Aims and objective: Body temperature of a neonate continues to be under-documented, under- recognized, and under-managed, even though studies have shown that neonatal hypothermia increases mortality and morbidity. We studied and analyzed temperature control (thermal chain) from point of referral to admission in NICU and overcome the pitfalls in management thorough serial PDSA (plan-do-study-act). Material and methods: Prospective observational analysis done over a period of 1 year. Study conducted in 3stages. In 1st stage protocol planned to record the temperature of all babies within 15min of admission. In the 2nd stage quality team formed and point of referral, mode of transport, and casuality stay were added. In 3rd stage management of temperature at casuality, referral point and in NICU was included. Results: In the 1st stage of study 93% adherence to protocol was seen and 58.6% of patient presented with moderate hypothermia and 24.1% patient having cold stress. As study progressed in 2nd stage, compliance increased to 96% but 73% cases were still not in the normal range of temp. Management of hypothermia was not done appropriately and 24% cases remain hypothermia on reaching NICU. Casuality stay was 69min. After subtle changes in infrastructure compliance increased to 100%, and time taken to note temperature was 2min. Average waiting time to casuality was decrease to 15min, and Normothermic cases coming through ambulance increased to 70%. Conclusion: This is live example which shows how a unit has built steps from basic change ideas of recording temperature to a comprehensive chain of ideas in maintaining thermal chain from the point a baby is received.

Present paper deals with the review analysis of various physico chemical parameters like temperature, pH, turbidity, TDS, DO, total hardness, chlorides, alkalinity, phosphates, sulphates, BOD,COD, heavy metals etc. in the effluents of pharmaceutical industries in India. During the review analysis of various pharmaceutical effluents, it has been studied that the values of DS and SS were higher than permissible limits in the pharmaceutical effluents of various industries. Different metals were found within the permissible limit in ground water sample except for the heavy metals like Cr, Pb, Cd and Ni which were found to be above the permissible limit recommended by WHO standards. The value of BOD and COD was many fold higher as compared to the permissible limits. Increased level of water pollution due to discharge of pharmaceutical effluents highlights the need for continuous assessment/characterization of pharmaceutical industrial wastewater. There is a great need that each industry should treat their effluents, in accordance with the legal requirements, before discharging these into the streams otherwise 'Polluter pays' principle should be implemented.

Background: Hypertensive disorders of pregnancy are one of the most common medical disorders in pregnancy with a 5-15% incidence rate in India. These are multisystem disorders and lead to a lot of cellular death. LDH is an intracellular enzyme and its level is increased in these women due to cellular death. Hyperuricemia is found to be one of the earliest laboratory manifestations of preeclampsia. It is likely to be resulted from reduced UA clearance from reduced glomerular filtration rate (GFR) and reduced tubular secretion. Its increased levels suggest serious impending damage to kidney functions. So, serum LDH levels and Uric acid can be used to assess the extent of cellular death and thereby the severity of disease. Objectives: This study was done to compare serum levels of lactate dehydrogenase (LDH) and uric acid (UA) among women with HDP and normal pregnant women and its significance as prognostic markers in Hypertensive disorders of pregnancy. Materials and methods: This study was a comparative observational study conducted among 140 Antenatal women in third trimester attending Antenatal OPD/Labour ward at SMS Medical College during January to December 2017. Serum levels of LDH and UA were measured using commercially available kits. Statistical analysis was done. Observation and results: In our study, Serum levels of LDH and UA were significantly increased in women with HDP compared with controls. LDH & UA were significantly high in preeclampsia & eclampsia group. Their levels significantly positively correlated with systolic and diastolic BP. Conclusion: Serum LDH and UA levels gradually increase as the disease severity increases. Regular monitoring of their serum levels in women with HDP may give a clue of disease severity and associated organ damage.

Background: Pregnancy-related acute kidney injury (PRAKI) contributes to 3–7% of overall acute kidney injury (AKI) cases in Indian subcontinent. It reflects the absence of prenatal care and early detection of high-risk pregnancies, the delay in transfer of patients and the paucity of relevant human and material resources. It is certainly a treatable and curable complication, but one that imposes a heavy burden of maternal morbidity and mortality if its diagnosis and treatment are delayed. The best treatment remains prevention, a goal very difficult to attain in the developing countries.Materials and methods: AKI was diagnosed when there was a history of sudden oliguria (urinary output < 400 ml over 24 hrs or less than 20ml/hour) or anuria with a sudden increase in serum creatinine to more than 1.5mg/dl or an increase in serum creatinine of > 0.5mg/dl/day from baseline. All patients with obstetrical AKI, antepartum as well as postpartum, were included in this study. Results: Out of 40 patients detected, the mean gestational age of the patients at the time of admission was 32 + 1.2. 62.5% of the subjects were detected in the third trimester.75% of the subjects were Multigravida and 25% were primigravida. Around 80% of the study subjects developed ARF in the antenatal period and 20% in the postpartum period.57.5% of the AKI patients had hypertensive disorder of pregnancy, followed by APH (20%),PPH (17.5%),Septic abortion (5%).Maternal outcome is graded was as per KDIGO grading, maximum no. of patients (75%) fall in grade 1, followed by grade 2 (20%), grade 3 (5%).There was complete recovery in 23 patients , and death was 1 in our study. There were 21 preterm births, Live births > 2.5 kg were 14, there were 3 IUFD. Total NICU admissions were 24.In most of the cases, termination of pregnancy was done after stabilizing the patient owing to obstetric emergency Conclusions: Multidisciplinary services at tertiary level may reduce mortality due to Pregnancy related Acute Renal Failure. Most common etiological factor was pre eclampsia and eclampsia. Disappearance of illegal abortion, improvement in ANC with effective management of complicated pregnancy, the facility for safe early elective delivery whenever indicated, the improvement in resuscitation of obstetric hemorrhage and increased preparation of hospital birth had all contributed to the prevention of this devastating complication of pregnancy.

Dentistry has undergone significant advancement and has seen several changing concepts over a decade. One such novel innovation is piezosurgery. Piezoelectric bone surgery or otherwise known as piezosurgery is a novel technique invented by Vercellotti in 1988 to overcome the limitations of traditional instrumentation in oral bone surgery by modifying and improving conventional ultrasound technology. Piezosurgery’s patented, controlled three dimensional ultrasound vibrations open up a new age for Periodontology, Implantology, Endodontics and Surgical orthodontics. The absence of macrovibration makes the instrument more manageable and allows greater intraoperative control with a significant increase in cutting safety in the more difficult anatomical cutting zone. Therefore the aim of this review is to describe peiezosurgical devise and its use in the field of periodontology and implantology in detail.

Purpose: To compare the outcome of sublingual misoprostol versus intramuscular oxytocin in the active management of third stage of labour.

Methods: This randomized control study included 332 cases who fulfilling selection criteria, the study cases comprised of those women in the third stage of labour after vaginal delivery. Patients were randomly allocated into two groups, group A (166 cases) receive 400μg sublingual Misoprostol tablet and group B (166 cases) receive 10 IU intramuscular oxytocin after delivery of baby, before cord clamping. The main outcome measures estimation of amount of blood loss in 1st one hour of labour, next 23 hours and total blood loss upto 24 hours.

Results: There Mean blood loss during third stage of labour.was not statistically significant in groupA, recieve 400 μg sublingual Misoprostol tablet and groupB, receive 10 IU intramuscular oxytocin after delivery (p>.05).

Conclusion: The sublingual misoprostol 400 mcg appers to be as effective as intramuscular oxytocin 10 IU in the active management of third stage of labour.

The transgender community in Pakistan is prevalently treated with prejudice in most walks of life. Transgender (called Khwajasira in Pakistan) reflects a group of people who enjoys the least amount of respect or rights in Pakistan. Due to the controversial nature and typical mindset of people, the subject of Transgender rights in Pakistan is not even discussed in sophisticated circles. Most people do not even consider them as a part of their community; massive rejections are often faced by transgenders in almost all the parts of Pakistan. This is a study of the socio-economic conditions and the problems faced by members of the transgender community in the Rawalpindi region of Pakistan. The main objectives of this study include, identification of the problems faced by the transgender community living in Rawalpindi. An analysis of the on ground socio-economic conditions of this community and highlight various aspects of issues faced by the transgender community in district Rawalpindi. Members of the community selected by using simple random sampling for the purpose of interviews. The data thus, collected and analyzed through SPSS, frequency distribution and percentage tabulation.