Impact of weather and climate advisories on agricultural outcomes in Pakistan.

The earth is warming, and the frequency of extreme weather events have been rapidly growing globally with unprecedented consequences to farming communities. In principle, weather and climate information services (WCIS) can help farmers better manage their activities and farm level outcomes by supporting their decision-making with relevant and usable information to address the potential impacts of expected changing climate conditions. But, in practice, can the availability and use of WCIS help improve agricultural outcomes given the weather and climate related uncertainties? To understand the use and impact of WCIS in the cotton-wheat cropping areas of Pakistan, we conducted a multistage stratified clustered random sample of 612 farm households in the provinces of Punjab and Sindh. Over 55% of the farm households in the sample indicated that they used WCIS provided by the Pakistan Meteorological Department and other sources for making their agricultural decisions. Our analysis, however, suggests that the impact of using WCIS on major farm outcomes (i.e. farm revenue, costs, profits, and input usage) is not statistically significant when compared with those farm households not using WCIS (null result). This result is robust to different estimation techniques (i.e. ordinary least squares, instrumental variable approach, and propensity score matching method). From the focus group discussions, we gathered that farmers perceived WCIS as less reliable, often unclear, and difficult to understand as this information is not translated and transmitted in local languages. Addressing these issues can help reduce the impact of climate and weather variability on farm outcomes in those provinces as well as in Pakistan more generally. Our study suggests that, under uncertainty, emphasis should be on WCIS that farmers can rely on for making farming related decisions.

Hemolytic Uremic Syndrome: A Case Report.

Thrombotic microangiopathy is a pathological condition comprised of microvascular thrombosis involving any body organ leading to thrombocytopenia, coombs-negative hemolytic anemia, and end-organ damage. The clinical presentation of the case shows typical hemolytic uremic syndrome, however, lab reports show atypical hemolytic uremic syndrome (low C3). Pain abdomen and loose stool with some signs of dehydration were initial presentations. Early initiation of renal replacement therapy and management of dehydration was done. Simple diarrhea can also manifest as acute kidney injury with the hemolytic uremic syndrome. Hence we should keep hemolytic uremic syndrome as the differential diagnosis of diarrhea. Irrespective of lab parameters, early management in line with the typical hemolytic uremic syndrome should be done for better outcomes. Keywords: anemia; case reports; dehydration; renal replacement therapy.

Scenario of Neonatal Respiratory Distress in Tertiary Hospital.

BACKGROUND: Respiratory distress is one of the most common reasons for admission in Neonatal Intensive Care Unit. However, studies of newborn admitted with respiratory distress in our setup are limited. This study aims to look for incidence of neonatal respiratory distress in our setup, to analyze the common causes of respiratory distress and to determine possible strategic plan needed for better clinical outcome. METHODS: A cross sectional study was conducted from March 2013 to December 2014 in Nepal Medical College and Teaching Hospital. Data of all the neonates with respiratory distress admitted during this period were analyzed. RESULTS: Total 317 (13.4%) neonates were admitted to Neonatal Intensive Care Unit during the study period.109 neonates developed respiratory distress comprising 34.3% of all Neonatal Intensive Care Unit admissions. Incidence of neonatal respiratory distress was 4.6%. The common causes of respiratory distress in our study were meconium aspiration syndrome in 21.1%, septicemia in 16.5%, transient tachypnea of newborn in 15.5%, pneumonia in 14.6%, birth asphyxia and hyaline membrane disease were in each 11.9% of the neonates. Caesarean section was the most common predisposing factor associated with the development of transient tachypnea of newborn in 82.3% newborns (p=.001). The overall mortality rate due to respiratory distress was 12.8%. CONCLUSIONS: Meconium aspiration syndrome, septicemia and hyaline membrane disease are the most important causes of respiratory distress in our setup. Good obstetric care, proper training of health care personnel in neonatal resuscitation and early recognition of potential risk factors of respiratory distress will be helpful.