Interventions for trichomoniasis in pregnancy

Background: Vaginitis due to Trichomonas vaginalis is one of the most common of sexually transmitted diseases. Trichomoniasis affects women during pregnancy as well but it is not clearly established whether it causes preterm birth and other pregnancy complications.Objectives: The objective of this review was to assess the effects of various treatments for trichomoniasis during pregnancy.Search strategy: We searched the Cochrane Pregnancy and Childbirth Group\u27s Trials Register ( 14 January 2011).Selection criteria: Randomized trials comparing anti-trichomonas agents during pregnancy. Trials including symptomatic or asymptomatic women with trichomoniasis were eligible.Data collection and analysis: Two review authors assessed eligibility and trial quality.Main results: We included two trials with 842 pregnant women. In both trials around 90% of women were cleared of trichomonas in the vagina after treatment. In the US trial, women with asymptomatic trichomoniasis between 16 and 23 weeks were treated with metronidazole on two occasions at least two weeks apart. The trial was stopped before reaching its target recruitment because metronidazole was not effective in reducing preterm birth and there was a likelihood of harm (risk ratio 1.78, 95% confidence interval 1.19 to 2.66). The South African trial recruited women later in pregnancy and did not have the design and power to address adverse clinical outcomes. We excluded two recent studies, identified for the current update, because they did not address the primary question.Authors\u27 Conclusion: Metronidazole, given as a single dose, is likely to provide parasitological cure for trichomoniasis, but it is not known whether this treatment will have any effect on pregnancy outcomes. The cure rate could probably be higher if more partners used the treatment

Non-traumatic coma in paediatric patients: Etiology and predictors of outcome

Objective: To determine the common etiological features of non-traumatic coma in children and evaluate possible predictors of morbidity and mortality in these patients.Method: A cross sectional study was carried out at the Paediatric Department of Civil Hospital Karachi from February 2008 to February 2009. In total 100 children, up to 14 years of age having history of non-traumatic coma were included. At the time of enrolment demographic data, clinical features, laboratory parameters and radiological workup were recorded. Data was entered and analyzed with SPSS version 16. Descriptive statistics were generated for all variables. Relationships between categorical variables were evaluated by examining cross-tabulations, chi2 test and Fisher\u27s exact tests. P-values \u3c 0.05 were considered statistically significant.Results: Mean age of the patients in months were 45 months. Male female ratio was 1.45:1. Among 65 survivors 38 (58%) showed no disability and 27 (41%) showed disability. Infections emerged as major cause of mortality (n=23, 79%). Clinical features that showed association with mortality included hypothermia (P = 0.032), hypotension (P = 0.002), altered breathing pattern (P = 0.0001), non reactive pupils (P = 0.001), low Glasgow coma scale (GCS) (P = 0.038), hypotonia (P = 0.002), hyporeflexia (P = 0.0001) and muscle power score of two (P = 0.043).Conclusion: Infections were the leading cause of non-traumatic coma as well as the leading cause of mortality in our study. Hypothermia, hypotension, altered breathing pattern, non reactive pupils, low GCS, hypotonia, hyporeflexia and low muscle power score were significantly associated with mortality in children presenting with non-traumatic coma

Psychosocial experiences of women with vesicovaginal fistula: a qualitative approach.

Abstract Vesicovaginal fistula (VVF) is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women\u27s Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships and financial constraints. However, concerns with religious practices were experienced by 87.5% of the participants. Pakistani women who are suffering through VVF face many challenges. Combined efforts should be made to offer supportive services to women suffering from this condition

Antimicrobial, Antioxidant and Cytotoxic Potential of Aerial Parts of Monotheca buxifolia

In this study, different aerial parts of Monotheca Buxifolia were screened for their antibacterial, antifungal, and anti-oxidant activity. Extract of the fruit was most active against P. mirabilis, MSSA and M. morganii strains. Moreover, the methanolic fruit extract demonstrated good antibacterial properties against VRSA, S. aureus and Acinetobacter. Despite having good antibacterial properties, Monotheca buxifolia showed low antifungal activity. The cytotoxic activity was the highest in the pet-ether fruit extract, causing 60% of lethality against Artemia salina larvae with LD50 at 3.307. The highest scavenging activity was shown by the methanolic leaf extract in a concentration-dependent pattern. The findings of this study suggest that Monotheca Buxifolia has good antibacterial, antioxidant potential but low antifungal properties

Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy

Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop in flow and pumping power leading to failure of the LVAD, if left unattended. If a clot becomes dislodged and circulates in the bloodstream, it may disturb the flow or occlude the blood vessels in vital organs and cause internal damage that could be fatal, for example, ischemic stroke. That is why patients with LVADs are on anti-coagulant medication. However, the anti-coagulants can cause a set of issues for the patient-an example of gastrointestinal (GI) bleeding is given in illustration. On account of this, these devices are only used as a last resort in clinical practice. It is, therefore, necessary to develop devices with better mechanics of blood flow, performance and hemocompatibility. This paper discusses the development of LVADs through landmark clinical trials in detail and describes the evolution of device design to reduce the risk of pump thrombosis and achieve better hemocompatibility. Whilst driveline infection, right heart failure and arrhythmias have been recognised as LVAD-related complications, this paper focuses on complications related to pump thrombosis, especially blood coagulopathy in detail and potential strategies to mitigate this complication. Furthermore, it also discusses the LVAD implantation techniques and their anatomical challenges

Qualities of PBL Leader: The Students’ Perspective

Introduction: Problem based learning is an educational strategy in which students work together in a collaborative way to solve a given problem/scenario that they are expected to experience in their real life setting. Students' work in a group of 12-13. The group members' work under the leadership of the group leader. Aims & Objectives: This study aims to investigate the perceptions of students' regarding the qualities of PBL group leaders. Place and duration of study: The study was conducted in the University College of Medicine and Dentistry. Total 30 2nd Year MBBS students were included in the study. Material & Methods: This was a qualitative descriptive exploratory study. Three focus group discussion sessions were conducted. The sessions were tape- recorded and were then converted into written document. The data was analyzed by using Atlas ti; a qualitative data analysis tool and themes were generated. Results: Initially the entire document was read and line to line coding was done which resulted in 300 codes, a second cycle of coding resulted in 95 codes, which were reduced to 78 codes after the third cycle. Finally, 17 codes were formed which were pertinent to the research objective and 5 themes with various sub-themes. Conclusion: PBL promotes collaborative learning under the group leader. This current study provides a guideline to students and medical colleges regarding the qualities of PBL group leaders and will also help in inculcating these qualities

Is pegylated interferon superior to interferon, with ribavarin, in chronic hepatitis C genotypes 2/3?

Over the past decade, significant improvements have been made in the treatment of chronic hepatitis C (CHC), especially with the introduction of combined therapy using both interferon and ribavarin. The optimal dose and duration of treatment is still a matter of debate and, importantly, the efficacy of this combined treatment varies with the viral genotype responsible for infection. In general, patients infected with viral genotypes 2 or 3 more readily achieve a sustained viral response than those infected with viral genotype 1. The introduction of a pegylated version of interferon in the past decade has produced better clinical outcomes in patients infected with viral genotype 1. However, the published literature shows no improvement in clinical outcomes in patients infected with viral genotypes 2 or 3 when they are treated with pegylated interferon as opposed to non-pegylated interferon, both given in combination with ribavarin. This is significant because the cost of a 24-wk treatment with pegylated interferon in less-developed countries is between six and 30 times greater than that of treatment with interferon. Thus, clinicians need to carefully consider the cost-versus-benefit of using pegylated interferon to treat CHC, particularly when there is no evidence for clinically measurable benefits in patients with genotypes 2 and 3 infections

Student’s Perception of Computer Based Assessment Environment in an Undergraduate Medical College

Background: It is emphasized in medical education that assessment drives learning. In 2020, during the first COVID-19 lockdown, University College of Medicine and Dentistry made a shift towards Computer Based Assessments (CBAs) in order to facilitate learning. Objective: To determine undergraduate medical student’s perception for computer based assessment environment in medical school Methods: The cross-sectional descriptive study was conducted at the University of Lahore, Pakistan, from May 2022 to September 2022, and included undergraduate medical students who were requested to complete the Assessment Environment Questionnaire. Students' individual perception scores were calculated and the means of individual domains and global scores were compared in different academic years. SPSS version 23 was used for statistical analysis.   Results: Of 574 participants, 20% of the participants were from 1st year, 20.7% were from second year, 20% from 3rd year, 19.9% from 4thyear and 19.3% from final year. Generally, the students perceived their assessment environment positive resulting in a global mean score of 67.6±13.7 out of the maximum 80. First year students scored significantly higher (P <0.01) compared to other years. Conclusion: The students' perception for computer based assessment environment was positiv

A multidirectional two-tube method for chemical pleurodesis could improve distribution of the sclerosing agent within the pleural cavity - A pilot study.

Introduction: Malignant pleural effusion (MPE) affects approximately 200,000 people in the United States per annum. Chemical pleurodesis is a recommended first line treatment in the management of MPE, however, success rates as low as 43% has been reported. A bedside chemical pleurodesis can cost up to $11,224 and an estimated inpatient annual expenditure of more than$5 billion in the US alone. This study aims to assess the distribution of the talc slurry within the pleural space using human cadaveric models and to determine the force required to push the talc slurry though a 14 Fr chest tube.Materials and methods: The force required to administer the talc slurry through a 14 Fr chest tube was tested using a Zwick/Roelle Z005 mechanical tester, using a porcine thoracic biomodel. Talc slurry distribution within the pleural cavity was assessed by direct visualisation following administration to the human cadaveric models using single and multidirectional two-tube methods.Results: Maximum force required to push the talc slurry through a 14 Fr chest tube was 11.36 N ± 2.79 N. Distribution of the talc slurry within the pleural cavity was found to be poor with a single tube method. Multidirectional two-tube method of administration showed more even distribution.Conclusion: The experimental multidirectional two-tube method results in wider distribution of the talc slurry within the pleural cavity and could further improve success rate of the talc pleurodesis.</div

Diuretic therapy in congestive heart failure.

In heart failure, fluid overload is a major pathological mechanism leading to vascular congestion, pulmonary congestion and elevated jugular venous pressures. Diuretics play a significant role in the management of patients with congestive heart failure. It is used to relieve the congestive symptoms of heart failure. However, the appropriate use of diuretics remains challenging due to various complications like electrolyte abnormalities, worsening renal function and diuretic resistance. This has prompted towards the search of safer and effective alternatives. This review evaluates the use of diuretics in congestive heart failure and discusses the complications of different types of diuretics, which is essential for successful management of congestion in patients with heart failure and hence to optimise the outcome for the patients