How the coronavirus disease 2019 pandemic is impacting sexual and reproductive health and rights and response : results from a global survey of providers, researchers, and policy-makers

Introduction We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID-19) pandemic and what is being done to mitigate its impact. Material and methods We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. Results The survey was answered by 51 people representing 29 countries. Eighty-six percent reported that access to contraceptive services was less or much less because of COVID-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P < .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P = .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID-19 pandemic as a window of opportunity to push forward women's health and rights. Conclusions Many countries have seen decreased access to and increased violations of SRHR during the COVID-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic

Impedance Spectroscopy Analysis of PbSe Nanostructures Deposited by Aerosol Assisted Chemical Vapor Deposition Approach

From MDPI via Jisc Publications RouterHistory: accepted 2021-08-21, pub-electronic 2021-10-23Publication status: PublishedFunder: Higher Education Commision, Pakistan; Grant(s): 7363This research endeavor aimed to synthesize the lead (II) diphenyldiselenophosphinate complex and its use to obtain lead selenide nanostructured depositions and further the impedance spectroscopic analysis of these obtained PbSe nanostructures, to determine their roles in the electronics industry. The aerosol-assisted chemical vapor deposition technique was used to provide lead selenide deposition by decomposition of the complex at different temperatures using the glass substrates. The obtained films were revealed to be a pure cubic phase PbSe, as confirmed by X-ray diffraction analysis. SEM and TEM micrographs demonstrated three-dimensionally grown interlocked or aggregated nanocubes of the obtained PbSe. Characteristic dielectric measurements and the impedance spectroscopy analysis at room temperature were executed to evaluate PbSe properties over the frequency range of 100 Hz–5 MHz. The dielectric constant and dielectric loss gave similar trends, along with altering frequency, which was well explained by the Koops theory and Maxwell–Wagner theory. The effective short-range translational carrier hopping gave rise to an overdue remarkable increase in ac conductivity (σac) on the frequency increase. Fitting of a complex impedance plot was carried out with an equivalent circuit model (Rg Cg) (Rgb Qgb Cgb), which proved that grains, as well as grain boundaries, are responsible for the relaxation processes. The asymmetric depressed semicircle with the center lower to the impedance real axis provided a clear explanation of non-Debye dielectric behavior

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Demographic variation and risk factors regarding breast cancer among female in Southern Punjab, Pakistan

Objective: Breast cancer is a second major cause of female death worldwide. This study aimed to explore epidemiology, clinical profiles and contribution of reproductive and non-reproductive risk factors in breast cancer development among females from South Punjab, Pakistan. Methods: Data was collected through hospitals between October 2017 and March 2018 and study got approval by Bioethical Committee of Quaid-i-Azam University in September, 2017. A total of 163 cases and 163 age-matched controls were recruited through non-probability consecutive sampling method. All histologically confirmed patients irrespective of age, family history, clinical presentation and histopathological type were included in the study as cases. Patients, who were not willing to participate were excluded from the study. Details regarding socio-demographic characteristics, family history of cancer, reproductive health and lifestyle factors were recorded using a structured questionnaire. Conditional logistic regression was performed to calculate odds ratios at 95% confidence intervals for breast cancer by menstrual and reproductive factors after adjustment of potential confounders. Conditional logistic regression was also applied for various demographic and medical risk factors/exposures. Results: We found positive family history and hypertension significantly linked to an increased breast cancer risk (adjusted O.R >1.5, 95% CI, P<0.05) whereas, intense physical activity, increased anthropometric measurements and breastfeeding per child in months were inversely associated with breast cancer risk (adjusted O.R <1.0, 95% CI, P<0.05) in our study cohort. Conclusion: Our study reaffirms contribution of established risk factors for breast cancer, highlights protective factors and necessitates awareness/screening programs to reduce breast cancer burden in upcoming generations. Continuous..

Frequency of different clinical presentations/ symptoms of irritable bowel syndrome in patients presenting to the outpatient department of lady reading hospital Peshawar

In the absence of any structural aetiology, irritable bowel syndrome is a condition of gastrointestinal motility and sensation that is defined by persistent abdominal pain and irregular bowel movements. It is the communal reasons for gastroenterology consultations. Therefore, knowledge of the relative frequency of these symptoms in our population will enable healthcare practitioners to tailor their management to the symptom patterns of our population. Objective: To determine the frequency of different clinical presentations/symptoms (frequent stools, looser stools, infrequent stools, harder stools, abdominal pain) of irritable bowel syndrome in patients presenting to the outpatient department of Lady Reading Hospital, Peshawar. Place and Duration: In Gastroenterology outpatient department of Lady Reading Hospital, Peshawar for six months duration from 25th June, 2019 to 25th December, 2019. Study Design: A Cross-sectional Study. Methods: In this study a total 192 patients were observed. The patients were given a questionnaire containing questions about their clinical presentation including present and past symptoms. These questions were including details of how frequently they need to pass stools, consistency/form of stools (graded according to Bristol Stool Chart) as well as presence or absence of pain.&nbsp

Frequency of celiac disease in patient with irritable bowel syndrome

Background: One of the most prevalent functional gastrointestinal illnesses is irritable bowel syndrome (IBS), which causes a variety of gastrointestinal symptoms, including changed bowel habits and stomach pain or discomfort, without an underlying basis. Objective: To assess the frequency of celiac disease in patient with irritable bowel syndrome. Methodology: This cross sectional study was carried out at the department of gastroenterology, Lady Reading Hospital Peshawar. The duration of study was two years from January 2018 to December 2019.&nbsp; The serological tests for celiac disease like IgA anti TTG and IgG anti TTG was determined.&nbsp; Biopsies were taken on upper gastrointestinal endoscopy. Data was collected in a specialized proforma for our research. All the data collected was analyzed by employing IBM SPSS version 23. Results: In our study, a total of 240 patients with irritable bowel syndrome were enrolled. Gender wise distribution shows that there were 132 (55%) male patients while the female patients were 108 (45%). The mean age of patients (SD) was 26.72 (± 2.27) years. The frequency of celiac disease based on serological testing was 20 (8.33%). The frequency of celiac disease based on histological findings was 15 (6.25%).&nbsp

Outcome of patients with primary sclerosing cholangitis and ulcerative colitis undergoing colectomy

Background and Aim: Patients with ulcerative colitis (UC) are at risk of developing primary sclerosing cholangitis (PSC). As a form of continence preservation, ileal pouch-anal anastomosis or ileorectal anastomosis are used for patients undergoing colectomy. The present study aimed to determine the patient outcomes following colectomy for primary sclerosing cholangitis and ulcerative colitis. Patients and Methods: 64 patients with PSC and UC undergoing colectomy were enrolled and investigated in the Department of Gastroenterology, Lady Reading Hospital, Peshawar from January 2018 to June 2020. Study protocol was approved by the institutional research and ethical committee. Patient’s data regarding clinical information, preoperative liver tests, colectomy date, pathological findings, and follow-up liver tests were reviewed from medical records. The colectomy-leading indications such as colonic dysplasia, bowel perforation, and colonic inflammation etc. were recorded. Several preoperative tests were conducted, including total bilirubin, albumin levels, direct bilirubin and ALP. SPSS version 26 was used for data analysis.&nbsp;&nbsp;Results: The overall mean age was 40.42±3.6 years. Of the total 64 patients, there were 42 (65.6%) male and 22 (34.4%) females. Colectomy was most commonly indicated by severe intestinal inflammation (52%), bowel perforations (4%), and dysplastic colons (38%). The incidence of postoperative complications were 43.8% (n=28)

Impedance Spectroscopy Analysis of PbSe Nanostructures Deposited by Aerosol Assisted Chemical Vapor Deposition Approach

This research endeavor aimed to synthesize the lead (II) diphenyldiselenophosphinate complex and its use to obtain lead selenide nanostructured depositions and further the impedance spectroscopic analysis of these obtained PbSe nanostructures, to determine their roles in the electronics industry. The aerosol-assisted chemical vapor deposition technique was used to provide lead selenide deposition by decomposition of the complex at different temperatures using the glass substrates. The obtained films were revealed to be a pure cubic phase PbSe, as confirmed by X-ray diffraction analysis. SEM and TEM micrographs demonstrated three-dimensionally grown interlocked or aggregated nanocubes of the obtained PbSe. Characteristic dielectric measurements and the impedance spectroscopy analysis at room temperature were executed to evaluate PbSe properties over the frequency range of 100 Hz–5 MHz. The dielectric constant and dielectric loss gave similar trends, along with altering frequency, which was well explained by the Koops theory and Maxwell–Wagner theory. The effective short-range translational carrier hopping gave rise to an overdue remarkable increase in ac conductivity (σac) on the frequency increase. Fitting of a complex impedance plot was carried out with an equivalent circuit model (Rg Cg) (Rgb Qgb Cgb), which proved that grains, as well as grain boundaries, are responsible for the relaxation processes. The asymmetric depressed semicircle with the center lower to the impedance real axis provided a clear explanation of non-Debye dielectric behavior

Sexual and reproductive health and rights of refugee and migrant women: gynecologists\u27 and obstetricians\u27 responsibilities

Ensuring universal access to sexual and reproductive healthcare services is Target 3.7 of the United Nations Sustainable Development Goals (SDG). Refugee and migrant women and children are at particular risk of being forgotten in the global momentum to achieve this target. In this article we discuss the violations of sexual and reproductive health and rights (SRHR) of particular relevance to the refugee and migrant reality. We give context-specific examples of denial of health services to vulnerable groups; lack of dignity as a barrier to care; the vulnerability of adolescents; child marriage; weaponized rape; gender-based violence; and sexual trafficking. We discuss rights frameworks and models that are being used in response to these situations, as well as what remains to be done. Specifically, we call for obstetricians and gynecologists to act as individual providers and through their FIGO member societies to protect women\u27s health and rights in these exposed settings