Exploring midwives’ challenges and strategies to provide care in maternity settings during the harsh winter weather in the northern areas of Pakistan: A qualitative study

Background: Midwives play a vital role in enhancing the quality of care and achieving substantial reductions in maternal and newborn mortality rates. However, in Gilgit Baltistan, the harsh winter weather and frequent heavy snowfall present distinct challenges for midwives providing essential maternal care. These challenges can lead to an increased risk of maternal infections and newborn hypothermia. Consequently, the limited accessibility to healthcare facilities due to frequent harsh winter weather and the resulting scarcity of resources like heating, electricity, and water exacerbate the situation.Objective: The study aims to explore the challenges and barriers midwives face in maternity settings and the strategies they use to overcome those challenges during winter weather in the Northern Areas of Pakistan.Methodology: The qualitative exploratory design was used in this study. A total of 9 midwives were purposely selected. Data were collected using individual semi-structured interviews and analyzed through qualitative content analysis.Results: Five main themes emerged from the data analysis. These themes included; 1) Harsh Winters: Hindrances & Adversities. 2) Indigenous Strategies for Warmth and Wellness. 3) Coldness Jeopardizing Midwives Well\u27 Being. 4) Midwives\u27 Resilience and Struggles: Harsh Winters. 5) Future Directions for Advancement.Conclusion: Midwives experience numerous challenges in delivering maternal care, especially in remote areas with harsh winter conditions. Effectively addressing these challenges demands a comprehensive approach. This approach should include providing adequate resources and infrastructure improvements, including the prevention and management of hypothermia, the implementation of telemedicine services, the availability of dedicated emergency transport services, the establishment of maternity health centers in each remote area, and specialized training for midwives to enhance their capacity to handle winter emergencies, including cases of hypothermia

Exploring midwives\u27 challenges and strategies to provide care in maternity settings during harsh winter weather in northern areas, Pakistan: A qualitative study protocol

Background: Midwives play a vital role in enhancing the quality of care and achieving substantial reductions in maternal and newborn mortality rates. However, in the context of Gilgit Baltistan, the harsh winter weather, and frequent heavy snowfall present distinct challenges for midwives providing essential maternal care. These challenges can lead to an increased risk of maternal infections and newborn hypothermia. Consequently, the limited accessibility to healthcare facilities due to frequent harsh winter weather, and resulting scarcity of resources like heating, electricity, and water further exacerbates the situation.Objective: The objective of the study is to explore the challenges and barriers that midwives face in maternity settings and the strategies they use to overcome those challenges during winter weather in Northern Areas of Pakistan.Methodology: The qualitative exploratory design will be used in this study. Where approximately 11 midwives will be recruited using purposive sampling technique. Interviews will be conducted by using a semi-structured interview guide. Data will be analyzed by using Creswell content analysis approach

Tuberculous and cryptococcal meningitis in a setting with high TB and low HIV prevalence

OBJECTIVE: To compare the differences in presentation and outcome of patients with tuberculous meningitis (TBM) and cryptococcal meningitis (CCM). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from December 1995 to December 2005. METHODOLOGY: Patients with a confirmed diagnosis of TBM or CCM were included in this study. The signs and symptoms, laboratory findings and other variables of patients were entered and analyzed by Statistical Package for Social Sciences (SPSS) Software version 14. RESULTS: We compared 16 patients of TBM with 11 of CCM. None of the patients with TBM were Human Immunodeficiency Virus (HIV) positive while 4 patients with CCM had HIV. The common initial signs and symptoms in patients with TBM were fever, altered mental status and headache; and in patients with CCM were fever, headache and cough. The mean CSF glucose level decreased according to the Medical Research Council (MRC) stage in TBM. The mean CSF RBCs, WBCs, glucose and protein in TBM were 2010/mm3, 228/mm3, 52.32 mg/dL and 289.48 mg/dl respectively and in CCM were 178.54/mm3, 529.54/mm3, 32.63 mg/dL and 432.18 mg/dL respectively. CONCLUSION: TBM and CCM should be suspected in all cases that present with symptoms of chronic meningitis. Patients with TBM are more likely to have altered mental status and higher CSF RBCs; those with CCM are more likely to have headache, cough and higher CSF WBCs

Association of CYP2C19*2 and *17 genetic variants with hypertension in Pakistani population

Purpose: To investigate the association of *2 and *17 single nucleotide polymorphisms (SNPs) of CYP2C19 gene with hypertension in Pakistani population. Methods: The study was conducted on 527 hypertensive patients and 530 unrelated healthy controls from selected regions of Pakistan. DNA was extracted from leukocytes and all patients and controls were genotyped for two SNPs (rs4244285 and rs12248560) of CYP2C19 gene by allele specific polymerase chain reaction (AS-PCR). Results: Multi-allelic polymorphism in CYP2C19 identified four distinct phenotypes known as ultra-rapid metabolizer (UM), extensive metabolizer (EM), intermediate metabolizer (IM) and poor metabolizer (PM) in hypertensive patients and controls. For CYP2C19*2 polymorphisms, overall wild type and mutant allele frequency were 75 and 25 % in hypertensive patients, and 64.2 and 35.8 % in controls. For CYP2C19*17 polymorphisms, the overall wild type and mutant allele frequency were 66.6 and 33.4 % in hypertensive patients and 75.6 % and 24.4 % in controls. Significant difference in allele frequencies for CYP2C19*2 and *17 was demonstrated between hypertensive and non-hypertensive subjects. Conclusion: To the best of our knowledge, this is the first report on CYP2C19 frequencies in hypertensive Pakistani patients. The finds should help clinicians to determine a suitable optimal dosage of some drugs in order to reduce side effects

Needs assessment for faculty development in health professions education at a medical university in Karachi, Pakistan

Faculty Development (FD) embraces all educational activities used by teachers to improve their knowledge and skills for enhancing their academic competencies. This study aimed to identify the areas in Health Professions Education (HPE) in which formal faculty development is required. A needs assessment survey was conducted from among the faculty members at the Aga Khan University (AKU), Karachi, Pakistan, and the French Medical Institute for Mother and Children, Afghanistan. Data was analysed using SPSS 20.0 and reported frequencies and percentages according to various academic tracks. Competency-based curricula (51%), providing effective feedback (51%), developing Objective Structured Clinical Exam (51%), and clinical supervision (48%) were identified as significant areas for faculty development. Faculty in clinician teacher and clinician educator track require advanced training, i.e., Masters and PhD in HPE. The needs assessment facilitated prioritising the areas for FD. This will contribute to enhancing academic practices and inculcating the culture of lifelong learnin

The availability of some of the Professional criteria of “Level One” Teachers' performance in Basic Teaching are available- Afield Study from the Schools' Managers point of view in Lattakia Governate

  This research aims to identify to what extent some of the Professional criteria of “Third Grade” Teachers' performance in Basic Teaching are available from the Schools' managers point of view in Lattakia Governate. To achieve this research, used the descriptive analytical approach, A sample  was included (64) managers of Basic Teaching Schools in Lattakia Governorate for the academic year 2017/2018. A questionnaire was designed for Professional Standards, it contained five basic Standards which are: (preparation of lesson plans which are necessary to the learning process, the ability of educational knowledge in teacher's specialization field, showing the distinct educational culture at teacher, the teacher's used methods in Evaluation, classroom management), which composed of (55) Performance indicators. The research ended up with the following results: - The extent of availability some Professional criteria “Third Grade” Teachers' performance from the View of Schools' managers in Lattakia Governorate was middle degree. - No statistically significant differences between the averages of the Schools' managers about the extent of availability some Professional criteria “Third Grade” Teachers' performance from the View of Schools' managers according to the variables (kind, years of experience), while statistically significant differences according to the variable scientific qualification in favor of postgraduate students (Master, Doctorate). The research  had some suggestions,  training course for Basic Teaching before joining in Teaching profession

Frequency and associated factors for anxiety and depression in pregnant women: a hospital-based cross-sectional study.

Antepartum anxiety and/or depression is a major public health problem globally. The aim of this study was to estimate the frequency of antepartum anxiety and/or depression among pregnant women. This was a cross-sectional study conducted in a tertiary care hospital among pregnant women. A total of 165 pregnant women were interviewed by a clinical psychologist using HADS for assessing anxiety and/or depression and also collected information regarding sociodemographic, obstetric, family relationships, and home environment. Out of the total of 165 pregnant women about 70 percent of them were either anxious and/or depressed. The increasing age of women (P-value = 0.073), not having any live birth (P-value = 0.036), adverse pregnancy outcome in past including death of a child, stillbirth or abortion (P-value = 0.013), participant\u27s role in household decision making (P-value = 0.013), and domestic violence (verbal or physical abuse towards mother or children by any family member) (P-value = 0.123). Our study highlights that anxiety and/or depression is quite common among pregnant women. Therefore, there is a need to incorporate screening for anxiety and depression in the existing antenatal programs and development of strategies to provide practical support to those identified

Virtual Reality in Neurosurgery- A Neurostimulator – Based Postgraduate Residency Training: A Novel Step Towards Skillful Young Neurosurgeons

Introduction/Objective:  Virtual Reality (VR) is the need of time in every field of life. Recent biotechnological advances have molded the surgeon-computer relationship. Department of Neurosurgery Jinnah Hospital Lahore has updated the postgraduate training program by adding the virtual reality simulator. We aim to explore the current and future roles and applications of VR and simulation in neurosurgical training that may reduce the learning curve, improve conceptual understanding and enhance visuospatial skills. Materials & Methods:  Eight residents were enrolled in this program. They exercised the basic skills of neurosurgery e.g. suction, use of bipolar cautery, handling of CUSA, use of micro scissors, etc., and the automated software recorded each participant’s graph of performance separately. After 1.5 years, they were assessed in real-time on actual patients under the direct supervision of a qualified neurosurgeon. The assessment was done on DOPS (Directly Observed Procedural Skills) Performa. Results:  The results showed that there was a gradual upward learning curve in simulator-based procedures from negative marking to 70% in basic surgical skills and 60% in advanced procedures on average for all the residents whereas the DOPS showed that all residents performed above expectation i.e., 4 or above. Conclusion:  Neurostimulator-based postgraduate training program is opening new horizons for the safe and skillful training of residents. With the advancement of artificial intelligence, its use in training programs will lead to structured and systematic training patterns in the world of neurosurgery

ASSESSMENT OF ADVERSE DRUG REACTIONS ON CARDIOVASCULAR DRUGS IN HOSPITALIZED PATIENTS OF A TERTIARY CARE HOSPITAL – A PROSPECTIVE ANALYSIS

Objective: The present study was taken up to assess the adverse drug reactions (ADRs) based on the spontaneous reactions among the inpatients who were hospitalized for the treatment of cardiac ailments. Methods: A prospective and observational study was done in the department of cardiology for a period of 6 months. Patients on cardiac drug therapy were evaluated to detect unwanted effects and were given treatment for the developed complications. The ADRs were identified, followed up, and documented. Results: In the present study, 255 inpatients were assessed to pinpoint the negative effects and about 80 (n=80) sufferers were recognized with 28 types of ADRs. The highest percentage of ADRs was in adults of age group 60–70 years. Type A accounted for most of the reports which was based on severity. The number of ADRs in heart muscle disorders was found to be 44% (n=35) followed by coronary artery disease 40% (n=32), then heart valve disorders and patients underwent surgery were affiliated to 8% (n=6) each. The highest number of ADRs was reported in patients suffered from disorders pertained to heart muscle. Majority of ADRs were rated as possible, preventable, and moderate according to causality, preventability, and severity parameters, respectively. The data were tabulated, analyzed, and subjected to statistics using Graph Pad Prism 8. Conclusion: It was concluded that proper management and monitoring of drug therapy are the key to prevent ADRs