Interventions for trichomoniasis in pregnancy

Background: Vaginitis due to Trichomonas vaginalis is one of the most common of sexually transmitted diseases. Trichomoniasis affects women during pregnancy as well but it is not clearly established whether it causes preterm birth and other pregnancy complications.Objectives: The objective of this review was to assess the effects of various treatments for trichomoniasis during pregnancy.Search strategy: We searched the Cochrane Pregnancy and Childbirth Group\u27s Trials Register ( 14 January 2011).Selection criteria: Randomized trials comparing anti-trichomonas agents during pregnancy. Trials including symptomatic or asymptomatic women with trichomoniasis were eligible.Data collection and analysis: Two review authors assessed eligibility and trial quality.Main results: We included two trials with 842 pregnant women. In both trials around 90% of women were cleared of trichomonas in the vagina after treatment. In the US trial, women with asymptomatic trichomoniasis between 16 and 23 weeks were treated with metronidazole on two occasions at least two weeks apart. The trial was stopped before reaching its target recruitment because metronidazole was not effective in reducing preterm birth and there was a likelihood of harm (risk ratio 1.78, 95% confidence interval 1.19 to 2.66). The South African trial recruited women later in pregnancy and did not have the design and power to address adverse clinical outcomes. We excluded two recent studies, identified for the current update, because they did not address the primary question.Authors\u27 Conclusion: Metronidazole, given as a single dose, is likely to provide parasitological cure for trichomoniasis, but it is not known whether this treatment will have any effect on pregnancy outcomes. The cure rate could probably be higher if more partners used the treatment

Medicolegal issues in neurology Practice in Pakistan

Neurology despite its challenges have made tremendous improvement in past few decades. At the same time, the rapid advancement of media and internet has changed the traditional doctor-patient relationship into one of a service provider-consumer relationship1. The health service is now considered a commodity, and has become prone to lack of trust and litigation. Medical professionalism is challenged by increasing commercialism and influence of legal syste

The study of fetomaternal outcome in second stage caesarean section

Background: Caesarean section is commonly perceived as a simple alternative to difficult vaginal birth and in the recent years its prevalence during the second stage is increasing. Caesarean section in second stage of labor has additional associated risks for the mother such as obstetric hemorrhage, extended uterine tear, bladder injury and longer hospital stay. It is also associated with increased neonatal morbidity in terms of NICU admissions, fetal acidemia, hypoxemia and prolonged NICU stay. This study was conducted to know the indications of second stage caesarean section and to assess maternal and neonatal outcomes in second stage caesarean section. Methods: We conducted a prospective observational study conducted at a tertiary perinatal care center from August 2021 to August 2022. All second stage caesarean sections performed during this period were analyzed in terms of indication for caesarean section, intraoperative, postoperative complications and fetal outcomes. Results: During the study period there were a total of 10433 deliveries. Out of this, 5392 deliveries done by caesarean section, in which 67 were second stage caesarean section. Deep transverse arrest was the most common indication for caesarean section in second stage of labor. Most common intra operative complication was uterine atony, seen in 32.5% cases. 16 (24%) NICU admission were noted with respiratory distress being the most common indication. 15 (23%) had post operative complications like febrile illness. Conclusions: Second stage caesarean section is associated with significant maternal and neonatal morbidity. A skilled obstetrician and proper training are required to take appropriate decisions for caesarean section at full dilatation of cervix

Effectiveness of Nasheed-based Teaching of Islamic Education Subject to Fifth-Grade Female Students and Its Impact on their Achievement and Retention of Learning

هدفت الدراسة إلى الكشف عن فاعلية التدريس بالأناشيد في مادة التربية الإسلامية على التحصيل الدراسي، لطالبات الصف الخامس الأساسي، وبقاء أثر التعلم لديهن. ولتحقيق أهداف الدراسة استخدم المنهج شبه التجريبي، حيث أُعدت المادة العلمية باستخدام الأناشيد التعليمية واختباراً تحصيليا مكونا من 21 سؤالا من نوع الاختيار من متعدد، وبعد التأكد من صدق الأداة وثباتها، طبقت على عينة مكونة من 65 طالبة، من مدرسة أم ورقة الأنصارية للتعليم الأساسي 5-7 بمحافظة مسقط، تم تقسيمهن إلى مجموعتين: تجريبية، وعدد طالبتها 33 طالبة، درست باستخدام الأناشيد، وضابطة وعدد طالبتها 32 طالبة، درست بالطريقة الاعتيادية. أظهرت نتائج الدراسة بعد تطبيق الاختبار البعدي الفوري، وجود فروق دالة إحصائيا عند مستوى 0.05 بين متوسطات درجات المجموعة التجريبية والضابطة، لصالح المجموعة التجريبية. ولقياس بقاء أثر التعلم لدى عينة الدراسة، طبق الاختبار البعدي المؤجل؛ بعد مرور أربعة أسابيع من تطبيق الاختبار البعدي الفوري، فأظهرت النتائج أيضا، وجود فروق دالة إحصائيا بين متوسطات درجات المجموعتين؛ التجريبية والضابطة في الاختبار التحصيلي البعدي المؤجل، لصالح المجموعة التجريبية التي درست بالأناشيد. وفي ضوء النتائج التي خلصت إليها الدراسة، أوصت بعدد من التوصيات أهمها: تطبيق التجربة على شريحة واسعة من طلبة الصف الخامس الأساسي ونظرائهم.The study aimed to reveal the effectiveness of the Nasheed-based teaching of Islamic Education subject to fifth-grade female students and its impact on their achievement and the retention of learning effect among them. The sample of the study consisted of 65 fifth-grade students who were selected from a 5-7 grade school at one of the primary schools in Muscat Governorate. The sample was divided into two groups: an experimental group consisting of 33 female students who were taught using nasheeds (Islamic songs) and a control group of 32 female students who were taught using the traditional teaching method. To measure the differences between the two groups, the researchers created an achievement test that consisted of 21 multi-choice questions. The findings of the study showed statistically significant differences between the mean scores of the two groups (the experimental and control groups) in the immediate achievement post-test and the postponed post-test in favor of the experimental group that was taught using nasheeds. The study offers a number of recommendations that include the application of the experiment to a wider category of fifth-grade students in the area of education

Development of processes allowing near real-time refinement and validation of triage tools during the early stage of an outbreak in readiness for surge: the FLU-CATs Study

BACKGROUND: During pandemics of novel influenza and outbreaks of emerging infections, surge in health-care demand can exceed capacity to provide normal standards of care. In such exceptional circumstances, triage tools may aid decisions in identifying people who are most likely to benefit from higher levels of care. Rapid research during the early phase of an outbreak should allow refinement and validation of triage tools so that in the event of surge a valid tool is available. The overarching study aim is to conduct a prospective near real-time analysis of structured clinical assessments of influenza-like illness (ILI) using primary care electronic health records (EHRs) during a pandemic. This abstract summarises the preparatory work, infrastructure development, user testing and proof-of-concept study. OBJECTIVES: (1) In preparation for conducting rapid research in the early phase of a future outbreak, to develop processes that allow near real-time analysis of general practitioner (GP) assessments of people presenting with ILI, management decisions and patient outcomes. (2) As proof of concept: conduct a pilot study evaluating the performance of the triage tools 'Community Assessment Tools' and 'Pandemic Medical Early Warning Score' to predict hospital admission and death in patients presenting with ILI to GPs during inter-pandemic winter seasons. DESIGN: Prospective near real-time analysis of structured clinical assessments and anonymised linkage to data from EHRs. User experience was evaluated by semistructured interviews with participating GPs. SETTING: Thirty GPs in England, Wales and Scotland, participating in the Clinical Practice Research Datalink. PARTICIPANTS: All people presenting with ILI. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Study outcome is proof of concept through demonstration of data capture and near real-time analysis. Primary patient outcomes were hospital admission within 24 hours and death (all causes) within 30 days of GP assessment. Secondary patient outcomes included GP decision to prescribe antibiotics and/or influenza-specific antiviral drugs and/or refer to hospital - if admitted, the need for higher levels of care and length of hospital stay. DATA SOURCES: Linked anonymised data from a web-based structured clinical assessment and primary care EHRs. RESULTS: In the 24 months to April 2015, data from 704 adult and 159 child consultations by 30 GPs were captured. GPs referred 11 (1.6%) adults and six (3.8%) children to hospital. There were 13 (1.8%) deaths of adults and two (1.3%) of children. There were too few outcome events to draw any conclusions regarding the performance of the triage tools. GP interviews showed that although there were some difficulties with installation, the web-based data collection tool was quick and easy to use. Some GPs felt that a minimal monetary incentive would promote participation. CONCLUSIONS: We have developed processes that allow capture and near real-time automated analysis of GP's clinical assessments and management decisions of people presenting with ILI. FUTURE WORK: We will develop processes to include other EHR systems, attempt linkage to data on influenza surveillance and maintain processes in readiness for a future outbreak. STUDY REGISTRATION: This study is registered as ISRCTN87130712 and UK Clinical Research Network 12827. FUNDING: The National Institute for Health Research Health Technology Assessment programme. MGS is supported by the UK NIHR Health Protection Research Unit in Emerging and Zoonotic Infections