Lichtheimia corymbifera and Aspergillus flavus pulmonary coinfection has been rarely reported in immune-competent patients. We report case of a young male who presented with clinical features of pulmonary-renal syndrome and was later diagnosed to have bilateral polymicrobial fungal lung infection

Comparison of neonatal respiratory morbidity in neonates delivered at term by elective caesarean section with and without antenatal Corticosteroid

Introduction:Performing elective caesarean section prior to 39 completed weeks,it can lead to breathing problems in neonates as compare to those, who are born through caesarean section without antenatal Corticosteroid. WHO recommends the administration of intramuscular corticosteroids either dexamethasone or betamethason (total 24mg in divided doses) in the antenatal period, when there is a risk of preterm birth. The advantages and disadvantages of a similar regimen given after 37 weeksof pregnancy prior to elective caesarean section (LSCS) to prevent respiratory morbidity in a newborn is yet a topic of discussion.In Pakistan still,many clinicians are doing caesarean section at 37 or 38 weeks without antenatal Corticosteroids. The rationale is to emphasize the use of steroidsbefore caesareanat 39 weeks. Objective:To compare neonatal respiratory distress in neonates delivered between 37 --38+6 weeks of gestation by elective caesarean section with and without antenatal Corticosteroid. Study design:Randomized controlled trial. Setting:Department of Gynae & Obstetrics, unit 2, Shalamar Hospital, Lahore. Duration:Six months from 12th September 2018 to 12th March 2019. Materials and Methods:The study included women who were, planned for elective LSCS at 37-38+6 weeks, divided into two groups .The sample size was 140 (70 in each group),recruited by non-probability consécutive sampling. Inclusion criteria were singleton pregnancy, at 37 to 38+6 weeks for elective LSCS due to indications like primi breech, previous caesarian scar/scars, and maternal wish. All eligible participants were allocated to one of the following groups. Group (A) received an injection of dexamethasone 48 to 72 hours before elective LSCS. Group (B), did not receive an injection of dexamethasone. The outcome to be measuredinthis study were the Apgar score at 1& 5 minutes, the incidence of transient tachpnea of the neonate (TTN) and respiratory distress syndrome (RDS) in newborns,and the need for mechanical ventilation among neonates from two different groups. The data was collected and analyzed by SPSS version 20.Descriptive statistic were applied to calculate the mean and SD for age, gestation age & BMI. Student T-test was used to compare the continuous outcome measures. Neonatal respiratory morbidity was compared in two groups by using the chi-square test at the level of significance of 0.05.Results:Mean age in Group-A was 28.12± 5.6 and in Group-B was 28.97± 6.3 years. There was no statistically significant difference in these groups in termsof Body mass index, gestational age at the time of delivery, age of mother, birth weight, Apgar score at 1 and 5 min,and indications for cesarean section. Neonatal respiratory morbidity was higher in Group-B as compared to Group-A (30% vs.12.9%)p-value-0.013. Conclusion:Antenatal dexamethasone administration significantly reduces the respiratory morbidity among neonates delivered at 37 to 38+6by elective cesarean section. But further studies are required to assess the beneficial role of dexamethasone in the reduction of neonatal respiratory morbidity with a large sample size.Keywords:Neonatal respiratory morbidity, transient tachypnea of newborn, elective caesarean section, antenatal corticosteroids

Morphological and biochemical characterization of Xanthomonas oryzae pv. oryzae isolates collected from Punjab during 2013

Background: Bacterial leaf blight (BLB) of rice occupies the most significant position among various potentially important bacterial diseases all over Pakistan. The first important step towards the management of this disease is the characterization of the pathogen.Methods: Survey was conducted and disease samples were collected from 9 different locations of Punjab. Isolation and characterization by biochemical tests was done from the diseased samples under standard conditions in the laboratory. For pathogenicity and virulence characterization, all isolates were inoculated on IR-24, Basmati super and Basmati-2000 varieties. Data was recorded after three weeks of inoculation.Results: 30 isolates of Xanthomonas oryzae pv. oryzae (Xoo) were purified from the diseased plants of different geographical origin which had very similar morphological and biochemical characteristics. PXo-20 (causing 51.35% leaf damage) and PXo-16 (causing 50.05% leaf damage) were found most virulent for Basmati Super and Basmati-2000.Conclusion: The presence of highly virulent isolates in Sheikhupura is alarming and there is dire need to incorporate new resistance genes in commercial rice cultivars to cope with BLB