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This study investigated the combination of UV persulfate (UV/PS) treatment of recycled water and deficit irrigation to minimize pharmaceutical and personal care products (PPCPs) accumulation and improve crop quality. Lettuce, carrot, and tomato, commonly consumed raw, were cultivated in a greenhouse using PPCPs spiked recycled water, UV/PS treated recycled water, and tap water control, under irrigation rates at 60 %, 80 % and 100 % of crop evapotranspiration (ETC) rates. UV/PS removed ≥ 99 % of carbamazepine, diclofenac, and fluoxetine from spiked recycled water. Post-treatment, carbamazepine accumulation in harvested lettuce, carrot, and tomato was reduced by 96–99 %, 35–70 % and 72–93 %, respectively. Minimal accumulation of diclofenac and fluoxetine occurred in edible crops due to their existence as dissociated ions. Three edible crops exhibited distinct trends of PPCPs accumulation in response to irrigation rates. Lettuce exhibited a decreasing PPCPs accumulation with a reduced irrigation rate, which was attributed to slower transpiration. In contrast, carrot and tomato exhibited increased PPCP accumulation due to osmotic adjustment. Lettuce and carrot exhibited higher irrigation water utilization efficiency at deficit irrigation, while the opposite was observed for tomato. This study highlights the beneficial integration of UV/PS with deficit irrigation to conserve water, maintain crop yield, and minimize PPCPs accumulation.

The current study was directed to examined the two excellent herbal plants Azadirachta indica and Moringa oliefera leaf powder as an alternative to antibiotic growth promoters on the growth performance in terms of (FC, LWW, BWG, FCR and mortality rate), blood biochemistry (WBC, RBC, MCHC, MCH, MCV, LYM, GRA, MID and HCT) and carcass characters weight performance (Carcass Components, Yield of Main Carcass Parts (%), Giblets weight (%) and visceral organs weight (g). Feed conversion ratio measured is significantly (p

Drinking water that is secure to drink is a basic human need that should be met by every-one. Waterborne disease prevention and control begin with ensuring the safety of drinking water. The present study was designed to evaluate the physical and chemical quality of ground water in 20 different localities of Tehsil Taunsa DG Khan, Punjab Pakistan. For this purpose, ground water samples were collected from Mangrotha, Sokar, BastiBuzdar, KotQaisrani, JhokeBodo, Litra, Vehova, Bohar, MakwalKalan, Bindi, Dona, NariJanubi, TibbiQaisrani, Morejhangi, Babbi, Nutkani, JaluWali, Lakhani, Kotani and Chulani were physico-chemically (Turbidity, Odor, Color, TDS, HCO3, Alkalinity, Ca, CO3, Cl, EC, Fl, Hardness, Mg, SO4, pH, Na and K) characterized. The results revealed a significant increase in physical and chemical counts. Among Chemical parameters, the concentration of Alkalinity was in range of 205 mg/L to 235 mg/L, the concentration of Calcium was in range of 60 mg/L to 112 mg/L, the concentration of carbonates only in one location (BastiBuzdar) was slightly high 64 mg/L, the value of Electrical Conductivity was in range of 1230 µS/cm to 1260 µS/cm, the concentration of hardness varies between 145 mg/L to 550 mg/L. The levels of all other parameters were within WHO's acceptable ranges. A survey was also done to assess the impact of drinking water on city inhabitants' fitness. Globally, 780 million people, and 100 million people in Pakistan are exposed to insecure water sources. To estimate the health threat of infected water, a total of 160 residents interviewed. The information acquired from this field work will reveal a high prevalence of suspected water borne diseases like diarrhea, nausea & vomiting, gastrointestinal issues, Skin Rash, Skin irritation, Diabetes, Neural diseases, Renal dysfunction, Cholera, malaria, prolonged fever, Cancer, Hepatitis and jaundice. To resolve water and environmental problems, consciousness and regular monitoring programs of water organization and safe removal of waste was proposed. As a result, in all of the research areas, a well-organized waste disposal and management system is required. To make sure that the water is suitable for human consumption, regular drinking water quality assessments of the resource, main allotment tanks, distribution systems and pipes should be used.

The current study was directed to examined the two excellent herbal plants Azadirachta indica and Moringa oliefera leaf powder as an alternative to antibiotic growth promoters on the growth performance in terms of (FC, LWW, BWG, FCR and mortality rate), blood biochemistry (WBC, RBC, MCHC, MCH, MCV, LYM, GRA, MID and HCT) and carcass characters weight performance (Carcass Components, Yield of Main Carcass Parts (%), Giblets weight (%) and visceral organs weight (g). Feed conversion ratio measured is significantly (p

The purpose of this study is to examine the awareness and perception of malaria and dengue fever in Multan Punjab, Pakistan while taking into account the important role of government policies and other variables. The goal of this study is to examine the awareness of students in Multan, Pakistan on malaria and dengue. This study is based on a quantitative approach of secondary evidence from scientific journals and questionnaire surveys. It is also based on observational evidence gathered in Multan Punjab Pakistan, in a field study. The survey with school children, teachers and healthcare professionals were both formal and semi-structuralize. Studies have found that malaria and dengue mainly affect children's schooling through their absence, but can also induce brain loss and cognitive disability. In questionnaires, students were seen to have different understanding of the illness, but also to be able to serve as agents of health reform only through teachers. A sample size of 500 respondents has been selected from different colleges of district Multan Punjab, Pakistan. Correlation technique is used for the data analysis. According to our results it is concluded that the students at college level are aware of malaria and dengue diseases, but they are not capable of engaging and serving as agents for health reform. On the basis of results it is recommended that students must teach about epidemics diseases regarding how to handle these diseases.

The current study was directed to investigate the effect of temperature and humidity on insect pest complex of cotton. This study was carried out on the farmer field of a farmer of MouzaMehraywala tehsil and district Rajanpur southern part of the Punjab, Pakistan (29.1044° N, 70.3301° E) in the month of May, 2019 to November 2019. The climatic conditions of the study site were; a Rajanpur lie on 96m above sea level Rajanpur has a desert climate. During the year, there is virtually no rainfall. The average temperature in Rajanpur is 26.0°C | 78.8°F. Precipitation here is about 205 mm / 8.1 inch per year. Our results indicate that's the correlation of temperature (minimum and maximum), humidity (minimum and maximum), rainfall and weather condition (clear or cloud), it is clear that except temperature there is a positive correlation of jassid population. While among the relation of jassid with different factor there is very weak relation with jassid population regarding temperature (-0.001), the relation of humidity, rainfall and sky condition with jassid population is positive and moderate (0.520, 0.668 & 0.575 respectively), while the relation of jassid population among these factor is significant except temperature. The results indicate that's the correlation of temperature, humidity, rainfall and weather condition, it is clear that there is positive correlation of thrips population. While among the relation of thrips with different factor there is very weak relation of thrips population with temperature (.103), the relation of humidity, rainfall and sky condition with thrips population is positive and moderate (.515.751& .577 respectively), while the relation thrips population among these factor is significant except temperature. The results indicate that's correlation of temperature, humidity, rainfall and weather condition, it is clear that there is positive correlation of Whitefly population. While among the relation of Whitefly with different factors there is very moderate relation of Whitefly population with temperature (.076), the relation of humidity, rainfall and sky condition with Whitefly population is negative and moderate (-.051.-.368 & -.559 respectively), while the relation Whitefly population among these factor is significant except temperature.

Gossypium hirsutum L. is also called upland cotton or Mexican cotton. It is the most widely cultivated species of cotton in the whole world. Globally, about 90% of all cotton production comes from the cultivars derived from this species. Some genetic parameters like monopodial branches per plant, sympodial branches per plant, sympodial branch length, bolls per plant, boll weight, sympo-boll distance, Ginning Out Turn%, staple length (rg = 0.9199**), and fiber strength along with seed cotton yield were evaluated for their potential utilization via selection in seed cotton yield improvement. Significant positive genetic correlations were estimated for monopodial branches per plant (rg = 0.9722**), sympodial branches per plant (rg = 0.7098**), sympodial branch length (rg = 0.617**), bolls per plant (rg = 0.8271**), boll weight (rg = 0.8065**), sympo-boll distance (rg = 0.6507**), Ginning Out Turn (GOT)% (rg = 0.7541**), staple length (rg = 0.9199**), and fiber strength (rg = 0.7534**) with seed cotton yield. A path analysis of all the yield traits under study revealed strong positive direct effects of monopodial branch length (1.1556), sympo-boll distance (0.8173) and staple length (0.7633), while plant height exerted a highly strong direct negative effect (-1.2096) on yield. It is concluded that a direct selection based on monopodial branch length and sympo-boll distance, and staple length is effective, whereas, monopodial branch length, and sympodial branch length are good selection indicators via bolls per plant for yield improvement in cotton.

Being the highest and largest land mass of the earth, the Tibetan Plateau has a strong impact on the Asian climate especially on the Asian monsoon. With high downward solar radiation, the Tibetan Plateau is a climate sensitive region and the main water source for many rivers in South and East Asia. Although many studies have analyzed energy fluxes in the Tibetan Plateau, a long-term detailed spatio-temporal variability of all energy budget parameters is not clear for understanding the dynamics of the regional climate change. In this paper, satellite remote sensing and reanalysis data are used to quantify spatio-temporal trends of energy budget parameters, net radiation, latent heat flux, and sensible heat flux over the Tibetan Plateau from 2001 to 2019. The validity of both data sources is analyzed from in situ ground measurements of the FluxNet micrometeorological tower network, which verifies that both datasets are valid and reliable. It is found that the trend of net radiation shows a slight increase. The latent heat flux increases continuously, while the sensible heat flux decreases continuously throughout the study period over the Tibetan Plateau. Varying energy fluxes in the Tibetan plateau will affect the regional hydrological cycle. Satellite LE product observation is limited to certain land covers. Thus, for larger spatial areas, reanalysis data is a more appropriate choice. Normalized difference vegetation index proves a useful indicator to explain the latent heat flux trend. Despite the reduction of sensible heat, the atmospheric temperature increases continuously resulting in the warming of the Tibetan Plateau. The opposite trend of sensible heat flux and air temperature is an interesting and explainable phenomenon. It is also concluded that the surface evaporative cooling is not the indicator of atmospheric cooling/warming. In the future, more work shall be done to explain the mechanism which involves the complete heat cycle in the Tibetan Plateau.

Objective: To compare the effects of positional distraction with stabilisation exercises versus stabilisation exercises alone in the management of lumbar radiculopathy., Methods: The randomised controlled trial was conducted from July to December 2020 at the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, and the Neurosurgery ward of Civil Hospital, Karachi, and comprised individuals of either gender with lumbar radiculopathy pain who were randomised into positional distraction with stabilisation exercises group A and stabilisation exercise group B. The treatment duration was 3 sessions per week for 8 weeks. Intensity of pain and disability were assessed using the Visual Analogue Scale and the Roland Morris Disability Questionnaire, respectively. Data was analysed using SPSS 21., Results: Of the 100 patients, 63(63%) were males and 37(37%) were females. Overall, 89(89%) were married. There were 50(50%) subjects in group A with mean age 39.42±6.36 years and 50(%) in group B with mean age 38.80±6.69 years. There was no significant difference in terms of age, gender and marital status between the groups (p>0.05). The study was completed by 96(96%) patients; 48(50%) in each of the 2 groups. Intragroup improvement post-intervention compared to baseline was significant (p<0.001) in both groups. Outcomes in group A were significantly better than in group B (p<0.05)., Conclusions: Addition of positional distraction to stabilisation exercises was found to have superior effects compared to stabilisation exercise alone on pain and functional disability among patients with lumbar radiculopathy., Clinical Trial Number: NCT04427423 dated 27th April 2020.

Objective: To evaluate the association of treatment with nebulized tranexamic acid (TXA) with rates of operative intervention in post-tonsillectomy hemorrhage (PTH)., Methods: Single tertiary-referral center and satellite hospitals, retrospective cohort of adult and pediatric patients who were diagnosed with PTH in 2015-2022 and treated with nebulized TXA and standard care, compared with an age- and gender-matched control cohort treated with standard care. Patients were typically treated in the emergency department with a single dose of 500mg/5 mL TXA delivered via nebulizer., Results: 1110 total cases of PTH were observed, and 83 were treated with nebulized TXA. Compared to 249 age- and gender-matched PTH controls, TXA-treated patients had a rate of operating room (OR) intervention of 36.1% versus 60.2% (p < 0.0001) and a rate of repeat bleeding of 4.9% versus 14.2% (p < 0.02). The odds ratio for OR intervention with TXA treatment was 0.37 (95% CI 0.22, 0.63). There were no adverse effects identified with an average follow-up time of 586 days., Conclusion: Treatment of PTH with nebulized TXA is associated with lower rates of operative intervention and lower rates of repeat bleeding events. Prospective studies are needed to further characterize efficacy and optimal treatment protocols., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Injuries are common in mixed martial arts (MMA) competitions. However, the risk factors for facial injury have not been delineated. Objective: Identify the facial injuries and associated risk factors of professional MMA fights. Methods: The Nevada State Athletic Commission medical injury reports from all professional Ultimate Fighting Championship bouts from 2010 to 2020 was reviewed. Fighter characteristics, details of the competition, and injuries sustained were collected. Binary logistic regressions determined significant predictors of facial injury. Results: A total of 1462 fighters were included. Most participants were male (91.0%) with mean age of 29.5 ± 4.1 years. Most fights took place between 135 and 185 lbs., lasted ≥3 rounds (59.4%), and resulted in judges' decision (50.5%) or knockout (31.2%). The facial injury rate was 15.8%, which were predominantly lacerations (12.0%) and fractures (3.6%). Multivariate regression revealed being male ( p  = 0.026), heavier weight ( p  = 0.028), more rounds fought ( p  = 0.019), losing ( p  < 0.001), and nonsubmission outcome ( p  = 0.017) predicted facial injury. Conclusion: Facial injuries are common in MMA fighting. The risks should be iterated to participants in this sport.

Purpose: Verbal fluency tasks assess the ability to quickly and efficiently retrieve words from the mental lexicon by requiring subjects to rapidly generate words within a phonological or semantic category. This study investigated differences between cochlear implant users and normal-hearing peers in the clustering and time course of word retrieval during phonological and semantic verbal fluency tasks., Method: Twenty-eight children and adolescents (aged 9-17 years) with cochlear implants and 33 normal-hearing peers completed measures of verbal fluency, nonverbal intelligence, speech perception, and verbal short-term/working memory. Phonological and semantic verbal fluency tests were scored for total words generated, words generated in each 10-s interval of the 1-min task, latency to first word generated, number of word clusters, average cluster size, and number of word/cluster switches., Results: Children and adolescents with cochlear implants generated fewer words than normal-hearing peers throughout the entire 60-s time interval of the phonological and semantic fluency tasks. Cochlear implant users also had slower start latency times and produced fewer clusters and switches than normal-hearing peers during the phonological fluency task. Speech perception and verbal working memory scores were more strongly associated with verbal fluency scores in children and adolescents with cochlear implants than in normal-hearing peers., Conclusions: Cochlear implant users show poorer phonological and semantic verbal fluency than normal-hearing peers, and their verbal fluency is significantly associated with speech perception and verbal working memory. These findings suggest deficits in fluent retrieval of phonological and semantic information from long-term lexical memory in cochlear implant users.

This study aimed to evaluate the minimum inhibitory concentration (MIC) of azithromycin (AZM) in clinical isolates of extensively drug-resistant (XDR) Salmonella Typhi (i.e., resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin) using the E-test versus the broth microdilution method (BMD). From January to June 2021, a retrospective cross-sectional study was carried out in Lahore, Pakistan. Antimicrobial susceptibility was performed initially by the Kirby-Bauer disk diffusion method for 150 XDR Salmonella enterica serovar Typhi isolates, and MICs of all the recommended antibiotics were determined by the VITEK 2 (BioMérieux) fully automated system using Clinical Laboratory Standard Institute (CLSI) 2021 guidelines. The E-test method was used to determine AZM MICs. These MICs were compared with the BMD, which is the method recommended by the CLSI but not adopted in routine laboratory reporting. Of 150 isolates, 10 (6.6%) were resistant by disk diffusion. Eight (5.3%) of these had high MICs against AZM by the E-test. Only three isolates (2%) were resistant by E-test, having an MIC of 32 μg/mL. All eight isolates had a high MIC by BMD with different MIC distributions, but only one was resistant, having an MIC of 32 μg/mL by BMD. The sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of the E-test method versus BMD were 98.65%,100%, 99.3%, 33.3%, and 98.6%, respectively. Similarly, the concordance rate was 98.6%, negative percent agreement was 100%, and positive percent agreement was 33%. The BMD is the most reliable approach for reporting AZM sensitivity in XDR S. Typhi compared with the E-test and disk diffusion methods. Potentially, AZM resistance in XDR S. Typhi is around the corner. Sensitivity patterns should be reported with MIC values, and if possible, higher values should be screened for the presence of any potential resistance genes. Antibiotic stewardship should be strictly implemented.

Bibliometric studies are important to understand changes and improvement opportunities in academia. This study compared bibliometric trends for two major sports medicine/arthroscopy journals, the American Journal of Sports Medicine® ( AJSM® ) and Arthroscopy® over the past 30 years. Trends over time and comparisons between both journals were noted for common bibliometric variables (number of authors, references, pages, citations, and corresponding author position) as well as author gender and continental origin. Appropriate statistical analyses were performed. A p < 0.001 was considered statistically significant. One representative year per decade was used. There were 814 manuscripts from AJSM® and 650 from Arthroscopy® . For AJSM® the number of manuscripts steadily increased from 86 in 1986 to 350 in 2016; for Arthroscopy® the number of manuscripts increased from 73 in 1985/1986, to 267 in 2006, but then dropped to 229 in 2016. There were significant increases in all bibliometric variables, except for the number of citations which decreased in Arthroscopy® . There were significant differences in manuscript region of origin by journal (p = 0.000002) . Arthroscopy® had a greater percentage of manuscripts from Asia than AJSM® (19.3% vs 11.5%) while AJSM® had a greater percentage from North America (70.3% vs 59.2%); both journals had similar percentages from Europe (18.2% for AJSM® and 21.6% for Arthroscopy® ). For AJSM® the average percentage of female first authors was 13.3%, increasing from 4.7% in 1986 to 19.3% in 2016; the average percentage of female corresponding authors was 7.3%. For Arthroscopy® , the average percentage of female first authors was 8.1%, increasing from 2.8% in 1985/1986 to 15.7% in 2016 (p = 0.00007). In conclusion, AJSM® and Arthroscopy® showed an increase in most variables analyzed. Although Arthroscopy® is climbing at a higher rate than AJSM® for female authors, AJSM® has an overall greater percentage of female authors., (© 2020 The Author(s).)

Background/aim: Blood flow deficiencies of the retinal and retrobulbar circulations have been previously reported in open-angle glaucoma (OAG) and other eye diseases. Herein we investigated the effects of image brightness and contrast dynamic altering stimuli (DAS) when viewing a video content on ocular blood flow, intraocular pressure (IOP) and ocular perfusion pressure (OPP) in OAG and healthy subjects., Methods: Thirty-five subjects, 25 with OAG (mild to moderate) and 10 healthy controls, were evaluated for blood pressure, IOP, OPP and retinal capillary blood flow before, immediately after, 30 min after and 60 min after using ReviView (a dichoptic video goggles device), which stimulates one eye with a DAS video image that is brighter and with greater contrast than the fellow eye (duration of exposure 30 min). Differences between each subject's eyes and between OAG and healthy subjects were evaluated using repeated-measures analysis of variance with p<0.05 considered statistically significant., Results: All subjects demonstrated a significant increase in OPP in both eyes immediately following viewing. In all DAS eyes, retinal capillary blood flow rose immediately after stimulation and remained elevated for an hour postviewing. Viewing DAS increased retinal blood flow compared with control eyes (p=0.0014, 0.0135 superiorly and p=0.0094, 0.0001 inferiorly, at 30 and 60 min, respectively). OAG eyes had a significant reduction in the number of dormant retinal capillaries (p=0.0174), while healthy eyes demonstrated a larger increase in retinal capillary blood flow (p=0.0006 and p=0.0093 at 60 min, superior and inferior, respectively) following DAS viewing., Conclusion: Viewing DAS video for 30 min using ReviView increased retina blood flow both in healthy subjects and in patients with OAG., Trial Registration Number: NCT02959593., Competing Interests: Competing interests: AH would like to disclose that he receives remuneration from CIPLA, AdOM and Shire for serving as a consultant. AH also holds an ownership interest in AdOM and Oxymap. All relationships listed above are pursuant to Indiana University’s policy on outside activities.​ The contribution of ACVV was supported by Fondazione Roma and by the Italian Ministry of Health., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Antenatal corticosteroids for pregnant women at risk of preterm birth are among the most effective hospital-based interventions to reduce neonatal mortality. We aimed to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of antenatal corticosteroids at all levels of health care in low-income and middle-income countries., Methods: In this 18-month, cluster-randomised trial, we randomly assigned (1:1) rural and semi-urban clusters within six countries (Argentina, Guatemala, India, Kenya, Pakistan, and Zambia) to standard care or a multifaceted intervention including components to improve identification of women at risk of preterm birth and to facilitate appropriate use of antenatal corticosteroids. The primary outcome was 28-day neonatal mortality among infants less than the 5th percentile for birthweight (a proxy for preterm birth) across the clusters. Use of antenatal corticosteroids and suspected maternal infection were additional main outcomes. This trial is registered with ClinicalTrials.gov, number NCT01084096., Findings: The ACT trial took place between October, 2011, and March, 2014 (start dates varied by site). 51 intervention clusters with 47,394 livebirths (2520 [5%] less than 5th percentile for birthweight) and 50 control clusters with 50,743 livebirths (2258 [4%] less than 5th percentile) completed follow-up. 1052 (45%) of 2327 women in intervention clusters who delivered less-than-5th-percentile infants received antenatal corticosteroids, compared with 215 (10%) of 2062 in control clusters (p<0·0001). Among the less-than-5th-percentile infants, 28-day neonatal mortality was 225 per 1000 livebirths for the intervention group and 232 per 1000 livebirths for the control group (relative risk [RR] 0·96, 95% CI 0·87-1·06, p=0·65) and suspected maternal infection was reported in 236 (10%) of 2361 women in the intervention group and 133 (6%) of 2094 in the control group (odds ratio [OR] 1·67, 1·33-2·09, p<0·0001). Among the whole population, 28-day neonatal mortality was 27·4 per 1000 livebirths for the intervention group and 23·9 per 1000 livebirths for the control group (RR 1·12, 1·02-1·22, p=0·0127) and suspected maternal infection was reported in 1207 (3%) of 48,219 women in the intervention group and 867 (2%) of 51,523 in the control group (OR 1·45, 1·33-1·58, p<0·0001)., Interpretation: Despite increased use of antenatal corticosteroids in low-birthweight infants in the intervention groups, neonatal mortality did not decrease in this group, and increased in the population overall. For every 1000 women exposed to this strategy, an excess of 3·5 neonatal deaths occurred, and the risk of maternal infection seems to have been increased., Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Pakistan presently has one of the largest cohorts of young people in its history, with around 36 million people between the ages of 15 and 24 years. One of the main reasons for high population growth in Pakistan is almost stagnant contraceptive prevalence rate of 30% nationally and 17.4% amongst youth. The study was conducted to explore the perceptions regarding myths and fallacies related to male contraceptive methods among married youth aged 18-24 year in Karachi, Pakistan. Qualitative exploratory study design was adopted and a total of eight Focus Group Discussions (FGDs) were conducted. Study was conducted in two Union Councils of Korangi Town in the squatter settlement of Karachi, Pakistan from July to September 2010. Thematic analysis was done manually. General, physical, sexual, psychological, socio-cultural and religious were the common categories which lead to myths and fallacies related to condoms use and vasectomy among the married youth. The foremost myth amongst male and female youth was that use of both condoms and vasectomy cause impotence in males. Additionally, condoms were thought to cause infections, backache and headache in males. Some youth of the area think that vasectomy is meant for prisoners only. In conclusion our findings suggest that the potential reasons behind low use of male contraceptive methods among youth of squatter settlement of Karachi were myths and fallacies about male contraceptive methods. There are some important policy implications like counseling of the couple through peers and well trained family planning service providers to address these myths and misconceptions from the minds of youth.

A comparative double blind study of Ketamine and Morphine was conducted on eighty children following tonsillectomy to assess the analgesic, respiratory rate depressant and emesis. Children (6-12 years) were divided into two groups randomly (n=40). General anesthesia was induced followed by 0.1mg/kg morphine (I/M) and 0.5mg/kg ketamine (I/M) to Group I and Group II respectively before the initiation of surgical procedure. Pain scores (face score and CHEOPS score) were estimated for children at thirty, sixty, one hundred and twenty and two hundred and forty minutes following surgery. Comparison of CHEOPS score estimation reflected that pain scores were statistically significant (P < 0.05) in Group I receiving Morphine as compared to Group II who received Ketamine. The analgesic effect of ketamine and morphine showed statistically insignificant results (P >0.05) in case of face score. Moreover, respiratory rate in Group I had shown statistical association (p<0.05) as compared to the ketamine at 60 and 120 minutes. Furthermore, incidence of vomiting was more in Group I (0.05) as compared to Group II. It can be concluded from the study that ketamine may be used as a suitable substitute to that of morphine in children undergoing tonsillectomy.

Objective: To determine the frequency, types (disease states) and outcome of severe obstetric morbidity in patients presenting at a public-sector tertiary care hospital., Methods: The cross-sectional study was conducted at the Obstetrics and Gynaecology Unit II, Civil Hospital, Karachi, from April to September 2010. Consecutive cases of severe obstetric morbidity (near-miss), as defined by specific criteria, presenting in emergency were included. They were categorised into six groups: haemorrhage, hypertensive disorders in pregnancy, sepsis, ruptured uterus, anaemia, and a miscellaneous group encompassing morbidities not falling in the aforementioned groups. Obstetric near-miss (ONM) cases were described by disease-specific criteria. Primary outcome measures were frequency of near-miss in each disease specific group, type (disease state) of near miss in a group, maternal outcome measures i.e. hospital stay >7 days, hysterectomy, urinary/faecal fistula, morbidity due to management intervention and maternal death. Maternal near-miss ratio and mortality to near-miss ratio were calculated. Secondary outcome measures were ventilator support for >24 hours, and intensive care admission for >48 hours., Results: There were 1508 deliveries during the study period from which 130 patients met the inclusion criteria. Among the 130 enrolled patients, obstetric near-miss (survivors) were 111. Among the total of 1442 livebirths, the maternal near-miss ratio was calculated to be 76.97/1000 livebirths. Nineteen maternal deaths resulted in the near-miss to mortality ratio of 5.8:1. Haemorrhage (34.2%) was the most frequent group, followed by hypertensive disorders (29.1%) and ruptured uterus (11.53%). Case fatality rates of sepsis (35%) and miscellaneous (30%) groups were the highest. Hysterectomy rates were 3.60% and hospital stay > 7 days stood at 31.33%. The intensive care admission rate was 42.34%., Conclusion: Haemorrhage, hypertensive disorders and ruptured uterus were the leading causes of obstetric near-miss, whereas sepsis, acute fatty liver of pregnancy and peripartum cardiomyopathy resulted in the highest case fatalities.

Objectives: To assess the levels of stress in the face of terrorism and the adopted coping strategies, amongst the student population of universities in Karachi., Methods: A descriptive, cross sectional study was conducted on undergraduate students from four universities of Karachi. Self-administered questionnaires were filled out by 291 students. Pearson Chi-Square test was used to assess associations between stress levels and different variables at a level of significance of 0.05%., Results: A total of 65.8% of the students had mild stress levels, 91.5% of university students were exposed to terrorism through television, while only 26.5% students reported personal exposure to terrorism. 67.4% students were forbidden by their parents to go out (p = 0.002). Most of those who had self exposure to an attack were the ones whose parents forbade them from going out (p = 0.00). Most commonly used coping strategy was increased faith in religion. Irritability was the most common stress symptom., Conclusion: A majority of students studying in universities of Karachi had mild stress levels due to the constant threat of terrorism whereas a minority had severe stress levels. Possible reasons for resilience and only mild stress levels could be the history of Karachi's internal conflicts and its prolonged duration of being exposed to terrorism. These students who are positive for stress need to be targeted for counseling either through the media or through their universities. More extensive research is needed in this area.

Objective: To compare perinatal outcome and near-miss morbidities between placenta previa versus abruptio placentae in patients of antepartum haemorrhage (APH)., Study Design: Cross-sectional, analytical study., Place and Duration of Study: Gynaecology Unit II, Civil Hospital, Karachi, from August 2007 to July 2009., Methodology: Patients with APH diagnosed as placenta previa and abruptio placentae who delivered after 24 weeks of pregnancy were selected from labour room. Outcome measures were birth weight, neonatal intensive care admission, stillbirth, perinatal mortality rates, near-miss, surgical intensive care admission, postpartum haemorrhage, hysterectomy, massive transfusion, renal failure, coagulopathy and maternal death. Stillbirth was defined as a fetus weighing≥500 gm showing no sign of life after birth. Near-miss was defined as severe organ dysfunction which if not treated appropriately, could result in death. Descriptive statistics were calculated and chi-square was applied with significance level<0.05., Results: Stillbirths and perinatal mortality rates were significantly higher in abruptio placentae, 52.97% versus 18.18% and 534/1000 versus 230/1000 (p<0.01). Near-miss cases were also significantly higher in abruptio placentae, 22.27% verus 11.18% (p<0.01). Hypovolemic shock and coagulation failure were also significantly higher in abruptio placentae (p<0.05)., Conclusion: Abruptio placentae carry significantly higher perinatal mortality and near-miss morbidity than placenta previa.