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In energy scarcity, particularly in Agri-based developing economies, bio-coal briquetting is the most suitable means of meeting sustainable energy needs utilizing agricultural waste. In this study, briquettes were made from an indigenously designed briquetting machine for investigating coal–biomass proportion blend using coal from Dara Adam Khel, Khyber Pakhtunkhwa in Pakistan, and pomegranate/olive waste to analyze their resulting calorific value, strength, and geochemical properties. A central composite design (CCD) and response surface methodology (RSM) were employed to design the experiments and analyze the data. Regression models were developed for each biomass type, demonstrating their adequacy and reliability for further analysis and prediction. Energy Dispersive X-ray Spectroscopy (EDX) analysis provided insights into the elemental composition of the coal briquettes. Mechanical analysis was performed to assess the strength of the briquettes, with varying compositions showing different levels of strength. Optimization using a composite desirability function yielded an optimal calorific value of 6728 kJ/kg. In summary, this study underscores the viability of bio-coal briquetting as a transformative solution to alleviate energy scarcity. Repurposing agricultural waste curtails resource depletion while mitigating waste disposal challenges. The optimized calorific value aligns with eco-friendly energy initiatives, advancing a greener path toward energy security. [ABSTRACT FROM AUTHOR]

Diarrhea and pneumonia are the leading causes of morbidity and mortality in children under five, and Pakistan is amongst the countries with the highest burden and low rates of related treatment coverage. We conducted a qualitative study as part of the formative phase to inform the design of the Community Mobilization and Community Incentivization (CoMIC) cluster randomized control trial (NCT03594279) in a rural district of Pakistan. We conducted in-dept interviews and focused group discussions with key stakeholders using a semi-structured study guide. Data underwent rigorous thematic analysis and major themes identified included socio-cultural dynamics, community mobilization and incentives, behavioral patterns and care seeking practices for childhood diarrhea and pneumonia, infant and young child feeding practices (IYCF), immunization, water sanitation and hygiene (WASH) and access to healthcare. This study highlights shortcomings in knowledge, health practices and health systems. There was to a certain extent awareness of the importance of hygiene, immunization, nutrition, and care-seeking, but the practices were poor due to various reasons. Poverty and lifestyle were considered prime factors for poor health behaviors, while health system inefficiencies added to these as rural facilities lack equipment and supplies, resources, and funding. The community identified that intensive inclusive community engagement and demand creation strategies tied to conditioned short term tangible incentives could help foster behavior change. [ABSTRACT FROM AUTHOR]

This paper provides a feasibility model of using satellite imaging technology to indicate hydrate presence and evaluate gas hydrate saturation trapped in the premises of Pakistan. The study compiles an effort to justify the potential of gas hydrates in Pakistan and their effective extraction. Satellite images of the Arabian Sea are correlated with previously available Bottom Simulating Reflectors (BSRs) to predict the presence of hydrates and potential energy trapped in them. Additionally, the innovative and optimistic hydrate-detection technique of thermal imaging is merged to add the methodological value. The thermal gradient helps to understand the thermodynamic behavior of subsea natural gas hydrates in particular area. Unfortunately, gas production from hydrates is still commercially unaccepted because very limited ventures have been launched in this domain. But no doubt, all those limited projects have shown very promising results. In case of Pakistan, the prolific expedition to hunt for hydrates was made in 1998 with Pak-Germany collaboration. The expedition revealed that the gas hydrates buried under Makran Coast in the Arabian Sea are around 29% saturated with methane gas; 7.5% free gas also exists with hydrates. Further, the BSRs in the Arabian Sea are traced at the depth of 500 to 800 m below the seafloor. On the other hand, demand for natural gas rises by 60 to 75 MMCFD every year in Pakistan; therefore, the development of natural gas hydrates can be a prudent solution to meet the future energy demand of whole country. The novelty of this paper is the incorporation of satellite imaging technology to prove natural gas hydrate potential in the maritime vicinity of Pakistan. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI)-based multispectral remote sensing has been the best supporting tool using limited resources to enhance the lithological mapping abilities with accuracy, supported by ground truthing through traditional mapping techniques. The availability of the dataset, choice of algorithm, cost, accuracy, computational time, data labeling, and terrain features are some crucial considerations that researchers continue to explore. In this research, support vector machine (SVM) and artificial neural network (ANN) were applied to the Sentinel-2 MSI dataset for classifying lithologies having subtle compositional differences in the Kohat Basin's remote, inaccessible regions within Pakistan. First, we used principal component analysis (PCA), minimum noise fraction (MNF), and available maps for reliable data annotation for training SVM and (ANN) models for mapping ten classes (nine lithological units + water). The ANN and SVM results were compared with the previously conducted studies in the area and ground truth survey to evaluate their accuracy. SVM mapped ten classes with an overall accuracy (OA) of 95.78% and kappa coefficient of 0.95, compared to 95.73% and 0.95 by ANN classification. The SVM algorithm was more efficient concerning computational efficiency, accuracy, and ease due to available features within Google Earth Engine (GEE). Contrarily, ANN required time-consuming data transformation from GEE to Google Cloud before application in Google Colab. [ABSTRACT FROM AUTHOR]

During underground construction, the behavior of the ground is influenced by characteristics of the rock mass with situ stresses and ground water, cross section of the excavation area, excavation method, and the rate of excavation. These fundamental features are considered to ensure the support and stability of underground excavations and achieve long-term successful operation. However, the ground composition of the Himalayas hinders tunnel excavation, especially in case of mechanized tunneling; this causes time and cost overruns. This study has reviewed the recently completed Neelum–Jhelum Hydroelectric Project; the project complexities, geological environments involving significant overburden and tectonic stresses, and effects of the excavation method on tunnel stability were analyzed. The major challenges that were encountered during construction are discussed herein along with their countermeasures. An analysis of project-related data reveals that latest techniques and approaches considering rock mechanics were used to complete the project; the existing approaches and methods were accordingly verified and extended. Apart from ground composition, the excavation methods used play an important role in the occurrence of severe rock bursts. Thus, the findings of this study are expected to be helpful for future tunneling projects in the Himalayas. [ABSTRACT FROM AUTHOR]

Calorific value provides a strong measure of useful energy during coal utilization. Previously, different AI techniques have been used for the prediction of calorific value; however, one model is not valid for all geographic locations. In this research, Lower Calorific Value (LCV) of the Thar coal region in Pakistan is predicted from proximate analysis of 693 drill holes extending to 9,000 sq. km. Researchers have applied different techniques to produce the best model for prediction of calorific value; however, Gradient Boosting Trees (GBT) has not been used for this purpose. A comparison of GBT, Back-propagation Neural Networks (BPNN), and Multiple Linear Regression (MLR) is presented to predict the calorific value from a total of 8,039 samples with 1 m support interval. The samples were split randomly into 70:15:15 for training, testing, and validation of GBT, BPNN, and MLR models, reporting correlations of 0.90, 0.89, and 0.80, respectively. The features' importance was reported by the intuitive and best-performing GBT model in decreasing order of importance as: Volatile Matter, Fixed Carbon, Moisture, and Ash with corresponding feature importance values of 0.50, 0.30, 0.12, and 0.08. [ABSTRACT FROM AUTHOR]

This paper proposes an analysis of Fehmida Riaz's Pakistani English short story: "The Daughters of Aai" (2007) in the light of Pierre Bourdieu's notion "field" (1986, 1990) taken from his Theory of Practice. The field is a context and place of survival of individuals, which determines their position in a social order. Keeping in view this notion, the short story "The Daughter's of Aai" is viewed as a remarkable story of innocence, abuse and the resourcefulness of women in a village in Pakistan. Following close reading analysis method, the study focuses on women's plight in their contextual field. The study finds out that there are two major fields in the village; poor villagers' field (which is again sub-divided into the field of men and that of women) and landlords" field. The village women struggle hard to survive in their devalued and dominated field. They save an insane and innocent handicapped girl Fatima in the name of accepted and identical practices in their field, which is to make her Allah Walli (holy woman). Thus, the collective efforts and unity of women helped to make Fatima a resourceful woman, which otherwise was impossible. The study also finds out that the field of village men supports them in their every action taken for their dis/honour. The men can molest any woman (i.e. Fatima) but cannot afford a word for their own woman. For the sake of honour their whole tribe involves in years long fighting and killing, leaving their women widows and children orphans who face prolonged court cases. [ABSTRACT FROM AUTHOR]

Interest in learning English is at rise. Students confront a number of barriers in the way to learn English. Acquiring a particular accent/pronunciation of English is one of the issues of non native speakers of English. This paper deals with this issue at length through a qualitative research survey report covering the issue of people's and specifically students' anxiety of native dialect and accent. Linguists and scholars opine that although for the children under five years of age, it is easy to acquire a native like pronunciation of a foreign language, for adults, it is very difficult. Since in Pakistan the purpose of any foreign language is likely to be able to communicate successfully with the native speakers of that target language or with other people through this language, attention should be to focus on conveying the message correctly not necessarily with any of the native features of the target language. [ABSTRACT FROM AUTHOR]

The important role of media in any country is its culture and country?s success and principal aspiration of mass media ought to be the human solidity in all its magnitude. What is needed that people could engagethemselves in positive behavior? How to achieve it? The media?s objectives should be by highlighting the problems of citizens and not it could spoil everything by diverting the attention of people from important issues towards insignificant issues to create chaos and confusion among the masses. It is only possible if all truth is brought forward. The international media propaganda that the whole world is a global village with a new time order of living is monetary based slogan. To achieve this profitable/ commercial culture a new name is given to mankind that as common faith of ?Civic religion?. It is further coded/ camouflaged as ?democracy? i.e. a ?mankind?s religion? mean with ?democratic faith? that whole human beings have a common culture and ethics mean ?Living style?. The world is in the grip of money- making mass media i.e. woman, wine and wealth (www.com) oriented culture. That is a war against very aim of peace and prosperity of human being. This mass media cultural/ fashion war is only in few powerful companies/ agencies. A Pakistani electronic/ print media?s day and night broadcasting of a fashion is against the Islamic teaching. This broadcast of multi culture invasion has many organized ethical issues which are directly challenging the Islamic values and culture. In this paper to save guard against Islamic culture and Pakistan integrity/solidarity. The endeavor is made to highlight various aspects of mass media?s ethics invasion. And some remedial measures for countering this media?s culture offensive on divine Islamic culture and Pakistan. [ABSTRACT FROM AUTHOR]

Devolution in education from provinces to district was a major shift in governance system in Pakistan. The devolved system of education revolved around the political leadership of the district, District Nazim who was an elected representative. This study explored the level of understanding of District Nazims' regarding their role in the devolved system, the policy of decentralization in education, the problems they had been facing and the strategies they adopted to address those problems. The study used a qualitative interpretative research design employing semi-structured interviews. The questions were developed on the roles and responsibilities of District Nazim as given in the decentralization document. The results of the study showed that the level of their understandings was pretty much associated with the academic qualifications. Moreover, they needed training in identifying and resolving the problems at their districts. They also need education and training to decentralize powers to lower levels of district management. [ABSTRACT FROM AUTHOR]

In this paper, a sample preparation method based on ultrasonic assisted acid extraction (UAE) of Al, As, Cd, Ni and Pb from filler tobacco (FT) of different local branded (LBCs) and imported branded cigarettes (IBCs) consumed in Pakistan. Acid extracts obtained upon sonication were determined by atomic absorption spectrometry. Parameters influencing extraction such as pre-sonication time 10–15 min, sonication time 2–10 min, mass of sample 0.1–0.5 g, particle size <35–125 μm and, extractant (nitric acid) concentrations (2–10%) were fully optimized to get quantitative recovery of toxic elements (TEs). The proposed method was validated with a certified reference material (CRM) Virginia tobacco leaves (ICHTJ-cta-VTL-2), and also applied a conventional acid digestion method (CDM) on same CRM, for comparative purpose. The average relative standard deviation of UAE method of CRM, ranged as 1.64–8.42% for N = 6, depending on the analytes. Extraction efficiencies for CRM were close to 97.1, 97.5, 98.5, 97.8 and 96.7 for Al, As, Cd, Ni and Pb, respectively. The concentrations of Al, As, Cd, Ni and Pb in cigarettes were present in all branded cigarettes, there is no any significance difference among LBCs and IBCs, except in few cases of LBCs, have high level of Cd and Al. Our results were compared with other worldwide studies. [ABSTRACT FROM AUTHOR]

Low-resolution Geological Survey of Pakistan (GSP) maps surrounding the region of interest show oolitic and fossiliferous limestone occurrences correspondingly in Samanasuk, Lockhart, and Margalla hill formations in the Hazara division, Pakistan. Machine-learning algorithms (MLAs) have been rarely applied to multispectral remote sensing data for differentiating between limestone formations formed due to different depositional environments, such as oolitic or fossiliferous. Unlike the previous studies that mostly report lithological classification of rock types having different chemical compositions by the MLAs, this paper aimed to investigate MLAs' potential for mapping subclasses within the same lithology, i.e., limestone. Additionally, selecting appropriate data labels, training algorithms, hyperparameters, and remote sensing data sources were also investigated while applying these MLAs. In this paper, first, oolitic (Samanasuk), fossiliferous (Lockhart and Margalla) limestone-bearing formations along with the adjoining Hazara formation were mapped using random forest (RF), support vector machine (SVM), classification and regression tree (CART), and naïve Bayes (NB) MLAs. The RF algorithm reported the best accuracy of 83.28% and a Kappa coefficient of 0.78. To further improve the targeted allochemical limestone formation map, annotation labels were generated by the fusion of maps obtained from principal component analysis (PCA), decorrelation stretching (DS), X-means clustering applied to ASTER-L1T, Landsat-8, and Sentinel-2 datasets. These labels were used to train and validate SVM, CART, NB, and RF MLAs to obtain a binary classification map of limestone occurrences in the Hazara division, Pakistan using the Google Earth Engine (GEE) platform. The classification of Landsat-8 data by CART reported 99.63% accuracy, with a Kappa coefficient of 0.99, and was in good agreement with the field validation. This binary limestone map was further classified into oolitic (Samanasuk) and fossiliferous (Lockhart and Margalla) formations by all the four MLAs; in this case, RF surpassed all the other algorithms with an improved accuracy of 96.36%. This improvement can be attributed to better annotation, resulting in a binary limestone classification map, which formed a mask for improved classification of oolitic and fossiliferous limestone in the area. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to evaluate the uptake of arsenic (As) by grain crops (wheat, maize and sorghum) grown on agricultural soil irrigated with tube well water (SIT) as test samples and for comparative purposes, same grain crop samples grown on agricultural soil irrigated with fresh canal water (SIC) were marked as control samples, collected simultaneously from three sub-districts of Khairpur, Pakistan. Moreover, this paper demonstrated the total and EDTA (0.05M) extractable As in both understudied soils that correlate with the respective total As in the edible parts of the studied grain crops. A significantly high accumulation of As was found in grains grown on SIT as compared to those grown on SIC. This study highlights the increased danger of growing food crops in the agricultural land continuously irrigated by As contaminated ground water. [Copyright &y& Elsevier]

Abstract: In this study, a survey has been conducted during 2005–2007 on surface and groundwater arsenic (As) contamination and its impact on the health of local population, of villages located on the banks of Manchar lake, southern part of Sindh, Pakistan. We have also assessed the relationship between arsenic exposure through respiratory disorders in male subjects with drinking water and smoking cigarettes made from tobacco grown in agricultural land irrigated with As contaminated lake water. The biological samples (blood and scalp hair) were collected from As exposed subjects (100% smokers) and age matched healthy male subjects (40.2% smoker and 59.8% non smokers) belong to unexposed areas for comparison purposes. The As concentration in drinking water (surface and underground water), agricultural soil, cigarette tobacco and biological samples were determined by electrothermal atomic absorption spectrometry. The range of As concentrations in lake water was 35.2–158 µg/L (average 97.5 µg/L), which is 3–15 folds higher than permissible limit of World Health Organization (WHO, 2004). While the As level in local cigarette tobacco was found to be 3–6 folds higher than branded cigarettes (0.37–0.79 µg/g). Arsenic exposed subjects (with and without RD) had significantly elevated levels of As in their biological samples as compared to referent male subject of unexposed area. These respiratory effects were more pronounced in individuals who had also As induced skin lesions. The linear regressions showed good correlations between As concentrations in water versus hair and blood samples of exposed subjects with and without respiratory problems. [Copyright &y& Elsevier]

Arsenic contamination in water has caused severe health problems around the world. The purpose of this study was to evaluate the geological and anthropogenic aspects of As pollution in surface and groundwater resources of Jamshoro Sindh, Pakistan. Hydride generator atomic absorption spectrophotometry (HG-AAS) is employed for the determination of arsenic in water samples, with detection limit of 0.02¿gl¿1. Arsenic concentrations in surface and underground water range from 3.0 to 50.0, and 13 to 106¿gl¿1, respectively. In most of the water samples As levels exceeded the WHO provisional guideline values 10¿gl¿1. The high level of As in under study area may be due to widespread water logging from Indus river irrigation system which causes high saturation of salts in this semi-arid region and lead to enrichment of As in shallow groundwater. Among the physico-chemical parameters, electrical conductivity, Na+, K+, and SO4 2¿ were found to be higher in surface and ground water, while elevated levels of Ca2+ and Cl¿ were detected only in ground water than WHO permissible limit. The high level of iron was observed in ground water, which is a possible source of As enrichment in the study area. The multivariate technique (cluster analysis) was used for the elucidation of high, medium and low As contaminated areas. It may be concluded that As originate from coal combustion at brick factories and power generation plants, and it was mobilized promotionally by the alkaline nature of the understudy groundwater samples. [Copyright &y& Elsevier]

Arsenic (As) poisoning has become a worldwide public health concern. The skin is quite sensitive to As and skin lesions are the most common and earliest nonmalignant effects associated to chronic As exposure. In 2005–2007, a survey was carried out on surface and groundwater arsenic contamination and relationships between As exposure via the drinking water and related adverse health effects (melanosis and keratosis) on villagers resides on the banks of Manchar lake, southern part of Sindh, Pakistan. We screened the population from arsenic-affected villages, 61 to 73% population were identified patients suffering from chronic arsenic toxicity. The effects of As toxicity via drinking water were estimated by biological samples (scalp hair and blood) of adults (males and females), have or have not skin problem (n =187). The referent samples of both genders were also collected from the areas having low level of As (<10 μg/L) in drinking water (n =121). Arsenic concentration in drinking water and biological samples were analyzed using electrothermal atomic absorption spectrometry. The range of arsenic concentrations in lake surface water was 35.2–158 μg/L, which is 3–15 folds higher than World Health Organization [WHO, 2004. Guidelines for drinking-water quality third ed., WHO Geneva Switzerland.]. It was observed that As concentration in the scalp hair and blood samples were above the range of permissible values 0.034–0.319 μg As/g for hair and <0.5–4.2 μg/L for blood. The linear regressions showed good correlations between arsenic concentrations in water versus hair and blood samples of exposed skin diseased subjects (R 2 =0.852 and 0.718) as compared to non-diseased subjects (R 2 =0.573 and 0.351), respectively. [Copyright &y& Elsevier]

Background: Infectious diseases remain the leading cause of death among children younger than 5 years due to disparities in access and acceptance of essential interventions. The Community Mobilisation and Community Incentivisation (CoMIC) trial was designed to evaluate a customised community mobilisation and incentivisation strategy for improving coverage of evidence-based interventions for child health in Pakistan., Methods: CoMIC was a three-arm cluster-randomised, controlled trial in rural areas of Pakistan. Clusters were formed by grouping villages based on geographical proximity, ethnic consistency, and ensuring a population between 1500 to 3000 per cluster. Clusters were randomly assigned (1:1:1) to either community mobilisation, community mobilisation and incentivisation, or the control arm. Community mobilisation included formation of village committees which conducted awareness activities, while clusters in the community mobilisation and incentivisation group were provided with a novel conditional, collective, community-based incentive (C3I) in addition to community mobilisation. C3I was conditioned on serial incremental targets for collective improvement in coverage at cluster level of three key indicators (primary outcomes): proportion of fully immunised children, use of oral rehydration solution, and sanitation index, assessed at 6 months, 15 months, and 24 months, and village committees decided on non-cash incentives for people in the villages. Data were analysed as intention-to-treat by an independent team masked to study groups. The trial is registered at ClinicalTrials.gov, NCT03594279, and is completed., Findings: Between Oct 1, 2018 and Oct 31, 2020, 21 638 children younger than 5 years from 24 846 households, with a total population of 139 005 in 48 clusters, were included in the study. 16 clusters comprising of 152 villages and 7361 children younger than 5 years were randomly assigned to the community mobilisation and incentivisation group; 16 clusters comprising of 166 villages and 7546 children younger than 5 years were randomly assigned to the community mobilisation group; and 16 clusters comprising of 139 villages and 6731 children younger than 5 years were randomly assigned to the control group. Endline analyses were conducted on 3812 children (1284 in the community mobilisation and incentivisation group, 1276 in the community mobilisation group, and 1252 in the control group). Multivariable analysis indicates improvements in all primary outcomes including a higher proportion of fully immunised children (risk ratio [RR] 1·3 [95% CI 1·0-1·5]), higher total sanitation index (mean difference 1·3 [95% CI 0·6-1·9]), and increased oral rehydration solution use (RR 1·5 [1·0-2·2]) in the community mobilisation and incentivisation group compared with the control group at 24 months. There was no evidence of difference between community mobilisation and control for any of the primary outcomes., Interpretation: Community mobilisation and incentivisation led to enhanced acceptance evidenced by improved community behaviours and increased coverage of essential interventions for child health. These findings have the potential to inform policy and future implementation of programmes targeting behaviour change but would need evaluation for varying outcomes and different contexts., Funding: Bill & Melinda Gates Foundation., Translations: For the Sindhi and Urdu translations of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

A field study was conducted on the reuse of wastewater from Mardan city to evaluate its risk of contaminating soil and wheat grains at different NPK levels. Three irrigation sources i.e. waste water (WW), canal water (CW) and alternate waste + canal water (WW+CW) were applied to wheat (cv Atta Habib 2010) grown at 0, 50, 75 and 100% NPK levels of 120:90:60 kg N:P2O5:K2O ha-1 at Palatoo Research Farm, Amir Muhammad Khan Campus, Mardan during 2015.The results showed higher grain and biomass yields in WW irrigated plots as compared to CW at NPK levels up to 50% of recommending dose revealing supplementing nutrient requirements in deficient conditions. However, irrigation of WW at higher NPK levels especially at or beyond 75% of recommended dose tended to reduce the crop yield that could be associated with heavy metals toxicity and nutritional imbalances. The use of WW substantially increased AB-DTPA extractable Zn, Mn, Pb, Ni and Cd indicating a potential threat to soil contamination. Similarly, WW irrigated wheat had higher concentrations of these heavy metals as compared to CW which limits its use for production purposes without any remediation measures. The alternate use of CW and WW as revealed by its comparative lower contamination in soil and wheat than sole WW could be one of the possible solutions and may increase the time required for threshold soil contamination., Competing Interests: The authors have declared that no competing interests exist.

Understanding key healthcare system challenges experienced by women during pregnancy and birth is crucial to scale up available interventions and reduce perinatal mortality. A community perspective about preferences and experience of care during this period can be used to improve community-based programs to reduce perinatal mortality. Using a qualitative exploratory approach, we examined women's experience of perinatal loss, aiming to understand the main factors, as perceived and experienced by women, leading to perinatal loss. Qualitative in-depth Interviews were conducted with 25 mothers with a recent perinatal loss, three family members, six healthcare officials, and two focus group discussions with 17 lady health workers. Data were analysed using inductive and deductive coding, by thematic analysis. Our findings revealed three distinct but interrelated themes, which include: 1) poor access to care during pregnancy and birth, 2) unavailability of appropriate healthcare services, and 3) poor quality of care during pregnancy and birth. Women frequently delayed seeking formal care around birth because of delays by themselves, their family members, or the local traditional birth attendants who frequently induced births at women's homes without recognising the dangers to the mothers or their babies. Preference for private care was common, however they often could not bear the cost of care when they needed caesarean section or in-patient care for their sick newborns because these services were absent in public health facilities of the district. Referral to the regional tertiary care hospital was often not officially arranged leading to risky births in small and crowded private clinics. Women's views about negative staff attitudes and the lack of attention given to them in public health facilities highlighted a lack of quality and respectful antenatal care. Improvement in women's access to essential care during pregnancy and around birth, availability of emergency obstetric and newborn care, improving the quality of maternal and newborn care in both public and private health facilities at the district level might reduce perinatal mortality in Pakistan., Competing Interests: The authors have declared that no competing interests exist.

This study was focused on the analysis of arsenic (As) levels in scalp hair of children (age, <10 years) collected from two towns of Khairpur, Pakistan, to evaluate the effects of As-contaminated groundwater. For comparative purposes, scalp hair samples of children were also collected from that area having low levels of As (<10 μg/L) in drinking water. Groundwater and scalp hair samples of children were collected and analyzed by electrothermal atomic absorption spectrometry prior to microwave-assisted acid digestion. The average As concentrations in groundwater samples of two towns, Thari Mirwah and Gambat, were found to be 28.5 and 98.3 μg/L, respectively. The range of As concentrations in scalp hair samples of children who belong to Thari Mirwah and Gambat was 1.25-1.61 μg/g and 1.73-3.63 μg/g, respectively. Twenty percent of the total children who belong to Gambat have skin lesions on their hands and feet. A positive correlation coefficient (R = 0.91-0.99) was obtained between As contents in drinking water and scalp hairs of children of both towns.

Objective: To correlate and quantitate lymphocyte subsets with clinically diagnosed smear-negative pulmonary tuberculosis and severity of disease., Design: Case-control study., Place and Duration of Study: Military Hospital and Armed Forces Institute of Pathology Rawalpindi. 1999-2000., Subjects and Methods: Freshly diagnosed, well-characterized smear-negative patients (n=15) of pulmonary tuberculosis were selected. Non-induced three-consecutive negative smears of sputum with simultaneous culture for AFB for 6-8 weeks, positive Mauntoux test (Z10 mm), blood complete picture with ESR and chest x-rays were done. Selected panel of monoclonal antibodies against specific CD markers were used. Statistical analysis done by student t-test or Mann-Whitney rank-sum test with the help of Sigma State software., Results: Hemoglobin and total lymphocyte counts were significantly reduced whereas total leukocyte counts with absolute neutrophil counts were increased. Fraction of CD4+ and CD8+ T lymphocytes with HLA-DR expression was reduced while no significant change in rest of the TB and NK lymphocytes., Conclusion: Low hemoglobin level, high neutrophil count and low total lymphocytes suggest possible direct relationship with extent of disease. The number of activated CD4+, CD8+, ab and gd TCR T cells have tendency to increase during Mycobacterium infection. This seems to have a potential of being a good, non-invasive prognostic indicator for patients with pulmonary tuberculosis.

Background: Hypothyroidism is a common endocrinological disorder. Its clinical presentation is variable but well established. However, clinical features vary significantly among different populations owing to their climate, education status and awareness about the disease. This study is designed to evaluate the difference in clinical presentation of our population from already available literature., Methods: In this study we have compared the symptoms and signs of hypothyroid and euthyroid patients coming to a diagnostic centre (PINUM, Faisalabad) from January to July 1999. Of the 1594 patients coming to the centre, 394 were included in the study and were examined. After the laboratory investigations, 109 were identified as the cases of hypothyroidism, the rest were declared as euthyroid and selected as controls. We compared the 21 common signs and symptoms of hypothyroidism in our patients., Results: Lethargy was the commonest symptom and facial oedema was the most prevalent sign in our population. Old age is reported to be a risk factor for hypothyroidism but in this study we could not find a rising trend with increasing age (odds ratio 1.15, p-value 0.71). We also compared the clinical presentation of our patients with the available literature. It was also proved that the signs elicited by the physicians were more reliable and specific for the identification of hypothyroidism., Conclusion: Thus, the presentation of hypothyroidism is non-specific and high degree of suspicion is required for its early diagnosis.