Maternal Care Disparities: Impact Of Pregnancy Profiles, Socioeconomic Factors, and Age on Maternal Outcomes

OBJECTIVES This study aimed to evaluate the impact of pregnancy profiles, socioeconomic factors, and age on maternal at teaching hospitals in Mardan, Khyber Pakhtunkhwa. METHODOLOGY This descriptive-exploratory/qualitative study was conducted at the genealogical outside-patient department of the Mardan Medical Complex, with the approval of the ethics committee. A total of 1187 patients attended the complex between January 2021 and January 2022. Informed consent was obtained, and a comprehensive history and physical examination were conducted using a pre-designed proforma. Patients meeting specific criteria, such as gestational age >36 weeks, singleton pregnancies, and absence of maternal co-morbidities, were included. Exclusion criteria encompassed conditions such as antepartum haemorrhage and fetal anomalies. Data analysis was performed using SPSS-24 version, ensuring the confidentiality and anonymity of participants. RESULTSOut % of 1187 patients, 48% had previous pregnancies (multiparous), while 52% were experiencing their first pregnancy (primiparous). Gestational age distribution showed that 45% of cases fell within the 36-38 week range, and 55% were between 39-40 weeks. Regarding booking status, 29% of patients were booked, while 71% were unbooked. Finally, the socioeconomic status analysis indicates that 61% of cases were above the poverty line, while 39% were below. These findings highlight important factors such as previous pregnancies, gestational age, booking status, and socioeconomic status that can influence maternal care and outcomes. Among the different age groups, the <20 age group had the highest percentage of spontaneous deliveries (31%), while the >30 age group had the highest percentage of cesarean sections (25%). Induced labour rates were relatively consistent across age groups. Not being in labour was more prevalent in the 25-30 and >30 age groups. CONCLUSION The findings highlight that important factors such as previous pregnancies, gestational age, booking status, and socioeconomic status can influence maternal care and outcomes

Potential of Indigenous Plants for Skin Healing and Care

The outer protective layer of body is skin which not only guards it from external fluctuations and effects but also performs its thermoregulation. Its functioning may get affected due to several factors like dermal wounds, injuries, aging and many other disorders. These dermal ailments can be cured with the help of indigenous flora to get economical pharamcognosal benefits with no side effects which is a serious concern of synthetic drugs now days. Furthermore, research efforts are necessary for their proper dose optimization and administration to achieve low cost and side effects free pharamcognosal skin cure and care gains

Estimation of Finite Population Mean by Utilizing the Auxiliary and Square of the Auxiliary Information

This article fundamentally aims at the proposition of new family of estimators using auxiliary information to assist the estimation of finite population mean of the study variable. The objectives are achieved by devising dual use of supplementary information through straightforward manner. The additional information is injected in mean estimating procedure by considering squared values of auxiliary variable. The utility of the proposed scheme is substantiated by providing rigorous comparative account of the newly materialized structure with the well celebrated existing family of Grover and Kaur (2014). The contemporary advents of the new family are documented throughout the article

Development of a highly sensitive electrochemical sensing platform for the trace level detection of lead ions.

Herein we report for the first time a highly sensitive electrochemical platform for the trace level detection of Pb (ӏӏ) using glassy carbon electrode modifiedwith 1-dodecanoyl-3-phenylthiourea (DPT). The performance of the designed sensor was tested by electrochemical impedance spectroscopy, chronocoulometry, cyclic voltammetry and Square Wave Anodic Stripping Voltammetry (SWASV). The DPT was found to play an efficient role in enhancing the sensing response of the electrode for the detection of lead ions in aqueous samples. A number of experimental conditions such as deposition potential, accumulation time, surfactant concentration, pH, number of scans and supporting electrolytes were examined to optimize conditions for getting intense signal of the target analyte. Linear calibration curve was obtained using SWAS voltammetric data obtained under optimized conditions. The limit of detection with a value of 0.695 μg/L suggests that the designed sensor can sense lead ions even below the permissible concentration level (10 μg/L) recommended by the World Health Organization and Environmental Protection Agency of USA. The designed sensor demonstrated sensitivity, selectivity and stability for the targeted analyte. Percentage recoveries from real water samples with standard deviations of less than 2% suggested precision of the proposed method. Moreover, computational findings supported the experimental outcomes

Availability of anticancer medicines in public and private sectors, and their affordability by low, middle and high-income class patients in Pakistan

Abstract Background Availability and affordability of anticancer medicines is a matter of great concern especially for low and middle income countries e.g., Pakistan. Prime focus of this study was to evaluate the availability of anticancer medicines in public and private sectors, and their affordability among patients with different income levels. Methods A descriptive, cross-sectional survey was conducted in 22 cancer care hospitals (18 public hospitals and 04 private hospitals) and 44 private pharmacies in Punjab, Pakistan. All (n = 4400) participants were ≥18 years of age. Data were collected at different intervals and analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) Results A total of 4913 patients were approached, and 4400 responded to the survey (response rate = 89.6%). Non-hodgkin lymphoma (12.3%), breast cancer (8.6%), and leukemia (7.6%) were the most prevailing cancers. Conventional medicines like cisplatin, cyclophosphamide, and etoposide were the most prescribed medicines. Oncologists were reluctant to prescribe newer anticancer medicines due to high prices. Originator brands (OBs) were more readily available (52.5%) but less affordable (53.4%); whereas, lowest price generics (LPGs) were less available (28.1%) but more affordable (67.9%). Anticancer medicines were more affordable by the high income class patients than the low income class patients. Conclusion The availability of both OBs and LPGs was greater at private hospitals and pharmacies as compared to public hospitals. The high income class had more affordability of both OBs and LPGs; however, LPGs were more affordable for all income classes

Antimicrobial use by WHO methodology at primary health care centers: a cross sectional study in Punjab, Pakistan

Abstract Background To investigate the antimicrobial (AM) use and prescribing patterns at primary health care centers (PHCCs) in Punjab, Pakistan. Methods A cross-sectional study was designed according to the World Health Organization (WHO) methodology for AM usage from January, 2017 to June, 2017. Standard data collection forms designed by the WHO were used to collect the data from 32 PHCCs (16 rural healthcare centers (RHCs) and 16 basic health units (BHUs)) in Punjab province of Pakistan. PHCCs were randomly selected from 8 main cities. The study sample consisted of prescription records of 6400 outpatients (200 prescriptions records from each PHCC) and 800 inpatients (25 inpatient records from each PHCC). Data of the year 2016 were collected retrospectively by using systematic random sampling technique and analyzed through SPSS. Results Among the hospital indicators, standard treatment guidelines (STGs) regarding the infectious diseases were not available in PHCCs. Number of days during which key AMs were out of stock was 12.1 days per month (range = 3.1–19.2). Out of total PHCC medicines costs, expenditures on AMs were 26.2% (range = 17.1–39.0). In case of prescribing indicators, the average number of AMs per prescription was 1.4 (range = 1.1–1.7), percentage of prescriptions prescribed with AMs was 81.5% (range = 68.9–89.1) and duration of AM treatment on average was 5.1 days per patient (range = 3.3–6.4). Average cost of prescribed AMs per patient was 1.3 USD (range = 0.6–4.3). The PHCCs prescribed a median of 5 (range = 3–9) types of AMs, including 10 (range = 5–15) individual agents. Out of 79.3% prescriptions of outpatients prescribed with AMs, only 16.4% were properly prescribed. Out of 100% prescriptions of inpatients prescribed with AMs, 12.1% were properly prescribed. Out of all the AM prescriptions 23.6% contained penicillins, 20.1% contained cephalosporins and 19.4% contained fluoroquinolones Metronidazole (18.0%), ciprofloxacin (16.5%) and co-amoxiclav (14.3%) were most commonly prescribed AMs. Conclusions In PHCCs, AMs were prescribed more frequently. However large proportions of these prescriptions were inappropriate. Continuous education and training of medical staff and cost effective policies could play an important role in promotion of rational use of AMs

Causality and preventability assessment of adverse drug events of antibiotics among inpatients having different lengths of hospital stay: a multicenter, cross-sectional study in Lahore, Pakistan

Abstract Background A large number of hospital admissions are attributed to adverse drug reactions (ADRs) and they are the fifth leading cause of death worldwide. The present study aimed to assess the causality and preventability of adverse drug events (ADEs) of antibiotics among inpatients having different lengths of hospital stay. Methods A prospective, observational study was conducted in four tertiary-care public sector hospitals of Lahore, Pakistan. Study population consisted of hospitalized patients who were prescribed one or more antibiotics. Data were collected between 1st January, 2017 and 30th June, 2017 from 1249 patients. Naranjo score, modified Schumock and Thornton scale were used for causality and preventability assessments, respectively. Medication errors (MEs) were assessed by MEs tracking form. SPSS and Microsoft Excel were used for data analysis. Results A total of 2686 antibiotics were prescribed to 1249 patients and 486 ADEs were found. The preventability assessment revealed that most of the ADEs (78.8%) were found among patients having long length of stay (LOS) in hospital and were preventable (59.3% of the ADEs were definitely preventable while 44.7% were probably preventable) and caused by MEs including wrong drug (40.1%) and monitoring errors (25%). The errors were caused due to non-adherence of policies (38.4%) and lack of information about antibiotics (32%). Most of the non-preventable ADEs or ADRs among patients having long and short LOS in hospital were “probable” (35.5%) and “possible” (35.8%), respectively. Logistic regression analysis revealed that ADEs were significantly less among females (OR = 0.047, 95% CI = 0.018─0.121, p-value = < 0.001), patients aged 18─52 years (OR = 0.041, 95% CI = 0.013─0.130, p-value = < 0.001), patients with ARTIs (OR = 0.004, 95% CI = 0.01–0.019, p-value = < 0.001), patients prescribed with 2 antibiotics per prescription (OR = 0.455, 95% CI = 0.319─0.650, p-value = < 0.001) and patients with long LOS (OR = 14.825, 95% CI = 11.198─19.627, p-value = < 0.001). Conclusion Antibiotics associated definitely preventable ADEs were more commonly found in patients having long LOS in the inpatient departments because of MEs and lack of proper pharmacovigilance system. The ADRs showed a probable and possible causal association with both β-lactams and non β-lactams antibiotics