Prevalence of Neural tube defects at PUMHS Hospital.

Introduction: Spina bifida, anencephaly, and encephalocele are neural tube defects (NTD) and result from failure of closure of the neural tube between 21and 28 days following conception. Encephaloceles are possibly post-closure defects. NTDs are an important cause of mortality and morbidity globally. NTD encompasses about one-tenth of the burden of all congenital conditions and make up the third largest congenital burden after congenital heart disease and Down’s syndrome. In low income countries, NTDs may account for 29% of neonatal deaths in observable birth defects Objective: To know the prevalence of neural tube defects at PUMHS Benazirabad.. Methodology: All pregnant ladies when diagnosed to have fetus with neural tube defect through ultrasound examination were counselled for termination of pregnancy. Data collected through proforma with details of demography, gynecological history, and type of neural tube defect evaluated by senior gynecologist and neonatologist. NTDs were defined as cases of anencephaly, spina bifida, encephalocele and meningocele among infants of any gestational age. Results: A total of 7152 deliveries took place in the obstetrics department of PUMHS Hospital from January 2018 to September 2019. 38 (thirty-eight) pregnancies were terminated at different gestational ages, diagnosed as cases of neural tube defects, making a prevalence of 5.313 per 1000 births. Among the NT defects, 22/38 (57.89%) were anencephaly and 12/38 (31.57%) were spina bifida with hydrocephalus. Conclusion: The most common neural tube defect is anencephaly followed by spina bifida with hydrocephalus. Overall prevalence of NTD is comparable published literature from South East Asia.   Keywords: Neural tube defects, Anencephaly, Spina bifida, Hydrocephalus. &nbsp

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

FDI and Export Linkage Revisited: The Case of Bangladesh

This empirical research examines the export effect of foreign direct investment (FDI) with reference to Bangladesh economy. An export supply function extended with the FDI variable has been employed with panel data. Econometric estimations unveil clear-cut contribution of inward FDI to boost export. Thus, this study ascertains that FDI and export are positively related to each other which mean trade and factor flows act as complements. Under such circumstance, higher growth of FDI will promote export growth

التأثير الضد بكتيري والضد بيوفيلوي لبعض المستخلصات النباتية ضد بعض الكائنات الدقيقة الممرضة للانسان

Background and Objective:Biofilm is a complex microbial community highly resistant to antimicrobials agents. The formation of biofilmsin biotic and abiotic surfaces is associated with high rates of morbidity and mortality and considered as a major factor of bacterialpathogenicity. In the present study the antimicrobial and antibiofilm activities of 5 plant extracts (Glycyrrhiza glabra roots, Laurus nobili,Malus domestica peels, Melissa officinalis and Lagenaria siceraria peels) were evaluated against clinical isolated microorganisms (E. coli,S. aureus, P. aeruginosa and K. pneumonia). Materials and Methods: The extracts of medicinal plants were prepared using microwaveassisted method by ethanol and water. Results: The results of this study revealed that, the aquatic extract of M. domestica peels showedpowerful antimicrobial activity against E. coli with MIC value 1.56 mg mLG1, the ethanolic extract of G. glabra roots showed goodantimicrobial activity against P. aeruginosa with minimum inhibitory concentration (MIC) of 12.5 mg mLG1. Most plant extracts in thisstudy gave the minimum bactericidal concentration (MBC) ≥200 mg mLG1 against tested bacteria. However, the aquatic extract of L. nobiliat concentration of 12.5 mg mLG1 showed the highest antibiofilm activity (86.7%) against S. aureus biofilm formation. The ethanolicextract of M. domestica peels at concentration of 25 mg mLG1 showed the highest inhibition rate (90%) against P. aeruginosa biofilmformation. Conclusion: These results revealed the importance of the tested extracts in the control of common human pathogenicmicro-organisms. Plant extracts used in this study may contain potential antimicrobial and antibiofilm components that may be of greatuse for the development of new therapies against the most common infectious bacterial isolates.Background and Objective:Biofilm is a complex microbial community highly resistant to antimicrobials agents. The formation of biofilmsin biotic and abiotic surfaces is associated with high rates of morbidity and mortality and considered as a major factor of bacterialpathogenicity. In the present study the antimicrobial and antibiofilm activities of 5 plant extracts (Glycyrrhiza glabra roots, Laurus nobili,Malus domestica peels, Melissa officinalis and Lagenaria siceraria peels) were evaluated against clinical isolated microorganisms (E. coli,S. aureus, P. aeruginosa and K. pneumonia). Materials and Methods: The extracts of medicinal plants were prepared using microwaveassisted method by ethanol and water. Results: The results of this study revealed that, the aquatic extract of M. domestica peels showedpowerful antimicrobial activity against E. coli with MIC value 1.56 mg mLG1, the ethanolic extract of G. glabra roots showed goodantimicrobial activity against P. aeruginosa with minimum inhibitory concentration (MIC) of 12.5 mg mLG1. Most plant extracts in thisstudy gave the minimum bactericidal concentration (MBC) ≥200 mg mLG1 against tested bacteria. However, the aquatic extract of L. nobiliat concentration of 12.5 mg mLG1 showed the highest antibiofilm activity (86.7%) against S. aureus biofilm formation. The ethanolicextract of M. domestica peels at concentration of 25 mg mLG1 showed the highest inhibition rate (90%) against P. aeruginosa biofilmformation. Conclusion: These results revealed the importance of the tested extracts in the control of common human pathogenicmicro-organisms. Plant extracts used in this study may contain potential antimicrobial and antibiofilm components that may be of greatuse for the development of new therapies against the most common infectious bacterial isolate

Frequency, Management and Outcome of Postpartum Hemorrhage at a tertiary care Hospital.

Introduction: According to WHO, world estimates of 2017, 295 000 maternal deaths were reported all over the world and maternal mortality rate ranged from UI 99 to 243 per 100 000 live births. There has been 35% reduction since year 2000. Similarly, there has been 51% reduction in maternal mortality rate in Pakistan. 94% of all maternal deaths occur in low and lower middle-income countries. The major complications that account for nearly 75% of all maternal deaths are: severe bleeding mostly Post-Partum Hemorrhage (PPH), Postpartum sepsis, pre-eclampsia and eclampsia and other. Objective: To find out the frequency of patients presenting with PPH among all patients delivered during the study period, their management and subsequent morbidity and mortality. Methodology: This retrospective study was conducted between January 2018 to December 2019 at the department of Obstetrics and Gynecology PUMHS Hospital Nawabshah, Benazirabad.  The demography, parity, gestational age, mode of delivery and type of PPH developed as well as treatment for PPH and subsequent morbidity and mortality were all documented. Data analyzed using SPSS version 20. Results: During study period frequency of PPH was 32.73 per 1000 deliveries, prevalence of primary PPH was 90.51%. Among the causes of PPH, Uterine atony was the leading cause 42/137 (30.65%). 56 (40.87%) patients were managed in the ICU for ventilatory &, inotropic support and septic shock, management. Mortality was 7(5%). Conclusion:  Majority of patients are of primary PPH and uterine atony remains the most common cause of PPH which requires prompt and timely management as per guidelines. &nbsp

HPV tests for cervical cancer screening in low resource settings

Human papillomavirus tests for cervical cancer screening in low resource setting