Efficacy of Uterovaginal Packing Versus Uterine Balloon Tamponade to Control Postpartum Hemorrhage Due to Uterine Atony

OBJECTIVES To determine and compare the efficacy of Uterovaginal packing versus uterine balloon tamponade to control postpartum haemorrhage due to uterine atony unresponsive to medical treatment. METHODOLOGY This comparative prospective cross-sectional study was conducted in Hayatabad Medical Complex, OBG department. A total of 140 patients were categorised into two groups, group A underwent Uterovaginal packing and group B underwent uterine balloon tamponade. All women of 18 to 40 years with a history of delivery after 28 weeks of gestation, who developed primary postpartum haemorrhage due to uterine atony, unresponsive to medical treatment were included in the study. Women with a history of delivery before 28 weeks of gestation, secondary postpartum haemorrhage, genital tract trauma, retained placental tissue and membranes, placenta previa, morbidly adherent placenta, febrile illness and uterine structural lesion were excluded from the study. Efficacy was labelled if there was no ongoing blood loss after the procedure with concomitant hemodynamic stability. All information was recorded in a predesigned proforma, and data were analysed using SPSS version 22.RESULTS Our study included 140 women; 113 had a normal vaginal delivery, and 27 underwent cesarean section. Among cases with normal vaginal delivery, 45 women had Uterovaginal packing, and 68 had uterine balloon tamponade, while among cases of cesarean sections, 25 women had uterovaginal packing and 2 had uterine balloon tamponade. The efficacy of Uterovaginal packing was 90%, and that of uterine balloon tamponade was 87.1%, with no significant difference statistically (p- 0.51). Overall efficacy of both procedures was 88.6%.CONCLUSION All orthodontic and non-orthodontic treatment group participants required oral hygiene instructions and had periodontal treatment needs (TN1). The patients requiring scaling and prophylaxis and Oral hygiene instructions (TN 2) were more in the orthodontic treatment group than the non-orthodontic treatment group. A higher percentage of patients requiring complex treatment (deep scaling, root planning and complex surgical procedures), scaling and prophylaxis and Oral hygiene instructions (TN3) belonged to the non-orthodontic treatment group

Effect of diabetic counseling based on conversation map as compared to routine counseling on diabetes management self-efficacy and diabetic distress among patients with diabetes in Pakistan: a randomized controlled trial (study protocol)

Background: Novel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM). Methods: This will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30–60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders. Discussion: In a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials. Trial registration: ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018

University Students’ and Teachers’ Wellbeing During COVID-19 in Bangladesh: A Qualitative Enquiry

The wellbeing of teachers and students has emerged as a common concern in research studies in recent times, specifically during the critical period of COVID-19. Based on the findings drawn from the qualitative data through focus group discussions of five groups of teachers (16 females and 8 males) and students (10 males and nine females) at the tertiary level of education in Bangladesh, this paper shows that online teaching during COVID-19 is affected by personal and social challenges, and consequently, both teachers and students experience anxieties and stresses. Teachers are anxious because of the university authorities\u27 surveillance, frequent pay cuts, and fear of losing jobs due to students\u27 low enrollment in universities. They also suffer from physical discomforts, such as back pain, blur vision, and headache because of the prolonged engagement with online activities. Students, especially those from a non-privileged background located in peripheral rural contexts, seem to suffer more from contextual realities that are non-conducive for technology-based learning. Increased numbers and various forms of online assessments also seem to become a burden for them. In general, educational experiences of online teaching seemed to have a peripheral role in their conceptualization of wellbeing. The paper concludes that the insurmountable attention given to online pedagogic practices across the world needs to be balanced out by an equal effort in improving the wellbeing of both teachers and students

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Frequency of Missing Dose of Anti-Diabetic Medications and its Impact on Blood Glucose Levels Among Patients of Diabetes Mellitus

Objective: To determine the frequency of missed medications and its association with glycemic control among patients of diabetes mellitus. Methodology: This cross-sectional study was conducted at the Outpatient Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from January 2022 to June 2022. Patients with type-1 or type-2 diabetes mellitus who visited the outpatient department and had a disease duration of at least six months were included in the study. Participants might be either gender and ranged in age from 18 to 70. Along with sociodemographic information, characteristics of diabetes mellitus were recorded including fasting and postprandial blood glucose levels, kinds of DM, drugs used, and family history of DM. All patients' frequency of missing diabetic mellitus prescription doses was also assessed. Results: In a total of 230 patients of DM, 148 (64.3%) were male. The mean age was a 45.00±12.48 year. Family history of diabetes was present in 113 (49.1%) patients. There were 215 (93.5%) patients who had type 2 DM while remaining 15 (6.5%) were type-1 DM. Mean duration of DM was 7.63±7.6 years. It was found that 105 (45.7%) patients were using both oral and insulin. It was noted that 30 (13.0%) patients were missing their DM medications daily, 43 (18.7%) most frequently, 21 (9.1%) frequently and 54 (23.5%) missed their DM medications/dosages occasionally. It was observed that statistically significant differences existed for blood glucose parameters and frequency of missed medications (p<0.0001). Conclusion: Vast majority of diabetes mellitus patients were found to miss their anti-diabetic medications. Missed medication frequency was significantly linked with higher blood glucose levels

Discovery of ABT-267, a Pan-Genotypic Inhibitor of HCV NS5A

We describe here <i>N</i>-phenylpyrrolidine-based inhibitors of HCV NS5A with excellent potency, metabolic stability, and pharmacokinetics. Compounds with 2<i>S</i>,5<i>S</i> stereochemistry at the pyrrolidine ring provided improved genotype 1 (GT1) potency compared to the 2<i>R</i>,5<i>R</i> analogues. Furthermore, the attachment of substituents at the 4-position of the central <i>N</i>-phenyl group resulted in compounds with improved potency. Substitution with <i>tert</i>-butyl, as in compound <b>38</b> (ABT-267), provided compounds with low-picomolar EC₅₀ values and superior pharmacokinetics. It was discovered that compound <b>38</b> was a pan-genotypic HCV inhibitor, with an EC₅₀ range of 1.7–19.3 pM against GT1a, -1b, -2a, -2b, -3a, -4a, and -5a and 366 pM against GT6a. Compound <b>38</b> decreased HCV RNA up to 3.10 log₁₀ IU/mL during 3-day monotherapy in treatment-naive HCV GT1-infected subjects and is currently in phase 3 clinical trials in combination with an NS3 protease inhibitor with ritonavir (r) (ABT-450/r) and an NS5B non-nucleoside polymerase inhibitor (ABT-333), with and without ribavirin