Partograph versus no partograph: effect on labour progress and delivery outcome: a comparative study

Background: Abnormal labour which includes prolonged labour and obstructed labour remain major causes of maternal morbidity. The major reason for neonatal mortality, birth asphyxia and subsequent morbidity is essentially the repercussion which occurs when a complicated labour is not intervened at the right time. A Partograph provides a graphic overview of the progress of labour and records information about maternal and fetal condition during labour. It is considered to be a very effective tool to monitor labour progress and prevent prolonged and obstructed labour.Methods: This prospective randomised comparative study was conducted in the Department of Obstetrics and Gynaecology, JLN Hospital and RC, Bhilai, Chattisgarh, from January 2015 to June 2016. Pregnant women were randomly assigned to two groups, of 200 each, after satisfying the inclusion and exclusion criteria. Women assigned to Group 1 had their active labour modified using modified WHO partograph whereas those assigned to Group 2 were not monitored using the partograph.Results: Use of Partograph (group 1) significantly reduced the duration of active phase of labour (p 0.05).Conclusions: The use of Partograph, when compared to no Partograph plotting in active labour, is associated with better monitoring of labour progress as well as delivery outcome in the form of a healthy mother and a healthy child

Assessment of factors responsible for early menopause in Interior Sindh, Pakistan

Objective: To evaluate the factors leading to the early onset of menopause (<40 years) in the women in the interior of Sindh. Materials and Methods: A cross-sectional study was conducted on 218 individuals among them 109 were postmenopausal women (with premature menopause)  and 109 were normal menstruating females during the period of six months from November 2014 to April  2015, data was obtained from Interior Sindh, Larkana, Hyderabad, and Benazirabad.  Factors considered were age, number of children, history of the obstetric process (ovarian and uterine), diseases, and premature menopause history in first-cousin marriages. The questionnaire data and blood samples were collected for hormonal assays such as LH,  prolactin, and FSH. The hormone levels were analyzed by ELISA method, SPSS version 17 was used for data analysis. Results:  Out of 109 subjects the percentage of early menopause due to: anorexia nervosa was 17%, brain tumor 7%, ovarian cancer 6%, hormonal disorders 23%, hysterectomy 15%, oophorectomy 5%, Pituitary gland dysfunction 4%, Sheehan Syndrome 24%, Polycystic Ovarian Syndrome (PCOS) 8%. Conclusion: Early menopause was found related to pathological and psychological factors including brain tumor, ovarian cancer, family history, Anorexia nervosa, and certain surgical interventions

Hidradenocarcinoma: Five years of local and systemic control of a rare sweat gland neoplasm with nodal metastasis

Hidradenocarcinoma is a rare and locally aggressive tumor rendering a poor prognosis. Furthermore, very few cases present with nodal metastasis. Diagnosing such an entity, and then differentiating it from a benign counterpart, poses a great challenge to the clinicians. There are no established treatment guidelines for the management of this disease, particularly in patients with nodal involvement. We present a case of a young male who was diagnosed with hidradenocarcinoma of the scalp, along with a neck swelling. A thorough diagnostic evaluation was done with endoscopy, pathological, and radiological investigations. He was successfully treated with resection of the scalp lesion and right-sided neck dissection followed by adjuvant concurrent chemoradiation. He remains free of any local and distant disease after five years of regular follow-up

Brand community: The right crowd for crowdfunding

Recently crowdfunding has become popular among entrepreneurs, startups and non-profit organizations. Funders often seek to get something back either in form of equity or non-financial terms.Members of the same group show strong relationship for crowdfunding rather than individuals.Brand community including online communities has more response for open call crowdfunding.Brand community members are relatively enthusiastic in funding altruistic way that is often pursued by many firms. Besides brand community members make surveillance for project success and often volunteer in addition to funding.This study suggests brand communities as the right crowd for crowdfunding

Acute toxicity and local response using three fractions of high dose rate (HDR) brachytherapy for curative treatment of carcinoma cervix

To determine the acute vaginal mucosal toxicity and clinical response of cervical cancer after definitive treatment with external beam radiotherapy (EBRT) and three fractions each of 8 Fray (Gy) high dose rate intracavitary brachytherapy (HDR-BT).Study design: Descriptive study.Place and duration: Radiation Oncology Section, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan from January 2008 till December 2015.Methodology: Protocol was formulated for carcinoma cervix to complete treatment in 7 weeks. Patients were treated with chemotherapy and pelvic EBRT to a total dose of 45 Gy/25 fractions, followed by three intracavitary HDR brachytherapy fractions of 8 Gy each. Vaginal toxicity and local clinical response was assessed at the end of treatment, at 4 and 8 weeks.Results: A total of 57 patients were treated with HDR brachytherapy and 49 patients were evaluated for assessment of toxicity and response. According to FIGO staging system, two had stage IB2, one had IIA, thirty-six had IIB, seven had IIIB, one had IVA disease and two had IVB with para aortic nodes. Concurrent gemcitabine and cisplatin were given to 26 (46%); whereas, 28 (49%) received concurrent cisplatin alone. Grade III acute vaginal mucosal toxicity was seen in 52 and Grade IV acute vaginal mucosal toxicity was observed in 08 patients. At completion of treatment, 40 patients had complete clinical response, at 4 weeks follow-up, complete regression of disease was found in 3 more and at 8 weeks none had clinical residual disease.Conclusion: This regimen of HDR brachytherapy treatments is feasible, efficacious, and well-tolerated for carcinoma cervix in a setup with cost constraints. Long term toxicity and disease control remains to be reported with longer follow-up. Key Words: Carcinoma cervix, High dose rate brachytherapy, Acute toxicity, Local response, External beam radiation therapy, Intracavitary brachytherapy

EXPLORATORY FACTOR ANALYSIS OF ENTREPRENEURIAL ORIENTATION IN THE CONTEXT OF BANGLADESHI SMALL AND MEDIUM ENTERPRISES (SMES)

Generally, Exploratory Factor Analysis (EFA) is required to expose the appropriate items for using in the research instrument. Thus, this study takes steps to develop and validate instrument of Entrepreneurial Orientation (EO) construct through EFA particularly in the context of Small and Medium Enterprises (SMEs) in Bangladesh. This study is exercised EFA as it is far different from previous studies in terms of socio-economic, racial and cultural status and some items of the previous studies are no longer suitable for current research. More importantly, maximum number of previous studies examined only innovativeness, pro-activeness, and risk-taking as the dimensions of EO. However, quite a few researchers concentrating on other substantial attributes of EO. Hence, there is still no common agreement among researchers as the number of dimensions as well as items should be employed to measure EO. So, this study has examined innovativeness, pro-activeness, risk-taking, and resource-leveraging as the core dimensions to measure EO and also presenting an instrument of EO. This study adopted a cross-sectional research design, while quantitative data was collected from 384 SMEs across eight states in Bangladesh, using structured survey. Based on the reliability testing, this study finalized the instrument to twelve (12) items yielding three (3) dimensions, i.e., innovativeness (3 items), pro-activeness (3 items) risk-taking (3 items), and resource-leveraging (3 items). In this regard, researchers calculated the value of internal reliability (i.e., Cronbach Alpha value) for the current EO instrument. This study explained in detail the procedures for carrying out EFA analysis for EO construct. Future researchers could further extend the instrument presented in this study by cross-examining across the underdeveloped, developing and developed countries.  Article visualizations

Simplified antibiotic regimens for treatment of clinical severe infection in the outpatient setting when referral is not possible for young infants in Pakistan (Simplified Antibiotic Therapy Trial [SATT]): a randomised, open-label, equivalence trial

Background: Parenteral antibiotic therapy for young infants (aged 0–59 days) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality. Outpatient treatment could save lives in such settings. We aimed to assess the equivalence of two simplified antibiotic regimens, comprising fewer injections and oral rather than parenteral administration, compared with a reference treatment for young infants with clinical severe infection.Methods: We undertook the Simplified Antibiotic Therapy Trial (SATT), a three-arm, randomised, open-label, equivalence trial in five communities in Karachi, Pakistan. We enrolled young infants (aged 0–59 days) who either presented at a primary health-care clinic or were identified by a community health worker with signs of clinical severe infection. We included infants who were not critically ill and whose family refused admission. We randomly assigned infants to either intramuscular procaine benzylpenicillin and gentamicin once a day for 7 days (reference); oral amoxicillin twice daily and intramuscular gentamicin once a day for 7 days; or intramuscular procaine benzylpenicillin and gentamicin once a day for 2 days followed by oral amoxicillin twice daily for 5 days. The primary outcome was treatment failure within 7 days of enrolment and the primary analysis was per protocol. We judged experimental treatments as efficacious as the reference if the upper bound of the 95% CI for the difference in treatment failure was less than 5·0. This trial is registered at ClinicalTrials.gov , numberNCT01027429 . Findings: Between Jan 1, 2010, and Dec 26, 2013, 2780 infants were deemed eligible for the trial, of whom 2453 (88%) were enrolled. Because of inadequate clinical follow-up or treatment adherence, 2251 infants were included in the per-protocol analysis. 820 infants (747 per protocol) were assigned the reference treatment of procaine benzylpenicillin and gentamicin, 816 (751 per protocol) were allocated amoxicillin and gentamicin, and 817 (753 per protocol) were assigned procaine benzylpenicillin, gentamicin, and amoxicillin. Treatment failure within 7 days of enrolment was reported in 90 (12%) infants who received procaine benzylpenicillin and gentamicin (reference), 76 (10%) of those given amoxicillin and gentamicin (risk difference with reference −1·9, 95% CI −5·1 to 1·3), and 99 (13%) of those treated with procaine benzylpenicillin, gentamicin, and amoxicillin (risk difference with reference 1·1, −2·3 to 4·5). Interpretation: Two simplified antibiotic regimens requiring fewer injections are equivalent to a reference treatment for young infants with signs of clinical severe infection but without signs of critical illness. The use of these simplified regimens has the potential to increase access to treatment for sick young infants who cannot be referred to hospital

Impact of peer review in the radiation treatment planning process: Experience of a tertiary care university hospital in Pakistan

Purpose: To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week.Materials and Methods: Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. All recommendations were stratified on the basis of treatment intent, site, and technique. Data were analyzed by Statistical Package for the Social Sciences and are presented descriptively.Results: Out of 116 plans, 26 (22.4%) were recommended for changes. Minor changes were suggested in 15 treatment plans (12.9%) and a major change in 10 (8.6%), and only one plan was suggested for missing contour. The frequency of change recommendations was greater in radical radiation plans than in palliative plans (92.3% v 7.7%). The head and neck was the most common treatment site recommended for any changes (42.3%). Most of the changes were recommended in the technique planned with three-dimensional conformal radiation therapy (50%). Clinical target volume (73.1%) was identified as the most frequent parameter suggested for any change, followed by treatment field (19.2%) and dose (0.08%).Conclusion: Peer review is an important tool that can be used to overcome deficiencies in radiation treatment plans, with a goal of improved and individualized patient care. Our study reports changes in up to a quarter of radiotherapy plans

Simplified antibiotic regimens for the management of clinically diagnosed severe infections in newborns and young infants in first-level facilities in Karachi, Pakistan: study design for an outpatient randomized controlled equivalence trial.

BACKGROUND: Infection in young infants is a major cause of morbidity and mortality in low-middle income countries, with high neonatal mortality rates. Timely case management is lifesaving, but the current standard of hospitalization for parenteral antibiotic therapy is not always feasible. Alternative, simpler antibiotic regimens that could be used in outpatient settings have the potential to save thousands of lives. METHODS: This trial aims to determine whether 2 simplified antibiotic regimens are equivalent to the reference therapy with 7 days of once-daily (OD) intramuscular (IM) procaine penicillin and gentamicin for outpatient management of young infants with clinically presumed systemic bacterial infection treated in primary health-care clinics in 5 communities in Karachi, Pakistan. The reference regimen is close to the current recommendation of the hospital-based intravenous ampicillin and gentamicin therapy for neonatal sepsis. The 2 comparison arms are (1) IM gentamicin OD and oral amoxicillin twice daily for 7 days; and (2) IM penicillin and gentamicin OD for 2 days, followed by oral amoxicillin twice daily for 5 days; 2250 "evaluable" infants will be enrolled. The primary outcome of this trial is treatment failure (death, deterioration or lack of improvement) within 7 days of enrollment. Results are expected by early 2014. DISCUSSION: This trial will determine whether simplified antibiotic regimens with fewer injections in combination with high-dose amoxicillin are equivalent to 7 days of IM procaine penicillin and gentamicin in young infants with clinical severe infection. Results will have program and policy implications in countries with limited access to hospital care and high burden of neonatal deaths