Implementation of a Bachelor’s in midwifery programme in Pakistan: Reflections of Midwifery Faculty

Introduction/Objective: There is an international consensus on the significant role of competent midwives in improving maternal and newborn health indicators. Midwives and midwifery education in the developing world including Pakistan have lagged behind in being part of higher education. To enhance the quality of maternal and newborn services through competency based higher education in midwifery, the first Bachelors of Science in Midwifery (BScM) programme was introduced in Pakistan. As part of a larger study about establishing this programme, this paper focuses on the reflective logs of midwifery faculty members who initiated this new programme in Pakistan. Method: The team of faculty members involved in the planning and execution of the programme were asked to record their reflections throughout the process of planning the programme to facilitating students in the first cohort. These reflections were collected at the time of the graduation of first cohort in 2014 and content analysis was applied to identify major themes emerging from the reflections. Findings: Major themes which emerged were: a) Scaling up of faculty competence, b) Utilizing student diversity as strength, c) Supporting students’ transition and adjustments in the programme d) Scaffolding students’ learning e) Helping students acquire clinical competencies. Overall, the team regarded the experience as unique and enriching for both students and faculty. The first Bachelors in Midwifery demanded a great deal of theoretical and clinical proficiency from faculty. Rigorous planning, networking with international midwifery experts, continuous faculty development, facilitating student learning through scaffolding, and incorporating periodic feedback from students were found to be the major strengths of the programme. Conclusion: The Bachelor of Midwifery programme in Pakistan has given new hope to the profession. The lessons learned and some of the practical recommendations may prove useful to other institutions and South Asian countries intending to initiate similar programmes

Knowledge, Attitude, and Practices of Mid-Level Providers regarding Post Abortion Care in Sindh, Pakistan

Background: In Pakistan, half of all pregnancies are unintended (4.2 million per year); out of which 2.2 million end in induced abortions. Almost 700,000 women seek medical treatment for post abortion complications every year. This necessitates access to quality Post-Abortion Care (PAC) services from skilled providers in Pakistan. Purpose: This study aimed to assess the knowledge, attitude and practices of Mid-Level Providers (MLPs) regarding PAC services in Sindh, Pakistan. Method: The study utilized a cross-sectional design. Convenience sampling was used to recruit 116 MLPs, including Nurse Midwives (NM), Lady Health Visitors (LHVs), and Community Midwives (CMWs) from different parts of Sindh. Data were collected using a self-administered questionnaire. Data were analyzed using SPSS version 19.Key Findings: The participants comprised 47% NMs, 35% LHVs, and 18% CMWs. The median age of the participants was 30 years. Nearly half of the participants (45%) worked in their own private practices. The remainder were almost evenly divided into those working in primary health care centres and those in secondary care hospitals. The mean score on the knowledge component was 8.9±2.2, from a maximum total of 16. Almost all (98%) the participants had heard about PAC. However, only 29% were aware of the need for a community and service provider partnership as a key element of PAC. Most (81%) of the participants knew about counseling compared with 54% who knew about Manual Vacuum Aspiration (MVA) and 46% about misoprostol. The mean score on the attitude component was 14.9±2.0, from a maximum total of 21. Various gaps were identified in the practices of MLPs regarding PAC counseling, referral linkages, and in addressing reproductive and health issues.Conclusion: The findings highlighted the need for providing comprehensive training and mentorship to the groups of midwives about PAC and building strong networks to enable improved referral processes. Moreover, it is crucial to expand this study at a national level to identify the gaps and to plan strategies to promote safe PAC services

Practice of Medical Ethics among House Officers at Tertiary Care Hospital in Karachi

Medical malpractice is commonly seen in public as well as private hospitals of Pakistan. Most institutions in Pakistan do not emphasize the practice of medical ethics. To determine the awareness of medical ethics among house officers A cross sectional study was conducted on house officers posted at Medicine, Surgery, and Gynecology and Obstetrics Ward of Jinnah Postgraduate Medical Centre, Karachi from December 2020 till June 2021. All recent graduates between the ages of 18 and 30, who worked as a full-time house-officer were eligible to partake in the study. All doctors who were not designated as house officers and other healthcare professionals including nurses were excluded from the study. A structured questionnaire was used to examine the participants\u27 knowledge, attitude, and practice of medical ethics. A total of 227 house officers participated in this study. Out of these, majority considered the knowledge of medical ethics very important during their work however, most participants (59%) had not read the PMDC code of medical ethics. Surprisingly three house officers assumed it was not important at all. Upon further interrogation 16 percent said that they find the task of obtaining informed consent to be very challenging. Conclusion: A lack of knowledge of medical ethics amongst house officers was seen. This is due to the lack of emphasis on teaching medical ethics in the medical curriculum. To ensure quality health care to patients, medical ethics teachings should be made mandatory in the medical curriculum

The Role of Radiology (X-Ray versus Computed Tomography) in Medicolegal Cases Presented at a Tertiary Care Hospital in Pakistan

Objectives:  A prospective observational study was aimed to assess the role of plain radiographs and computed tomography in detecting head injuries presented at the medicolegal office at the Forensics and Radiology Departments, Gambat Medical Hospital, Sindh. Material and Methods:  All cases referred from the Medicolegal Office (MLO) with head injury were included. All victims underwent X-ray head and computed tomography skull was done with 1 or 1.5 cm thick axial sections without administration of intravenous contrast. The radiological reports of X-ray head and CT scans were documented and comparatively evaluated. Results:  Mean age was 38.63 ± 3.91 years. In 51 (45.13%) cases, X-ray was able to detect skull fracture, while CT scan detected 64(56.64%) skull fractures. There were 54 (84.3%) true positives, 3 (2.6%) false positives, 10(8.8%) false negatives, and 40 (40.7%) true negatives. The accuracy of X-ray to detect skull fracture was 88.50%. Conclusion:  X-ray had a sensitivity and specificity of 84.38% and 93.88%, respectively. It is a reliable tool to detect skull fractures in victims of assault in comparison with CT scans. X-ray is also associated with low dose radiation exposure as compared with CT scan which delivers 70 times more exposure than the former

Involvement of hedgehog pathway in early onset, aggressive molecular subtypes and metastatic potential of breast cancer

Background Dysregulation of hedgehog pathway is observed in numerous cancers. Relevance of hedgehog pathway genes in cancer cohort and inhibition of its downstream effector (GLI1) towards metastasis in cell lines are explored in the study. Method One hundred fifty fresh tumours of breast cancer patients were collected for the study. Based on differential expression, panel of 6 key regulators of the pathway (SHH, DHH, IHH, PTCH1, SMO and GLI1) in microarray datasets were identified. Expressional profiles of aforementioned genes were later correlated with clinico-pathological parameters in Pakistani breast cancer cohort at transcript and protein levels. In addition, GLI1 over expressing breast cancer cell lines (MDA-MB-231 and MCF-7) were treated with GANT61 to explore its probable effects on metastasis. Result SHH, DHH, PTCH1 and GLI1 were significantly over-expressed in tumours as compared with respective normal mammary tissues. A significant correlation of SHH, DHH and GLI1 expression with advanced tumour size, stages, grades, nodal involvement and distant metastasis was observed (p < 0.05). Over-expression of SHH, DHH and GLI1 was significantly related with patients having early onset and pre-menopausal status. Of note, hedgehog pathway was frequently up regulated in luminal B and triple negative breast cancer affected women. In addition, positive correlations were observed among aforementioned members of pathway and Ki67 (r-value: 0.63–0.78) emphasizing their role towards disease progression. Exposure of GANT61 (inhibitor for GLI1) significantly restricted cell proliferation, reduced cell motility and invasion. Conclusion Role of activated hedgehog pathway in breast cancer metastasis provides a novel target for cancer therapy against aggressive cancer subtypes

Simple ammonium salts acting on sigma-1 receptors yield potential treatments for cancer and depression

Sigma-1 and sigma-2 receptors are emerging therapeutic targets. We have identified that simple ammonium salts bind to these receptors and are effective in vivo. Radioligand binding assays were used to obtain structure-activity relationships of these salts. MTS assays were performed to determine their effect on growth in MCF7 and MDA-MB-486 cells. Anticancer properties were tested in NMRI mice transplanted with a fragment of mouse adenocarcinoma (MAC13). Antidepressant activity was tested using the forced-swim test and tailsuspension tests. Dipentylammonium (Ki 43 nM),tripentylammonium (Ki 15 nM) and trihexylammonium (Ki 9 nM) showed high affinity for the sigma-1receptor. Dioctanoylammonium had the highest affinity (K50 0.05 nM); this also showed the highest affinity for sigma-2 receptors (Ki 13 nM). Dipentylammonium was found to have antidepressant activity in vivo. Branched-chain ammonium salts showed lower affinity. Bis(2-ethylhexyl)ammonium (K50 29 μM), triisopentylammonium (K50 196 μM) and dioctanoylammonium showed a low Hill slope,and fitted a 2-site binding model for the sigma-1 receptor. We propose this two-site binding can be used to biochemically define a sigma-1 receptor antagonist. Bis(2-ethylhexyl)ammonium and triisopentylammonium were able to inhibit the growth of tumours in vivo. Cheap, simple ammonium salts act as sigma-1 receptor agonists and antagonists in vivo and require further investigation

Knowledge & Awareness about COVID-19 and the Practice of Respiratory Hygiene and Other Preventive Measures among Patients with Diabetes Mellitus in Pakistan

COVID-19 is a global pandemic that has emerged and it is rapidly spreading throughout the world and subsequently causing great damage to the global economy and health-care. Patients with diabetes or other comorbidities are at a greater risk of developing severe illness. Knowledge and awareness are key elements to stimulate practice of preventive measures. The present study evaluated the level of knowledge and awareness about COVID-19 among individuals with diabetes and their compliance with the preventive measures against it. A total of 242 individuals who were diagnosed with diabetes mellitus and were 18 years or older participated in the study. The data was collected using an interview based questionnaire. Data was analyzed using Statistical Package for Social Sciences(SPSS) version 24. The mean age ± SD of the study population was 50.78 ± 11.24 years. In this study, 215 (88.8%) participants were aware that COVID-19 is caused by a virus and the disease is spread through droplets after sneezing or touching and shaking hands with an infected person (78.5%). However, only half the study populace regularly monitored their glucose level and complied with the “sick day rules” that is applicable during this pandemic. The present study indicates that despite the adequate knowledge and awareness about the coronavirus disease, the study participants were non-compliant with the practice of preventive and precautionary measures against the pandemic