The study was carried out in ENT Department ofKEMU, Lahore from December 2012 to November 2015 to assess theoutcome of early tracheostomy in grade II (moderate) tetanus patients.A total of fifty-six adults of both genders, diagnosed as grade II tetanus patients, were included. Clinical characteristics,mode of trauma, incubation period, vaccination status and investigations were recorded. All patients were managed in ICU and early tracheostomy was performed in addition to standardized medical treatment. A total of 86% males with age 32±8.3 years presented the study participants. Results demonstrated thatmost common mode of trauma was road traffic accident, and majority (54%) of patients were never vaccinated. Incubation period noted was 7±1 days. Tracheostomy was performed in 16±3 hours of admission and tracheostomy decannulation was performed in 23±3 days. Patients were discharged in 27±3 days.Weconcludethat early control of airway with tracheostomy in grade II tetanus patients helped in better patient management with early recovery and decreased hospital stay with minimal morbidity.

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There is a growing recognition in developing countries of community-based infrastructure procurement and its potential to achieve sustainable development. The advantages of such an approach are that it encourages participative negotiation of activities and speedier implementation, the use of local resources, skills and appropriate technology, and entrepreneurship within communities. These wider socio-economic impacts arising from community-partnered micro-projects can lead to more sustainable infrastructure through meeting local stakeholders' needs, community empowerment and capacity building. This paper describes the development and use of performance indicators for community-contracted urban infrastructure provision in low-income communities in India, Pakistan and Sri Lanka. In particular, these indicators refer to the dimensions of time and cost; some key performance yardsticks are also proposed. The urban infrastructure and services referred to in these cases are the facilities needed for water and sanitation provision, access roads, street lighting and solid waste management. In general, it was found that costs for community-contracted micro-projects were normally very close to being on target. The quality of infrastructure and service provision also tended to be superior to that envisioned by local government engineers. However, project duration generally exceeded the target but was still comparable to conventional contracts. The overall performance of the community-partnered micro-projects was found to be comparable or better than the conventional micro-contracts; in addition, the performance of these projects in terms of socio-economic elements was likely to far exceed that of the conventional micro-projects.