Community Based Midwives Practice in Patriarchal Social System

It is well accepted globally, that midwives can save the lives of mothers and their new-born successfully, if the community stakeholders provide support and freedom for full scope of practice. Recognising this many countries deploy midwives in the community as an intervention to achieve the MDGs (Millennium Development Goals) 4 and 5 targets set for decreasing maternal and neonatal mortality, respectively. However, high-income countries’ reports show very good results, in achieving MDGs 4 and 5 while the low-income countries lag behind in this regard. The situation in high-income and low-income countries is different because midwives practising in the community in low-income countries face many barriers. These barriers include a lack of understanding of midwives’ role, inadequate logistic arrangements, patriarchy, culture, and norms at the level of the family and society that affect all CMWs’ (Community Midwives) lives as women. This case report seeks to explain how the pattern of the patriarchal social system imposes barriers on the practice of midwives in low-income countries, with particular focus on Pakistan. It also recommends that midwives should be empowered in order to deal with barriers that are imposed due to patriarchy and tradition

Development of Mentorship Module and its Feasibility for Community Midwives in Sindh, Pakistan: A Pilot Study

Numerous articles describe the concept of mentorship for providing professional support in midwifery settings in different countries; however, in Pakistan the concept is under developed. Before implementing the concept in the Pakistani context, it was important to first develop a mentorship module and pilot test the idea. Therefore, the aim of the present study was to develop and test a mentorship module to determine its feasibility for educating community midwives about providing mentoring, so that a formal mentorship program could be established in the future. The training aimed to provide skill focused mentorship training to experienced midwives, so that they could perform the role of mentors for newly graduate midwives, in order to support them and build their confidence. The mentorship module was developed with the help of literature review and experts’ suggestion. A structured questionnaire was given to 50 community midwives after they had been provided mentorship training. Community midwives from nineteen districts of Sindh, Pakistan, were surveyed through purposive sampling. All the community midwives agreed that there was a need for mentorship, that the training module was useful, and that they would be able to integrate it into their practice. Over 80% community midwives rated the content of the module as useful, the majority agreed that the total duration of the training (two days) and the length of each session in the training were appropriate. Similarly, all participants reported that the mentoring strategies were helpful. Hence, the mentorship training module was strongly perceived to be feasible and useful by the community midwives of Sindh, Pakistan

Analysis of cross matching to transfusion ratio of blood components in blood bank SKIMS, Soura: a prospective one year study

Background: Blood requisitions received in blood bank for elective and emergency procedures from surgery, trauma, Obstetrics and Gynaecology Department are often associated with excessive demand for cross matching of blood which is often more than the required blood and blood components. In this study, our goal was to use the blood stocks more efficiently and reduction in the wastage due to over dating and to prevent injudicious pre-operative cross-matching and utilization of blood.Methods: This was a prospective study conducted in the Department of Blood Transfusion and Immunohematology of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar over a period of one year with effect from September 2017 to August 2018. Source was requisition forms and blood bank records of patients who underwent elective procedures in the hospital. For the purpose of analysis, departments were categorized into surgical and allied branches i.e Cardiovascular Surgery (CVTS), Neurosurgery, General Surgery and Obstetrics and Gynaecology. Department wise utilization of blood Components cross matching to Transfusion ratio (C/T), transfusion probability (T%) and Transfusion Index (TI) were calculated. Data was entered and analyzed using Microsoft excel window 2010. The obtained data was evaluated and presented in the tabular and diagrammatic forms.Results: A total of 3940 requests for cross matching of blood and its components were received for 3072 patients. Out of these, 2048 units were transfused. The total C/T Ratio, Transfusion Probability (T%) and Transfusion Index (TI) was 1.92, 42.5% and 0.6 respectively.Conclusions: To reduce the injudicious usage of blood, blood transfusion services need to adopt blood conserving policies. Efforts should be made to adopt more conservative transfusion thresholds, periodic feedback to improve blood ordering, conduct regular auditing, handling, distribution and utilization practices of this scarce resource

Histological development of human foetal shoulder joint

Background: Shoulder joint is a multiaxial, diarthrodial joint of ball and socket variety. The various components of shoulder joint i.e. capsule, various ligaments, joint cavity and synovial tissue start developing in early embryonic and foetal life roughly in between 6th to 12th week of foetal development. The present study aims to analyze the sequences of development of various structures of shoulder joint in human embryo and compare the findings with other observers to gain some insight regarding its development and an attempt is made to correlate these observations clinically to analyze cause and management of recurrent shoulder dislocations. Methods: Shoulder joints of 32 foetuses collected from areas in and around Jammu were dissected properly and decalcified in Gooding and Stewart’s solution. Sections were cut after obtaining blocks by paraffin wax embedding method. Slides were stained using Haematoxylin and Eosin, Masson’s trichrome and orcein staining and important findings were documented.Results: The bony structures - head of humerus and glenoid fossa and joint cavity appear by 10 weeks which prolongs into bicipital sulcus by 12-1/2 weeks. Synovial tissue appears by 10 weeks and synovial villi appear by 14 weeks. Glenoid labrum, capsular ligament, coracohumeral ligament and superior glenohumeral ligament are seen by 10 weeks. Middle glenohumeral ligament is seen at 12-1/2 weeks while inferior glenohumeral ligament is seen at 14 weeks. Tendon of biceps is seen at 10 weeks. Conclusions: By 10 weeks of gestational age various structures of shoulder joint develop in situ, resembling in form and arrangement as those of adults. From these early stages, development proceeds rapidly to achieve adult characteristics. There are no intermediate stages in between where structures similar to those of lower forms i.e. syn/amphi artroses appear temporarily.

Contribution from selected organic species to PM2.5 aerosol during a summer field campaign at K-Puszta, Hungary

A summer field campaign was conducted at the forested background site of K-puszta in Hungary. The main aim was to assess the contribution of terpene-derived particulate organic compounds to the PM2.5 organic carbon (OC) and of the secondary organic carbon (SOC) from -pinene to the OC. The study lasted from 24 May to 29 June 2006; the first half the weather was cold, while the second half was warm. Separate daytime and night-time PM2.5 samples were collected with a high-volume sampler and the samples were analysed by several analytical techniques, including ion chromatography (IC) and liquid chromatography-mass spectrometry (LC/MS). The latter technique was used for measuring the terpene-derived species. Ancillary high time resolution measurements of volatile organic compounds (VOCs) were made with proton-transfer reaction-mass spectrometry. The temporal and diurnal variability of the particulate compounds and VOCs and interrelationships were examined. It was found that the monoterpenes and a number of terpene-derived particulate compounds, such as cis-pinic and cis-caric acid, exhibited a strong day/night difference during the warm period, with about 10 times higher levels during the night-time. During the warm period, the IC compounds and LC/MS compounds accounted, on average, for 3.1% and 2.0%, respectively, of the OC, whereas the contribution of SOC from -pinene to the OC was estimated at a minimum of 7.1%

Effect of cyclophosphamide on the microanatomy of liver of albino rats

Background: Cyclophosphamide is widely used in the treatment of various neoplastic diseases and diseases associated with altered immunity. Higher doses used for longer duration effects many organs like urinary bladder, lungs, liver, heart and male reproductive organs.Methods: To study the effect of cyclophosphamide on the micro anatomy of liver, sixty eight Albino rats were taken and divided into three groups, group A (control group) of 20 animals, were fed with routine diet, group B (low dose group) of 24 animals, were given cyclophosphamide at the dose of 0.5 mg/100 gms in addition to the routine diet and group C (high dose group) of 24 animals, were given high dose of cyclophosphamide at the dose of 0.7 mg/100 gms of weight of animal in addition to the routine diet. The animals were sacrificed at intervals of 3, 6, 9 and 12 weeks, 5 microns sections of the tissue were prepared and stained with Haematoxylin and Eosin stain.Results: Microscopic changes in liver were apparent in the drug treated animals. In group B the changes appeared after 6 weeks while in group C they started appearing after 3 weeks of drug treatment. The changes were in the form of fatty changes, hemorrhages and central vein congestion.Conclusion: Cyclophosphamide induces histological changes like fatty infiltration and central vein congestion in the liver. These changes are with low doses given for longer durations and manifest earlier when larger doses are used. Thus it is advised that patients receiving cyclophosphamide should be periodically evaluated for liver dysfunction.

Phycochemical and Biological Activities From Different Extracts of Padina antillarum (Kützing) Piccone

Seaweeds are non-vascular, photosynthetic that inhabit the coastal regions commonly within rocky intertidal or submerged reef-like habitats and have been one of the richest and most promising sources of bioactive primary and secondary metabolites with antimicrobial properties. They selectively absorb elements like Na, K, Ca, Mg, I, and Br from the seawater and accumulate them in their thalli. Padina antillarum (Kützing) Piccone is a member of Phaeophycota and has remarkable phycochemistry as well as bioactivity. The phycochemical tests of the different extracts showed the presence of alkaloids, terpenoids, saponins, tannins, steroids, and phenols. The relative percentage of Oxirane, tetradecyl (C16H32O), and Cyclononasiloxane (C18H54O9Si9) are higher while Tetrasiloxane (C16H50O7Si8) is lowest in Gas Chromatography – Mass Spectrometry analysis. FRAP, %inhibition, the total antioxidant value of P. antillarum was higher in methanolic extract. Hexane, chloroform extracts showed no zone of inhibition against Bacillus subtilis, Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus, and Staphylococcus epidermidis. The methanolic extract of P. antillarum exhibits a maximum zone of inhibition against S. epidermidis (18.66 ± 0.09). Antifungal activity of the P. antillarum in hexane extract exhibited no zone of inhibition against Aspergillus niger and Penicillium notatum while the chloroform extract yields maximum zone (37 ± 0.012, 21.66 ± 0.03). Diabetes mellitus is one of the most familiar chronic diseases associated with carbohydrate metabolism. It is also an indication of co-morbidities such as obesity, hypertension, and hyperlipidemia which are metabolic complications of both clinical and experimental diabetes. The treatment of P. antillarum methanol extract in mice reduced the body weight loss, low level of triglycerides, and elevated HDL cholesterol level as compared to diabetic mice

Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis

Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumonia (IP) caused by leflunomide (LEF) were reported, but many of them were considered as the victims of opportunistic infection currently. In this paper, efficacy and safety of low-dose LEF classified by body weight (BW) were studied. Methods: Fifty-nine RA patients were started to administrate LEF from July 2007 to July 2009. Among them, 25 patients were excluded because of the combination with tacrolimus, and medication modification within 3 months before LEF. Remaining 34 RA patients administered 20 to 50 mg/week of LEF were followed up for 1 year and enrolled in this study. Dose of LEF was classified by BW (50 mg/week for over 50 kg, 40 mg/week for 40 to 50 kg and 20 to 30 mg/week for under 40 kg). The average age and RA duration of enrolled patients were 55.5 years old and 10.2 years. Prednisolone (PSL), methotrexate (MTX) and etanercept were used in 23, 28 and 2 patients, respectively. In case of insufficient response or adverse effect, dosage change or discontinuance of LEF were considered. Failure was defined as dosages up of PSL and MTX, or dosages down or discontinuance of LEF. Last observation carried forward method was used for the evaluation of failed patients at 1 year. Results: At 1 year after LEF start, good/ moderate/ no response assessed by the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score, including a 28-joint count (DAS28)-C reactive protein (CRP) were showed in 14/ 10/ 10 patients, respectively. The dosage changes of LEF at 1 year were dosage up: 10, same dosage: 5, dosage down: 8 and discontinuance: 11 patients. The survival rate of patients in this study was 23.5% (24 patients failed) but actual LEF continuous rate was 67.6% (11 patients discontinued) at 1 year. The major reason of failure was liver dysfunction, and pneumocystis pneumonia was occurred in 1 patient resulted in full recovery. One patient died of sepsis caused by decubitus ulcer infection. DAS28-CRP score was decreased from 3.9 to 2.7 significantly. Although CRP was decreased from 1.50 to 0.93 mg/dl, it wasn't significant. Matrix metalloproteinase (MMP)-3 was decreased from 220.0 to 174.2 ng/ml significantly. Glutamate pyruvate transaminase (GPT) was increased from 19 to 35 U/l and number of leukocyte was decreased from 7832 to 6271 significantly. DAS28-CRP, CRP, and MMP-3 were improved significantly with MTX, although they weren't without MTX. Increase of GPT and leukopenia were seen significantly with MTX, although they weren't without MTX. Conclusions: It was reported that the risks of IP caused by LEF in Japanese RA patients were past IP history, loading dose administration and low BW. Addition of low-dose LEF is a potent safe alternative for the patients showing unsatisfactory response to current medicines, but need to pay attention for liver function and infection caused by leukopenia, especially with MTX. Disclosure statement: The authors have declared no conflicts of interes

Multi-messenger searches via IceCube’s high-energy neutrinos and gravitational-wave detections of LIGO/Virgo

We summarize initial results for high-energy neutrino counterpart searches coinciding with gravitational-wave events in LIGO/Virgo\u27s GWTC-2 catalog using IceCube\u27s neutrino triggers. We did not find any statistically significant high-energy neutrino counterpart and derived upper limits on the time-integrated neutrino emission on Earth as well as the isotropic equivalent energy emitted in high-energy neutrinos for each event

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension