To determine the rate of success of external cephalic version in low risk breech presentations and possible factors affecting its success in POF hospital, Wah Cantt.

Abstract   Background The caesarean section rate  is on the rise for various reasons. One of the reason is breech presentation . External cephalic version is a procedure to manipulate the baby from breech to cephalic presentation externally through the maternal abdomen under USG guidance . Success in ECV decreases the breech presentation and  hence caesarean section rate . Methods This retrospective study was conducted by Wah Medical College in POF hospital from10 Oct 2015- 10 Oct 2019 after approval from the ethical committee .  It included 56 low risk singleton  breech presentations from 36 wks- 40 wks after taking their informed consent  While those with < than 36 wks (primis) and >40 wks gestation, refusal to ECV , with absolute contraindication to ECV& with medical and obstetric complications (ie scarred uterus, liquor <than 8 cm & > than 17 cm, fetal growth restriction, preclampsia, gestational diabetes & abnormal cardiotocography) were excluded  from the study. ECV was performed by single obstetrician in labour room with facilities  of cardiotocograph and emergency caesarean section. Cardiotocography of the fetus  for 30-40 min was done just before & after the procedure of ECV. ECV was declared successful on cofirming head of the fetus occupying the lower uterine segment on ultrasound.  .Number  of successful ECVs & specific factors  of the women & the baby (age . parity, amniotic fluid index ,type of breech, engagement of breech, position of back of baby)  were chosen to observe their effect on success of  ECV. Results External cephalic version was successful in 27 (48.2%)  & unsuccessful in 29 (51.8%)of women .Multiparity , unengaged breech & type of breech (complete flexed) ( with p values .001, .000 & .001 respectively) had statistically significant positive association with successful external cephalic version. Conclusion ECV should be offered to all  women with low risk breech presentations. Knowledge of factors predictive of ECV success can be utilized in selecting cases for ECV &counselling the women regarding the success and failure of ECV.   &nbsp

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Abstract Objective: Dilatation and curettage have been replaced by ultrasound measurement of uterine endometrial thickness (ET) especially by Transvaginal ultrasound (TVS) as a first step in the workup of women with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

Cathetar Related Antimicrobial Resistance Pattern in Intensive Care Unit Patients: A Single Centre Study

Background Urinary catheter is the most common cause of urinary tract infection (UTI) which has been associated with three fold increase risk in mortality. A high level of resistance was noted among the admitted patients for cephalosporin. The primary aim of the study is to known the strain of pathogens; its drugs sensitivity and resistance in intensive care unit (ICU) patients which help the physician in proper management and reduces the mortality and morbidity in urinary catheter related complication. Methods            This study was conducted in Intensive care unit patients of Hayatabad medical complex Peshawar Pakistan over a period of 1 year from 1st January to 31st December 2019. Medical charts were reviewed and 100 patients were selected based on inclusion criteria and  their urine culture and sensitivity reports were noted to know about the most common pathogens, its drugs sensitivity and resistance in these patients. Clinical and Laboratory Standards Institute (CLSI) used for uropathogen by culture and Disc diffusion method to determined antimicrobial susceptibility pattern. The data were shifted from excel sheet to SPPS 21 IBMS version. Results    The mean age (standard deviation) of patients was 51.60+26.59 years (Median age 58.50 years). Of the total, 64 were female and the remaining were male patients. It was found that most common pathogens in urine sample was E. coli. Maximum pathogens were sensitive to intra venous meropenem (65%), and fosfomycin (55%). Conclusion It is concluded that resistance patterns of uropathogens changes which results in treatment failure. Further, based on clinical practice, meropenem, fosfomycin, and cefepime had high sensitivity profile against catheter related infection in ICU

An evaluation of Pakistan's food supply and security

Governments prioritize global food insecurity. Food insecurity affects a billion people, with Asia and the Pacific Islands having the highest rates and Sub-Saharan Africa the lowest. Pakistan is one of the worst-hit countries due to a surge in chronically food-insecure people. Pakistan's food crisis persists. Due to improved worldwide methods and statistics on population, food balance sheets, and consumption patterns, Pakistan's PoU for 2017-19 is 12.3%, up from 12.0% the year before. This is helping measure progress on SDG indicator 2.1.1. 26 million individuals cannot fulfill their basic calorie needs, and the number is rising

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

دجالی نظام کے خدوخال اور حضرت عیسیؑ کا خاتمہ دجال:اسلامی تناظر میں

Abrahamic religions (Judaism, Christianity and Islam) share the common grounds in eschatology, dealing with the end of this world. The main character of this eschatological belief is the arrival of a saviour who will save the world. Islamic eschatology also elaborated the character of Dajjal, the greatest liar who will deceive the world by his deceptions. Dajjal will deceive people by claiming himself the promised saviour, the Messiah. He will also claim that he is Almighty God. The system he will impose will be named as Dajjali system. This paper aims to explore the main features of this dajjali system in the light of Quran and Ahadith. And what hikmah of Allah will reveal at the end of dajjal and his Dajjali system by Hazrat Issa (A.S.)

Unlocking Academic Success: Exploring the Impact of Teacher-Student Relationships on ESL Learners' Performance

The current study, examined the fundamental role of positive teacher-student relationships in shaping students' English language acquisition journey. Drawing insights from the Social-Cognitive Theory of Self-Efficcy and Well-Being in Education, the research highlights the multifaceted impact of these interactions on learners' holistic development. Through a comprehensive synthesis of previous studies, the study reveals that effective teacher-student interactions foster intrinsic motivation and active engagement in language learning. Such interactions also enhance students' self-efficacy, resilience, and overall well-being. By addressing individual learning needs and preferences, teachers create inclusive and productive learning environments. Additionally, nurturing relatedness and autonomy within these relationships fosters students' sense of connection and ownership over their learning process. This research emphasizes the enduring influence of teacher-student relationships beyond academic outcomes, encompassing emotional well-being and personal growth. As education evolves, understanding and nurturing these relationships remain critical for cultivating comprehensive and enriching learning experiences

LEAD IDENTIFICATION AND OPTIMIZATION OF PLANT INSULIN-BASED ANTIDIABETES DRUGS THROUGH MOLECULAR DOCKING ANALYSES

Objective: Diabetes mellitus (DM) is a multifactorial disorder of the pancreas and the third leading cause of deaths in humans. Presence of plant proteins whose genomic sequences are similar to those of animal insulin has been demonstrated. We wished to discover anti-DM drugs having high inhibitory activity based on plant proteins.Methods:  Computer-aided molecular docking methods were applied using Auto Dock Vina software.Results:  We selected a plant protein with Uni Prot identification Q7M217 insulin in Canavalia ensiformis as the target protein for DM. We identified an active lead compound among eight candidate compounds on the basis of significant binding interactions with the target protein and half-maximal inhibitory concentration (IC50) values. We designed four analogs of the lead compound. Molecular docking analyses showed that the four analogs could be used as anti-DM agents with suitable drug-like properties as compared with a standard compound for the treatment of DM (aleglitazar). These analogs can also be used for future studies.Conclusion: We identified an anti-DM compound, a biphenyl derivative, based on plant insulin. We designed its analogs using a functional-group inter-conversion approach. Our computer-aided study provided information on binding energies and binding interactions of the analogs to predict their anti-DM activity.Â