Incomplete miscarriage during the first trimester: a comparison of indoor versus outdoor procedure

Introduction: Miscarriage is defined as the natural death of a fetus inside the uterus. To remove complete conception material after a miscarriage, vacuum aspiration or dilatation & curettage are methods to remove uterine contents. Controversies exist regarding both procedures. So we conducted this study to confirm the more successful method. Objective: To compare the effectiveness of manual vacuum aspiration versus traditional evacuation and curettage (E & C) among females presenting with incomplete miscarriage during the first trimester of pregnancy Materials and Methods: This randomized controlled trial was done at the Department of Obstetrics & Gynecology, Shalamar Hospital, Lahore for 6 months. Then the selected females were divided randomly into 2 equal groups. In group A, females had manual vacuum procedure while in group B, females had evacuation & curettage under general anesthesia. After 12 hours of the procedure, ultrasonography was done to confirm complete evacuation. Results: The mean age of the patients was 29.87 ± 6.71 years, the mean gestational age was 8.06 ± 2.82 weeks. The effectiveness was noted in 248 (91.85%) patients. Statistically, manual vacuum showed significantly more effective as compared to evacuation & curettage procedure in the management of incomplete miscarriage i.e. p-value = 0.008. Conclusion: It has been proved that manual vacuum aspiration is more effective than traditional evacuation & curettage in the management of incomplete miscarriage

Histological changes in the liver of diabetic rats: A review of pathogenesis of nonalcoholic fatty liver disease in type 1 diabetes mellitus

Abstract: Abundant knowledge is present over nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus but no attention has been given to the same aspect with type 1 diabetes mellitus (T1DM) in humans. However, various animal modeled studies are documented having induced T1DM using chemical induction by alloxan (ALX) or streptozotocin (SZ) to investigate and comprehend the nature and pathophysiology of NAFLD in T1DM. The objectives of this review were to assess whether T1DM induced by ALX or SZ could cause histological (morphological and ultrastructural) changes in rat liver to illustrate the effects of these drugs and diabetes, and pathophysiology of NAFLD in T1DM. To achieve these objectives, we systematically searched the studies from EconLit, Embase, Google Scholar, Medline, PubMed, ProQuest, Scopus, Springer Link, and Science Direct databases. Initially, 150 studies were retrieved. Out of these, 107 studies were removed as these failed to provide relevant details. Finally, 43 articles were selected for this review. This review concluded that diabetes induced by ALX or SZ, cause biochemical alterations in blood and pathophysiological variations in the liver of rats. These changes can vary from steatosis to steatohepatitis and liver fibrosis, and are similar to the modifications observed in human liver

Privacy preserving and serverless homomorphic-based searchable encryption as a service (SEaaS)

Serverless computing has seen rapid growth, thanks to its adaptability, elasticity, and deployment agility, embraced by both cloud providers and users. However, this surge in serverless adoption has prompted a reevaluation of security concerns and thus, searchable encryption has emerged as a crucial technology. This paper explores the Searchable Encryption as a Service (SEaaS) and introduces an innovative privacy-preserving Multiple Keyword Searchable Encryption (MKSE) scheme within a serverless cloud environment, addressing previously unmet security goals. The proposed scheme employs probabilistic encryption and leverages fully homomorphic encryption to enable operations on ciphertext, facilitating searches on encrypted data. Its core innovation lies in the use of probabilistic encryption for private multi-keyword searches. To validate its practicality, we deploy the scheme on the public cloud infrastructure, “Contabo,” and conduct rigorous testing on a real-world dataset. The results demonstrate that our novel scheme successfully preserves the privacy of search queries and access patterns, achieving robust security. This research contributes to the field of serverless cloud security, particularly in the context of searchable encryption, by providing a refined solution for safeguarding data while maintaining usability in a serverless computing landscape

Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure - A national survey of the cardiologists in Pakistan

<p>Abstract</p> <p>Background</p> <p>The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines.</p> <p>Methods</p> <p>A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File <supplr sid="S1">1</supplr>). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines.</p> <suppl id="S1"> <title> <p>Additional file 1</p> </title> <text> <p><b>Questionnaire</b>. Description: Questionnaire that was administered to participants.</p> </text> <file name="1471-2261-11-68-S1.DOC"> <p>Click here for file</p> </file> </suppl> <p>Results</p> <p>A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation.</p> <p>Conclusion</p> <p>We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.</p

Cancer prevalence, incidence and mortality rates in Pakistan in 2012

According to estimates from the International Agency for Research on Cancer (IARC), there were 14.1 million new cancer cases and 8.2 million cancer deaths in 2012 worldwide. In this article, we provide an overview of the cancer burden in Pakistan, including the 1, 3, 5-years prevalence, estimated number of new cancer cases and deaths in 2012 by age. Data from GLOBOCAN 2012, produced by the IARC, were used. GLOBOCAN provides estimates of cancer prevalence, incidence and mortality worldwide, and for countries and regions. This article concluded that the most prevalent cancers in Pakistan include breast, lip and oral cavity, cervix uteri, colorectum and bladder, respectively. The cancers responsible for the highest incidence in both the genders (total = 148,041) in Pakistani population includes breast (n = 34038, 23%), lip and oral cavity (n = 12761, 8.6%), lung (n = 6800, 4.6%), non-hodgkin lymphoma (n = 5964, 4%) and colorectum (n = 5335, 3.6%), respectively. Whereas, the cancers responsible for the highest deaths (total = 101,113) in Pakistani population includes breast (n = 16232, 16.1%), lip and oral cavity (n = 7266, 7.2%), lung (n = 6013, 5.9%), oesophagus (n = 4748, 4.7%) and non-hodgkin lymphoma (n = 4374, 4.3%), respectively

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

Investigation of antimicrobial use at a tertiary care hospital in Southern Punjab, Pakistan using WHO methodology

Abstract Background Globally, between 20 to 50% of antimicrobial consumption is inappropriate, causing significant impact on the quality of care, cost of therapy and incidence of adverse drug reactions. The purpose of this study was to investigate the prescribing patterns and utilization of antimicrobials in ten selected wards at Bahawal Victoria Hospital (BVH), Bahawalpur, Punjab, Pakistan. Methods A descriptive cross-sectional study was designed using the World Health Organization (WHO) indicators for antimicrobial use. Standard data collection forms were used in ten wards and the Pharmacy Department at BVH. Antimicrobial utilization patterns in terms of frequency and percentage were also determined. Systematic random sampling techniques were used to collect data from 1,000 prescription records out of 21,115 prescriptions written for the six months January to June 2016. Results For the hospital indicators, a formulary list or essential medicines list (FL/EML) was available, but standard treatment guidelines (STGs) for infectious diseases was not. The average number of days that key antimicrobials were out of stock was 3.3 days per month. The expenditure on antimicrobials as a percentage of the total medicines costs was 12.2%. For the prescribing indicators, the percentage of hospitalizations with antimicrobial(s) prescribed was 82.3%, and the average number of antimicrobials per hospitalization was 1.4 (SD = 0.6). The average duration of antimicrobial treatment per hospitalization was 5.4 days (SD = 3.2). The average cost of antimicrobials prescribed per hospitalization was USD 5.4 (SD = 6.7). None of the patients who were prescribed antimicrobials, received AM according to the STGs (pneumonia and cesarean section cases). Among the patient-care and supplemental indicators, the average duration of hospital stay of patients who received antimicrobials was 6.4 (SD = 4.3) days. The drug sensitivity testing was almost non-existent, with only 0.24% prescription records having drug sensitivity tests. Ceftriaxone (39.6%), metronidazole (23.4%) and cefotaxime (23.1%) were the top most frequently prescribed antimicrobials. Conclusions The results of the current study revealed less than optimal antimicrobial prescribing and utilization patterns of selected wards at BVH. Continuous education and training of physicians, and cost-effective policies could play an important role in promoting the rational use of antimicrobials in this setting

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