Search

Objective: In the past, brain stem was treated with surgery or placement of shunt in Pakistan. Gamma Knife surgery is currently an alternative to surgery for deep brain lesions. In the current study, we show the clinical experience of our Centre treated with Gamma Knife surgery Methods: This is a descriptive study conducted between February 2016 and October 2021. We had total 47 patients presented with focal brainstem gliomas which were selected for Gamma knife radiosurgery at the Neurospinal and Cancer Care Institute Karachi. Results: Clinical Response was observed among them 20 (42.55%) patients improved, 22(46.80%) were stable, while 05 (10.63%) got worse The mean duration of symptoms was 31.9(SD10.5± 3months). Karnofsky Performance Status (KPS) scores during Gamma knife radiosurgery were 90 in 24 patients (51%), 80 in 21 patients (44.6%), and 70 in two patients (4.2%). Four patients (10.6%) had received conventional radiotherapy before Gamma knife radiosurgery. Conclusion: Among the diverse gliomas, their peril varies not just by type but also by their intricate location within the brain. The efficacy of gamma knife radiation is excellent particularly when tackling high-grade tumors, exhibiting its prowess in both adult and pediatric cases. [ABSTRACT FROM AUTHOR]

Objective: To note the factors linked with delayed diagnosis of congenital heart diseases (CHDs) among children. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan. Period: September 2022 to February 2023. Material & Methods: We analyzed children aged up to 15 years who presented for the first time with echocardiographic evidence for the diagnosis of CHDs. Socio-demographic data along with clinical information like gender, age, residential status, maternal education status, history of maternal fetal echocardiography and the frequency of delayed diagnosis of CHDs were noted on a specially made proforma. Parent or guardians were asked for possible reasons of delayed diagnosis for CHDs. Results: In a total of 250 children, the mean age was 2.33±3.81 years while 162 (64.8%) children were aged below 2 years. There were 138 (55.2%) boys. Residential status of 159 (63.6%) children was rural while maternal educational status of 99 (39.6%) was illiterate. There were 164 (65.6%) children who were diagnosed to have cyanotic CHDs while 86 (34.4%) had acyanotic CHDs. Frequency of delayed diagnosis was noted among 182 (72.8%) children. In these 182 cases, delayed first consultation was the commonest factor behind delayed diagnosis noted in 78 (42.9%) children while missed diagnosis by the pediatrician was the 2nd most common factors linked with the delayed diagnosis of CHDs as described by 62 (34.1%) parents. Conclusion: Almost 3/4th of the studied children had delayed diagnosis of CHDs while cyanotic CHDs were the most common CHD types. Delayed first consultant and missed diagnosis by the pediatrician were the most common factors linked with delayed diagnosis of CHDs. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness and accuracy of deep brain stimulation in Parkinsonian Disease (PD). Methods: This study was a descriptive prospective study, and patients were treated at Neurospinal and Cancer Care Institute Karachi, from February 1, 2016, to June 30, 2020. We had 21 cases of parkinsonian disease. Inclusion criteria was Idiopathic Parkinson's disease, marked motor fluctuations against the response to dopaminergic therapy, UPDRSIII scores, which is 30 or higher, with a duration of disease of five years or longer, developing dyskinesia while the exclusion criteria was patient with known comorbid or active psychiatric disease Results: Mean age of patient was 64 years. The standard deviation was 1.11697. The male patients' mean, median and mode had a standard deviation of 0.3. For the duration of disease, the mean was 1.4, the median 1 (5-6 years) and mode one. The standard deviation was 0.51177. The primary symptoms' mean was 2.2857, the median was 2.0, and the mode was two (tremor). The mean on medication (age) was 2 (45-49), and the median and mode were the same. Conclusion: Deep brain stimulation (DBS) is an effective treatment option for a carefully selected patient. DBS improves tremors, dyskinesias, rigidity, motor fluctuations and bradykinesia. DBS is unlikely to benefit Autonomic dysfunction, cognitive disorders, hypophonia, and postural instability. Although it is an expensive treatment compared to lesioning or gamma knife, it is reversible. [ABSTRACT FROM AUTHOR]

Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material & Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p<0.001), brain abscess (p=0.001) and atrophic changes (p=0.032) were significantly associated with incomplete recovery. Surgery as a mode of treatment for the underlying neurological disease was associated with good recovery outcomes (p<0.001). Conclusion: Most common underlying diagnosis among children with cyanotic CHDs was tetralogy of fallot. CT findings at the time of enrollment as haemorrhagic infarct, brain abscess and atrophic changes, as well as hypotonia, down going plantars and developmental delay at the time of presentation were significantly linked with incomplete recovery. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical features and echocardiographic findings among children presenting with Ebstein's anomaly (EA). Study Design: Descriptive Case-series. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan. Period: July 2021 to June 2022. Material & Methods: Children of both genders aged above 1 month up to 18 years, having echocardiographic confirmed EA were analyzed. Demographic data along with clinical features, presenting symptoms and echocardiographic findings were noted in all case. Results: In a total of 48 cases of EA, 38 (79.2%) were female. The mean age was 8.4±4.21 years. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms reported in 31 (64.6%), 27 (56.3%), 26 (54.2%) and 24 (50.0%) patients respectively. Arrhythmias and heart failure were the most frequent clinical features noted in 29 (60.4%) patients each. Small atrial septal defect (ASD) was noted in 27 (56.3%) patients while ventricular septal defect in 19 (39.6%) cases. There were 11 (22.9%) patients who presented timely with diagnosis of EA while 37 (77.1%) patients had late diagnosis. Conclusion: Majority of the patients with Ebstein's anomaly were female. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms whereas arrhythmias and heart failure were the most frequent clinical features observed. ASD was the most commonly noted associated CHDs observed in almost half of the Ebstein's anomaly case. Almost 3/4th of the patients had late diagnosis. [ABSTRACT FROM AUTHOR]

Semi-volatile organic compounds (SVOCs) are a major global problem that causes the greatest impact on urban settings and have been linked to bronchial asthma in both children and adults in Pakistan. The association between exposure of polycyclic aromatic hydrocarbons (PAHs) and asthma in the adult population is less clear. The current study aimed to assess the clinico-chemical parameters and blood levels of naphthalene phenanthrene, pyrene, and 1,2-benzanthracene and urinary levels of 1-OH pyrene and 1-OH phenanthrene as well as asthma-related biomarkers immunoglobulin E (IgE), resistin, and superoxide dismutase (SOD) of oxidative stress and other hematologic parameters in adults and their relationship with bronchial asthma. The GC/MS analysis showed higher mean concentrations of blood PAHs in asthma respondents (4.48 ± 1.34, 3.46 ± 1.04, 0.10 ± 0.03, and 0.29 ± 0.09) (ng/mL) as compared to controls (3.07 ± 0.92, 1.71 ± 0.51, 0.06 ± 0.02, and 0.11 ± 0.03) (ng/mL), with p =.006, p =.001, p =.050, and p =.001. Similarly, urinary levels of 1-OHpyr and 1-OHphe were significantly increased in adults with bronchial asthma (0.54 ± 0.16; 0.13 ± 0.04) (μmol/mol-Cr) than in controls (0.30 ± 0.09; 0.05 ± 0.02) (μmol/mol-Cr), with p =.002 and p =.0001, respectively, with a significant positive correlation to asthma severity. The asthma-related biomarkers IgE, resistin, and SOD were significantly higher (p 0.0001, 0.0001, and 0.0001) in people with asthma than in control persons. The findings showed that higher blood and urine PAHs levels were linked to higher asthma risk in adults and significant interaction with participants who smoked, had allergies, had a family history of asthma, and were exposed to dust. The current study's findings will be useful to local regulatory agencies in Lahore in terms of managing exposure and advocating efforts to minimize PAH pollution and manage health. [ABSTRACT FROM AUTHOR]

Air pollution levels rise as a result of industrial and vehicular emissions, epidemiological issues such as asthma become more prevalent in Lahore, Punjab, Pakistan and cause adverse public health effects. Many studies explored the association between air pollutants and frequency of asthma hospital visits, although their effects are unclear. This study examined the link between air pollution, asthma, and socioeconomic and demographic factors. A questionnaire survey was administered among four age groups (15–25, 25–45, 45–60, and over 60 years old) in public and private hospitals of Lahore city. Daily average concentrations of five air pollutants including carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and particulate matter (PM2.5 and PM10) were recorded at ten fixed air monitoring sites in Lahore city. There were favorable connections between outpatient department (OPD) asthma visits (64%) and levels of outdoor air quality during winter season throughout the study period. The correlation between 1, 29, and 370 asthma patients and average daily air pollution levels found that the condition was more prevalent in females (53%) than males (47%). There was a significant correlation between PM10 exposure and asthma OPD visits in the city (p 0.001), as well as the elevated PM10 levels were substantially linked with OPD asthma visits over the winter season in the city. The hazard index (HI) for all adult population was estimated 0.001132. The study's findings indicate that exposure to ambient air pollution is a significant predictor of asthma hospital visits, particularly among the elderly. Strategies can be developed by policymakers in response to the worrying situation of allergic disease asthma in industrial cities due to air pollution. [ABSTRACT FROM AUTHOR]

Solid Waste Management (SWM) is a technical subject which requires comprehensive planning, execution, and effective operational monitoring under cost-effective modes compatible with environmentally sound technologies. The policymakers made some enormous efforts for the sustainability of this sector as well as setting a benchmark for other municipalities and Waste Management Companies (WMCs) in the country. Provincial Government prioritizes its focus on SWM, i.e., waste collection, transportation, treatment, and final disposal. The waste management sector in Lahore has achieved sustainability in waste collection and haulage components by gaining experience from international outsourcing and, now, sharing its knowledge with other municipalities to strengthen the sector in the country. Lahore has emerged with the highest collection efficiency (84%) in SAARC countries and placed fifth in rank in comparison to 54 low–middle-income countries/cities worldwide. The sectorial interventions in Lahore reveal an aspiration for the sustainability of the SWM sector in Pakistan. However, there is an urgent need to focus and invest in waste-related infrastructure development, i.e., permanent/mobile transfer stations, semi-underground containers for commercial and planned areas, material recovery facilities (MRF), and landfill. Environmental and economic sustainability in this sector can be achieved through public–private partnership (PPP) modality in compost, anaerobic digestion, recycling, and refuse-derived fuel (RDF) as it is a more feasible option to strengthen the industry in the country. [ABSTRACT FROM AUTHOR]

This study aims to evaluate municipal landfill sites' operational and financial viability, waste amount and characterization, primary and secondary collection systems, revenue generation from MSW, vehicle routing, and age of landfill sites located in Akhtarabad, Sahiwal Division. Three operational and financial models were developed to calculate cost/ton value based on obtained data. The obtained results indicate that the cost/ton values for models are the following: 20.01 USD for Model-1, 8.96 USD Model-2, and Model-3 is about 10.23 USD. The waste characterization represented waste consisting of compostable (57%), recyclable (10%), Refuse Derived Fuel (RDF) (12%), earth fill (20%), and disposable material (1%). Revenue/ton of municipal solid waste was about 19.47 USD, and according to cost-benefit analysis, the cost of Model-1 was higher than the benefit. In contrast, the costs of Model-2 and Model-3 were found to be lower than the revenue/ton. However, the waste collection efficiency of Model-1 was greater than both remaining models. The study concluded that utilizing all generated waste, only 21% of waste is dumped at the landfill site. It will reduce the area required for landfill sites from 431437 to 90602 m2 for the next 10 years and increase the age of landfill sites by over 20 years. It is recommended that the reuse of municipal solid waste and implementation of the no waste to landfill model would surely save money, land, and fuel, and it will also increase the age of landfill sites. [ABSTRACT FROM AUTHOR]

Medicinal plant Fagonia cretica L., is well known in traditional medicines for curing various complaints of human beings from ancient times and is locally known as Dhamasa. Previous many studies have reported the presence of many phytochemicals, antimicrobial, and antioxidant properties in the various parts of this plant. Therefore, here in this study, we have presented a comprehensive study on the presence of similar medicinal and chemical properties of Dhamsa found in Jamshoro District, Pakistan. For this study, extracts of the root, stem, leaf, and pod of the plant were prepared separately from three different solvents, water, ethanol, and methanol. Then the amount and presence of various phytochemicals, antimicrobial, antioxidant properties, and allelopathic effects were determined in all the extracts. The obtained results of this study confirm the presence of medicinal important phytochemicals in the plant extracts. The antimicrobial testing of this plant proved its highest activity against E. coli (16 ±1.4mm), Salmonella typhi (18±0.7mm), and Pseudomonas aeruginosa (15±1.4mm) in methanol, water, and ethanol extracts respectively. The presence of antioxidant activities was also observed in the ethanolic extract of the leaf at about 0.98 mg/ml. While this plant showed allelopathic effects on the growth of radish and spinach plants. So, we have concluded this study that Fagonia cretica L., collected from Jamshoro has the same or more important properties compared to the same plant from other regions, which proves the similar significant value of the Fagonia cretica plant of Jamshoro in various fields of medicinal sciences. [ABSTRACT FROM AUTHOR]

Pakistan's agriculture and economy rely heavily on the Tarbela Reservoir. The present storage capacity of Tarbela is 8.2 BCM and it has been depleted by more than 40% due to sedimentation since 1976. It also has had a 0.94 percent (0.134 BCM) decrease in gross reservoir capacity every year. Historically, the amount of sediment trapped in the Tarbela Reservoir during the period 1976–2020 was 198.5 million tonnes annually. Based on the current operation by the Water and Power Development Authority (WAPDA), the delta is expected to extend to 2.41 km from the dam in 2035. The reservoir will become a run-of-the-river reservoir with a gross storage capacity of 2.87 BCM. This rapid loss of storage capacity will significantly impact reservoir benefits while also putting turbine performance at risk due to abrasion. Slowing the sediment deposition phenomena by a flexible operational strategy is a worthwhile aim from the dam manager's viewpoint to achieve Sustainable Development Goals (i.e., poverty and hunger alleviation, clean affordable energy, protecting ecosystem etc.). Therefore, for the safe and long-term operation of the turbines, the existing Standard Operating Procedures (SOPs) adopted by WAPDA need to be appraised to delineate their impact on future optimized operations. The aspect of considering static SOPs on the whole period of reservoir operation has not been attempted earlier. The Tarbela Reservoir was selected as a case study to enhance the existing reservoir operation. The methodology relies upon the use of a 1-D sediment transport model in HEC-RAS to study the impact of the operational strategy on sedimentation. In conjunction, the existing reservoir operation of Tarbela was modelled in HEC-ResSim using its physical, operational, and 10-daily time-series data for simulation of releases and hydropower benefits based on a revised elevation-capacity curve for sedimentation. After calibration and validation, the model was applied to predict future reservoir operation impacts on a 5-year basis from 2025 to 2035 for determining storage capacity, irrigation releases, power production and energy generation. It was predicted that as the storage capacity of the reservoir is depleted (by application of the WAPDA current SOPs in future years), the irrigation releases would be increased in the Kharif season (April–September) by 7% and decreased by 50% in the Rabi season (October–March) with a corresponding increase in power generation by 4% and decrease by 37%, respectively, and the average annual energy generation would be decreased by 6.5%. The results showed that a gradual increase in the minimum operating level will slow down delta movement but it will reduce irrigation releases at times of high demand. The findings may assist water managers to improve the Tarbela Reservoir operation to achieve sustainable development goals and to attain societal future benefits. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the psychosocial impact during the current epidemic situation of COVID-19 in Pakistan. Design/methodology/approach: A total of 1,149 respondents were recruited in the study. Mental health status and psychological impact of COVID-19 outbreak were measured by impact of events scale–revised (IES-R) instrument and depression, anxiety and stress scales (DASS-21), respectively. Findings: Results of IES-R revealed moderate or severe psychological impact in 13.05% respondents (score > 33). DAAS score revealed that severe and extremely severe depression (score: 21–42), anxiety (score: 15–42) and stress (score: 27–42) were reported in 6.35%, 6.87% and 2.78% respondents, respectively. Higher levels of stress, anxiety and depression were recorded in female gender, student, medical professionals, farmer and daily wages employed, exhibiting significant (p < 0.05) association with psychological impact of the COVID-19 outbreak. Majority of respondents received increased support, shared feeling and family care. Originality/value: Mild to moderate psychological impact on mental health status was recorded in this study, which enables further planning and opportunities for health authorities to design psychological interventions for the improvement of negative psychological impact of COVID-19 epidemic in vulnerable groups. [ABSTRACT FROM AUTHOR]

Current economic conditions in developing countries are very problematic, particularly devaluations in a currency that leads to an increase in the Exchange rate(ER), Moreover, change in exchange rate with less export and more imports developing countries have faced the problem of trade deficit(TD) at same time deficit balance of payment(DBOP), due to deficit balance of payment developing country has unable to pay external debts(EDs) which leads to again increase in ER this cycle generates several problems So, researchers 1st core objective is to ascertain the impact of TD on EDs and 2nd core objective is to ascertain the impact of EDs on ER. Several literature and theories highlighted the relationship between these IVs and DV. Researchers used preceding 15 years' secondary data related to Pakistan. 15 years of data consist of three different governments and different policymakers. For analysis, scholars used correlation and OLS techniques with the help of Ms excel and Eviews to check whether the result are the same or not with other researchers. The finding of this study shows that all three alternative hypotheses are accepted and have a significant impact. [ABSTRACT FROM AUTHOR]

Poor irrigation management is a common issue of irrigated agriculture. Assessment of irrigation system performance is essential to improve the irrigation system, which requires real-time data. Satellite data has been found the best alternate. This manuscript presents a methodology to assess irrigation system performance using combination of satellite and ground data. The developed methodology was applied on a canal system of Punjab Pakistan. High resolution satellite images were processed to images of normalized difference vegetation index (NDVI), evaporative fraction (EF) and evapotranspiration (ET). These images in combination with ground data provided information on pixel to pixel vegetated area, water availability/ requirement consequently the irrigation system performance indicators. The results revealed that potential water requirement of the area was 401.66 million cubic meters (MCM) and available canal water supply was 247.14 MCM, thus indicating shortage of 38%. Adequacy of the system was found to be 74% while its reliability varied from 35–73%. Average coefficient of variance (Cv) was found 0.43 showing poor reliability of the system. Performance in equity terms revealed that head areas of irrigation channels were receiving more water supplies than the tail areas. Strong correlation was found between crop yields and water supplies i.e., crop yield was strongly dependent on water supplied (R2 = 0.80). [ABSTRACT FROM AUTHOR]

Pakistan is a patriarchal culture in which men have the most power and women are seen as second-class citizens. This has major ramifications for both women and men's lives. The goal was to investigate contemporary gender roles in urban Pakistan, as well as how they are reproduced and perpetuated, and how they affect men's and women's lives. It was also said that the younger age was more supportive of gender norms being modernised than the older generation. In Pakistani society, there are substantial gender inequities and human rights abuses against women, according to this report. The uneven gender roles were seen as permanent and imposed by societal systems. Women were frequently subjected to severe restrictions and constraints on their liberty. Higher levels of education, on the other hand, were seen as a catalyst for change, not only for women but also for males. Furthermore, the media was seen to play a good role in promoting women's empowerment. COVID-19 has a negative influence on employee performance and increases the risk of making a mistake. It's all about figuring out if there's a link between employee support and corporate success on a large scale. Let's look at the differences between workplace justice and job fairness. For this study, a convenience poll of 100 gender based employees was defined and chosen. The surveys were kept open-ended to stimulate responses. A Pseudo-Differential Templating Method was employed to analyse a subset of the replies. Employee morale rises during periods of high cash flow, since COVID-19 views this as delivering additional resources to employees rather than laying the groundwork for their positions. [ABSTRACT FROM AUTHOR]

This paper presents an energy plan for harnessing electrical power from hybrid energy resources, including biomass and solid waste, through hybrid technologies for microgrid development to overcome the current energy crisis and provide future sustainable electricity pathways for a developing country. Biomass and solid waste were collected from different dumping sites in Pakistan and were tested for their calorific value, which was found to be 6519Kcal/Kg. The total power was calculated based on this calorific value and it was found that there is a potential of total 11,989.5GW of power generation. Thus, hybrid energy resources are suitable for harnessing electrical energy through hybrid technologies. Different hybrid systems were examined for these resources and the gasification technique is finally proposed as the most suitable method for producing energy from biomass and solid waste resources in Pakistan. This technique is also found to be economically feasible for processing all kinds of waste. [ABSTRACT FROM AUTHOR]

Tick infestation is the main issue for animal health that causes substantial economic losses in the form of mortality and morbidity, particularly in tropical and subtropical countries of the world including Pakistan. The rural economy of Pakistan depends upon on livestock industry which faces the problems of some zoonotic diseases spread by tick infestation. Tick infestation caused Crimean-Congo hemorrhagic fever (CCHF), Lyme disease, theileriosis and babesiosis in wild and domestic animals including humans. Climate change is highly associated with the distribution of ticks and ticks bornediseases (TBDs). Due to global warming, the temperature of the globe is rising which directly and indirectly affects vector-borne diseases like TBDs. To minimize the ticks and TBDs various approaches have been used in different regions of the world including Pakistan. The need for a review paper is to investigate the impact of climate change on ticks and TBDs in livestock as well as public health in Pakistan. To evaluate the effectiveness, environmentally safe, economically feasible and acceptable tick management approaches, literature was reviewed. [ABSTRACT FROM AUTHOR]

Objective: To find out the mode of presentation and severity of cardiac involvement in children presented with established rheumatic heart diseases (RHD) at first presentation at a tertiary care setup. Study Design: Cross-sectional study. Place and Duration of the Study: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi Pakistan, from Jul 2020 to Jun 2021. Methodology: One hundred seven children of genders aged 3 to 18 with a confirmed diagnosis of RHD were included. Demographic features, chief presenting complaints, possible reasons for late presentation, and echocardiographic findings were noted. Results: In 107 patients with RHD, 63(58.9%) were male. The sensation of the rapid pounding of heartbeat (palpitation) was observed among 72(67.3%) children, while a similar number of cases, 72(67.3%), presented with breathlessness. There were 33(30.8%) children who were diagnosed for the first time with RHD. The most common reason for late diagnosis was socio-economic factors in children (18, 26.1%). Primary prophylaxis for acute rheumatic fever (ARF)/RHD was noted to be given in 11(10.3%) patients. Mitral regurgitation was the most common echocardiographic finding in 103(96.3%), followed by aortic regurgitation in 99(92.5%). Conclusion: The majority of children with RHD are diagnosed late, which exposes them to an increased risk of undiagnosed valvular disorders. Palpitation, orthopnea and breathlessness were RHD most frequent presenting clinical features. Mitral regurgitation and aortic regurgitation were the most common echocardiographic findings. [ABSTRACT FROM AUTHOR]

The elimination of persistent organic pollutants (POPs) obsolete pesticides stockpiles, particularly the organochlorine pesticides (OCPs), is one of the critical environmental issues faced by many developing countries. This pioneering study aimed to investigate the occurrence, source fingerprinting, human health, and ecological risks of OCPs in the surroundings of the lone POPs pesticide destruction facility in Pakistan. The ΣOCPs residual levels in soil ranged from 35.98 to 566.77 ng/g dry weight (dw), with a mean concentration of 174.42 + 111.62 ng/g (dw). The OCPs contamination levels in the soil followed the pattern as ΣHCHs > Σendrins > Σendosulfans > dieldrin > Σheptachlors > ΣDDTs > Σchlordanes > methoxychlor. The ΣHCHs residual concentrations were comparatively higher than the previous national and global soil studies. The recent accumulation of HCHs, DDTs, and heptachlor was observed in the study area as identified by β-HCH/∑HCHs, (DDE + DDD)/ΣDDTs, heptachlor/Σheptachlor, and heptachlor exo-epoxide/heptachlor ratios. The OCPs' lifetime carcinogenic risk through ingestion, dermal, and inhalation exposure routes ranged from 1.65E-08 to 2.91E-07, whereas the noncarcinogenic hazard quotient (HQ) ranged from 9.12E-05 to 1.61E-03. The risk vulnerability among age groups was in the order: adult > toddler > child > teen > infant. The calculated risk levels were within an acceptable limit of one in a million (1 × 10−6) for carcinogenic risk and HQ < 1 for noncarcinogenic risk. The current OCPs residual levels, especially dieldrin and endrin, exhibited low to medium ecological risks when compared to various worldwide limits. The upsurge of the OCPs' environmental contamination levels over the years and consideration of the food chain transfer might amplify the human health and ecological risks intensities. [ABSTRACT FROM AUTHOR]

Since 2001 substantial resources have been allocated to the reproductive, maternal, newborn and child health sector (RMNCH) in Pakistan. Many new programmes have been started and coverage of some existing programmes has been extended to un-served and rural areas. Despite these efforts the Millennium Development Goals (MDGs) 4 and 5 were not achieved (2000-15). Maternal Mortality Ratio was reduced to 170 per 100 000 live births (target 100) by 2013 at an annual reduction rate of 3.6% (1990-2013). Against the target of 46 per 1000 live births, the Under Five Mortality Rate was reduced to 81 per 1000 live births by 2015 at an annual reduction rate of 2.1% (1990-2015). We evaluated the comparative expenditures for the RMNCH sector and analysed impact of public expenditures on the use of the public facilities for the RMNCH services. Expenditure on RMNCH increased by 181% (2000-10), reaching PKR 628.79 billion (US$9.67 billion). The Share of the RMNCH expenditure in the total health expenditure increased from 16 to 21% (2005-10). The share of official development assistance for the RMNCH increased from 36 to 51% (2003-10). Equity was modestly achieved with a greater proportion of the poor using public facilities for the childhood diarrhoea (Concentration Index -0.06 in 2001-02 to - 0.11 in 2010-11) and reduction in the proportion of the rich using the public health facilities for institutional births (Concentration Index 0.30 in 2001-02 to 0.25 in 2010-11). Overall the RMNCH disease control programmes focused on vertical primary health approach and targeted the district health system in the un-served areas. Our findings confirm that diseconomies of scale, donor dependence and supply side perspective could only result in a modest progress towards achieving the MDGs. We call for urgent attention of the policy makers for the integration of the vertical and the routine primary health care and reliance on indigenous sustainable healthcare financing. We also recommend acknowledging economic perspective on health policy and health programmes. [ABSTRACT FROM AUTHOR]

Objective: to find out the impact of cardiopulmonary bypass time (CPBT) and aortic cross-clamp time (ACCT) on immediate post-operative outcomes in patients with congenital heart disease (CHD) undergoing open heart surgery at a tertiary care centre. Study Design: Prospective longitudinal study. Place and Duration of the Study: Department of Paediatric, Cardiac Intensive Care Unit, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan, from Jul to Dec 2021. Methodology: We enrolled 104 patients of both genders up to any age with CHD undergoing open heart surgeries. At the time of admission, age, gender, body weight, presence of cyanosis and types of CHDs were noted. Duration of mechanical ventilation, pediatric cardiac intensive care unit (PCICU) stay, and mortality was recorded. Baseline characteristics and pos t-surgery parameters were compared about CPBT and ACCT. Results: Of 104 patients, 58(55.8%) were males. Overall, the mean age was 7.9±5.1 years. Cyanosis was noted in 34(32.7%) cases. Mean CPBT was 74.6±42.9 minutes, while the mean ACCT was 43.5±29.5 minutes. Most types of CHDs were noted to be tetralogy of Fallot (ToF) 28(26.9%). An increase in the duration of CPBT and ACCT was found to have a significant association with post-surgical morbidity (p<0.001). Conclusion: Increased cardiopulmonary bypass time and aortic cross-clamp time were found to have a significant association with post-surgical morbidity and outcomes among cases undergoing open heart surgeries for congenital heart diseases. [ABSTRACT FROM AUTHOR]

Fishery is one of the natural resources of Pakistan, and Indus River is ideal for fishing. Kotri barrage is the last barrage on the river and the downstream area is utilized for fishing and effluent. The most popular Ilish (Palla fish) is found in Kotri downstream. The production of fish is directly proportionate to the flow of water in the river. The downstream water is considered a waste and extravagant, but that downstream includes 34 landing sites for fishing and cater to 21550 of population on both sides in four districts. The paper aimed to explore the water discharge in Kotri downstream, number of license issued, fish production, and estimated income and correlation among them. It also sought to explore population of landing centers in downstream Kotri and the demand of fish and consumption pattern by survey. The downstream water is livelihood of fishermen, source of delicious and nutritious food which can be traded nationally and internationally and contribute to GDP. A wise management and conservation of water is required, otherwise Kotri downstream area will turn into desert whereas fishermen will turn to beggars. [ABSTRACT FROM AUTHOR]

At the end of each of the ten general elections in Pakistan a debate regarding its fairness is erupted. Every losing contestant and political party pronounces it to be rigged and engineered. On the other hand the winners claim it to be historically free and fair. Statistical analysis of the election data may be used to gauge the legitimacy, and level of fairness of an election. Putting such data on statistical analyses is unprecedented in Pakistan. In this paper we have set an example and precedence. [ABSTRACT FROM AUTHOR]

This research paper focuses on the medium of instruction that has been the burning issue not only in Pakistan but all around the world. This issue has remained unresolved in Pakistan due to overwhelming practice of other local and native languages in different provinces. The use of English as a medium of instruction in schools has given opportunity to a long debate whether English is better verified than any of the native languages especially to build up the learner's comprehension level at secondary school level. The n = 68 public higher/secondary schools of Hyderabad District were taken as the sample. The two groups of the Class VIII students comprised 100 out of which 50 were from mother tongue and 50 were from non-mother tongue schools respectively. Simultaneously, 15 teachers from mother tongue and 15 from non-mother tongue schools were respectively selected for interview. Appropriate interview protocols were made to inspect the effect of the medium of instruction on cognition of learners. In this regard, 5 item semi-structured interview protocol in each was developed for teachers and students. Data were analyzed quantitatively. The results of the study demonstrated that students' cognition is better when taught in their mother tongue and they prefer to learn the subject in their respective mother tongues. This understanding of the subject enhances their cognition level as well. On the other hand, teachers also illustrated their preferences to teach in the mother tongue through which students have better learning and understanding. Finally, recommendations were provided for the improvement of the situation planning. [ABSTRACT FROM AUTHOR]

This research investigates the Pareto Analysis on Textile Industry of Pakistan Data were collected 100 textile mills, in the form of unstructured questionnaire from the textile industry of Pakistan. The main respondents of the questionnaire were senior to middle level management located in Karachi, Hyderabad, Kotri, Nooriabad, Faisalabad and Lahore the for the purpose of this study yellow pages were used for identification and address of the respondents and web site of APTMA. From the 100 e-mail addresses, 10 were bounced and returned as either address unknown or not active anymore. Out of the remaining 90 respondents 48 agreed for the qualitative interviews in which respondents were met face to face in textile mills located in different cities of Pakistan. Response rate was 90% during this survey. [ABSTRACT FROM AUTHOR]

This research investigates the issues of textile industry in Pakistan. Data were collected 100 textile mills, in the form of unstructured questionnaire from the textile industry of Pakistan. The main respondents of the questionnaire were senior to middle level management located in Karachi, Hyderabad, Kotri, Nooriabad, Faisalabad and Lahore. For the purpose of this study yellow pages were used for identification and address of the respondents and web site of APTMA. From the 100 e-mail addresses, 10 were bounced and returned as either address unknown or not active anymore. Out of the remaining 90 respondents 48 agreed for the qualitative interviews in which respondents were met face to face in textile mills located in different cities of Pakistan. Response rate was 90% during this survey. It was revealed that textile industry is facing problems like electricity, cotton chipping and processing. [ABSTRACT FROM AUTHOR]

There is a good rationale behind teaching of note-taking to the learners of English as a second language that learners can not get chance to listen a lecture again. Note-taking is one of the study skills. It amalgamates listening, reading, writing, and comprehension skills for academic achievement and performance. Notes may be defined as the main points of any topic written in symbolic and abbreviated form. The main purpose of note-taking in academic life is to remember whatever is important either in lectures or in textbooks for passing tests/examinations. Hence the teaching of note-taking to the learners of English as a second language is pivotal, and purposive in teaching learning process. There are various methods of note-taking such as Cornell Method, Outline Method, Mapping Method, Charting Method and Sentence Method etc. However, note-taking makes studies of learners systematic, organized, easy, and well-remembered. [ABSTRACT FROM AUTHOR]

Education is a behavior forming activity, while permanent change in the behavior of a person is known as learning It is gained by the senses (listening, reading, watching and doing etc.). The more the senses are used during the process of acquiring knowledge, the easier it will be to comprehend. There are a number of children in classrooms with normal body and appearance but with certain hidden disabilities, which could not disfigure or leave visible signs while they study in the class along with other normal students. Present study attempts to identify students with learning disabilities and evaluate their behavior with school teachers and classmates along with their habits. A sample of 14 private schools of Qasimabad, A tlaka of Hyderabad, Pakistan was selected as sample of study. Two tools, one for identification of LD students and second for evaluating their behavior and habits were used. It was found that students with LD remain mostly silent but become easily hyper. Mostly they do not take part in games. Keeping in view the findings suggestions were given for schools, teachers and parents. [ABSTRACT FROM AUTHOR]

Present study was carried out to study insect diversity and influence of abiotic factors such as temperature and humidity on insect population at Lawrence garden, Lahore from January 2009 to June 2009. Higher number of insect species was observed in Order Lepidoptera (17 species), Diptera (15 species), Hymenoptera (14 species) and Coleoptera (13 species). It was also revealed that increasing temperature and humidity from January to March positively affected the number of insect species but from April to June gradual decrease in humidity with increasing temperature reduced the number of insects. Similarly insects with chewing mouthparts were more abundant in the Lawrence Garden as compared to other insects. [ABSTRACT FROM AUTHOR]

Environmental impact assessment (EIA) is an important legislative and scientific tool that may assist and improve the quality assistance for the decision-making process in sustainable development. Here, a comparison of EIAs from three cases of hydropower projects in Pakistan, Norway and Sweden is reported. A huge difference concerning the incorporation of environmental considerations into the decisionmaking process between developed and developing countries is observed. The EIA system of Pakistan appears to be less efficient in the application and review process. In addition, the appraisal of issues, the decision-making process and evaluation through post-monitoring is not as well performed in Pakistan as in cases of hydroelectric power plants in Sweden and Norway. The key reason for this shortcoming is misconceptions about the EIA process, which initially receives intense attention but becomes weakened by the time of implementation. This implies that there is a need to adopt simplified and flexible EIA techniques suitable for the infrastructure and resources of a specific country, taking into account institutional, technical and financial constraints. Improvements are required in public participation, awareness, as well as in environmental control and data system sectors in Pakistan, besides simply enacting legislation to achieve the goals of the EIA system. [ABSTRACT FROM AUTHOR]

Marala Barrage was constructed in 1968 on River Chenab as a replacement of old Marala weir, which was constructed in 1912. Two canals, Marala Ravi Link (MRL) Canal andUpper Chenab Canal (UCC) off-take from left side of the barrage. It has an old history of varying sediment problems in both of these canals. Several attempts were made to investigate the problems and suggest remedial measures in the past and some of them were partially implemented as well. This paper reviews the major sediment management problems at Marala Barrage and their possible causes. The previous interventions are critically examined for their suitability and effectiveness in general and the effect of raising crest of MR Link canal in particular. The paper concludes that some of the past interventions have a positive effect on silt control entry in the off-taking canals. The analysis of data regarding sediment entry at the head of the canals indicate that the raising of crest of MR Link in the year 2000-2001 has improved the sediment intake in this canal to some extent, but its effect on the UCC is almost negligible. The data regarding sediment entry at the head of the UCC which had a scouring tendency, does not show any significant effect of this intervention as was perceived at the implementation stage. However, it is worth mentioning that analysis of data related to cross-sections and L-sections of the head reaches of these canals show a different trend, which makes it difficult to assess the long term and sustainable effect of this intervention on both of the canals. A critical review of data collection process and effective monitoring of the system is compulsory for meaningful analysis and future course of action if the present tendency seems to be changing, the possibility of which does exist. [ABSTRACT FROM AUTHOR]

The solid waste management (SWM) system is in a transitional phase in developing economies, and local municipalities and waste management companies are stepping toward integrating a waste treatment approach in the scheme of waste handling. However, there is an urgent need to explore cost-effective techniques, models, and potential revenue streams to sustain the state-run waste sector self-sufficiently. The proposed SWM model aims to support the local waste sector in Islamabad, the capital city of Pakistan, with 100% service area coverage to attain environmental and economic sustainability by defining dedicated waste collection streams to ensure quality material recovery under a cost-effective approach and modality. The innovative approach is applied to allocate the tonnage to various streams as per the city's current land use plan. The estimated/cost of the cleanliness services will be USD13.1 million per annum with an estimated per ton cost of USD 23. The establishment of the proposed material recovery facility (MRF) will process about 500 t/d of waste to produce 45 t/d compost and recover 130 t/d of recyclables. The environmentally friendly model saves 2.4 million tons of CO 2 ‒eq/month from composting and recycling. The average economic potential from MRF and debris-crushing plants, including environmental benefit value, is calculated as USD 3.97 million annually. Recovery of services fee (70%) for various collection streams based on city land use and socio-economic conditions will generate revenue of USD 7.33 million annually. The total revenue will be USD 11.31 million (86% of total annual expenditures) to track the sector's self-sufficiency. To successfully reach the Sustainable Development Goals (SDGs) and Nationally Determined Contributions (NDCs), engaging the private sector from environmentally advanced economies to collaborate in the waste sector to enhance local technical capabilities is recommended. [Display omitted] • Solid waste management model was proposed for economic sustainability. • Composting and resource recovery in waste management sector was examined. • 2.4 million tons of CO 2 -eq/month was saved through proposed model can be achieved. • Total revenue of US$ 11.53 million was achieved from proposed model. • Global and local collaboration can enhance waste management capabilities. [ABSTRACT FROM AUTHOR]

Introduction: Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration. Methodology: We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan. Results: Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate. Conclusion: Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study. [ABSTRACT FROM AUTHOR]

This study examines point and non-point sources of air pollution and particulate matter and their associated socioeconomic and health impacts in South Asian countries, primarily India, China, and Pakistan. The legislative frameworks, policy gaps, and targeted solutions are also scrutinized. The major cities in these countries have surpassed the permissible limits defined by WHO for sulfur dioxide, carbon monoxide, particulate matter, and nitrogen dioxide. As a result, they are facing widespread health problems, disabilities, and causalities at extreme events. Populations in these countries are comparatively more prone to air pollution effects because they spend more time in the open air, increasing their likelihood of exposure to air pollutants. The elevated level of air pollutants and their long-term exposure increases the susceptibility to several chronic/acute diseases, i.e., obstructive pulmonary diseases, acute respiratory distress, chronic bronchitis, and emphysema. More in-depth spatial-temporal air pollution monitoring studies in China, India, and Pakistan are recommended. The study findings suggest that policymakers at the local, national, and regional levels should devise targeted policies by considering all the relevant parameters, including the country's economic status, local meteorological conditions, industrial interests, public lifestyle, and national literacy rate. This approach will also help design and implement more efficient policies which are less likely to fail when brought into practice. [Display omitted] • Air pollution and particulate matter are emerging challenges in South Asia. • Legislative and policy gaps on air pollution in South Asia were scrutinized. • South Asia has surpassed the permissible limits of air quality. • India, China and Pakistan have severe health issues due to air pollution. • Spatial-temporal monitoring studies in China, India, and Pakistan are needed. [ABSTRACT FROM AUTHOR]

A pneumonia-like disease of unknown origin caused a catastrophe in Wuhan city, China. This disease spread to 215 countries affecting a wide range of people. World health organization (WHO) called it a pandemic and it was officially named as Severe Acute Respiratory Syndrome Corona virus 2 (SARS CoV-2), also known as Corona virus disease (COVID-19). This pandemic compelled countries to enforce a socio-economic lockdown to prevent its widespread. This paper focuses on how the particulate matter pollution was reduced during the lockdown period (23 March to April 15, 2020) as compared to before lockdown. Both ground-based and satellite observations were used to identify the improvement in air quality of Pakistan with primary focus on four major cities of Lahore, Islamabad, Karachi and Peshawar. Both datasets have shown a substantial reduction in PM 2.5 pollution levels (ranging from 13% to 33% in case of satellite observations, while 23%–58% in ground-based observations) across Pakistan. Result shows a higher rate of COVID-19 spread in major cities of Pakistan with poor air quality conditions. Yet more research is needed in order to establish linkage between COVID-19 spread and air pollution. However, it can be partially attributed to both higher rate of population density and frequent exposure of population to enhanced levels of PM 2.5 concentrations before lockdown period. • The COVID-19 has caused severe health concerns and economic disruptions worldwide. • Larger spread of COVID-19 can be associated with elevated levels of PM 2.5 • The lockdown had a positive change in severely polluted cities of Pakistan. • Besides improvement, it has posed sever challenges of environmental monitoring. • Restricted mobility resulted in pile up and improper disposal of hospital waste. [ABSTRACT FROM AUTHOR]

• PM levels in all major cities of Pakistan are beyond permissible limits • Biogenic pollution sources are least studied in Pakistan • No continuous monitoring facilities available in the country • Lack of emission inventories, political will and awareness are the biggest challenges • The academic institutes have been sidelined from the policy and industrial spheres This study, for the first time, aims to evaluate the situation of air quality in Pakistan critically; through a detailed assessment of sources, policies, and key challenges to identify the plausible way forward. Air pollution and particulate matter have merged as a global challenge in recent years because of its growing health and socio-economic risks. The intensity and impacts of these risks have become more pronounced, especially in developing countries like Pakistan that lack adequate warning, protection, and management systems. Various epidemiological studies have linked poor air quality with different health disorders and increasing death rates. In Pakistan, mortality rates as a result of exposure to increased levels of air pollutants, especially particulate matter, are alarming. According to the World Bank's estimates, Pakistan's annual burden of disease from outdoor air pollution is responsible for around 22,000 premature adult deaths and 163,432 DALYs (disability-adjusted life years) lost. The concentration of major air pollutants in Pakistan, such as NOx, O 3, and SO 2 have also been increasing significantly over the last two decades. Several studies are also reporting multiple instances of air quality around the major cities of Pakistan being consistently exceeding the national guidelines. During teh year 2019 PM 2.5 cocnentrations in the city of Lahore revealed that almost every single day was in exceedance of the WHO and national air quality standards. Although the substantial effects of these rising pollutant concentrations in Pakistan have been stated in a few studies, however, the total extent, nature of contributing factors, and consequences remain inadequately understood. This study aims to use data available from monitoring stations, satellites, and literature to highlight the gaps in our understanding and emphasize the critical challenges associated with poor air quality faced in Pakistan. Topmost is the lack of air quality monitoring systems followed by poor initiatives by policymakers and enforcement agencies. A way forward while addressing these key challenges is also discussed, which focuses on the development of flexible monitoring, new technologies, and monitoring approaches in addition to communications among the various public, private agencies, and all relevant stakeholders. [ABSTRACT FROM AUTHOR]

Objective: To determine the distribution pattern and possible reasons of delayed diagnosis of congenital heart disease in adult population., Methods: The analytical, cross-sectional study was conducted at the Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, from July to December 2021, and comprised patients of either gender aged 18 years and above with congenital heart disease confirmed by echocardiographic examination. Age, gender, weight, height, provincial affiliation, marital status, number of children, if any, duration of disease and New York Heart Association classification were noted on a predesigned proforma. Patterns of congenital heart disease types and reasons behind delayed diagnosis, if noted, were recorded. Data was analysed using SPSS 26., Results: Of the 129 patients, 68(52.7%) were males. The overall mean age was 25.8±9.8 years. Mean age at the time of diagnosis was 12.4±14.8 years. There were 91(70.5%) cases with delayed diagnosis. There was no significant gender difference with respect to delayed diagnosis (p>0.05). Delayed referral 39(42.9%), delayed consultation 22(24.2%), delayed diagnosis by the doctor 21(23.1%), and social factors 9(9.9%) were the most frequent reasons behind delayed diagnosis. Ventricular septal defect was the most frequently defect 38(29.5%), followed by Tetralogy of Fallot 32(24.8%). Right ventricular dysfunction was the most common complication of delayed diagnosis 35(27.1%)., Conclusions: Delayed diagnosis of congenital heart disease was reported in over two-thirds of the cases, with ventricular septal defect being the most frequent type of defect, and delayed referral being the most common reason.

Purpose: The purpose of this research is to examine the relationship between high- performance work systems (HPWS) and organisational innovation in hospital settings, examining the role of employee engagement as a mediator in this relationship. Additionally, the study aims to investigate the moderating role of perspective-taking between HPWS and employee engagement as well as the moderating effect of trust in leader on the connection between employee engagement and organisational innovation., Design/methodology/approach: A quantitative-deductive causal method, along with a cross-sectional approach, was utilized. Structural equation modelling was applied to analyse data from a sample of 530 doctors employed in hospitals, practicing human resources management in the public and private sectors of Sindh province, Pakistan., Findings: The findings show positive effects of HPWS on employee engagement and organisational innovation. Additionally, employee's engagement partially mediates the relationship between HPWS and organisational innovation, while the moderating role of perspective-taking significantly influences the link between HPWS and employee engagement., Originality/value: While HPWS are recognized for enhancing organisational innovation, this study confirms their positive effects on individual and organisational outcomes, particularly within the healthcare sector in Pakistan. This study suggests that when HPWS are effectively perceived and implemented, these integrated practices can be beneficial for both employees and organizations, even in challenging situations., (© Emerald Publishing Limited.)

Objective: This study aimed to assess the International Quality Improvement Collaborative single-site data from a developing country to identify trends in outcomes and factors associated with poor outcomes., Design: Retrospective descriptive study., Setting: The National Institute of Cardiovascular Diseases, Karachi, Pakistan., Participants: Patients undergoing surgery for congenital heart disease (CHD)., Outcome Measure: Key factors were examined, including preoperative, procedural and demographic data, as well as surgical complications and outcomes. We identified risk factors for mortality, bacterial sepsis and 30-day mortality using multivariable logistic regression., Results: A total of 3367 CHD surgical cases were evaluated; of these, 59.4% (2001) were male and 82.8% (2787) were between the ages of 1 and 17 years. Only 0.2% (n=6) were infants (≤30 days) and 2.3% (n=77) were adults (≥18 years). The in-hospital mortality rate was 6.7% (n=224), and 4.4% (n=147) and 0.8% (n=27) had bacterial sepsis and surgical site infections, respectively. The 30-day status was known for 90.8% (n=3058) of the patients, of whom 91.6% (n=2800) were alive. On multivariable analysis, the adjusted OR for in-hospital mortality was 0.40 (0.29-0.56) for teenagers compared with infancy/childhood and 1.95 (1.45-2.61) for patients with oxygen saturation <85%. Compared with Risk Adjustment for Congenital Heart Surgery (RACHS-1) risk category 1, the adjusted OR for in-hospital mortality was 1.78 (1.1-2.87) for RACHS-1 risk category 3 and 2.92 (1.03-8.31) for categories 4-6. The adjusted OR for 30-day mortality was 0.40 (0.30-0.55) for teenagers and 1.52 (1.16-1.98) for patients with oxygen saturation <85%. The 30-day mortality rate was significantly higher in RACHS-1 risk category 3 compared with category 1, with an adjusted OR of 1.64 (1.06-2.55)., Conclusions: We observed a high prevalence of postoperative infections and mortality, especially for high-risk procedures, according to RACHS-1 risk category, in infancy/childhood, in children with genetic syndrome or those with low oxygen saturation (<85%)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts., Methods: All children (1 month- 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C., Results: Thirty children with median age of 24 (interquartile range (IQR)1-192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis., Conclusions: Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes., Competing Interests: The authors have declared that no competing interests exist.

Propolis is a highly adhesive and resinous product of honey bee (Apis mellifera L.) which is produced from the exudations of plants. Bee propolis being a source of bioactive compounds like polyphenols and flavonoids imparts numerous biological properties including, antioxidant, anti-inflammatory, antimicrobial and anticancer activities. Present study was designed to elucidate the composition and antioxidant status of locally available propolis using in-vitro conditions. Propolis collected from locally found apiaries and its hydroalcoholic extract of propolis was prepared using different concentrations of ethanol and methanol. The results regarding proximate composition of propolis showed a higher proportion of ether extract (85.59±0.87%) and lowest contents of crude fiber (0.31±0.08%). Among the mineral's sodium, potassium and calcium was found in a concentration of 11.33±0.91, 52.10±2.9 and 10.53±0.83.59±0.23mg/Kg respectively whilst zinc was noticed as 3.59±0.23mg/Kg. HPLC characterization indicates a highest concentration of Chlorogenic acid 31.80±2.56mg/Kg whereas gallic acid (0.21±0.01mg/Kg) was found in lowest concentration among the polyphenols. Ethanol extract represents more phenolic contents, DPPH activity and antioxidant status as 327.30±14.89mg/gGAE, 73.18±4.43% and 60.59±4.38% accordingly in comparison to methanol and water extract. Bee propolis found an effective source of natural antioxidants which retards the production of free radicals and reactive oxygen species thus help to cope oxidative stress.

Background: Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder with strong genetic components. The reported association of vitamin D receptor (VDR) gene polymorphisms varies among ethnic groups., Objectives: The present study was conducted to determine association of vitamin D receptor gene Bsm I (rs1544410 A>G) polymorphism with type 2 diabetes mellitus in Pakistani population., Methods: Blood samples were collected from 150 T2DM patients and 100 non-diabetic engaged by convenient sampling method. After collection of demographic data, assessment of fasting glucose (FG), vitamin D, HbA1c, renal function tests, liver function tests and lipid profile was done. Candidate gene polymorphism was analyzed by DNA amplification with polymerase chain reaction and endonuclease digestion., Results: Biochemical parameters were significantly different among case and control groups. Associations of Bsm I genotype with T2DM, related complications and biochemical variables were not significant., Conclusion: The current study did not provide evidence for the association of VDR gene Bsm I polymorphism with T2DM in Pakistani population., (© 2019 Fatma et al.)

Objective: To determine the frequency, aetiology and outcome of respiratory distress in neonates in intensive care unit., Methods: The descriptive cross-sectional study was conducted at the Neonatal Intensive Care Unit, National Institute of Child Health, Karachi, from October 2009 to March 2010. It comprised neonates aged day 0 to 28 who were admitted to Neonatal Intensive Care Unit. The neonates were screened first for respiratory distress and presence of one or more signs and symptoms. History, examination and investigations were carried out to find out various aetiologies of respiratory distress. Outcome was measured in terms of discharge and death. Data was analysed using SPSS12., Results: Of the 205 neonates in the study, 120(58.6%) were boys and 85(41.4%) were girls The overall mean age was 70.58±110.02 hours and the mean gestational age was 36.32±2.72 weeks while the mean weight was 2.41±2.4kg. Respiratory rate >60/min was found in all (100%) the neonates. In terms of signs and symptoms, 125(60.9%) had grunting, 205(100%) had subcostal retractions and nasal flaring, and 81(40%) had cyanosis. The aetiologies observed were birth asphyxia, sepsis, transient tachypnoea of the newborn, pneumonia, meconium aspiration syndrome and respiratory distress syndrome in 22(10.75%), 37(18.05%), 29(14.1%), 36(17.6%), 34(16.7%) and 47(23.0%) neonates respectively. The incidence of neonates with respiratory distress was 68(33.3%)., Conclusions: The frequency of respiratory distress among the neonates was high, while mortality was high in neonates with respiratory distress, especially in pre-term and low birthweight neonates. Early diagnosis and management is important for better outcome.

Objective: To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan., Study Design: Descriptive, analytical study., Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010., Methodology: Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight (kg) and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated., Results: Among the 112 patients, 59 (53%) were younger than 5 years of age. Males (n=83, 74%) were predominant. Fifty (45%) children were admitted in winter. Thirty (27%) children found unvaccinated and one fourth (n=27; 24%) were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six (59%) were on some antibiotics prior to admission. Staphylococcus aureus (n=13) and Streptococcus pneumoniae (n=5) were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention (n=86). Surgically managed children were younger (p=0.01); had less weight (p=0.01) and prolonged fever (p=0.02); and stayed longer in hospital (p < 0.001) as compared to medically managed children. Requiring readmission (n=8), subcutaneous emphysema (n=5) and recollection of pus (n=5) were the major complications., Conclusion: Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management.

Objective: Congenital heart disease (CHD) has an incidence of ∼0.8-1%. Outcome of previously diagnosed CHD patients awaiting surgery (either correction or palliation) in a developing country setting is unknown. We strive to determine the outcome of patients with CHD awaiting surgery who present to pediatric intensive care unit (PICU) setting with an acute illness., Design: Retrospective cross-sectional chart review., Setting: Pediatric intensive care unit of The Aga Khan University Hospital, Karachi, Pakistan., Patient: Medical records of infants (1-12 months) with CHD awaiting surgery presenting to the PICU with an acute illness between January 2009 and June 2012 were included. Newly diagnosed CHD patients, those not requiring PICU admission, and those transferred to another hospital were excluded., Results: A total of 34 infants met the inclusion criteria. Median age at presentation was 5 months. Seventy-four percent of the infants had CHD lesion characterized by increased pulmonary blood flow (shunt lesions). Though none of the patients met the strict criteria for sepsis or pneumonia, 74% were admitted with a diagnosis of pneumonia or sepsis. Only 15% of patient had congestive heart failure as an admitting diagnosis. Oxygen therapy was given to 94% of these patients. Fifty-nine percent of these patients expired during the admission, 95% of those expired had multiorgan dysfunction., Conclusion: Patients with CHD awaiting surgery and who admitted to the PICU with acute illness are at high risk for mortality. Stringent criteria to diagnose pneumonia or sepsis should be used in these patients., (© 2013 Wiley Periodicals, Inc.)

Objective: To determine the concentration of C-reactive protein in pre- and post-operative serum samples of brain tumour patients in order to detect the potential risks of post-operative infections., Methods: Serum C-reactive protein was measured on pre- and post-operative Day 1, Day 2 and Day 7 in 18 patients who underwent surgery for brain tumours. The study was performed at the Neurosurgical Ward, Jinnah Postgraduate Medical Centre, Karachi, from May 2007 to April 2008. Mean pre-operative patients and control values were compared using Mann-Whitney or Wilcoxon tests for comparing between pre- and post-operative values. P-value was considered significant at < 0.05., Results: Five (27.7%) of the 18 pre-operative patients had elevated serum concentrations i.e. > 5.0 mg/L but no statistically significant difference was found when compared with healthy controls, with mean 4.4 +/- 6.6 and 0.9 +/- 0.7, respectively. Significantly raised serum concentrations were observed in all post-operative samples when compared with pre-operative samples. Serum CRP concentrations significantly increased post-operatively on Day 1, with mean value of 102.9 +/- 82.0 mg/L (p < 0.0005), and further increased on Day 2 with mean value of 166.9 +/- 128.1 mg/L (p < 0.0005), but declined on Day 7, with mean value of 42.7 +/- 63.6 mg/L (p < 0.005)., Conclusion: Pre-operative serum C-reactive protein concentrations of 28% of the patients were elevated, suggesting an association with brain tumours. Post-operative serum concentrations were significantly higher than those noted before the surgery. Absence of a fall of concentration from peak value on post-operative Day 2 or a secondary rise from post-operative Day 7 could be alarming for inter-current infection.

Introduction: Prolonged rupture of membrane (PROM) is an important risk factor for early onset neonatal sepsis (EONS), which is associated with increased neonatal morbidity and mortality. We reported the incidence and associated risk factors of PROM for culture-proven EONS., Methodology: The medical records of all neonates born at Aga Khan University, Karachi over a period of five years (2007-2011) with PROM (> 18 hours) were reviewed. Data about maternal and neonatal risk factors for EONS was collected and adjusted logistic regression (AOR) analysis was applied., Results: Incidence of PROM in this neonatal birth cohort was 27/1,000 live births. A total of 17 (4%) cases with blood-culture proven bacterial sepsis were identified within 72 hours of birth. Klebsiella pneumonia (n = 5; 29%) and Pseudomonas aeruginosa (n = 4; 24%) were the commonest isolates followed by group B Streptococcus (n = 3; 18%) and Escherichia coli (n = 2; 12%). Maternal fever (p = <0.001; AOR, 36.6), chorioamnionitis (p < 0.001; AOR, 4.1), PROM > 48 hr. (p < 0.001; AOR, 8.2), neonatal prematurity < 34 weeks (p < 0.001; AOR, 4.1) and low birth weight < 1,500 grams (p 0.001; AOR, 9.8) along with neonatal thrombocytopenia and raised CRP were found to be independent risk factors associated with culture-proven EONS in PROM., Conclusions: Preventive measures should focus on recognition of these high-risk infants with prompt laboratory screening for sepsis and early institution of empirical antibiotic based on local data. Such approaches would be a safe and cost-effective strategy, especially in developing countries.

Objective: To determine the clinico-demographic features and laboratory parameters of children with severe combined immunodeficiency (SCID)., Study Design: Case series., Place and Duration of Study: Department of Paediatrics and Child Health, the Aga Khan University, Karachi, from July 2006 to July 2011., Methodology: Thirteen infants who were discharged with a diagnosis of SCID were inducted in the study. Their clinicodemographic features and laboratory parameters were determined. Descriptive statistics has been used for computing frequency and percentage., Results: The median age at diagnosis was five months; 5 infants presented within 3 months of life. Three-fourth (77%) were males. Most of the infants were severely malnourished (85%) at the time of presentation. More than two-thirds (69%) were products of consanguineous marriages. All subjects had severe lymphopenia {absolute lymphocyte count (ALC) ranging between 170 - 2280} and low T and B lymphocyte counts., Conclusion: SCID should be considered in infants presenting with severe and recurrent infections. Low ALC (< 2500/mm³), is a reliable diagnostic feature of SCID. These infants should be promptly referred to a facility where stem cell transplant can be done.