IMPACTS OF HOT IN-PLACE RECYCLING TECHNIQUES IN PAKISTAN

A hot in-place recycling (HIR) technique was employed for the first time on Lahore-Islamabad Motorway in 2005 to rehabilitate sections where the rut depth was about 40 mm. Since HIR technology was new to Pakistan, research was carried out to study the effects of recycled wearing course of pavement.It was accomplished by comparing structural adequacy of pavement and material characterization before and after recycling.Analysis of recycled HMA wearing course indicated a reduction in modulus for a mix that was very stiff and aged prior to recycling. Relative degradation of the HMA wearing course was observed; however, it remained close to standard specifications specified by Executing Agency National Highway Authority (NHA). The research enhanced awareness of HIR among local engineers and contractors

IMPACTS OF COAL MINING IN BALOCHISTAN

The average emission and prevalence of methane CH4, carbon monoxide CO, and oxygen O2 measured as 11.8m3/ton, 36ppm and 14% respectively which exceeds the permissible limits of 1-10m3/ton, 30ppm and 18 %( Standardized by National institute of occupational safety and health NIOSH U.S.A) and are the source of high death ratio. The higher concentration of coal dust (carbon and quartz contents of Coal dust) have been measured as 4-5mg/m3 and 0.35mg/m3 against the threshold limits (Recommended by NIOSH) of 2mg/m3 and 0.05-0.1 mg/m3 for 8hours daily and 40hours/week. The high concentration of coal dust in coal mine areas of Baluchistan is not only the source of health problems like routine headache, irritation in throat ,nose, and eyes, drowsiness, shortness of breath, nausea, pneumoconiosis, tuberculosis, chronic obstructive bronchitis, heart problems, respiratory irritation, asthmatic and even lung impairment and lung cancer problem, but is causing severe damage to the Environment., The coal water and slurry being the residual of coal mining are disposed off in an unconfined area which becomes the source of soil and water degradation and the contaminated water taken by coal workers has several health impacts like ulcer, diarrhea, cholera, hepatitis B and C etc on coal workers of Baluchistan

IMPACTS OF COAL MINING IN BALOCHISTAN

The average emission and prevalence of methane CH4, carbon monoxide CO, and oxygen O2 measured as 11.8m3/ton, 36ppm and 14% respectively which exceeds the permissible limits of 1-10m3/ton, 30ppm and 18 %( Standardized by National institute of occupational safety and health NIOSH U.S.A) and are the source of high death ratio. The higher concentration of coal dust (carbon and quartz contents of Coal dust) have been measured as 4-5mg/m3 and 0.35mg/m3 against the threshold limits (Recommended by NIOSH) of 2mg/m3 and 0.05-0.1 mg/m3 for 8hours daily and 40hours/week. The high concentration of coal dust in coal mine areas of Baluchistan is not only the source of health problems like routine headache, irritation in throat ,nose, and eyes, drowsiness, shortness of breath, nausea, pneumoconiosis, tuberculosis, chronic obstructive bronchitis, heart problems, respiratory irritation, asthmatic and even lung impairment and lung cancer problem, but is causing severe damage to the Environment., The coal water and slurry being the residual of coal mining are disposed off in an unconfined area which becomes the source of soil and water degradation and the contaminated water taken by coal workers has several health impacts like ulcer, diarrhea, cholera, hepatitis B and C etc on coal workers of Baluchistan

THE IMPEDIMENTS IN CONSTRUCTION OF SUSTAINABLE BUILDINGS IN PAKISTAN

The Concept of “Sustainable building” is the design and construction of buildings using methods and materials that are resource efficient, wellbeing of the building’s occupants, workers, health and environment friendly. Construction of Sustainable building plays an important Role in GDP of a Country and provides a wide range benefits for the society but their development suffers from different kinds of market barriers in developing countries including Pakistan. In order to find out the Impediments in Pakistan, A Survey based (Through Questionnaire) study was conducted in General Area of Rawalpindi. The Questionnaire was designed to assess the present problems faced by construction industry in Pakistan. The Response remained 63.7% and ranking of identified barriers were compared with other Asian countries. The results indicate that lack of credit resources to cover up front cost and risk of investment are one of the most important factors contributing barriers against sustainable construction. Whereas the Government support, public awareness and promotion idea of sustainable building are the recommended solution for sustainable construction

DISASTER MANAGEMENT IN COAL MINE INDUSTRY OF BALOCHISTAN

The room and pillar mining method is responsible for high death toll and disability rate of coal mine workers in Baluchistan. The frequent incidents of roof falls day to day accidents, and suffocation due to sufficient emission of methane are the main causes of increased death rate. Substantial increase in injuries are also causing complications in the life of poor coal workers

A 12-year-old girl presenting with recurrent abdominal pain and vomiting

This article has no abstract. The first 100 words appear below: A 12-year-old immunized girl with only issue of non-consanguineous parents presented with the complaints of severe, agonizing, and continued upper abdominal pain which radiated to the back, aggravated after taking food and partially relieved on leaning forward for the last 4 days. The pain was associated with several episodes of vomiting. She had a history of similar types of 3 attacks within the last 1 year and in between attacks, she was comparatively well. On query, the mother gave a history of gradual weight loss

Accuracy of diffusion-weighted magnetic resonance imaging in diagnosing malignant musculoskeletal tumours

Background: Conventional magnetic resonance imaging (MRI) lacks specificity for differentiating several tumours. Combining advanced techniques like diffusion-weighted imaging (DW-MRI) with conventional MRI may enhance diagnostic accuracy. However, we do not have such data for Bangladeshi patients. This study aimed to examine the diagnostic accuracy of apparent diffusion coefficient values obtained by DW-MRI. Methods: A cross-sectional study was conducted from July 2022 to June 2023 in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU).  After collecting their baseline data, thirty-five patients with musculoskeletal tumours underwent DW-MRI and histopathology tests or fine needle aspiration cytology (FNAC). The apparent diffusion coefficient (ADC) values obtained by DW-MRI were examined for diagnostic accuracy against a standard of histopathology/FNAC. Results: According to the gold standard (histopathology/FNAC), there were 28 patients with malignancy, and 7 had benign tumours. Their mean age was 33 (standard deviation, 17) years (range, 4 to 74 years). The mean ADC value was 0.86 ± 0.30×10-3 mm2/s. The malignant musculoskeletal tumour group had significantly lower ADC (0.79 ± 0.24 ×10-3 mm2/s) compared to the benign tumour group (1.15 ± 0.37×10-3 mm2/s.) (P = 0.04). The DW-MRI ADC categories correctly diagnosed 27 malignant and five benign tumours using a cut-off value of ≤ 1.1×10−3 mm2/s. DW-MRI had a sensitivity of 96.4% and a specificity of 71.4%. Diagnostic accuracy was 91.4% for detecting malignant musculoskeletal tumours. Conclusions: Malignant musculoskeletal tumours have lower DW-MRI-derived ADC levels, demonstrating good diagnostic accuracy. However, a larger and more representative sample is needed before it is recommended for clinical practice

Appropriate age range for introduction of complementary feeding into an infant’s diet

Peer reviewedPublisher PD

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013