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Objective: The purpose of this study is to compare the effectiveness of oral progesterone and micronized progesterone pessary in reducing the spontaneous preterm births incidence. Study Design: Randomized controlled trial Place and Duration: Gynaecology and Obstetrics Department of Combined Military Hospital, Peshawar from January 2021 to December 2021. Methods: Total 112 pregnant females were presented in this study. Included females were aged between 18-45 years. After taking informed written consent, detailed demographics of enrolled cases included age, BMI, parity and gestational age was recorded. Females were divided in two groups. Group I received oral progesterone in 56 females and group II received micronized progesterone pessary. Post-operative outcomes among both groups were assessed. SPSS 23.0 was used to analyze all data. Results: Among 112 cases, 35 (31.3%) had age 18-25 years, 45 (40.2%) females had age 26-35 years and 32 (28.6%) cases had age 36-45 years. 64 (57.1%) patients had BMI 25kg/m2. Mean parity in group I was 2.5±1.23 and in group II parity was 1.72±3.16. Mean gestational age of the patients in group I was 33.16±10.42 weeks and in group II mean gestational age was 34.17±8.23 weeks. Frequency of c-section in both groups were higher as compared to vaginal delivery with p value

Introduction: Cataracts and Glaucoma are the leading causes of irreversible blindness worldwide. Lens extraction using the Phacoemulsification technique can be an effective IOP-lowering treatment for all types of glaucoma. Objective: To study was to measure the Intra-Ocular Pressure before and after phacoemulsification and to determine the mean change in Intra-Ocular Pressure. Methodology: This study included 53 glaucoma patients with Primary Open Angle Glaucoma (POAG), Angle Closure Glaucoma (ACG), and Pseudoexfoliation (PXF) % (n=4) Glaucoma who visited the Glaucoma Department of Al-Shifa Trust Eye Hospital Rawalpindi. Pre and post-interventional study designs were used. Based on a slit lamp examination, patients were labeled as having cataracts in glaucomatous eyes. Pre-operative Intraocular pressure (IOP) was noted using Goldmann Applanation Tonometer (GAT). Patients were referred for Phacoemulsification and their IOP was noted after 2 weeks of surgery. The non-Probability convenient sampling Technique was used. Paired t-test was used to find the mean change in IOP. Results: The mean age of respondents was (62.5±10.25) and had a maximum value of 81 years and a minimum value of 40 years among a sample of 53 respondents. The mean IOP before phacoemulsification was (16.25±7.251) the mean IOP after phacoemulsification was (13.28±5.940) and the mean difference was (2.962 ±8.364) in glaucomatous patients having cataracts. This difference was found to be statistically significant (p-value

Aim: Assessment of diagnostic accuracy of platelet distribution width in prediction of preeclampsia in females presenting with singleton pregnancy Study Design: A Descriptive case series study. Setting: Department of Obstetrics & Gynecology, Unit II, DHQ Teaching Hospital Gujranwala. Duration of Study: Seven months from 1st March 2019 till 30st September 2019. Methods: Total 170 pregnant females with age ranging between 18-40 years and gestational age from 16-20 weeks having less than 5 children were admitted from OPD of Department of Obstetrics & Gynecology, DHQ hospital, Gujranwala. Females with multiple pregnancy (on ultrasound), those diagnosed with chronic hypertension (BP≥140/90mmHg or taking anti-hypertensive) and those with Liver disease (ALT>40IU, AST>40IU), renal impairment (creatinine > 1.2mg/dl), chronic or gestational diabetes (BSR > 200mg/dl) were excluded. After taking informed consent, patient’s biodata including name, age, BMI, gestational age and parity was noted. At baseline, blood sample was collected in 5cc disposable syringe. Results: All patients were followed-up in OPD till term whereby they were evaluated for blood pressure and presence of proteinuria and preeclampsia was confirmed as positive or negative in accordance with operational definition. Quantitative variables like BMI, age of the patient and gestational age were presented in the form of mean and standard deviation whereas qualitative variables including preeclampsia (on PDW and actual event) were presented in the form of percentage and frequency. Presenting parity as frequency we generated 2x2 table for calculation of NPV, PPV specificity, sensitivity and diagnostic accuracy of PDW taking actual clinical occurrence of preeclampsia as gold standard. Data was stratified for age, parity, BMI of the patient and gestational age calculated in weeks. Conclusion: On the basis of this study we concluded that the PDW is a useful tool for prediction of preeclampsia in females presenting with singleton pregnancy but less had low sensitivity. Keywords: Preeclampsia, Platelet Distribution Width, blood pressure, proteinuria

Background: Effect of dates on pregnancy outcomes is in debate among researchers for optimum results. Aim: To compare the fetomaternal outcome with and without use of dates in primigravidae presenting at 37-38 weeks Main outcome: The outcome was measured as fetal (Apgar score at 5 min) and maternal (onset and induction of labor) parameters. Study design: Randomized controlled trial Setting: Department of Obstetrics and Gynaecology, District Headquarter Hospital, Gujranwala Duration of study: 6 months 1st January 2020 to 30th June 2020 Methods: A total of 110 patients reporting to OPD in their first pregnancy between 18 to 35 years of age at 37 to 38 weeks were included whereas multigravidae and those with previous miscarriage were excluded. Consecutive Non Purposive Sampling technique was used and patients were randomly divided in two groups of 55 each. Group A consumed dates in late pregnancy while Group B was asked not to. Duration of first and second stage of labour and Apgar score at 5 minutes were recorded. SPSS version 21 was used to enter and analyze the data. Quantitative variables Apgar score were presented in the form of mean ± SD. Qualitative variables like spontaneous labour, need for induction and good Apgar score were presented in the form of frequency and percentage. Chi-square test was applied to compare spontaneous labour, need for induction, and good Apgar score in both groups. P-value ≤0.05 was taken as significant. Results: The mean apgar score at five minutes was 8.76±1.157. The analysis of qualitative variables showed that spontaneous labor was started in 75(68.2%) of patients and induction was required in 35 (31.8%) patients. There was successful induction in 1 (9.1%) of patients. At five minutes 101(91.8%) of neonates showed good apgar i.e. >7. Both groups were compared among each other in terms of both quantitative and qualitative variables. The onset of spontaneous labor, success of IOL and good apgar score at 5 minutes were compared among groups. The was significant difference among groups A and B in terms of these parameters except good apgar score i.e. p values of 0.008, 0.021 and 0.297 for spontaneous labor, IOL and good apgar scores Good apgar score at 5 min was not statistically significant among any stratification group. Conclusion: The consumption of dates significantly improves the fetomaternal outcomes in primigravida term pregnancies. The results should be validated in large randomized controlled trials. Keywords: Date fruit, Labour outcomes, Labour progression.

Intezar Hussain, s legendary collection “Kankari” shows the connection of religious with the earth. It turns out that all religious are one and the same, with different paths leading to the same destination.Then they realiza that religion, heaven and hell and everything is on this earth. In which the reward process is of special importance. In this article religious consciousness is presemted in Intezar Hussain, s legendary collection“Kankari”. References Sohail Bukhari, Dr., Urdu Dastain Tahqeeq o Tanqedi Mutalia, Islamabad: Muqdara Qaumi Zuban, 1987, pg:527 Bever Selius, Joel D., A Source book for Earth Communities of Religion, Revised Edition, New York Conference Press, Global Education Associates, 1995 Intazar Hussain, Kankri, Lahore: Maktaba Jaded, Lahore: 1955, pg:7 Ramen sharma & Preety Choudhary, Dr., Common Themes and Techniques of Postmodern, Research India Publication, P:195. Intazar Hussain, Kankri, pg:37 As above, pg:64 As above, pg:107 As above, pg:127 As above, pg:171 As above, pg:179 As above, pg:192

Objective: Aim of current study is to determine either induction of labour at 40 weeks may reduce likelihood of cesarean section. Study Design: Controlled trial Place and Duration: Gynaecology and Obstetrics Department Combined Military Hospital Peshawar for the duration of six months from 1st Jan 2021 to 31st December 2021. Methods: Total 48 pregnant females of age 18-45 years were presented in this study. After receiving informed written consent, detailed demographic information about the enrolled cases; including age, parity, gestational age, level of education, and region of residence was collected. Frequency of cesarean section with respect to labour induction was calculated among all cases. SPSS 22.0 was used to analyze all data. Results: Among 48 cases, 28 (58.3%) had age 18-28 years, 15 (31.3%) patients had age 29-38 years and 5 (10.4%) cases had age >38 years. There were 26 (54.2%) patients with BMI 25kg/m2. There were 18 (37.5%) patients with gestational age 34-36 weeks, 16 (33.3%) patients with gestational age 37-38 weeks and 14 (29.2%) patients with gestational age 39-40 weeks. Frequency of cesarean section among all cases were 15 (31.3%) in which majority of the cases were from gestational age 34-36 weeks. There was no mortality found among mothers. Conclusion: In this study we found that labour induction at 40 weeks significantly reduce the frequency of cesarean section. There were benefits for the fetus and no increased risk of maternal death. Keywords: Pregnant patients, Labour Induction, C-section, Gestational age

Hafiz Muhammad Hussain Hafiz(1993-2010) is from Faisalabad,Pakistan. He is very successful Punjabi poet.At the public level ,his Natya Kalam is still read with great relish.He used to write in Urdu from time to time. God-given ability and extensive personal study, as well as the lifelong companionship of scholars, his thoughts and writings produce many virtues.Naat is fact a statement of the attributes of the Holy Prophet (PBUH). The Holy prophet is beloved of Allah and His creatures. He is the cause of the creation of the universe and the mercy of the worlds. His example of beauty is the best example for all believers.Hafiz Muhammad Hussain, s book “Shahar-e-Madina Asia Hai” in his naat has mentioned the caste, attributes and virtues of the Holy Prophet in a beautiful way.If his Naats are carefully studied,then the first of all his theory of Naat comes to the fore.His two Naatiya books “ Sarkar ki Gali Main” and “ Shahar –e- Madina Aisa Hai” are in Urdu. In this article an intellectual review of his Natya book “ Shahar Madina Aisa Hai” has presented.

Background: Ovarian cancer (OC) average lifetime risk is 1 in 70(1.4%).Ovarian cancer is diagnosed in 7300 women every year in UK and 239,000 women world wide.There are variations in incidence with ethnicity, white women have the highest incidence approximately14/100,000 where as Asian women have a lower incidence at 10/100,000. Aim: To find the frequency and different types of ovarian carcinomas in women presenting with pain lower abdomen. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, DHQ Hospital Gujranwala from1st May 2020 to 31st October 2020.A total of 282 women presenting with pain lower abdomen were included.All women underwent ultrasonography and ovarian tumors were noted as per operational definition. Patients with ovarian tumor underwent laparotomy, the specimen of tumors were collected with excision biopsies and sent for histopathological analysis. Results: The mean age of cases was 33.808±7.70 years, and the mean duration of complaint was 4.322±1.46 weeks and mean weight was 69.560±13.00 kg. Majority of the patients (82.3%) belonged to 20-40 years age groups. Ovarian Tumor was seen in 65(23%) patients. Among 65 patients with ovarian tumor, 72.3% were benign, 3.1% borderline and 24.6% were malignant. Conclusion: It was concluded that ovarian tumors were common between the 20 and 40 years of age. The frequency of Malignant neoplastic lesions was higher than the benign neoplastic lesions. Keywords: Women, Pain lower abdomen, Ovarian tumors

Background: Obstetric hemorrhage is the most common and dangerous complication encountered during child birth and postpartum hemorrhage accounts for about one-quarter of all maternal deaths globally, especially in developing countries. Tranexamic acid (TXA) with its antifibrinolytic properties, is widely in use for prophylactic treatment of heavy blood loss from trauma, surgery, removal of tooth, bleeding from nose, postpartum bleeding and heavy menstrual bleeding. Aim: To assess the mean blood loss with prophylactic tranexamic acid in females undergoing elective cesarean section Methods: Descriptive case series study conducted in the Department of Obstetrics & Gynecology, DHQ Hospital, Gujranwala from August 2018 to February 2019. After meeting the inclusion criteria 550 females were enrolled. Informed consent and demographic details of the selected females were taken. Then females were given 1g of intravenous TXA 30 minutes before cesarean section. All cesarean sections were done under spinal anesthesia. All included females were followed-up till delivery of the fetus and placenta and blood loss was also noted. SPSS version 21 was applied for data collection and analysis. Results: In this study the mean age of the females was 29.07±6.49 years, 92(16.73%) females were nulliparous. The mean value of BMI was 26.75±4.76 kg/m2. The mean intra-op, post-op and total blood loss of the females was 300.15±29.13 ml, 99.55±29.43 ml & 399.70±41.98 ml respectively. Conclusion: According to this study the total mean blood loss with prophylactic TXA in females undergoing elective cesarean section was 399.70±41.98 ml Keywords: Females, Cesarean Section, Prophylactic Tranexamic Acid, Blood Loss

The way people obtain information, learn, and connect with others across the world has changed dramatically as a result of technological advancements. Technology has eliminated distance constraints, allowing higher education to efficiently teach anybody. In order to improve teaching and learning, technology integration is becoming more common in classrooms. A better pattern for recognizing new teaching models has evolved as a result of the fast expansion of technology integration. As a result, it is critical in both learning and teaching language skills. There are numerous advantages to using technology to offer an environment for teaching and learning English skills. The objectives of the current review article were to discover answers to the issues of how technology integration promotes language learning and what the most current developments in language learning are. According to research, introducing technology into classrooms substantially improved teaching and learning English language skills.

We are exploiting the use of a versatile catalyst taken from heterogeneous catalysis, i.e., ZrOCl2.8H2O to efficiently catalyze the reaction of dextran-succinate conjugate (Dex-SAn) with salicylic acid (SA) under homogeneous reaction conditions. Dextran was first linked with succinic anhydride using triethylamine as a base in DMAc to provide active functionalities (succinate moieties) situated away from the polymer chains. The resultant Dex-SAn conjugate was further esterified with SA using zirconium (IV) oxychloride octahydrate (ZrOCl2.8H2O) as a catalyst at 80 °C under N2. Reaction conditions and amount of catalyst ZrOCl2.8H2O and chiral support MCM-41 were optimized. This reaction methodology resulted in macromolecular prodrugs of SA as Dex-SAn-SA conjugates in good yield. The structures of Dex-SAn and newly synthesized Dex-SAn-SA conjugates were characterized using various spectroscopic techniques, i.e., FT-IR, 1H, and APT-13C NMR spectroscopy. The degree of substitution of SA on to Dex-SAn-SA was determined by UV/Vis spectroscopic methods. This reaction methodology can be modeled as a new protocol for facile attachment of several drug molecules onto the highly potential and biodegradable drug carrier dextran.

Entrepreneurship education play an important role in rising nations and increase job opportunities. The present study was aimed to identify the impact of entrepreneurship education in term of university role and entrepreneurship curriculum or content on students’ entrepreneurial inclination. Quantitative approach with causal comparative research design was used. The population of the study comprised of final year under graduate students of public sector universities of Karachi, Pakistan who have studied entrepreneurship course as a compulsory subject. Stratified random sampling technique was applied and electronic survey questionnaire was sent to the 489 final year undergraduate students of public sector universities of Karachi. Finding suggest that of entrepreneurship education in term of university role and entrepreneurship curriculum or content have a significant impact on students’ entrepreneurial inclination. It is suggested that students should be prepared to change their existing learning strategy to one that is more practical, as this is essential in the entrepreneurial learning process.

Binary images have found its place in many applications, such as digital forensics involving legal documents, authentication of images, digital books, contracts, and text recognition. Modern digital forensics applications involve binary image processing as part of data hiding techniques for ownership protection, copyright control, and authentication of digital media. Whether in image forensics, health, or other fields, such transformations are often implemented in high-level languages without formal foundations. The lack of formal foundation questions the reliability of the image processing techniques and hence the forensic results loose their legal significance. Furthermore, counter-forensics can impede or mislead the forensic analysis of the digital images. To ensure that any image transformation meet high standards of safety and reliability, more rigorous methods should be applied to image processing applications. To verify the reliability of these transformations, we propose to use formal methods based on theorem proving that can fulfil high standards of safety. To formally investigate binary image processing, in this paper, a reversible formal model of the binary images is defined in the Proof Assistant Coq. Multiple image transformation methods are formalized and their reliability properties are proved. To analyse real-life RGB images, a prototype translator is developed that reads RGB images and translate them to Coq definitions. As the formal definitions and proof scripts can be validated automatically by the computer, this raises the reliability and legal significance of the image forensic applications.

Chinese huge $62 billion investment in China-Pakistan Economic Corridor (CPEC) project in Pakistan creates numerous prospects and challenges for the economy and stability of Pakistan. CPEC is part of the China’s One Belt and Road Initiative (OBRI), which connects different countries and encourages the global economic Initiative. CPEC includes energy, agriculture, tourism, Gwadar port, communication and connectivity infrastructure and many other different types of projects. Currently CPEC first phase is completed and now second phase has begun. CPEC can play the most important role in the future direction of the Pakistani economy. CPEC is very beneficial for the people of Pakistan and China. This review study on the prospects and challenges for economy of Pakistan from the perspective of CPEC is evaluating the recent scenarios, which sees the potential and evaluation of areas on economic activities and potential threats, which can counter by the governments of Pakistan and China on regional and global level. This study also highlights the difficulties, which are creating by the India to impose sanctions on economic products of Pakistan through the platform of (Financial Action Task Force) FATF and harm the projects of CPEC. The findings revealed that Pakistan must promote the CPEC, counter CPEC propaganda, and integrate with the plan to create a smoother image of Pakistan, achieve national cohesion and reduce radicalization. Moreover, China and Pakistan should work together to break the shadow of distrust.

Teaching practicum is an essential component of teacher education program. It helps to modify the behaviors of student teachers. The study focused on urban and rural teacher educators’ skills, professional competencies, and teaching methods. The scope of the study was limited to ADE practicum in teacher Education Institutes of Sindh. The objective of the study was to analyze the performance of Teachers Educators during practicum. Intensive literature review was done. The strategy of research was quantitative. The population of study was 427 teacher educators. Stratified random sampling design was used to draw a sample of 300. Hypotheses were analyzed statistically, and it was found that the difference of performance based on location of the teacher educator’s institute. The professional competence and methods employed to achieve the goals of teaching are same among all teacher educators. Based on findings concrete recommendations were made. Administration should arrange the refresher courses for teacher’s educators, adequate training and designing of skill practice session. The outcomes of the finding enhance the professional competency of the teacher educators and effectiveness to ADE practicum process.

Background Urinary stone disease is associated with renal impairment because of obstruction and infection. Comorbidities include hypertension, dyslipidemia, diabetes, and impaired renal function. Furthermore, as recurrences are common in urolithiasis, such patients undergo many treatments throughout their life. Percutaneous nephrolithotomy (PCNL) is an effective treatment for renal stones with a diameter greater than 2 cm. The primary objective of this study was to observe the mean changes in estimated glomerular filtration rate (GFR) in patients undergoing PCNL having renal stone disease. Methodology This cross-sectional study was conducted for six months between June and November 2020 at a tertiary care hospital in Karachi, Pakistan. All male and female patients aged between 15 and 70 years who were diagnosed with renal stones using X-ray of the kidney, ureter, and bladder or using ultrasound of the abdomen and planned for PCNL were selected. Patients with any duration of kidney stone disease were included. Statistical Package for Social Sciences version 20.0 (IBM Corp., Armonk, NY, USA) was used to statistically analyze the data. Results The mean age of the patients was 41.11 ± 14.30 (17-70) years. A total of 61 (38.1%) patients were female and 99 (61.9%) were male. Mean preoperative GFR was 91.22 ± 5.88 mL/min which decreased to 83.64 ± 5.70 mL/min at 48 hours post-PCNL. GFR significantly decreased after surgery (p = 0.0001). Conclusions During early postoperative days, GFR was decreased in patients undergoing PCNL. Factors that may impair renal function should be avoided during the first few days after undergoing PCNL. Further large-scale studies are needed to investigate these changes in GFR in post-PCNL patients.

Infections caused by Streptococcus (S.) pneumoniae have become one of the leading causes of mortality and morbidity worldwide. Through colonization, it causes local or systemic infection among the human population belonging to all age groups. Its spreads from the nasopharynx become the source of local infections such as sinusitis or acute otitis media. In the case of aspiration S. pneumonia directly spreads in the lungs and leads to pneumonia acquired from the community. More than 96 serotypes have been reported so far, so determining all serotypes’ susceptibility and resistance is a cumbersome process that needs hefty effort, time, and resources. Thus, it becomes evident and necessitates that there should be some appropriate approach or technique to effectively and timely identify strains of bacteria, especially widespread ones like S. pneumoniae. Instead of identifying all these reported strains, identifying only two pherotypes can effectively serve the purpose of accurate identification and treatment. As a result of effective identification, the susceptibility and resistance of prevalent strains of S. pneumoniae can be easily done promptly with a minimum level of complex technology or complex protocols. It will pave the way for effective treatment of S. pneumoniae strains with rapid and higher recovery rates and minimal mortality rates. This chapter aims to evaluate antibiotics susceptibility and resistance to S. pneumoniae pherotypes called CSP-1 and CSP-2. Different methods of pherotypes determination have also been objectively evaluated.

This article investigates the dynamics of droplet generation process in a microfluidic flow-focusing device under the effect of geometry altered by the intersection angle (φ), which the flanking inlets make with central inlet and wall wettability quantified by the contact angle (θ) using volume of fluid (VOF) model. These parameters have been found to alter the droplet shape and size greatly. The effect of intersection angles has been examined for φ = 15 deg, 30 deg, 45 deg, 60 deg, 90 deg, and 120 deg for generating size-controlled droplets. It was predicted that the diameter of droplet increased with the increase in intersection angle (φ = 15 deg, 30 deg, 45 deg, 60 deg, 90 deg, and 120 deg) and the maximum diameter has been generated at φ = 90. In addition, the wetting characteristics (hydrophilic to hydrophobic) have been studied numerically in detail by changing the contact angle of the dispersed phase with the channel wall ranging from 90 deg to 180 deg. It was indicated that the droplets of rectangular shape are formed in hydrophilic channel by completely wetting the wall when θ ≤ 90 deg. They transform their shape to slightly oval form with the increase in contact angle and start acquiring spherical shape when the channel becomes hydrophobic. Furthermore, Parameters such as dimensionless droplet diameter, droplet shape, and droplet breakup time have also been investigated extensively for flowrate ratios Q = 0.125, 0.25, 0.5, and 1, in order to optimize the microfluidic device.

Aims: To identify variables having a critical role in prostate cancer patients experiencing osteometastasis. Background: Prostatic carcinoma is a multifactorial complex disorder that exhibits an increased propensity to develop bone metastasis. An interplay of inflammatory and bone remodeling parameters promotes the formation of pre-metastatic niches in bones of patients, which could render them more vulnerable to skeletal disabilities. Objective: To evaluate the multi-dynamic inter-relationship of circulating variables in prostate cancer patients experiencing osteo-metastasis. Materials and Methods: Fifty-seven (n=57) men with clinically confirmed prostate cancer, fifty-nine (n=59) with skeletal metastases, and one hundred (n=100) healthy subjects i.e., men aging from 53-84 years with no clinical evidence of prostate were recruited from the Jinnah Hospital Lahore, Pakistan. Informed consent was obtained, and a venous blood sample was drawn and stored at -70oC until assayed. Levels of variables were evaluated using appropriate methods. Levels of Matrix Metalloproteinases (MMPs), Osteopontin (OPN), TGH- β, and sRANKL were estimated by the ELISA method. Each sample was suspended and the given protocol was employed. ELISA readings were obtained for the estimation of all variables. Conclusion: The altered oxidative and inflammatory responses endorse Matrix Metalloproteinases (MMPs) increased activity, RANKL/OPG imbalance, and enhanced bone matrix proteins turnover, which can foster the process of osteo-metastasis. The perturbed RANKL/OPG drift and enhanced PSA levels are associated with increased TGF-β activity to aggravate Epithelial Mesenchymal transition (EM) and osteo-tropism of prostate cancer. Thus, designing novel targets of these major variables can minimize the incidence of prostate cancer patients. Results: Highly significant (P˂0.05) differential expression of oxidative stress, inflammatory cytokines, and bone remodeling variables were observed in localized and osteo-metastatic CA prostate patients. A strong positive correlation was revealed among OPN, sRANKL, MMP-7, MMP-9, PSA, and TGF-β (OPN vs. MMP-7, r=0.698* and OPN vs. MMP-9, r=0.765**, OPN vs. RANKL, =0.856*, sRANKL vs. MMP-9, r=0.825**, TGF- β vs. RANKL, r=0.868* and PSA vs. TGF- β, r=0.752*); lower levels of OPG were estimated in metastasized patients, showing that both osteolytic and osteoblastic phases of bone remodeling occur simultaneously.

Background\ud 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.\ud \ud Methods\ud 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.\ud \ud Findings\ud 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.\ud \ud Interpretation\ud 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.\ud \ud Funding\ud London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.

Background The HIV epidemic in Pakistan is concentrated in key populations and is one of the fastest growing epidemics in South Asia. Over the years the number of people infected with the human immunodeficiency virus initiated on antiretroviral therapy has gradually increased. The effectiveness of the treatment programmes depends on retention in care and treatment adherence. The aim of the study is to the explore the sociodemographic characteristics and magnitude of loss to follow-up in patients initiated on ART in three provinces of Pakistan.Methods A retrospective cross-sectional study was conducted in the National AIDS Control Programme. Case-based data (n=5,215) of 16 treatment centres for all patients initiated on anti-retroviral therapy from 1 st January 2017 to 31 st December 2018 was extracted from the national management information system. Loss to follow-up was defined as a patient who has not visited/attended the ART clinic for >180 days (6 months) and has not been reported dead or transferred out to another ART clinic. Descriptive statistics were applied to study the sociodemographic characteristics and level of lost to follow up in patients initiated on treatment.Results Of the 5,215 patients, 3,097 (59.4%) were aged between 15-49 years. About 4,069 (78%) were male. Around 1,686 (34.3%) of the patients on ART were defined as lost to follow up. Age, gender, and patients with undisclosed identity were identified as the key characteristics of patients lost to follow-up. A greater proportion of the patients were lost to follow-up within the first year of initiation of treatment.Conclusions The loss to follow in the study is high. Efforts need to be focussed on linking people infected with human immunodeficiency virus to treatment, retaining them in care, and increasing patient time on treatment. Patient tracing mechanisms should be strengthened.

As there is enormous increase or rise in the data exchange by the electronic system, the requirements of information security have become a compulsion. The most important concern in the communication system which is between sender and receiver is the security of the information which is to be transmitted. To get rid of the intruders, various cryptographic algorithms are used for example, AES, DES, Triple DES, Blowfish, etc. In this paper, authors have attempted to transfer file securely using randomly generated keys with Blowfish symmetric algorithm for encryption process. A unique transaction id is also generated which is used to fetch the random key which will be used for decryption at the receiver end. A validation key is also proposed which is used to validate that file is decrypted by the intended user only. The combination of random key, validation key, and transaction id as proposed will provide more robustness to secure transfer of file using Blowfish symmetric key encryption.