Womens\u27 perceptions regarding obstetric complications and care in a poor fishing community in Karachi

Objective: To assess the knowledge of women about obstetric complications and care.Methods: The study was conducted in a remote coastal community in Karachi in 1999, where the Department of Community Health Sciences of Aga Khan University is operating its primary health care project since 1996. The information was collected using a structured questionnaire, interviewing a representative sample of 329 married-women of reproductive age, selected systematically from the community.Results: The mean age of the respondents was 29 years. On average they were married for 11 years and had four living children. Almost half of them had no antenatal care in their last pregnancy and 75% delivered at home. The findings indicate a poor knowledge of common and serious pregnancy related complications based on their perception related to danger signs. Five percent of the women perceived absent/decreased fetal movement as a danger sign of pregnancy. Other reported danger signs included premature uterine contraction by 3%, premature rupture of membranes by 3%, convulsions by 13%, obstructed labor by 23% and bleeding by 39%. Moreover, the women\u27s perception regarding obstetric care suggests that unsafe practices prevail: 86% of women thought that a case of ante-partum hemorrhage should be examined internally and 50% thought that no precaution is required to sterilize the instrument for cutting the cord.CONCLUSION: There is a clear need to create awareness regarding obstetric complications through a targeted community based health educational intervention aiming to promote early recognition of the obstetric emergency at the household level and also to create a demand of safe obstetric practices

A cross-sectional study of blood cultures and antibiotic use in patients admitted from the Emergency Department: missed opportunities for antimicrobial stewardship

BACKGROUND: Early review of antimicrobial prescribing decisions within 48 h is recommended to reduce the overall use of unnecessary antibiotics, and in particular the use of broad-spectrum antibiotics. When parenteral antibiotics are used, blood culture results provide valuable information to help decide whether to continue, alter or stop antibiotics at 48 h. The objective of this study was to investigate the frequency of parenteral antibiotic use, broad spectrum antibiotic use and use of blood cultures when parenteral antibiotics are initiated in patients admitted via the Emergency Department. METHODS: We used electronic health records from patients admitted from the Emergency Department at University Hospital Birmingham in 2014. RESULTS: Six percent (4562/72939) of patients attending the Emergency department and one-fifth (4357/19034) of those patients admitted to hospital were prescribed a parenteral antimicrobial. More than half of parenteral antibiotics used were either co-amoxiclav or piperacillin-tazobactam. Blood cultures were obtained in less than one-third of patients who were treated with a parenteral antibiotic. CONCLUSIONS: Parenteral antibiotics are frequently used in those admitted from the Emergency Department; they are usually broad spectrum and are usually initiated without first obtaining cultures. Blood cultures may have limited value to support prescribing review as part of antimicrobial stewardship initiatives

Kinematic alignment in total knee arthroplasty

Kinematic alignment (KA) is an alternative philosophy for aligning a total knee replacement (TKR) which aims to restore all three kinematic axes of the native knee. Many of the studies on KA have actually described non-KA techniques, which has led to much confusion about what actually fits the definition of KA. Alignment should only be measured using three-dimensional cross-sectional imaging. Many of the studies looking at the influence of implants/limb alignment on total knee arthroplasty outcomes are of limited value because of the use of two-dimensional imaging to measure alignment, potentially leading to inaccuracy. No studies have shown KA to be associated with higher complication rates or with worse implant survival; and the clinical outcomes following KA tend to be at least as good as mechanical alignment. Further high-quality multi-centre randomized controlled trials are needed to establish whether KA provides better function and without adversely impacting implant survival

EVALUATION OF OIL BASED AVIAN INFLUENZA VACCINE (H5NI) PREPARED WITH DIFFERENT CONCENTRATIONS OF ADJUVANT

Bird flu vaccine from H5N1 strain of avian influenza virus was prepared with two concentrations of adjuvant (Montanide ISA 70MVG). Two vaccines (I and II) were prepared containing 50 and 60% Montanide, respectively. Immune response of both the vaccines as single, as well as booster, dose was evaluated in layer birds through haemagglutination inhibition test. Single dose of both vaccines showed poor immune response, while booster dose gave better response with both the vaccines. However, the vaccine prepared with 60% Montanide provided better immune response compared with the vaccine containing 50% montanide

Mode-division-multiplexing of multiple Bessel-Gaussian beams carrying orbital-angular-momentum for obstruction-tolerant free-space optical and millimetre-wave communication links

We experimentally investigate the potential of using ‘self-healing’ Bessel-Gaussian beams carrying orbital-angular-momentum to overcome limitations in obstructed free-space optical and 28-GHz millimetre-wave communication links. We multiplex and transmit two beams (l = +1 and +3) over 1.4 metres in both the optical and millimetre-wave domains. Each optical beam carried 50-Gbaud quadrature-phase-shift-keyed data, and each millimetre-wave beam carried 1-Gbaud 16-quadrature-amplitude-modulated data. In both types of links, opaque disks of different sizes are used to obstruct the beams at different transverse positions. We observe self-healing after the obstructions, and assess crosstalk and power penalty when data is transmitted. Moreover, we show that Bessel-Gaussian orbital-angular-momentum beams are more tolerant to obstructions than non-Bessel orbital-angular-momentum beams. For example, when obstructions that are 1 and 0.44 the size of the l = +1 beam, are placed at beam centre, optical and millimetre-wave Bessel-Gaussian beams show ~6 dB and ~8 dB reduction in crosstalk, respectively

Molecular basis of arsenite (As+3)-induced acute cytotoxicity in human cervical epithelial carcinoma cells

Background: Rapid industrialization is discharging toxic heavy metals into the environment, disturbing human health in many ways and causing various neurologic, cardiovascular, and dermatologic abnormalities and certain types of cancer. The presence of arsenic in drinking water from different urban and rural areas of the major cities of Pakistan, for example, Lahore, Faisalabad, and Kasur, was found to be beyond the permissible limit of 10 parts per billion set by the World Health Organization. Therefore the present study was initiated to examine the effects of arsenite (As+3) on DNA biosynthesis and cell death.Methods: After performing cytotoxic assays on a human epithelial carcinoma cell line, expression analysis was done by quantitative polymerase chain reaction, western blotting, and flow cytometry.Results: We show that As+3 ions have a dose- and time-dependent cytotoxic effect through the activation of the caspase-dependent apoptotic pathway. In contrast to previous research, the present study was designed to explore the early cytotoxic effects produced in human cells during exposure to heavy dosage of As+3 (7.5 μg/ml). Even treatment for 1 h significantly increased the mRNA levels of p21 and p27 and caspases 3, 7, and 9. It was interesting that there was no change in the expression levels of p53, which plays an important role in G2/M phase cell cycle arrest.Conclusion: Our results indicate that sudden exposure of cells to arsenite (As+3) resulted in cytotoxicity and mitochondrial-mediated apoptosis resulting from up-regulation of caspases.Keywords: apoptosis; epithelial carcinoma; cytotoxicity; arsenite; caspases; Pakistan Responsible Editor: Amin Bredan, VIB Inflammation Research Center & Ghent University, Belgium