Foeto-Maternal Outcome in Women with Placenta Praevia and Morbidly Adherent Placenta Praevia

Objective: To determine the maternal and foetal outcome in pregnant women with placenta praevia and morbidly adherent placenta praevia Methodology: A prospective case series was carried out in a tertiary care institution between 2019 and 2021. All pregnant women with placenta praevia and placenta accreta spectrum who were over 28 weeks gestation were included, regardless of whether they received their diagnoses during pregnancy or during surgery. Data was collected on structured proforma regarding demographic characteristics, obstetric factors, management options, and intraoperative complications to determine foeto-maternal outcome in women with placenta praevia and morbidly adherent placenta praevia. Results: Total number of patients with placenta praevia was 140; out of which 31 (22.1%) had placenta accreta spectrum. All cases of morbid adherence were found in major degree placenta praevia (p= 0.00). Antepartum haemorrhage in current pregnancy was more associated with placenta praevia as compared to morbidly adherent placenta praevia (p=0.00). Both placenta praevia with and without morbid adherence led to preterm birth (p=0.00). LSCS as mode of delivery in previous pregnancy, step-wise-devascularization, caesarean hysterectomies, bladder injury, blood loss more than 1000ml, number of blood transfusions, and mothers required ICU care were significantly associated (p≤0.05) with morbidly adherent placenta praevia as compare to placenta praevia without morbid adherence. In cases of placenta accreta spectrum; 11(33.3%) babies were admitted in NICU as compare to 29(25.9%) in placenta praevia without placenta accreta spectrum. Conclusion: Placenta praevia is adversely affected by placenta accreta spectrum is associated with higher foeto-maternal morbidity as compared to placenta praevia without adherence

House Officers’ Perspective of Leadership in Undergraduate Curriculum: A Qualitative Study

Objective: To explore the house officers’ perspective about leadership skills and their development during undergraduate training. Methodology: This qualitative study was conducted in September 2019. Two audio-recorded focus groups discussions were conducted with house officers; each comprised of six participants. Purposeful maximum variation sampling was used with equal coverage of gender including low and high scorers based on their academic records. Open-ended questions were asked with short follow-up questions. Verbatim transcription of the entire discussion was done, followed by content analysis. The findings were described using quotes, and illustrations. Member checking and triangulation with the frequency of quotes was used for validation. Results: Leadership skills identified by the study participants were the same as priori themes given in “NHS-Medical Leadership Competency Framework” namely “demonstrating personal qualities” 47 (38.84%) (Self-management, self-awareness, acting with integrity), working with others 37 (30.58%) (Communication skills, teamwork), improving services 16(13.22%) (Empathy, ensuring patient safety), management skills 12(9.92%) (Time management, resource management, managing critical situations) and setting direction 9 (7.44%) (Setting and achieving targets, decision making). The process of leadership development was explored in three dimensions i.e. contributing factors, potential obstacles, and suggested improvements to enhance leadership skills. The most common theme in all these domains was faculty-related followed by environment-related and student-related factors.  Conclusion: “Faculty-related factors” was the most emerging theme in contributing factors, potential obstacles as well as in suggested improvements for leadership development

Awareness about breastfeeding practices among pregnant and postnatal women during COVID-19 pandemic

Objective: To determine the awareness of breast feeding practices among pregnant, and postnatal women during COVID-19 pandemic and its association with education, occupation, parity, and monthly income. Methodology: The study was conducted at Sharif Medical City Hospital from June to August 2020.Data was collected on a structured proforma in Urdu language. Purposive sampling technique was used. Level of awareness was categorized as poor, average and good based on percentage of correct answers as ≤33%, 34-66%, and 67-100% respectively. Quantitative and qualitative study variables were analyzed by mean and percent respectively using SPSS 23. Chi square was used to determine significance of association. Results: Total number of patients were four hundred. Their mean age was 27.57±3.96 years and mean parity was 2.14±1.22. Most of the study participants were multipara in 225 (56.3%) cases, and house wives in 386(96.5%) cases. Only 28 (7.0%) were illiterate while 372 (93%) have varying degree of education. Level of awareness about breast feeding was good in 133 (33.3%), average and poor in 123(30.8%), and 144(36%) respectively. However only 21% women were aware of the fact that a mother infected with COVID-19 can feed their baby taking care of respiratory, and hand hygiene. Only 35% study participants had knowledge that in case a mother is severely ill with COVID-infection; breast milk can be extracted while taking precautionary measures. Similarly 77.5% mother think that a mother infected with COVID-19 cannot keep her baby with her taking precautionary measures. Education status is significantly associated with awareness regarding breast feeding practices Conclusion: The awareness peculiar to COVID-19 breast feeding practices was low, and significantly associated with education level of women

COVID-19 Pandemic: Psychological Impact on Postgraduate Gynae Residents in Pakistan

Objectives: To determine the frequency, and severity of depression, anxiety, and stress among postgraduate gynae residents during COVID-19 pandemic and its associated factors.Methodology: It was a web based cross sectional survey conducted from July 2020 to August 2020. A structured google proforma comprised of a brief introduction of the study followed by the consent of participants, characteristics of study participants, and depression, anxiety, stress scale (DASS-21) was used. All the postgraduate gynae trainees working in different tertiary care hospitals of the country who submitted their response were included. Data was analyzed using SPSS 23.Results: Total numbers of respondents were 268. Their mean age was 29.10±2.62 years. Most of them were female trainees i.e., 264(98.5%) while 4 (01.5%) were male. Hundred thirteen (42.2%) were unmarried, 152(56.7%) were married and 03(01.1) were divorced. Most of the respondents were fourth year trainees i.e., 98(36.6%), followed by 2nd year, first year, and 3rd year 76(28.3, 49(18.3), 45(16.8) respectively. Out of 268, the study participants or their family members who got infected with COVID-19 were 132 (49.3%). Mean DASS score for depression, anxiety, and stress were, 6.17±3.30, 5.80±3.40, and 7.34±3.12 respectively. The frequency of the study participants who have depression, anxiety and stress during COVID-19 pandemic were 177 (66.8%), 198 (71.6%), and 150 (56%) respectively.Conclusion: Significant number of post-graduate gynae trainees have varying degree of depression, anxiety, and stress ranging from mild, moderate, severe and very severe according to DASS-21 scal

Economic Impact Assessment of Brackish Groundwater in Kirana Hills Region, District Chiniot, Pakistan¤

Good quality water is the basic need of every citizen. Contaminated water not only affects our health but also damages household items such as sanitary materials. The purpose of this study is to assess the economic impact of high Total Dissolved Solids (TDS) groundwater in Kirana hills region of district Chiniot. In order to evaluate the economic impact in areas of different TDS levels of water, a survey was conducted. The survey form comprised fifteen questions related to health impact, laundry, cooking and sanitary issues. Results of data collected from the respondents of very hard water area indicated that the water causes digestive, skin and hair related diseases. According to the survey, in very hard water areas, washing clothes with groundwater makes them look rough, dull or stained. However, people living in hard water areas responded that the water is relatively better for laundry. Overall residents of very hard water area and hard water area bear costs of rupees 73,850 and 16,200 per five years respectively. By provision of good quality water and taking measures to clean the groundwater, problems can be resolved as the quality of water is positively correlated with the quality of our lives. A collective effort by government and society can minimize the loss by installing appropriate filtration techniques

Mapping Flood Risk Assessment by Remote Sensing in District Chiniot, Pakistan

A flood is a catastrophic event of natural origin which involves exposure of human population, infrastructure, and resources. Heavy rainfall in river catchments, snow melting in monsoon season, inadequate drainage networks, water overflowing from the main drainage channels, conversion of natural vegetation, agricultural land, and wetlands due to urbanization are the core reasons of floods. Whereas, climate change has made the condition worse and increases the frequency of the floods. Asia consists approximately one-fifth of the earth's land area with half of the world's population living in this continent. As natural disasters increased around the world, Asian countries also continued to experience hazard events especially from 1994 to 2004, when nearly 60,000 people were killed in floods (Arambepola, 2009)

Analysis of Bacterial Load in Pre and Post-Filtered Drinking Water at the Educational Institutions of Rabwah, District Chiniot, Pakistan

Water-borne diseases mainly are due to bacterial contamination which mostly cause mortality among children of developing countries. The main objective of the study was to evaluate the bacterial load in the drinking water of educational institutions in Rabwah, district Chiniot and to evaluate different filters to provide clean drinking water. Samples were collected on a monthly basis for continuous 12 months (April 2016 – March 2017) from 15 educational institutions before and after the filtration process to check the effectiveness of the installed filters.Each sample was processed for the analysis of total bacterial load, the detection of Gram-ve bacteria as well as E.coliby plate detection method. Confirmatory biochemical tests were performed for the detection of E.coli. Results showed that pre-filtered samples were relatively more contaminated with bacteria than the post-filtered ones. The frequency of occurrence of bacterial load decreases in post-filtered samples, yet it is not always zero. This may be due to inappropriately installed filters. Different types of cleaning and filtering techniques such as ozone, chlorination and UV radiations were tested to remove bacterial contamination. The recommended amount of chlorination and passing of ozone for 15 minutes successfully eradicatedmicrobiological contamination in drinking water. The effectiveness of UV radiationin killing pathogens depends upon the amount of bacterial load in the water and exposure time of the UV radiation. Less exposure time of the UV radiations could not successfully remove the bacterial contamination. Therefore, UV radiation filter may not be effective at public places such as schools, where drinking water is extensively used and exposure time is not sufficient

Appraisement of the Pernicious Status of Drinking Water Exposed to Precambrian Rocks of Chenab Nagar Area, Punjab, Pakistan

Natural and anthropogenic indulgence in the form of industrialization, urban sprawl, and population increase deplete the water resources that entails immediate consideration. So, contemplating this need for eco-rehabilitation, drinking water quality predicted in contemporary research for surface and groundwater in proximity of Precambrian rocks (Chenab Nagar, Punjab) revealed poor water quality status. Physical parameters (EC, TDS, and temperature), chemical (pH, carbonates, bicarbonates, chlorides, and heavy metals) and microbiological (total coliforms, fecal coliforms, and the absence or occurrence of E. coli) distinctiveness of water were determined in forty-two samples, collected from study area. The mean values of pH, EC, TDS, carbonates, bicarbonates, chlorides, and temperature for water samples fluctuated discretely in all months. Likewise, heavy metals depicted an increasing trend as the concentration of cadmium and lead was high among all analyzed metals. Microbiological study shows that large number of the samples had elevated concentration of fecal coliforms and E. coli bacteria thus making water harmful for human consumption

Heavy Metal Concentration in Groundwater of Kirana Hill Region, Rabwah, District Chiniot, Pakistan

The present study has been undertaken with an objective to evaluate the heavy metals concentration in groundwater of Rabwah town, Pakistan. The area is highly depending on groundwater sources for drinking purpose. Detailed analysis was carried out to understand the contamination level and distribution of heavy metals specifically lead, cadmium, zinc, nickel and transitional metal iron in drinking water during winter and summer. Twenty five surveyed private well sites located in Precambrian Kirana hills region were tested to map the groundwater quality and assess its suitability for drinking purpose. Detected amount of lead, cadmium and nickel were found higher than World Health Organization Standard maximum permissible limits, whereas the Ni levels were observed lower than the acceptable limit in some of the samples in summer. Generally, the mean metal concentration in sampled water sources have a descending order Ni>Pb>Cd>Zn>Cr in winter while Ni>Zn>Pb>Cr>Cd> Fe in summer. Water samples were highly enriched with Ni and Cr during summer and by Pb, Cd and Zn in winter. The quality of the drinking groundwater sources was observed unsafe for drinking; moreover, there is still need to take proactive measures to check the levels of heavy metals. The spatial analysis and distribution of groundwater quality in Rabwah town will make it easier for authorities and decision makers to determine the groundwater quality and recommend most suitable location for boring wells in future