Pregnancy after embolization for arteriovenous malformation: An uncommon successful outcome

Uterine arteriovenous malformation (AVM) is an uncommon but fatal condition and can cause bleeding from abnormal connection between artery and vein. Pregnancy after embolization of uterine AVM is very uncommon, and there are increased risks of spontaneous abortion and growth retardation. We report a case of pregnancy after bilateral uterine artery embolization for AVM and its successful outcome.

Predictors of vaccination card retention in children 12-59 months old in Karachi, Pakistan

Objective: To determine the factors associated with retaining the vaccination card among care takers of 12-59 months old children in Karachi, Pakistan.Methods: This was an analytical cross-sectional study in Karachi. Households were randomly selected throughout a multistage cluster sampling technique. Data was collected for 504 children of 12- 59 months of age. Questionnaire was administered to caretakers to gather information regarding the children\u27s vaccination status, socio-demographic characteristics and reviewing their vaccination cards. Statistical analysis was done by SPSS 19 using logistic regression.Results: Among 462 vaccinated children, caretakers of 33% provided vaccination cards. Odds of card retention decrease if the caretaker has a large household i.e., \u3e5 people sharing one room (AOR 0.277, 95% CI: 0.096, 0.797) and if the child is of four to five years of age (AOR 0.544, 95% CI: 0.305, 0.970). Gender of the child, and the caretaker\u27s education and access to electronic media were not significant predictors of vaccination card retention in our study.Conclusion: Our study showed that vaccination card retention for children 12-59 months of age was low (33%) in Karachi. There is a need to educate caretakers of young children regarding the importance of keeping vaccination card and to disseminate this information through healthcare providers. Improving vaccination card retention is one of the key measures which will help towards accurately estimating coverage and to inform health policy decisions

Effect of body mass index on outcome of labour induction

The retrospective study to explore the adverse effect of obesity on pregnancy and labour was conducted at Aga Khan University Hospital, Karachi, Pakistan, and comprised data of all patients booked between 12-14 weeks and required induction of labour from January 1 to December 31, 2012. Women were grouped into two body mass index categories: normal weight (23 kg/m2). Obesity increased the risk of development of gestational hypertension and diabetes. Therefore obese women were more likely to be induced due to medical indication whether primiparous or multiparous adjusted odds ratio =2.89(95% confidence interval 1.29-6.48) and 2.77 (95% confidence interval 1.07-7.19) respectively. There was increased chance of having caesarean section in primigravida adjusted odds ratio = 1.45 (95% confidence interval 0.72-2.92), duration of caesarean section and blood loss during the procedure were not significantly associated with high body mass index (p\u3e0.05). Obesity may lead to a lot of problems in primigravida, but it did not have major impact

Exploring Gender Dynamics in On-Farm Climate Change Adaptation Strategies and Food Security among Smallholder Farmers in South Punjab, Pakistan

The study aims to explore the determinants of on-farm climate change adaptation strategies along with food security in the South Punjab Province of Pakistan. On-farm climate change adaptation strategies are the actions that farmers apply to mitigate the influence of climate change on their specific farms. The study stands out by comprehensively addressing five sub-strategies of on-farm adaptation strategies. The previous studies employed qualitative techniques or frequency analysis, but this study applied regression analysis.  Notably, there is a dearth of research on the intersection of gender, climate change adaptation, and food security in South Punjab. The study collected data from 1152 small landholders in four divisions (Multan, Bahawalpur, DG Khan) of South Punjab with a sample size of 384 small landholders from each division by using the Krejcie & Morgan (1970) sample size determination formula. The study employed a binary logistic technique to estimate the results.  The findings suggest that male farmers exhibit greater confidence in adopting on-farm climate change adaptation measures compared to their female counterparts. Planned adaptation strategies demonstrate a positive influence on autonomous climate change adaptation measures. Additionally, the study identifies various constraints or barriers, such as limited access to services, shortage of non-land assets, and farmers’ constrained income, as primary obstacles in the adoption of on-farm strategies. The study further reveals that food security negatively influences the adoption of on-farm strategies

Surgical management of inflammatory bowel disease: A low prevalence, developing country perspective

OBJECTIVE: To determine the outcomes of surgical management of inflammatory bowel disease. METHODS: The retrospective case series was conducted at Aga Khan University Hospital, Karachi, and comprised medical record of adult patients operated between January 1986 and December 2010 for inflammatory bowel disease. Outcomes consisted of complications till last follow-up and 30-day mortality (disease or procedure related). Functional status of patients with ileal pouch was determined via telephone. SPSS 16 was used to analyse data. RESULTS: Of the 36 patients whose records were reviewed, 21(58%) were males, and body mass index was less than 23 in 34(91%). A total of 27(75%) patients underwent elective surgery for their condition. Ileal pouch was formed in 9(25%). Overall mortality was 14(38.8%). Overall incidence of complications was 26(72%), with wound infection being the most common early morbidity in 11(30.5%). Late morbidity included pouchitisin 4/9 (44.9%) and strictures 2/36 (5.5%).On telephonic follow-up, 6 of the remaining 7patients (85%) with ileal pouch were satisfied with the functional results of the procedure. CONCLUSIONS: The retrospective case series represents results from a developing country with low prevalence of inflammatory boweldisease and hence limited experience

Comparing neonatal respiratory morbidity in neonates delivered at term by elective Caesarean section with and without dexamethasone: retrospective cohort study

Objective: To assess the effect of dexamethasone on neonatal respiratory morbidity in babies delivered by early term elective lower segment Caesarean section. Method: The retrospective cohort study was conducted at a secondary level hospital in Karachi. It reviewed the medical record of pregnant women and their babies who were delivered by elective lower segment Caesarean section between January 1 and June 30, 2013, at 37-38+6 weeks of pregnancy. The women were divided into exposed group (Group A) who received prophylactic dexamethasone, and non-exposed group (Group B) who did not receive dexamethasone Neonatal respiratory morbidity was compared between the two groups. Data was analysed using SPSS 19.Results: The 196 subjects in the study were equally divided in two groups. In Group A, only 1(1%) baby developed transient tachypnoea compared to 10(10%) babies in Group B (p=0.005). Besides, 11(11%) babies were admitted to nursery in Group B compared to 1(1%) in Group A (p=0.005). No baby was referred to any tertiary care hospital for intensive care.Conclusion: Beneficial effects of prophylactic dexamethasone in neonatal respiratory morbidity were found, but further prospective studies with large sample size are required

Selective lymphadenectomy in endometrial cancer: Retrospective analysis of morbidity and survival data at a tertiary care centre

Objective: To compare perioperative morbidity and survival data between patients with early-stage endometrial cancer who did or did not undergo selective lymphadenectomy.Methods: Retrospective analysis of 180 patients with early-stage endometrial carcinoma treated between 1999 and 2008 was performed in Aga Khan University Hospital, Karachi, Pakistan.Results: Data from 180 patients were analysed. The selective lymphadenectomy group contained 108 women (60%) and the no lymphadenectomy group contained 72 women (40%). The median number of lymph nodes removed was 9. The mean age and extent of disease, as assessed by staging, tumour size, myometrial invasion, and lymphovascular invasion were comparable between groups. Upstaging of the disease to stage 3 and 4 occurred in 11% of patients in the lymphadenectomy group. There were no significant differences in the medical or surgical complications between groups. At a median follow-up of 26 months, both groups had comparable survival (lymphadenectomy versus no lymphadenectomy: 34 versus 32 months). Similar survival was noted for patients who underwent the removal of more or less than 5 pelvic lymph nodes.Conclusion: Selective lymphadenectomy offers the advantage of improved surgical staging but no therapeutic benefit in terms of overall survival

Implementation of warning tool to improve maternal newborn health outcomes in a developing country

Objective: To improve health outcomes through the implementation of national early warning sign tool for babies delivered through emergency caesarean section in off-work hours. Methods: This comparative clinical study was conducted at the Aga Khan Hospital for Women and Children, Karachi, from April to August 2014, and comprised women who had an emergency caesarean section. Maternal and perinatal outcomes were compared of patients in Group A and Group B which represented individuals before and after the implementation of the national early warning score respectively. Results: Of the 200 participants, there were 100(50%) in each group. The overall mean age was 26.79±5.10 years. The mean age was 26.3±5 years in Group A, and 27.2±5 years in Group B (p=0.25). The two groups were also comparable in terms of parity (p=0.77) and co-morbidities (p =0.51). There was no stillbirth or maternal death, but decline in complications due to post-partum haemorrhage (p=0.00) was observed due to early recognition and timely management. None of the women required referral to higher facility. Conclusion: National early warning score was found to be a practical early warning tool for obstetric population

Rivalry Dynamics: Unveiling Alternative Motivations Behind Nations’ Arms Competition

Purpose: The study aims to explore the complex dynamics of the arms race (AR) between Pakistan and India, with a primary focus on examining various arms race models. Research Gap: No study in the current body of literature regarding the perspectives from Pakistan and India has comprehensively utilized all iterations of the Richardson Reaction model of the arms race, except for Hollist (1977), which did incorporate all versions of the Richardson Reaction model. However, in this particular study, the author merely compared R2 and F-statistics across four pairs of nations. Design/Methodology/Approach: The study consists of eight mini-models. The first six models have been estimated through OLS while in the last two models, we have adopted the GMM technique. The study used the data from Handbook statistics of Pakistan and India from 1972 to 2020. The Main Findings: Our study highlights that a country’s own previous year’s military spending inversely affects its current military outlays, while its opponents’ expenditures positively influence its military budget. The disparity between a country’s and its opponents’ military spending, as well as submissiveness, play significant roles. Moreover, real external debt negatively impacts military expenditures, while real GDP positively influences them. Theoretical/Practical Implications of the findings: The implications suggest that the decisions about military expenditure are affected by both internal and external aspects, including past expenditures and the military capabilities of adversaries. The study highlights the relevance of economic growth as a determinant of military spending decisions. Originality/Value: The originality and value of the study lie in a comprehensive utilization of all versions of the Richardson model, employing the advanced technique of the Generalized Method of Moments (GMM)

Long term effectiveness of cognitive behavior therapy for treatment of postpartum depression: A systematic review and meta-analysis

Background: The existing trials on the long term effectiveness of cognitive behavior therapy (CBT) for the treatment of postpartum depression have conflicting results. Therefore, we performed a systematic review to summarize the current evidence.Methodology: Literature search was performed using electronic databases Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsychINFO were explored from January 2000 to March 2013.All peer-reviewed English-published randomized controlled trials were eligible if they assessed the long term (at least at 24 weeks post partum) effectiveness of CBT versus standard postpartum care for prevention of postpartum depression. Data from eligible studies were abstracted by using structured data extraction form and pooled for calculation of relative risk ratio.Results: Five randomized controlled trials fulfilled eligibility criteria. In the included studies, the total number of women was 1087 with age ranged from 17 years to 42 years. Assessment carried on the ‘Cochrane Risk of Bias Tool’ showed the trials included in this review had low risk of bias. Two trials had sample size less than 50. Two out of five trials reported beneficial effect of CBT whereas three trials found no difference. Meta-analysis [random effect model] revealed 30% reduction in the prevalence of depression in the intervention group as compared with the control group [RR: 0.70 (95% C.I: 0.55 to 0.90)]. However, these results showed effectiveness of intervention because of one large trial and excluding this trial, there was no significant difference.Conclusion: In this systematic review, we found a beneficial effect of CBT in the prevention of postpartum depression at 24 weeks of postpartum period. However, the evidence is limited by a small number of trials with results being dominated by a single large trial. Robust research with larger sample size is needed to determine the long-term effectiveness of CBT for treatment of postpartum depression