Health-seeking behavior of Karachi women with reproductive tract infections

To explore the contextual factors influencing health-seeking behavior of women in Karachi regarding reproductive tract infections, 18 women with reproductive tract infections from different clinics and community settings were identified and in-depth interviews were conducted. Physicians in our study diagnosed a woman to have lower reproductive tract infection if she complained of malodorous vaginal discharge with or without perineal itching; and to have pelvic inflammatory disease or upper reproductive tract infection if she had any two of the following complaints: malodorous vaginal discharge, menstrual irregularities, lower abdominal pain or dyspareunia. Women consulted a variety of healthcare providers in their pursuit for treatment, mainly allopathic doctors and hakims. The different treatments prescribed to women ranged from oral and intravaginal medications to various home remedies including refraining from specific foods. Causes of reproductive tract infections reported were melting bones , consuming foods with perceived hot composition, poor personal hygiene and procedures like dilatation and curettage, delivery and induced abortions. None reported sexually transmitted diseases as the perceived cause of their problem. Interference with religious activities, sexual relationships or socializing was reported as consequences of reproductive tract infections, in addition to lower abdominal pain, menstrual irregularities, backache and kamzori (weakness). Pakistani women seek care for reproductive tract infections and visit a variety of providers, though causes and treatments offered are usually not related to sexually transmitted diseases. We therefore suggest training of healthcare providers for appropriate counseling and that treatment management protocols be advocated

Repellent potential of medicinal oils against Tribolium castaneum (Herbst) under laboratory conditions

Laboratory experiments were conducted to determine repellency of five local medicinal oils i.e., neem Azadirachta indica A. Juss., castor Ricinus communis L., rapeseed Brassica napus L., lettuce Lactuca sativa L. and chamomile Anthemis cotula L. against Tribolium castaneum Herbst, each applied at 0.1, 0.5- and 1.0-ml doses. A glass cylinder divided into A, B and C sections with one end close was used. Fifty grams of wheat flour was placed at A and C ends. Twenty freshly emerged T. castaneum was released at the center of cylinder (B). The data was recorded after one-, two- and three-days to count number of T. castaneum at A and C for calculating percentage repellency. All the oils showed repellent potential against T. castaneum as their repellency increased with dose and time exposure. After three days, 100% repellency of T. castaneum was recorded in 0.5- and 1.0-ml doses of neem oil, followed by 6.67±3.33% repellency at 0.1 ml neem oil. After three days, the maximum repellency of T. castaneum in rapeseed, castor, chamomile, and lettuce was 86.67±7.26, 76.67±6.01, 76.67±4.41, and 75.00±7.64%, respectively, all recorded at 1.0 ml dose. Overall, neem oil exhibited significantly more repellency of T. castaneum, whereas castor, lettuce, rapeseed and chamomile were found non-significant with each other. Among doses, although highest repellency was recorded at 1.0 ml dose, but not significantly different from 0.5 ml dose of the individual oil. Therefore, 0.5 ml should be applied per 50 grams of wheat flour to get effective repellency of T. castaneum

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Understanding of already known fact: Evaluating frequency and determinants of Hydatidiform Molar Pregnancy

Introduction: Sporadic presentation of hydatidiform has been reported previously as 1 in 1000 pregnancies. In rare cases asymptomatic molar pregnancies can cause problems if not identified in early radiological investigations. The aim of this study is to evaluate the frequency of hydatidiform (molar pregnancy) presenting with associated symptoms, analysis of determinants and management in Sindh, Pakistan. Methodology: This is a cross sectional study, patients were divided into categories according to maternal age, gravida while Beta HCG values were reported along with radiological investigation reporting to confirm hydatidiform molar pregnancy. Statistical package of social science version 21 was used to analyze the data. Results: Total 51 patients were identified with hydatidiform molar pregnancy during study period of 12 months from more than 1000 full term reported pregnancies, indicating 5.1% prevalence of disorder. The diagnosis has been confirmed only 1 (1.9%) case of partial molar pregnancy while 50 (99.1%) were complete molar pregnancy cases, managed by suction evacuation method, risks factors of hydatidiform molar pregnancy with advanced maternal age, recurrent molar pregnancy and positive family history the odds ratio has indicated positive association between first two determinants with OR of 1.71 and 1.21 respectively. Conclusion: Overall recorded frequency of hydatidiform in our institute is 5.1% within 1 year. Advanced maternal age and previous history of molar pregnancies are risk factors of hydatidiform

مرزا ابنِ حنیف اور پاکستان میں متبادل تاریخی بیانیہ کی تشکیل

Historiography of Pakistan has been criticized for a linear, vertical and repetitive approach and claims of scientific and objective writing of History. It is criticized for the Periodic shift/break ups, for an imbalance between indigenuity and exoticity, non-spatial centrality and metaphysical concerns supported by the state policy. In spite that a counter narrative has not been encouraged, several attempts can be found trying to present an alternate and parallel narrative of the Historical process in the areas forming Pakistan, and focusing on the People, indigenuity, continuity, culturality and regionality. Although, initially such attempts were considered as a sort of resistance to the state policies, but by the time, such narrative are identified as attempts to address the 'crises of identity' in Pakistan. Mirza Ibn Hanif (1930-2004) deserves a fundamental place in the history of the development of alternate and parallel narrative in Pakistan. He had begun to develop this narrative very early by 1960s and advocated the case for a historically distinct cultural and civilizational status of the region of Pakistan. In his narrative Multan occupies a central place. In this perspective, the paper explores Ibn Hanif's works as a counter and alternate narrative for the history of Pakistan.</p

The quest of infertile women in squatter settlements of Karachi, Pakistan: a qualitative study

Objectives: There is a dearth of knowledge regarding Pakistani women\u27s perceptions and treatment seeking behavior for infertility. We conducted this study to explore the contextual factors that influence the health-seeking behavior of infertile women in the lower socio-economic group.Methods: In-depth interviews were conducted with 17 women, identified from clinics and community using pre-tested interview guidelines covering issues as the chronological sequence of the number and types of the health care providers consulted for infertility, household dynamics regarding decision making, perceived causes and social and psychological effects of infertility on the woman and her family.Results: 14 of the 17 women interviewed presented with primary infertility and three with secondary infertility. Reasons reported for seeking treatment for primary infertility were: someone to carry on the family name, feeling alone and akhrat par maan bap bun kar uthna (getting up as a parent on judgment day). Two of the three women suffering from secondary infertility were seeking treatment because they did not have any male offspring. Of the 14 women, 11 initially sought treatment within the first two years of marriage; one woman reported that she was coerced by her mother-in-law to seek treatment following the first week of marriage. On average, a woman went to three health care providers (general practitioners, gynecologists and Traditional Birth Attendants) in her quest for assistance. The effects that infertility had on these women ranged from social pressure, coercion by in-laws and/or social isolation. Only one woman reported being put off by sex because it was not giving her what she \u27desired\u27.Conclusion: Women in Pakistan seek care for infertility early and go to various types of health care providers. Infertility is usually treated as a clinical disease by the health care providers without considering its social ramifications