Rahim Yar Khan Research Articles

Alcoholic Hepatitis: A Paradigm shift of Prevention and Treatment Analyzed at Cellular level by Histo/Pathological Micrometric Assessment.

Objective: To evaluate role of Vitamin C and Naproxen in Alcohol-induced liver toxicity by micrometric technique (hepatocyte count, size and nuclear diameter) in albino rats.Methodology: This experimental interventional study was conducted at the sheikh Zayed medical college and hospital Rahim yar khan from December 2022 to March 2023. 60 albino rats with equal gender distribution were selected based on the random probability sampling technique and placed in three groups of 20, again with an equal gender distribution (1:1). Group A (positive control) was given purified Ethanol for 10 days., Group B was given Vitamin C and NaproxenProphylaxis for 7 days and later intoxicated with Ethanol for 10 days and Group C was simultaneously Administered Vitamin C, Naproxen, and Ethanol for 10 days. The hepatocyte count, size and nuclear diameter of all the groups were recorded by micrometric technique using ocular and stage micrometric scales. Data analysis was conducted using SPSS 24.0 and P-Value of ≤0.05 considered Statistically Significant.Results: Group A animals experienced decreased number of hepatocyte count, increase in size of cell and decrease in nucleus size; Group B showed similar picture as group “A” but less in intensity and Group C showed nearly normal hepatic architecture with hepatocyte count, size and nuclear size close to normal ranges.Conclusion: The anti-oxidative and anti-inflammatory effects of Vitamin C and Naproxen demonstrated significant hepatoprotective effects on liver histologic architecture, providing safety from alcohol-induced liver injury. Keywords: Naproxen, Prophylaxis, liver toxicity, alcoholic liver disease, vitamin C.

Effects of dry needling on pain, range of motion and function in patients with upper cross syndrome

Background: In upper cross syndrome, upper trapezius, levator scapulae, sub occipital, sternocleidomastoid, pectoralis major and minor become tight. Whereas, the phasic muscle including lower and middle trapezius, deep neck flexor and serratus anterior muscle weaken. Objectives: To determine the effects of dry needling on pain, range of motion and function in upper cross syndrome. Methods: This randomized clinical trial was conducted at Sheikh Zaid Hospital Rahim yar khan. Ethical approval REC/RCRS/20/1049 was obtained from Riphah International University Lahore. Group A was treated with dry needling along with conventional therapy and group B was treated with conventional therapy and 34 subjects were allocated in both groups. The duration of study was of 2 weeks with 1 session per week. The pre and post intervention scores were taken for Visual analogue scale, Neck disability index and neck range of motion. The data was analyzed using SPSS 25. Results: There was no significant difference (p<0.05) between groups based on demographic data at baseline. The BMI in group A was 24.38(1.14) and in group B 23.19(2.59). The mean difference of VAS in group A was 2.89(1.68) with CI [1.98, 3.76] (p<0.05) and in group B was 2.87(1.03) with CI [2.33,3.42] (p<0.05). The mean difference for NDI in group A was 21.25(10.85) with CI [15.46, 27.03] (p<0.05) and in Group B was 14.68(8.42) with CI [10.20,19.17] (p<0.05). In VAS and NDI between group analysis did not show significant result (p>0.05). Conclusion: Dry needling along with conventional therapy only improves range of motion but in term of pain and functionality, dry needling and conventional therapy are equally effective. Clinical Trial Number: NCT04674904

THE POTENTIAL ROLE OF EGFR IN DIFFERENTIATING BETWEEN TRUE AND PSEUDOHYPERKALEMIA AT A TERTIARY CARE HOSPITAL

Objective: To determine the potential role of eGFR in differentiating between true and pseudohyperkalemia at a tertiary care hospital. Material and Methods: Cross-sectional study conducted in department of Chemical Pathology, Sheikh Zayed Hospital, Rahim Yar khan from January 1, 2022 to August 31, 2022. A total of 101 study subjects satisfying the inclusion criteria were included in study. Included specimen were analysed for serum creatinine level and estimated glomerular filtration rate (eGFR) was calculated by using chronic kidney disease-Epidemiology Collaboration (CKD-EPI) creatinine equation. Results: Of the total 101 study subjects, 59(58.4%) were male and 42(41.65%) were females. Mean age of study subjects was 45.28±12.265 years. Of the total 101 study samples, 75(74.3%) were classified as true hyperkalemia while 26(25.7%) were classified as pseudohyperkalemia with statistically significant difference of eGFR between two groups (P value: 0.00). Conclusion: Serum electrolytes are one of the most frequently requested diagnostic tests; thus, errors in these readings may alter the course of treatment for patients. As shown in our study that true hyperkalemia is very rare in patients with normal kidney function. So, estimated GFR can be taken as useful tool to differentiate between true and pseudohyperkalemia. Key Words: Pseudohyperkalemia, True hyperkalemia, Estimated GFR, CKD

Micro-Climatic effect on Cotton Yield, quality, Bt toxin & GT Gene

Unsuitable change in climatic conditions cause decline in quality and yield of major crops. Plant growth is directly affected if temperature, rainfall or humidity are not optimum. A multi-location and multi season evaluation of climatic effects on quality and yield may produce a reliable data for future breeding. A set of 39 upcoming varieties of cotton were evaluated on six different Micro-climatic locations of Punjab i.e. Multan, Bahawalpur, Sahiwal, Rahimyar khan, Vehari and Faisalabad in a triplicated trial. The experiment was repeated next year on same locations. Data for three key environmental factors such as temperature, rainfall and humidity was recorded at each station. The crop was analyzed for yield, fiber length, fiber strength and fiber fineness. The genotypes were also evaluated for Bt toxin and Glyphosate tolerance gene (GTG). The analysis revealed that high temperature has negative effect on yield, Bt expression, fineness, uniformity and GTG. Precipitation and humidity had positive effect on fiber fineness and uniformity, whereas, negative effect of both environmental factors was recorded for fiber length and strength. Increase in precipitation at early cropping stage was associated with increase in yield whereas higher humidity has negative impact on yield. As compared to high average temperature and number of days above 400C, cotton yield is more sensitive to heat waves (maximum temperature). Varieties with high temperature tolerance in cotton should be breed for climate change scenario.

Comparison of Mirror Therapy and Motor Relearning Program in improving the lower limb motor function of patients with stroke

Objective. The objective of the study was to compare the effectiveness of motor relearning programs and mirror therapy in improving the lower limb motor function of stroke patients.
 Methods. A randomized controlled trial was carried out at Al Noor hospital and Al Jannat Medicare of Rahim yar khan from January 2020 to July 2020. The data was collected after the ethical approval from Isra University. The sample consisted of 30 subjects with the age range of 40 to 65 years. Group A received MRP treatment while mirror therapy was given to Group B. Modified Fugl Meyer Assessment scale was used to measure the outcomes variables.SPSS 20 was used to analyze the research data. Non-parametric Friedman Test was used for intra-group comparison while Karuskal Wallis test was used for inter-group comparison. Three assessments were performed, pre-assessment at 0 weeks, mid-assessment at 3rd week, and post-assessment at 6th week.
 Results. Out of the total 30 participants in the study, males were 21 while females were 9. Patients with left hemiplegia were 22 while 8 were with right hemiplegia. The mean age was 53.80±7.66. The results showed that both treatments are effective in improving the motor function of stroke patients. But motor relearning program is more effective as a significant difference was found between the two treatments. (p<.005)
 Conclusion. This study concluded that a motor relearning program is more effective than mirror therapy in improving the lower limb motor function of stroke patients. 
 Keywords.Motor control, Mirror Therapy, Motor relearning, Stroke
 Trial Registration: IRCT20200316046791N1

Google Maps Data Analysis of Clothing Brands in South Punjab, Pakistan

The Internet is a popular and first-hand source of data about products and services. Before buying a product, people try to gain quick insight by scanning through online reviews about a targeted product. However, searching for a product, collecting all the relevant information, and reaching a decision is a tedious task that needs to be automated. Such composed decision-assisting text data analysis systems are not conveniently available worldwide. Such systems are a dream for major cities of South Punjab, such as Bahawalpur, Multan, and Rahimyar khan. This scenario creates a gap that needs to be filled. In this work, the popularity of clothing brands in three cities of south Punjab has been assessed by analysing the brand's popularity using sentiment analysis by prioritizing brands based on organic feedback from their potential customers. This study uses a combination of quantitative and qualitative research to examine online reviews from Google Maps. The task is accomplished by applying machine learning techniques, Logistic Regression (LR), and Support Vector Machine (SVM), on Google Maps reviews data using the n-gram feature extraction approach. The SVM algorithm proved to be better than others with the uni-bi-trigram features extraction method, achieving an average of 80.93% accuracy.

APPRAISAL PERFORMANCE AND TRAINING OF HRM PRACTICES ON EMPLOYEES’ TURNOVER INTENTION AND ORGANIZATIONAL LOYALTY: THE MEDIATING ROLE OF PSYCHOLOGICAL EMPOWERMENT

It is widely accepted that HRM techniques might have a comparative advantage when organizational commitment is taken into consideration. On the other hand, turnover intention has become a trend and is increasing in today’s work engagement. The primary objective of this study is to establish a relationship between human resource management techniques and organizational loyalty and their effect on turnover intention Data of 330 employees from selected different industries were collected from Rahim yar khan Pakistan. The findings indicate a correlation between Performance Appraisal and Training and Development (HRM practices) and organizational loyalty, which contributes to an inverse relationship between employee turnover intention and performance appraisal. Increased employee loyalty will boost organizational effectiveness through the retention of competent and experienced personnel, hence minimizing turnover intentions. As such, this study contributes to the body of information regarding the impact of human resource management methods on organizational loyalty and intention to leave. The data results might be used as a reference or guideline for future related studies.

Role of a Barrier or a Bridge: Translanguaging Pedagogy to Expand Vocabulary and Memory of ESL Learners

Translanguaging pedagogy has earned the fame of a highly approved and flexible approach in learning as well teaching realm. This article was about exploring the productive or unproductive role of translanguaging pedagogy to expand vocabulary knowledge and memory of ESL learners. Male undergraduates enrolled in Associate Degree Program during the session 2021-2023 at the public colleges of district Rahim Yar khan were the population of that study. Cluster random sampling was used to select 426 students. A questionnaire designed by the researcher was utilized to record the responses of the selected students about positive and negative effects of translanguaging pedagogy on vocabulary and memory enhancement. The findings of descriptive statistics showed that translanguaging pedagogy works more as a barrier for vocabulary knowledge rather than a facilitating tool for ESL learner. As far as development of memory was concerned, this pedagogical approach carried both efficient and inefficient effects for refining the memory of ESL learners. Moreover, its efficiency for memory could be improved by its vigilant manipulation in teaching context.

A Proposed Comparative Algorithm for Regional Crop Yield Assessment: An Application of Characteristic Objects Method

The agriculture sector plays a vibrant role in the economic prosperity of advanced and developing countries. It is a crucial source of revenue for the majority of the population. Nevertheless, unfortunately, in Pakistan, the share of the agricultural sector in Gross Domestic Product (GDP) is gradually declining. Therefore, comprehensive strategies and actions need to be developed and implement to enhance the agricultural productivity of Pakistan. In this study, an attempt has been made to examine the crop yield revenue of Punjab, Pakistan, by ranking the districts according to their contribution to the agricultural GDP of Pakistan's economy. A Multi-Criteria Decision Making (MCDM) technique, namely, characteristic objects method (COMET), which is entirely free of the rank reversal paradox, is used for this purpose. However, to make a fair comparison, in this research, a comprehensive framework is proposed to normalize the crop yield revenue of Punjab under probabilistic nature. The proposed framework is applied to various districts of Punjab, Pakistan, from 1992 to 2019. It is concluded that Jhang, Faisalabad, and Rahim Yar Khan (RYK) are the highest-ranked districts, while Nankana Sahib, Rawalpindi, and Islamabad are the lowest-ranked districts of Punjab, Pakistan, according to their contribution to the agricultural GDP of Pakistan's economy. Outcomes associated with this research would be helpful to build precise and accurate budget allocation policies.

The determination of potentially toxic elements (PTEs) in milk from the Southern Cities of Punjab, Pakistan: A health risk assessment study

The concentration of potentially toxic elements (PTEs) in milk samples (cow, buffalo, camel) from Rahim Yar Khan (RYK) district, Sadiqabad (SA), Khanpur (KP), and Liaqatpur (LP) was determined using a Flame Atomic Absorption Spectrometry. The mean concentrations milk samples were Zn > Fe > Cd > Cr > Cu. Copper (Cu) was absent in most milk samples, and the highest amounts of PTEs were detected in milk samples from the KP, and the lowest levels were observed in the RYK district. The mean concentration (0.0069 mg/ kg) of Cr was found lower than the allowable limit implemented by World Health Organization (WHO) 1.61 mg/ kg, and the levels of Cd (0.016 mg/ kg) were found within the permissible limits. However, Cu (0.023 mg/ kg), Fe (0.752 mg/ kg), and Zn (1.287 mg/ kg) mean concentrations were observed to be above the daily intake limits implemented by the International Dairy Federation (IDF), i.e., (0.01 mg/ kg), WHO (0.37 mg/ kg) and IDF (0.32 mg/ kg), respectively. CDI (Chronic daily intake), HQ (Hazard Quotient), and CR (carcinogenic risk) factors were also determined, and all the HQ values were found below 1. CR factor for Cd and Cr was 0.0024 and 0.0003, respectively. The results have encouraged the stakeholders to take necessary measures to avoid the exposure of toxic metal. Implementing strict regulations for these metals should also be effective for safeguarding their exposure to animals.

Deciphering Outbreaks of the Migratory Locust (Locusta Migratoria L.) (Orthoptera: Acrididae) With Their Management Strategies

The economic importance of locusts is well recognized throughout the world owing to their swarming behavior. The damage caused by hoppers on a small scale is mostly limited to local vegetation, primarily crops. Crop damage is overlooked, but it is tenacious in nature, and the effects they leave on planned systems, such as crop fields, are much more serious. Therefore, many taxa (genera or species) of the family Acrididae are considered as potential pests of farms, forests and even pastures. In general, the distribution of locusts decreases with increasing latitudes, i.e., Their occurrence increases towards the equator. When ecological conditions favour more plant growth and trigger more breeding, locusts can manage to aggregate in a huge voracious swarm and inflict damage to crops. When outbreaks of the migratory locust, Locusta migratoria L. arose in the southeastern part of Pakistan in the Sind, Bahawalpur, Bahawalnagar, Minchinabad and Chistian adjoining districts bordering the eastern sides of India. As a result, further damage to crops and migration to other areas were prevented. Morphometric measurements indicated that the migrants had reached the body dimensions typical for gregarious forms. Drum and empty tin beating and pesticide application are both effective in managing locusts under field conditions. Swarms of adults landed on the grazing and farming lands of the country, specifically from Sind (Thar) to Chistian, Bahawalpur, Rahim yar khan, Minchinabad, Lodhran and adjacent districts in the region in November 2019, and caused substantial damage to agricultural crops and pastures. In the fall of 2019, numerous locusts suddenly swarmed in the affected areas, and thus, control was essential. The organochlorines are highly persistent and include dieldrin and HCH. These insecticides were the most favoured for locust control because of their efficacy, cost and persistence. Sprayed from land or aerial vehicles, whole swarms can be targeted in relatively short periods of time. Traditionally, the use of empty tin/drum was beaten to produce a loud sound that drove the locust away. The practices are cost effective and environmentally friendly.

Gender Differences in Academic Performance in the subject of Pharmacology: A study conducted in a medical college

Background: The proportion of female students is increasing progressively in medical schools, but concern remains about differing performance in exams. A limited data is available on comparison of academic performance of male and female students from developing countries. Aim: To compare them regarding their academic performance in the subject of pharmacology. Methods: This comparative study was conducted at Pharmacology departments of Sheikh Zayed medical college Rahim yar khan and Quaid-e-Azam medical college Bahawalpur among 3rd yr MBBS students of sessions 2019 and 2020. The overall attendance of students was counted and compared as well as all the pharmacology test results were evaluated and compared on the basis of previous record of fortnightly, end of module, midterm and end term examinations. Results: Girls outnumbered boys (528 girls vs 437 boys) in medical admissions. The girls were having better attendance and test results ( 92% vs 65% for better attendance & 26% vs 19% for better results) in both sessions 2019 and 2020. The results also showed that students from literate background and urban areas got more admission in medical college but more number of boys are boarders compared to girls who prefer to be day scholars due to social circumstances of South Punjab. Conclusion: The female students tend to perform better than boys in pre clinical subjects. The number of female medical students is increasing progressively and they out perform their male counterparts both in attendance and internal assessments. The study is documentation of this fact, for future measures that can be done for improvement of male students performance. Keywords: Gender difference, pharmacology, performance

Outcome of Closure of Wide Based Defects by Various Rotational Flaps

Aim: To observe the outcome of closure of wide based defects by various rotational flaps for meningomyelocele defects. Study setting: Neurosurgery Department, Sheikh Zayed Hospital, Rahim yar khan Duration: From Oct 2018 to Oct 2020, Methodology: We included 15 patients with wide based myelomeningocele anomalies in the neurosurgery department, Sheikh Zayed Hospital, Rahim yar khan. Age ranged from four days to eight years. The flaw had a diameter of between 8x5cm and 12x8cm. Rotational flaps were used to restore soft tissue defects in all cases. Result: In this study, we did posterior intercostal artery perforator flap(superiorly based) in 40% patients, double rotation flap (yin yang) in 26.7% patients, superior gluteal artery perforator flap in 20 % patients and z plasty in 13.3 % patients. Regarding complications, 2 (13.3%) individuals had a superficial wound dehiscence. One individual (6.7%) developed necrosis of the distal portion of the flap, which was conventionally handled. Postoperatively, no neurosurgical problem occurred. After an average of 6 months, no patient experienced reappearance or dural sac herniation. Conclusion: Restoration of large meningomyelocele defects using local rotational flaps is a secure and reliable approach for abnormalities in the lumbosacral region. Keywords: Meningomyelocele, rotational flaps

Congenital limb defects in a married female population of the Rahim Yar Khan District in Pakistan.

Congenital limb defects (CLD) have a range of phenotypes and can be a substantial cause of disability. The prevalence of CLD in the adult population of Pakistan is not well described. To investigate the prevalence of CLD and their associated factors in a married female population of the Rahim Yar Khan (RYK) District in Pakistan. A cross-sectional population-based study was conducted in 4 tehsils of RYK District, and married women and girls from 22 different localities were enrolled by convenience sampling in public places and through door-to-door visits. Data regarding limb phenotype and demographic variables were obtained from participants. We enrolled 2,204 married women and girls. We found 11 participants with CLD suggesting a prevalence of 4.99/1,000 (proportion: 0.005; 95% confidence interval [CI] <0.001-0.01). Polydactyly was the most frequent (n = 5; prevalence: 2.27/1,000), followed by others in the following sequence: brachydactyly (n = 4; prevalence: 1.81/1,000), camptodactyly (n = 1; prevalence: 0.45/1,000), and oligodactyly (n = 1; prevalence: 0.45/1,000). The odds of occurrence of CLD were higher in individuals originating from Khanpur tehsil (odds ratio [OR] 2.05; 95% CI 0.37-11.27), speaking languages other than Punjabi and Saraiki (OR 2.35; 95% CI 0.24-22.80), belonging to Araien caste (OR 2.35; 95% CI: 0.24-22.80), of a nuclear family (OR 3.35; 95% CI 0.79-16.97), or having parental consanguinity (OR 1.87; 95% CI 0.49-7.06). Preliminary estimate of CLD prevalence in the married female sample population in RYK appears high compared with estimates from birth defects registries in other countries.

Socio-Cultural Issues of Religious Minorities in Southern Punjab, Pakistan

Minorities are basically defined as ascribed status such as gender, race, ethnic, and religious background. The objectives of the current study were to determine the socio-cultural issues of religious minorities in Southern Punjab; to know the minorities’ social condition and to examine the satisfaction of the respondents regarding government role regarding the protection of minorities. The study was conducted in two districts Rahim Yar khan and Multan of Southern Punjab, Pakistan. Data were collected from 200 minority residents of districts Rahim Yar Khan and Multan through structured interview schedule. Data were collected through purposive sampling technique. Collected data were analyzed by using Statistical Package for Social Science (SPSS) 23.0 version. It was found that majority of the respondents were from the rural areas and illiterate and less than ten thousand rupees per month. Majority of the respondents did not own the property and face lot of socio-cultural discriminations in daily routine of life. The respondents faced a lot of issues due to their religious identity and it strongly hit their socio-cultural, economic and even personal life. It is suggested that government should have to implement the prescribed laws to protect the minority rights and give them confidence to spend their life with full zeal and zest.

Temporal Analysis for Detection of Anomalies in Precipitation Patterns over a Selected Area in the Indus Basin of Pakistan

For efficient adaptation strategies, investigation of the variability in climatic data and its impact on meteorological drought is critical, particularly in semi-arid and arid regions. Innovative trend analysis (ITA), Mann–Kendall (MK) and Sen’s slope estimator (SSE) tests were employed to analyze the variations in precipitation (1981–2018) on annual, seasonal and monthly scale across 12 meteorological stations over the selected areas of the lower Indus basin (LIB) of Pakistan. The reliability of the ITA method was also compared and analyzed with both MK and SSE methods for 48 seasonal precipitation times series. Annual precipitation results indicated a significant increasing trend, i.e., 2.09 mm/year, at only one station (Rahim Yar Khan (RYK)-Khanpur), with MK test statistic Zmk = 2.09 and Sen’s slope estimator β = 2.56. On a monthly scale, the maximum number of positive significant trends were noted during June, with Zmk values of 2.01 to 3.24 and β values of 1.06–3.06, while the maximum number of negative trends was found during January, February, November and December. On a seasonal scale, ITA methods showed significant increasing trends during the summer at 12 selected meteorological stations, with trend indicator (B) values ranging from 0.22 to 2.46. Moreover, performance of the ITA method was found to be consistent with both MK and SSE test results at a verified significance level. The results of the study can help to increase our understanding of the annual, seasonal and monthly precipitation variability in the LIB that may be helpful in developing strategies for the proper management of water resources over the area.

Sugarcane Farmers Perception, Comprehension Regarding Climate Change and its Mitigation Through Adoption of Cultural Practices

Sugarcane is an important cash crop in Pakistan. Recently, the average per hectare production of sugarcane is low due to climatic variation. Therefore, sugarcane farmers are threatened by this emerging issue that has drastically affected their livelihoods, food security, and sustainability. This study was designed to analyze the perception, comprehension, and adoption of cultural practices in the mitigation of the impact of climate change. For this purpose, district Rahim yar khan was selected purposively from the Province of Punjab as the universe of the study; as one of the highly cultivated areas among all districts of Punjab. From selected districts, two tehsils were randomly selected, namely Sadiqabad and Kanpur. From each selected tehsil, 5 villages were selected using randomized sampling technique. In each selected village, 18 sugarcane farmers were selected randomly thus, making a total of 180 respondents. The data were collected through quantitative methods. A pre-tested and well-structured interview schedule was developed for the collection of information from sugarcane farmers. Data were analyzed using both descriptive and inferential statistics through the Statistical Package for Social Sciences. Results indicated that there was a significant difference between the two groups, adopter and non-adopters of mitigation strategies towards climate change. The results revealed that the majority (98.3 % and 75 %) of the growers reported that an increase in temperature and deforestation for the last five years respectively. Moreover, residues burring and deforestation were major causes of climate change followed by an excess of CO2 from agriculture activities and farm operations. The study recommended that the adoption of cultural practices in mitigation of the impact of climate change should be promoted through information sources.

Knowledge and Practices about Exclusive Breast Feeding among Mothers of Rahim Yar Khan

Background: Exclusive breastfeeding (EBF) practices have long been demonstrated to have significant implications for maternal and child health. Objective: To assess the knowledge and practices of exclusive breast feeding among mothers in RahimyarKhan. Methodology: Study design: Cross-Sectional study. Duration and Setting: From March to May 2018, in Sheikh Zayed Medical Hospital Rahimyar Khan. A sample of 105 women who attended the Outdoor and Indoor of Gynaecology and Pediatric department and EPI Center were enrolled by the convenient sampling technique. A pre-designed questionnaire was used having different variables like age, monthly income, education, occupation of mothers, residential area, knowledge about EBF, and breastfeeding practices during the last child. Data were statistically analyzed by SPSS version 20. Results: Mean age of mothers was 28± years, and 42.9% of mothers were illiterate, 77.1% were housewives, whereas, 52.3% of mothers belonged to urban areas. In this study, 90.5% of mothers had information about exclusive breastfeeding, and 55.6% of mothers acknowledged that breastfeeding should start immediately after delivery but regarding practice, only 21.9% of the mothers had started immediately after delivery. In this study, 48.6% of mothers knew that exclusive breast feeding is required for 6 months. Conclusion: Knowledge about exclusive breast feeding among mothers was satisfactory, however, practices regarding exclusive breastfeeding low in most among mothers. There is a need for health education program to start in Rahimyar khan.

Complications of organophosphorus poisoning.

Organophosphate (OP) compounds are insecticides whose toxicity is well reported. They can virtually involve any organ and cardiac and renal complications are one of the most dreadful ones. Objectives: To determine the frequencies of acute renal failure and cardiac complication in patients with Organophosphorus poisoning. Study Design: Cross Sectional study. Setting: Department of Medicine, Sheikh Zayed hospital, Rahim Yar khan. Period: January 2015 to December 2015. Material &amp; Methods: All adult cases with documented history of Organophosphorus poising either trans-dermally or oral ingestion with either accidental or intentional intake were included. The cases then underwent ECG and renal function tests. The abnormalities in ECG were documented and the urea more than 30 mg/dl and creatinine more than 1.5 mg/dl was labeled as acute renal failure. Results: In this study there were 100 cases, 58 (58%) were females and 42 (42%) males. The mean age was 22.58±48 years and mean duration of OP taken was 7±0.24 hours. Complications were seen in 35 (35%) cases out of which 6 had ARF and 29 had cardiac arrhythmias. IA, 6 had prolonged QT and remaining 3 observed ventricular tachycardia (VT). ARF was common in females but there was no significant association with any study variables. However a near significant was seen in cases that presented with more than 4 hours of toxicity (p= 0.07). Cardiac arrhythmias were also more common in females. There was significant association of it with oral intake and with suicidal intention with p= 0.001 and 0.001. Conclusion: OP poisoning is common and cardiac complications are more than acute renal failure. Oral intake and with suicidal intention are significantly associated with cardiac complications.

Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan

ABSTRACT Background In 2018, Pakistan had the world’s highest neonatal mortality rate. Within Pakistan, most neonatal deaths occur in rural areas where access to health facilities is limited, and robust vital registration systems are lacking. To improve newborn survival, there is a need to better understand the causes of neonatal death in high burden settings and engage caregivers in the promotion of newborn health. Objective To describe the causes of neonatal death in a rural area in Pakistan and to estimate the effect of an integrated neonatal care kit (iNCK) on cause-specific neonatal mortality. Methods We analyzed data from a community-based, cluster-randomized controlled trial of 5286 neonates in Rahim Yar Khan (RYK), Punjab, Pakistan between April 2014 and August 2015. In intervention clusters, Lady Health Workers (LHW) delivered the iNCK and education on its use to pregnant women while control clusters received the local standard of care. The iNCK included interventions to prevent and identify signs of infection, identify low birthweight (LBW), and identify and manage hypothermia. Verbal autopsies were attempted for all deaths. The primary outcome was cause-specific neonatal mortality. Results Verbal autopsies were conducted for 84 (57%) of the 147 reported neonatal deaths. The leading causes of death were infection (44%), intrapartum-related complications (26%) and prematurity/LBW (20%). There were no significant differences in neonatal mortality due to prematurity/LBW (RR 0.43; 95% CI 0.15–1.24), infection (RR 1.10; 95% CI 0.58–2.10) or intrapartum-related complications (RR 1.04; 95% CI 0.0.45–2.41) among neonates who died in the intervention arm compared to those who died in the control arm. Conclusion The major causes of neonatal deaths in RYK, Pakistan mirror the global landscape of neonatal deaths. The iNCK did not significantly reduce any cause-specific neonatal mortality.