Association of Caesarean Uterine Scar Health in Women with Previous One Caesarean Section in Relation to Inter- Pregnancy Interval

Background:To find out safe inter pregnancy interval in patients with previous one caesarean section and promote trial of labour after caesarean (TOLAC) . Methods: In this descriptive study one hundred and fifty patients with singleton pregnancy and previous one caesarean section, who were planned for elective caesarean section, between 37-40 weeks, were included. Patients with multiple pregnancies, ruptured uterus, failure of TOLAC, multiple caesarean sections and preterm pregnancies were excluded. Visual uterine scar health was assessed per operatively in relation to different inter pregnancy intervals. Scar health was categorized as healthy or thick, thin, transparent and partial dehiscence. . Result:Patients, with inter- pregnancy interval of 12-18 months, had a high (69.6%) healthy scar. In patients with inter-pregnancy interval of 19-24 months, 76.9% scars were healthy. The group of patients whose inter pregnancy interval was more than 24 months, 71.8% scar were healthy Conclusion: When intra operative visual scar health was assessed in relation with inter pregnancy interval. No significant difference was found in uterine scar health in different inter pregnancy intervals

Disease and Conceptual Metaphors: A Corpus Analysis of English Newspaper Articles Related to COVID-19

Metaphors are not just ornamental tools; they are fundamentally a reflection of human thought and embodiment. Based on the notion that metaphors are cognitive processes that reflect cognitive vision to understand human concepts through language, the current study is aimed at identifying Covid-19 conceptual metaphors in media discourse. To evaluate the metaphorical use of language, a corpus of three Pakistani English newspaper articles published in March 2020 was created. The needed data is extracted and analyzed using the corpus tool AntConcand the theoretical framework of Conceptual Metaphor Theory given by Lakoff and Johnson (1980). The results of the study demonstrate that the conceptual metaphor Covid-19 as waris excessively utilized in the Covid-19 editorial text. Whereas, other conceptual metaphors are also observed in the corpus, like Covid-19 as a killer, Covid-19 as a possession, and Covid-19 as an earthquake. The findings also reveal that the newspaper articles reflect persuasive ideology. Therefore, while stating the facts and figures, the use of metaphoric expressions is possibly used to instill seriousness among Pakistani public about Covid-19

Lung carcinoma: its profile and changing trends

BACKGROUND: Lung Carcinoma is the leading causes of morbidity and mortality worldwide with an incidence of 1.3 million cases per year. This study was undertaken to determine prevalence of various histological types of lung carcinoma and to analyse their changing trends with time. METHODS: This is a retrospective analytical study. A total of 330 cases of lung carcinoma were analysed from 2003 to 2008. Cases from Khyber Pakhtunkhwa and Federally Administered Tribal Area (FATA) were included in this study. Furthermore, only cases of lung carcinoma were considered while other malignancies were excluded. RESULTS: Squamous Cell carcinoma was found in 42.7% of cases. Overall male to female ratio was 2.67:1. Prevalence of Squamous Cell carcinoma increased from 32% to 57.9% while that of Small Cell carcinoma increased from 12% to 17.1%. Unspecified type showed decrease from 36% to 5.3%. Increase in the prevalence of Squamous Cell carcinoma was found in both males and females while change in the prevalence of Small Cell carcinoma was found on!y in males. CONCLUSION: Squamous Cell carcinoma was the most prevalent variant of lung carcinoma in our region, followed by Adenocarcinoma. Male to female ratio across different histological patterns did not show significant variation. Increase in the prevalence of Squamous Cell carcinoma was statistically significant in both males and females while in case of Small Cell carcinoma change in its prevalence was also significant in males

Reliability Of Transvaginal Ultrasound Measured Endometrial Thickness In Diagnosis Of Endometrial Cancer In Postmenopausal Women

Abstract Objective: Dilatation and curettage have been replaced by ultrasound measurement of uterine endometrial thickness (ET) especially by Transvaginal ultrasound (TVS) as a first step in the workup of women with postmenopausal bleeding for many years. Still, there is no unanimity for endometrial thickness cut-off value to define abnormality. We used an endometrial thickness of 4mm as a cut-off value in this study. Methods: This cross-sectional validation study included 120 patients who presented with postmenopausal bleeding in OPD of POF hospital from 01-12-2017 to 1-06-2018.TVS measured endometrial thickness ≥4mm was assumed positive for malignancy and ˂ 4 mm was taken negative for malignancy. The TVS findings of patients were compared with the histopathology report of endometrial sampling, which was performed in OPD by manual vacuum aspirator (MVA). Histopathology report was taken as a reference standard to confirm or refute the diagnosis of transvaginal ultrasound. Results: On TVS, 54 patients had ≥ 4mm endometrial thickness (taken positive for malignancy) while 66 patients had <4 mm endometrial thickness (taken negative for malignancy). Histopathology of the endometrium (reference standard) revealed that 47 (39.17%) patients had malignancy and 73(60.83%) patients did not have malignancy. The reliability of transvaginal ultrasound (TVS) using 4mm cut-off point ET in detecting endometrial malignancy in patients presenting with uterine bleeding after menopause, keeping histopathological findings as a reference standard showed 89.36% sensitivity, 83.56%, specificity, 92.42% negative predictive value and 77.78% positive predictive value & 85.83% accuracy rate. Conclusion: We concluded that there was a low probability of endometrial malignancy in women with ˂ 4 mm transvaginal ultrasound (TVS)measured endometrial thickness (ET).TVS  may replace invasive endometrial sampling in cases of postmenopausal bleeding with ˂ 4mm ET

One-Year Review Of Reduced Fetal Movements In Izzat Ali Shah MCH Center: A Predictor Of Poor Perinatal Outcome

Objectives: To find out common causes of reduced fetal movements. The purpose is to reduce perinatal morbidity and mortality. Methodology: This Prospective, Observational study was conducted at Izzat Ali Shah Maternal and child health center, unit III Gynae, Wah medical college Wah Cantt, from January 2019 to December 2019. A total of participants 160, who presented in the antenatal outpatient or emergency department with reduced fetal movements, were included in the study. Patients in the active phase of labor were excluded from the study. Patients were followed up till delivery. All necessary information, investigations, and examination points were noted on the predesigned proforma. Data were analyzed by using SPSS version 22. Results: Out of a total of 160 patients, 144 had alive and stable babies. Regarding the age group, out of 160, six patients were teenagers (3.75%), 98 (61.25%) were between 20-30 years, and 55(34.3%) were in the age group of 30-40 years. Regarding gestational age at presentation, 27 out of 160(16.8%) were between 30-35 weeks, 133(83.12%) was at 36-40 weeks. None of the patients presented below 30 weeks. Concerning the number of pregnancy, primigravida 82(51.25%), 60(37.5%) were multigravida, and 18 (11.25%) was grand multipara. Regarding medical history, anemia was seen in 31 patients (19.37%), pregnancy-induced hypertension in 20(12.5%), and 65 %( 104) has no significant medical history. Concerning past obstetrical history, 107(66.8%) fell under low-risk pregnancies, 18(11.25%) had previously normal deliveries but 08(05%) patients had H/O still births. Regarding placental position, 71(44.37%) had anterior, 71(44.37%) had posterior, and 18 (11.25) had fundal placenta. Regarding UAD, 136(85%) had normal umbilical artery Doppler, 13(8.12%) had altered, 06(3.75%) were Absent and 05 (3.12%) has reversed end diastolic flow. During study, 78(48.7%) had normal AFI, 69(43.12%) has Oligohydramnios, 10(6.25%) anhydramnios, while only 03(1.87%) had polyhydramnios.  Regarding birth weight, 122(76.25%) had average weight, 32(20%) were low birth weight and 05(3.12%) were very low birth weight. 61(38.12%) went into NICU, while 99(61.8%) no admission required. Conclusion: Most common risk factor or cause of reduced fetal movements was reduced liquor, (79). Out of which 69 remained alive and stable after birth, while 15 had early neonatal deaths. The second cause found was abnormal umbilical artery Doppler,(24). Out of which, 14 had early neonatal deaths and intrauterine deaths. This study showed the increased obligation of care required by patients with decreased fetal movement. Although the number of live births is more as compared to demise, it results in increased neonatal unit admission rates, higher induction and cesarean section rates, higher surveillance demands, and an increased financial burden on parents. It signifies the need for more vigilance in this area of practice. But we can’t neglect the perception of a mother. Mother’s feelings are more important than any other test

Investigation of the viable role of oil sludge-derived activated carbon for oily wastewater remediation

A wide range of studies has been carried out to describe the equilibrium data of adsorption for the surface adsorption process. However, no extensive investigation has been carried out to evaluate the oil sludge based activated carbon surface adsorption. Therefore, the possibility of carbon active production using different oil sludges and consequently the adsorption mechanism of these kind of adsorbents is still unknown. In this study, a novel low-cost approach was introduced to synthesize the activated carbon using oil sludge applying a two-step process including carbonization and chemical activation. In this way, four different types of oil sludges were characterized and then applied to synthesize different carbon actives and their performance were investigated as an adsorbent. The results showed that all synthesized activated carbons, with about 6% ash and pH = 7 and the specific surface area of 110 m2/gr, have the ability to treatment of oily wastewater; which can be referred to the high carbon content (>80%). The iodine number and the efficiency of prepared activated carbon were obtained as 406.8 mg/g and 94%, respectively. The adsorption process was also studied at different process conditions such as temperature (308–338 K), pH value (3–9) and adsorbent amount (50–200 mg/L) to find the optimum condition for wastewater treatment. The results show that the pH value has an optimum in the adsorption rate (the maximum adsorption was measured at pH = 5) and the adsorption capacity can be reduced by increasing the temperature or decreasing the adsorbent amount. Moreover, three different adsorption isotherm models were applied, i.e., Langmuir, Temkin, and Freundlich isotherms; which the Langmuir equation was more suitable than others investigated isotherm models with R2 ≈ 0.999

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

THE USE OF INTERNET BY STUDENTS OF SARGODHA UNIVERSITY

ABSTRACT This study was conducted to examine the trends of using internet by the students of Sargodha University. It also examined the gender difference regarding internet usage. The sample of the data was taken from the University of Sargodha. A survey of 252 students both male and female was randomly selected to participate in the study. The result of the study showed that most of the students of Sargodha University consider internet as a tool for information. They use it for study purposes. They think that internet is an easier way to get information then library. Further, it is recommended that students should be provided with internet at their institutions and they should be given proper education regarding internet usage