Suicide in the Australian Mining Industry: Assessment of Rates among Male Workers Using 19 Years of Coronial Data

Background@#International evidence shows that mining workers are at greater risk of suicide than other workers; however, it is not known whether this applies to the Australian mining sector. @*Methods@#Using data from the National Coronial Information System, rates of suicide among male mining workers were compared to those of three comparators: construction workers, mining and construction workers combined, and all other workers. Age-standardized suicide rates were calculated for 2001–2019 and across three intervals ‘2001–2006’, ‘2007–2011’, and ‘2012–2019’. Incidence rate ratios for suicide were calculated to compare incidence rates for mining workers, to those of the three comparative groups. @*Results@#The suicide rate for male mining workers in Australia was estimated to be between 11 and 25 per 100,000 (likely closer to 25 per 100,000) over the period of 2001–2019. There was also evidence that the suicide rate among mining workers is increasing, and the suicide rate among mining workers for the period 2012–2019 was significantly higher than the other worker group. @*Conclusions@#Based on available data, we tentatively deduce that suicide mortality among male mining workers is of concern. More information is needed on both industry and occupation of suicide decedents in order to better assess whether, and the extent to which, mining workers (and other industries and occupations) are at increased risk of suicide.

Critical Analysis of Serum Visfatin Levels in Obese and Non-Obese Primary Hypertensive Subjects

The purpose of this study was to look at the serum levels of Visfatinin non-obese ordinary circulatory strain, non-obese hypertension and obesity hypertension. Research plan was Comparative cross sectional study. The Place and span was collaborating with the Institute of Medical Science in Lahore at the Graduate School of Medicine Laboratory of Lahore. This research included 81 subjects, each separated into 3 gatherings: non-obese normotensive, non-obese hypertensive and obesity hypertension. Circulatory strain level, BMI (Body Mass Index) and WHR (Waist to Hip Ratio) were estimated. Fasting blood tests were gathered to evaluate Visfatin levels in the serum. The results showed that the Mean serum Visfatin levels of 70.97 ± 50.30 ng/ml were seen in obese hypertensive patients contrasted with 33.71 ± 10.66 ng/ml and 5.21 ± 3.57 ng/ml for non-obese hypertensive and non-obese ordinary circulatory strain. It is concluded that Serum Visfatin levels can be utilized as biomarkers for assessing hypertension in obese and non-obese patients.

Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.

Antibacterial potential of indigenous medicinal plants against methicillin-resistant Staphylococcus aureus isolated from septic wounds

Aims@#This study was aimed to screen indigenous medicinal plants for their antibacterial potential against methicillin-resistant Staphylococcus aureus (MRSA).@*Methodology and results@#Three indigenous plants (Nigella sativa, Zingiber officinale and Calotropis procera) and thymoquinone were screened for antibacterial activity against MRSA, isolated from septic wounds of patients admitted to Mayo Hospital Lahore, Pakistan. Isolated bacteria were screened for methicillin and cefoxitin resistance by the Kirby-Bauer method, followed by mecA gene-specific polymerase chain reaction (PCR). Confirmed MRSA was processed for antibacterial activity of plant extracts and thymoquinone followed by cytotoxicity assay of plant extract having least minimum inhibitory concentration (MIC) value. Out of total samples (n=100), S. aureus (29%), MRSA (26%) and vancomycin-resistant S. aureus (VRSA) (21.7%) isolates were recovered based on morphology, biochemical profile and antibiotic susceptibility testing. Nigella sativa showed the highest antibacterial activity (10.06 ± 6.53 mm) against MRSA followed by Z. officinale (4.06 ± 3.72 mm) and C. procera (3.65 ± 3.33 mm) in comparison to standard thymoquinone (17.93 ± 10.14 mm). The least MIC value recorded was for Z. officinale at 36.89 ± 3.75 μg/mL. Zingiber officinale was the most effective antibacterial agent, followed by N. sativa and C. procera and non-toxic for eukaryotic cells at all tested concentrations (1500 μg/mL to 2.92 μg/mL).@*Conclusion, significance and impact of study@#It was concluded that Z. officinale may be used as an effective alternative for treating septic wound infection in local or topical preparations. As pathogenic S. aureus is becoming life-threatening among antibiotic-resistant bacteria and traditional plants are in used for centuries to treat septic wound infections.

Oral versus intravenous maternal hydration in isolated third trimester oligohydramnios

Background: To study the effect of oral and intravenous maternal hydration in patients with isolated oligohydramnios in terms of mean change in amniotic fluid.Methods: A total number of 38 patients included in the study which fulfill the selection criteria.  Patients were randomly divided in two groups. Amniotic fluid index (AFI) of all patients was measured before the hydration therapy according to the method of Phelan et al.  In maternal oral hydration (Group A), every patient was instructed to drink two liters of water over two hours daily for 1 week. In intravenous hydration (Group B), every woman infused two liters of 0.9% normal saline in two hour daily for 1 week. After 48 hours and 1 week of oral and intravenous hydration, the AFI was reassessed by the same observer. Patients were monitored closely for sign and symptoms of fluid overload. Data was stratified for mean difference in improvement in amniotic fluid index.Results: After oral hydration therapy AFI was 5.926±0.4593 after 48 hours and 8.286±0.6000 after 7 days in Group A. In Group B AFI was 5.784±0.4622 after 48 hours and 7.868±0.2810 after 7 days of intravenous hydration. P value after 48 hours is 0.348 and p=0.014 after 7 days means oral hydration therapy significantly increase amniotic fluid index.Conclusions: Oral maternal hydration significantly increase the amniotic fluid index in patients with isolated oligohydramnios. It is simple, safe and non-invasive method.

Application of Total Quality Management to Ensure Food Quality in Food Industry

Total Quality Management (TQM) is a managerial and managemental approach of an organization focused on quality, based on participation of all of its members and while aiming at long term benefits to the organization and consumers health. It is focused on continuous improvement of all processes approached with combined fundamental management techniques and specialized tools under quality systems. TQM is a process of managing the whole organization so that it progress in all the dimensions of products and services that are important to the consumers. It roots from the belief that mistake can be avoided or mininimised and defects can be prevented, with sole objective being the continuous process improvement. The introduction of Hazard Analysis Critical Control Point (HACCP) has signaled a shift in emphasis from resource intensive end product inspection and testing to preventive control of hazards at all the stages of food supply chain. It also identifies and controls hazards that are fundamentals for food safety. The integrated approach to implementation of ISO standards and HACCP concept is vital for management of quality and safety of dairy products hence safeguarding the customer’s requirements, ensuring that certified products conform to minimum standards set internationally. These standards ensure and enhance transparency in the development of food quality and safety procedures, thus helping to upgrade and update food safety systems. ISO laid down guidelines, codes, specifications and requirements to evolve effective TQM system.

King Vision Videolaryngoscopy Versus Direct Laryngoscopy in Patients Requiring Endotracheal Intubation for General Anaesthesia: A Comparative Study

With new advances in technology, intubation using video laryngoscopy has been gaining popularity, particularlyin patients with difficult airways or as rescue devices in failed intubation attempts. This study was done tocompare the effectiveness of King Vision video laryngoscope (KVL) and Macintosh laryngoscope whenperforming tracheal intubation under general anesthesia Eighty patients requiring endotracheal intubationduring general anaesthesia were randomly assigned into two groups to undergo tracheal intubation usingeither a King Vision video laryngoscope (n=40) or Macintosh laryngoscope (n=40). The primary outcomeswere the time of intubation and Cormack-Lehane grading and secondary outcomes were number of attemptsand optimisation manoeuvres required and complications related to laryngoscopy and intubation. King Visionvideo laryngoscope was found to be significantly better than the Macintosh laryngoscope in terms of Cormackand Lehane grading, requirement of optimisation manoeuvres and need of second attempt for intubationexcept time of intubation which was comparable between the two groups.

Psychological complications of polycystic ovarian syndrome and women’s health

Background: Polycystic Ovarian Syndrome (PCOS) affects approximately 5-10% females of reproductive age worldwide. Recent research shows that this syndrome is associated with psychological upset and devastating effects on women′s mental health and wellbeing.  Lack of clinicians′ awareness of adverse psychological effects is a major concern in developing countries to provide standard care and to improve overall health outcomes.Purpose of study was to determine the frequency of anxiety and depression among women with PCOS in order to promote awareness among clinicians about psychological complications of disease.Methods: Present study was conducted in the department of Obstetrics and Gynaecology/ University Medical and Dental College, from October 2018 to March 2019. Sixty patients with diagnosis of PCOD and sixty participants without this disease were included in the study. Participants having other endocrine or metabolic disorders were excluded from study. Hospital anxiety and depression scale was used to detect anxiety and depression among both groups. SPSS version 16 was used for data analysis. Chi- square test was applied to compare prevalence of anxiety and depression in both groups, p-value ˂0.05 was taken as statistically significant.Results: Women having PCOD exhibited statistically significant prevalence of anxiety (78.3% vs 35%) and depression (60% vs 30%) with p value of 0.0001 and 0.001 respectively.Conclusions: It is highly recommended that initial evaluation of these patients should include assessment of psychological domain of disease to provide more comprehensive treatment to improve overall health related quality of life.

The Shape, Size And Position Of Mental Foramen In Human Dried Mandible In The Kalaburagi Region

Introduction: The mental foramen is a funnel-like opening located on the anterolateral aspect of body of themandible which marks the termination of the mental canal. The orientation and position of the mental foramenis important in performing anesthetic block prior to clinical procedures in lower-anterior teeth and also topreserve the integrity of the mental nerve trunk in surgical interventions.Materials and Methods: A total of 100 adult dry human mandibles were collected from the department ofAnatomy, Khaja Banda Nawaz institute of medical sciences, Faculty of Medicine, Khaja Banda Nawaz University,Gulbarga, Karnataka. The size, shape and position of the right and left side of the mandible were recorded in mmby direct visual inspection and digital vernier calipers.Results: The parameters which were considered in the present study were size, shape and position of the mentalforamen. In the present study the common shape encountered was oval shape, and the common position wasbelow the Apex of 2nd PM which coincides with the study by AGARWAL & GUPTA.Discussion: Agarwal & Gupta et al studied on 100 mandibles in gujarat population. Mean H.D was 3.33mm onright side and 3.25mm on left side, mean V.D was 2.15mm on right side and 2.13mm on left side. The comparativestudy of the present study and the other authors is tabulated in the tables.Conclusion: The present study enlightens and assist the maxillofacial and dental surgeons about the importanceof size, shape and position of the mental foramen for nerve block. It also has impact on the studies donepreviously like Agarwal et all and others. Hence this knowledge can be used as a tool for the dental surgeons.

Epidemiology and risk factors of transfusion transmitted infections in thalassemia major: a multicenter study in Pakistan

ABSTRACT Background: Blood transfusion-transmitted infections in individuals suffering from beta-thalassemia have been reported in Pakistan, but the information on their sociodemographic and clinical determinants is lacking. This study aims to describe the prevalence, as well as the factors, contributing in blood transfusion-transmitted infections. Method: Between December 2011 and December 2013, in a non-probable sampling, 350 thalassemia patients were recruited in Lahore, Multan, Karachi and Peshawar, Pakistan. Subjects were screened for transfusion-transmitted infections. Results: A seropositive rate of 36.5% was observed; males (94, 73.4%) and females (34, 26.6%). Among several risk factors associated with transfusion-transmitted infections, province (p = 0.001), gender (p = 0.003), age (p < 0.03), education (p < 0.00), degree of consanguinity (p = 0.05), age at fetal blood test (p = 0.005), fetal hemoglobin levels (p = 0.005), death due to thalassemia (p = 0.001) and iron-related complications (p = 0.04) showed significant correlation. Participants with an age >10 years were significantly more prone to seropositivity than those aged ≤10 years. Moreover, the ferritin level was also significantly higher in those aged >10 years than in those ≤10 years. It was observed that males had a higher seroprevalence rate (94, 73.4%) than females (34, 26.6%). The most prevalent transfusion-transmitted infections was the hepatitis C virus, with 115 cases (89.8%). Conclusion: A high prevalence rate of HCV in subjects with transfusion-dependent thalassemia is linked with insufficient facilities, poor management and compromised socioeconomic status. Therefore, more multicenter studies covering cities from different regions of the country are needed in order to develop preventive measurements at the regional and national level.

Levels of Empathy among Dental Students at CMH Lahore Medical College and Institute of Dentistry (NUMS ) Lahore Pakistan

Objectives: To measure levels of empathy among undergraduate dental students in Pakistani Dentistry Institute and to find the difference with respect to gender and academic year in the dental college. Methods: This cross-sectional study was conducted at CMHLMC and IOD in Pakistan, from December 2018 to April 2019, and comprised dental students of all four years. A valid and reliable “The Toronto empathy questionnaire” was used for the collection of data. Responses were indicated on a four-point Likert scale and total scores ranged from 0-64, with higher values indicating higher levels of empathy. Eight out of sixteen items were positively worded and the remaining eight items were negatively worded. Comparison of empathy scores across the year of study was analyzed using one-way ANOVA whereas a t-test was utilized for gender differences. SPSS version 20 was used for data analysis. Results: Questionnaire was returned by 281 students, with a 94% response rate. First-year dentistry students scored the highest mean score of 3.0, followed by second and third-year students by scoring 2.8 whereas the final year students obtained the lowest mean empathy score of 2.7. When mean empathy scores were compared among students of all 4 years by ANOVA test, it was found to be statistically significant, F=3.22, p=0.02. No significant differences in empathy scores were found with respect to gender (p ≥ 0.05). Conclusion: The present study reported a decline of empathy mean scores among dentistry students as the years of study progressed. This study reflects the need for early exposure to clinical training, educational programs and innovative teaching strategies in the undergraduate dentistry curriculum by emphasizing on dentists-patient communication skills, which in turn could encourage dentistry students to become empathetic health professionals.

Actinomycotic lacrimal canaliculitis: a rare case report

Actinomyces israelii is a gram-positive anaerobic organism commonly associated with canaliculitis in adults. Actinomyces are normal commensal bacteria in humans and primarily cause opportunistic infections during immunosuppressive state or when loss of continuity of epithelial lining in mucosa occurs. Lacrimal canaliculitis is a relatively rare condition and is undiagnosed for long periods of time. Being a relatively rare condition, it is commonly overlooked and undiagnosed for long periods of time. Primary chronic canaliculitis is an uncommon problem and Actinomycosis may form in up to 2% of all lacrimal disease. Here present study reports a case of lacrimal canaliculitis caused by Actinomyces israelii.

A study on needle stick injuries among health care workers in a tertiary care hospital in India

Background: Needle stick injury among health workers is regarded as an occupational hazard. Health care workers are at risk of having blood-borne diseases in case they are exposed to blood and other biological samples of the patients. Moreover, staff including doctors working in tertiary care hospitals has high work load which results in increased chances of getting these injuries. The aim and objectives of this study were to find out the prevalence of needle stick injury among different categories of health care workers. Authors also aimed to assess the knowledge, attitude and practices associated with it.Methods: A hospital based cross sectional study design to know the prevalence of needle stick injury among various health care workers of Karpagam Faculty of Medical Sciences and Research, a tertiary level care hospital in Coimbatore, Tamilnadu, India. A total of 250 health care workers were selected for the study purpose. A self-designed, semi-structured, pre-tested questionnaire was used to assess the prevalence of needle stick injuries and the factors associated with it.Results: A majority of health care workers (94%) knew about needle stick injury and 92% were aware that HIV can be transmitted through needle stick injury, 78.4% and 69.65% were aware of Hepatitis-B and Hepatitis-C transmission respectively. About 28.4% of subjects had encountered needle stick injury in their past. Furthermore, it was found that type of exposure and place of exposure was significantly associated with different categories of health care workers (p <0.001).Conclusions: Prevention of health workers against needle stick injury is the best possible way to prevent several bloods borne diseases. There should be a prevention programme which special focus on training of health care workers. Further strategies aiming at preventive measures and reporting of the Needle stick injuries accidents should be made compulsory among health care workers.

The Spectrum of Histopathological Patterns Observed in Prostate Specimens in a Tertiary Care Hospital in Kashmir

Introduction: Prostate gland involved by a no. of benignand malignant diseases is a common cause of morbidity andmortality in the elderly men. The present study was an attemptto understand the histopathological spectrum of prostaticlesions in the specimens received by a tertiary care hospital.Material and Methods: 433 cases of prostatic specimensincluding TURP chips, TRUS guided biopsies and Prostaticspecimens received in the Department of Pathology,Government Medical College Srinagar were included in thepresent study. There were 344 needle biopsies and 82 TURPchips. All the specimens were fixed in 10% neutral bufferedformalin and thin sections were stained with Hematoxylinand Eosin stain (H&E stain). Relevant clinical data includingage, the presenting complaints and S.PSA values in suspectedcases of carcinoma prostate were recorded.Results: A total of 433 prostate specimens were receivedduring the period of three years. The specimens included 344TURP chips and 82 TRUS guided biopsies. 7 prostectomyspecimens were also included. The age of the patients variedfrom 42 years to 89 years. There were 380 benign cases and53 malignant cases. The most common presenting featurewas increased frequency of micturition followed by difficultyin starting and stopping the stream of urine. Among benignlesions the most frequent histopathological entity observedwas benign nodular hyperplasia. The most common age ofpresentation was the sixth to seventh decade of life. Almostall neoplasms of the prostate were prostatic adenocarcinomaswith most of the cases seen in the sixth to seventh decade oflife with another peak in the seventh to eight decade of life.Conclusion: A variety of benign and malignant lesions areseen in prostatic specimens. These need to be differentiatedand classified. Benign nodular hyperplasia is the mostcommon benign lesion and prostatic adenocarcinoma isthe most common malignant lesion of Prostate. Perineuralinvasion is a significant finding and guide. Serum PSA is auseful adjunct in cases where the values are higher.

Pilomatrixoma: A Clinico - Pathological Study

Introduction: Pilomatrixoma (calcifying epithelioma ofMalherbe) is a benign skin tumor with differentiation towardshair follicles. Pilomatrixoma may be mistaken for many otherconditions like epidermoid cyst, dermoid cyst, calcified lymphnode or a hemiangioma. The aim of this study was to describethe clinical and histopathological characteristics of patientspresenting with pilomatrixoma.Material and Methods: The present study was conductedin the Post Graduate department of pathology, govt. medicalcollege Srinagar. 51 cases of pilomatrixoma were included inthe study. The final diagnosis was arrived by histopathologicalexamination of the specimens. The clinical features andphysical examination including age, sex, site of lesion andsize were noted and analyzed.Results: 51 cases of pilomatrixoma, comprising about 37%cases of all skin adnexal tumors were considered. The mostcommon age group involved was 11-20 years comprising of33.34% of all cases. 23 (45.10%) were males and 28 (54.90%)were females. There was a slight female predominance. Themost common anatomical location for the tumor was foundto be head and neck followed by trunk, upper limbs and lowerlimbs. The histopathological findings observed were: a benignwell demarcated lesion surrounded by a capsule in almost allof the cases. The lesions were found to be composed of islandsof epithelial cells embedded in a stroma. Two types of cellswere identified in these epithelial islands basaloid cells andshadow cells.Conclusions: Pilomatrixoma should be considered in thedifferential diagnosis of nodules, especially those on the headand neck. Careful clinical examination and familiarity withthe condition may lead to accurate diagnosis and appropriatetreatment.

Bloodstream Infections in Pediatric Population in a Tertiary Care Hospital

Introduction: In paediatric patients blood stream infection(BSI) is the leading cause of mortality and morbidity. Theemerging of causative agents and resistance to variousantimicrobial agents are increased from time to time. The aimof this study was to describe the microbiological characteristicsof BSI in paediatric patients (<12 years). Neonates wereexcluded.Material and Methods: Data was collected from paediatricpatients who had BSI. Blood culture was done in BacT Alert3D. Isolates from these patients were identified on Vitek IICompact. Study was done between from January 2018 toDecember 2018 at Paediatric hospital GMC Srinagar.Results: A total of 120 patients had BSI. All episodes weremonomicrobial.78 (65%) were males and 42 (35%) werefemales. 67 (56%) of the isolates were Gram positive bacteriaand 53 (44%) were Gram negative. The commonest Grampositive bacterial isolates were Staphylococcus aureus 52(78%) followed by Coagulase negative Staphylococci (CoNS)8 (12%), Enterococcus fecalis 4(6%) and Streptococcuspneumonia 3(4%).Conclusion: Majority of the isolates were multidrug resistant.These higher percentages of multi-drug resistant emergedisolates urge us to take infection prevention measures and toconduct other large studies for appropriate empiric antibioticchoice.

Community-acquired pneumonia with Acinetobacter radioresistens bacteremia in an immunocompetent host: A case report

Rationale: Acinetobacter radioresistens is a non-fermentative Gram-negative coccobacillus that is environmentally ubiquitous and is an uncommon cause of pneumonia in an immunocompetent patient with no known chronic medical illness. Patient concerns: A middle-aged Asian male with a smoking history presented with fever and cough. Physical examination was unremarkable. Chest imaging was consistent with pulmonary parenchymal infection and blood culture grew Acinetobacter radioresistens. Diagnosis: Community acquired pneumonia with Acinetobacter radioresistens bacteremia. Interventions: The patient received a combination of intravenous and oral ampicillin-sulbactam over 2 weeks. Outcomes: Repeat blood cultures showed resolution of bacteremia. Completion of antimicrobial treatment saw resolution of respiratory symptoms and radiological pneumonic changes. Lessons: Acinetobacter radioresistens causing community-acquired pneumonia in an immunocompetent host has never been described before. It may be a novel emerging infectious agent in pulmonary infections. Its clinical course in this immunocompetent patient appears to be relatively benign.

Antiviral, embryo toxic and cytotoxic activities of Astragalus membranaceus root extracts

Antiviral activity of Astragalus membranaceus aqueous and methanol root extracts was determined against Avian influenza H9 virus. Toxicity profile of extracts was evaluated using chicken embryos and BHK-21 cell line. Different concentrations [400, 200, 100, 50, 25. 12.5, 6.25 and 3.12µg/mL] of both aqueous and methanol extracts were mixed with standard virus inoculum [4HAunits] and incubated for 30minutes at 37oC prior to inject the chicken embryos. Chorioallantoic fluid harvested 72 hours post inoculation and evaluated for virus growth using hemagglutination assay. Same concentrations of both extracts without virus were injected in chicken embryos to evaluate embryo toxic activity as well. The cytotoxic activity of aqueous and methanol extracts was determined by MTT colorimetric assay using BHK-21 cells. Three concentrations [400, 200 and 100µg/mL] of aqueous and five concentrations [400, 200, 100, 50 and 25µg/mL] of methanol extract showed antiviral activity. None of the tested concentrations of aqueous and methanol A. membranaceus root extracts caused chicken embryo mortality. Cell survival percentage of aqueous extract was higher than 50 at all of the tested concentrations except 400µg/mL. Two concentrations [400 and 200µg/mL] of methanol extract showed cytotoxicity. It was concluded that aqueous and methanol roots extracts of A. membranaceus have antiviral activity and concentrations which were safe may be used for treatment of Avian influenza H9 virus infections

Factors and Determinants of Unmet Needs: Identifying Association Between Variables and Unmet Needs Among Married Women of Child Bearing Age in Lahore, Pakistan

Background: Unmet needs for family planning is an important method to evaluate family planning programs hence this study was conducted to assess the unmet needs of contraception and its associated factors and reasons. Objectives: 1) to determine the unmet needs, its determinants and reasons among fecund and sexually active married women 2) to identify association between variables and unmet needs among fecund and sexually active married women. Materials & Methods: It was a community based cross sectional study, conducted in the catchment area of Institute of Public Health Lahore. Sample size was 200 women of Child Bearing Age (CBA) who were fecund and sexually active, with no history of hysterectomy, and living with their husbands. Simple random sampling technique was applied to recruit the sample population. Data was collected upon a structured questionnaire. Dependent variable was unmet needs; and independent variables included socio demographic variables and factors related to reproductive health. Data entered and analyzed upon SPSS version 23. Descriptive statistics calculated; Bivariate analysis was applied to identify association of variables with met and unmet needs.  Results: About 19.38% women had unmet needs for family planning; 8.59% for limiting and 10.79% for spacing. Family Planning knowledge, discussion about family planning between spouses and Husband’s sole role as a decision maker were significantly associated with unmet needs. Reasons for unmet needs were fear of side effects 29.5%, experience of side effects 21.6% mainly menstrual cycle disturbance and weight gain, Lack of information 13.6%, disapproval from their husbands 20.5% and by their Mother in Laws 9.1%. Conclusion: Our study indicated unmet needs for contraception comparable to latest report by Pakistan Bureau of Statistics 2015-2016 (35.5%) but still there is a scope to improve health education system, plan a structured counselling for Family Planning, reduce the impact of obstacles and address current issues to meet contraception needs.

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives: To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan. Methods: Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species. Results: An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis. Conclusions: In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.