POSTPARTUM HEALTH RELATED QUALITY OF LIFE AFTER DIFFERENT MODES OF DELIVERY AMONG WOMEN IN PAKISTAN: THE NEGLECTED LINK FOR BETTER MATERNAL and CHILD HEALTH

Objective: The present study was designed to evaluate women postpartum quality of life after different modes of delivery in Pakistan.Methods: A descriptive cross-sectional study design was used. A pre-validated tool SF-36 was self-administered to a sample of 382 women in the postpartum period (6-8 w, 10-12 w, 14-16 w,>9 mo,>15 mo) undergone through elective/emergency cesarean sections or normal vaginal delivery and had delivered a single live child. After data collection, data was cleaned coded and entered in SPSS version 21.0. Descriptive statistics comprising of frequency and percentages was calculated. The non-parametric tests including Mann-Whitney and Kruskal-Walis (p ≥ 0.05) were performed to find out the difference among different variables.Results: Comparison of HRQOL domains by mode of delivery using Mann-Whitney test demonstrated a significant difference (p=0.01) between normal delivery and cesarean section. Women undergoing normal delivery had significantly higher scores as compared to women having cesarean section. Also, a significant difference (p=0.027) among HRQOL scores was observed between working women and house wives and as well who had better socioeconomic status (p=0.018).Conclusion: The results of the present study concluded that postpartum quality of life of most of the women undergoing normal vaginal delivery was better as compared to women undergoing cesarean sections in twin cities of Pakistan. Surgical intervention during cesarean section might lead to consistent postpartum pain, inability to cope with needs of newborn and family which in turn can reduce postpartum quality of life among women

DRESS syndrome: carbamazepine induced anaphylactic shock

A 51-year-old female of Southeast Asian ethnicity was referred to our Neurosurgery service for a newly diagnosed intracranial meningioma. She underwent surgical excision of the tumor and was discharged home on Carbamazepine. Four weeks later, she presented back to our Emergency Department (ED) with fever, generalized rash, and altered mental status. The rash appeared a week prior to the patient’s presentation to the ED, and she complained of spikes of fever for two days. On arrival, her temperature was 41 °C. She was tachypneic at 24 breaths/min, and hypotensive at 95/55 mm Hg, with a heart rate of 120 beats per minute (BPM). Soon after triage, she was moved to the resuscitation room for further assessment and management. On examination, the patient appeared to be in moderate distress, anxious, and slightly confused with a Glasgow Coma Scale (GCS) of 14/15. She had a generalized, macular, pruritic, urticarial rash with irregular confluent margins that was consistent with an allergic reaction. Apart from the above-detailed findings, her examination was unremarkable. There was no mucosal surfaces involvement. Her chest was clear on auscultation. Her abdomen was soft, non-tender, with no organomegaly. No focal neurological deficits were detected. Her investigations included a full septic panel. Laboratory workup revealed elevated Liver Function Tests {Alkaline Phosphatase (ALP) of 120 IU/L (Normal range 35 – 104), Aspartate Transaminase (AST) of 65 IU/L (Normal Range > 32), Alanine Aminotransferase (ALT) of 82 IU/L (Normal Range > 33)}, Lactate Dehydrogenase (LDH) of 367 IU/L (Normal Range 135 – 214), Procalcitonin of 1.01 ng/mL (Normal Range < 0.5), and C-Reactive Protein (CRP) of 150.2 mg/L (Normal Range < 0.5). Of note, she had no Leukocytosis nor eosinophilia. The patient’s empirical treatment plan in the ED included the administration of Intravenous (IV) Fluids, antihistamines, and Ceftriaxone. Upon admission, she was commenced on IV Dexamethasone 4 mg twice a day. Additionally, Carbamazepine was stopped immediately. The day following her admission, the patient’s lab work was repeated, and it showed an improvement in CRP, but most notably, her differential complete blood count revealed eosinophilia of 0.73x10^9/L (Normal Range > 0.7), which further went up to 1.33x10^9/L two days later. She was also reviewed by the dermatologist who agreed with the diagnosis of DRESS. A skin biopsy was proposed. However, the patient did not consent to the procedure. On day 3 of her admission, the patient clinically improved on treatment and remained afebrile and vitally stable. She was therefore discharged home with a follow-up clinic appointment. Written patient consent for publishing the case with no identifiable personal information was obtained

Fears and barriers: Problems in breast cancer diagnosis and treatment in Pakistan

Background: Women in Pakistan lack appropriate awareness about diagnosis and treatment for breast cancer due to a range of multifaceted barriers. There is a dearth of literature examining the socio-cultural factors that inhibit women from breast cancer screening, diagnosis and treatment in Punjab, Pakistan. Addressing this gap, this qualitative study sought to identify and explore the barriers that hinder women from seeking timely screening and treatment.Methods: In this process 45 women (age = 18-50 years) with breast cancer were purposively sampled and interviewed from the Punjab Institute of Nuclear Medicine (PINUM) hospital, Faisalabad, Pakistan.Results: An inductive approach was used to analyze the data which resulted in the emergence of eight subthemes under the umbrella of three major themes that delineate individual, socio-cultural and structural barriers to seek screening and treatment of breast cancer in Punjab. Individual barriers included lack of awareness, hesitance in accepting social support, and spiritual healing. The identified socio-cultural factors included feminine sensitivity, stigmatization, and aversion to male doctors. Lack of financial resources and apathetic medical services were structural barriers that hinder screening and treatment.Conclusions: These barriers can be addressed through raising awareness and community mobilization about breast-self exam and treatment. The healthcare system should also pay attention to socio-psychological and cultural factors impeding women\u27s access to available health facilities

Bouveret\u27s Syndrome: A Case Report and Review of the Literature

Bouveret syndrome is an exceedingly rare complication of cholelithiasis, characterized by gastric or intestinal obstruction due to the impaction of one or more gallstones in the proximal gastrointestinal tract. We present a case of an elderly woman with multiple comorbidities who presented with gastric outlet obstruction caused by a cholecystogastric fistula. The management and treatment of Bouveret syndrome present a challenge, as endoscopic retrieval is the first-line treatment strategy, but it is rarely successful. Most patients ultimately require surgery as was seen in our cas

Characterization of Toxic Metals in Tobacco, Tobacco Smoke, and Cigarette Ash from Selected Imported and Local Brands in Pakistan

In this study, concentrations of Cd, Ni, Pb, and Cr were determined in tobacco, tobacco smoke-condensate, and cigarette ash for selected brands used in Pakistan. Smoking apparatus was designed for metal extraction from cigarette smoke. Samples were digested through microwave digester and then analyzed by flame atomic absorption spectrophotometer (FAAS). Higher concentration of Ni was detected in imported brands than the counterparts in the local brands. Pb levels were however higher in local brands while significant concentration of Cd was observed in both brands. For Cr, the level in tobacco of local brands was higher than their emitted smoke, whereas imported brands showed higher level in smoke than in tobacco. The cigarette ash retained 65 to 75% of the metal and about 25 to 30% went into the body. While this study revealed the serious requirement to standardize the manufacturing of tobacco products, more importantly is the urgent need for stronger enforcements to put in place to alert the general population about the hazardous effects of cigarettes and the health risks associated with these toxic metals