Association between intravenous fluids during labor and primary postpartum hemorrhage: A retrospective cohort study.

INTRODUCTION: There is a major research gap relating to the impact of intravenous (IV) fluids administration during labor on maternal and neonatal outcomes. It is biologically plausible that a relationship between volume of IV fluids and primary postpartum hemorrhage (PPH) exists. The primary objective of this study was to evaluate whether the administration of high-volume IV fluids during labor (≥ 2500 mL) increases the risk of primary PPH and other adverse outcomes for women with a term, singleton pregnancy, in comparison to low-volume IV fluids during labor (<2500 mL). MATERIAL AND METHODS: A retrospective cohort study was conducted at a tertiary referral hospital in Sydney, Australia between 1st September 2021 and 31st October 2022. Inclusion criteria were: women with a live singleton fetus in a cephalic presentation; planning a vaginal birth; and admitted for labor and birth care between 37 and 42 week gestation. The study factor was IV fluids during labor and the primary outcome was primary PPH ≥500 mL. Secondary outcomes included cesarean section and major perineal injury. Pregnancy, birth, and postnatal data were obtained from the hospital's electronic clinical database, electronic medical records, and paper fluid order documentation. Multivariable logistic regression and multiple imputation were used to explore the relationship between volume of IV fluids in labor and PPH. RESULTS: A total of 1023 participants were included of which 339 had a primary PPH (33.1%). There was no association between high-volume IV fluids and PPH after adjusting for demographic and clinical factors (adjusted odds ratio [ORadj]1.02 95% confidence interval [95%CI] 0.72, 1.44). However, there was a positive association between high-volume IV fluids and cesarean section (ORadj 1.99; 95%CI 1.4, 2.8). CONCLUSIONS: The findings of this research are important to further knowledge relating to the administration of IV fluids during labor. The findings emphasize the importance of accurately documenting IV fluids administration and identifies research priorities to enable us to better understand the broader implications of IV fluids administration on pregnancy and perinatal outcomes.

Disaggregated energy consumption, industrialization, total population, and ecological footprint nexus: evidence from the world's top 10 most populous countries.

High population, energy consumption, industrialization, and environmental degradation are inherently linked, making the study of ecological footprints in the most populous countries crucial for understanding their environmental impact and guiding efforts to minimize ecological degradation through sustainable resource management and conservation. Therefore, this study examines the effects of disaggregated energy consumption, industrialization, and total population on the ecological footprint of the world's top 10 most populous countries namely Bangladesh, Brazil, China, India, Indonesia, Mexico, Nigeria, Pakistan, Russia, and the USA, using data for the period of 1990-2020. The research employs Kao and Pedroni techniques of cointegration to determine whether the variables are cointegrated in the long run. The long-term equilibrium association is measured utilizing panel autoregressive distributed lag/pooled mean group (ARDL/PMG), and method of moment quantile (MMQ) regression methods. Furthermore, to test for the causal relationships between the selected variables, we used the Dumitrescu and Hurlin (D-H) panel causality method. The findings of the study reveal that renewable energy consumption, as well as GDP square, have a significant negative influence on ecological footprint, implying that renewable energy and GDP square reduce ecological footprint and thus enhance environmental quality. Furthermore, non-renewable energy, industrialization, total population, and GDP have a detrimental impact on environmental quality by increasing ecological footprint. It is also found that there is a one-way causality from non-renewable energy and industrialization to ecological footprint and a bidirectional causal relationship between ecological footprint and total population, GDP, and GDP2. Important policy implications are drawn based on the findings.

Memory T-Waves: An Uncharted Territory in T-Wave Inversions.

T-wave inversions on electrocardiograms (ECGs) can present a diagnostic challenge due to their association with various underlying causes. One less-explored cause is memory T-waves, a phenomenon characterized by T-wave inversions, often seen in chest and inferior leads, following a period of abnormal ventricular conduction. In this case report, we discuss the intriguing case of an 80-year-old woman who recently underwent percutaneous coronary intervention (PCI) for a myocardial infarction and subsequently developed memory T-waves. We are also discussing how important it can be to understand and recognize memory T-waves, as it will avoid further unnecessary tests and longer hospital stays.

Using a validated instrument to assess pregnancy planning and preconception care at antenatal booking visits: a retrospective cohort study.

OBJECTIVE: To determine the completion rate for the London Measure of Unplanned Pregnancy (LMUP), a psychometrically validated measure of a woman's intention with regard to a current or recent pregnancy, during booking visits at two metropolitan antenatal care clinics; to identify socio-demographic characteristics associated with unplanned pregnancy. DESIGN, SETTING, PARTICIPANTS: Retrospective cohort study; analysis of LMUP data for women attending antenatal care booking consultations as public patients in the Sydney Local Health District, 31 December 2019 - 30 November 2020. MAIN OUTCOME MEASURES: Proportions of women with LMUP scores indicating unplanned (0-9) or planned pregnancies (10-12); associations between planned pregnancy and socio-demographic characteristics, crude and adjusted for age, parity, and socio-economic status (Index of Relative Socioeconomic Disadvantage). RESULTS: Of 4993 women with antenatal care bookings, the LMUP was completed by 2385 (47.8%; 1142 of 3564 women at the tertiary referral hospital [32.0%], 1118 of 1160 at the secondary hospital [96.3%]). Planned pregnancies were indicated by the total LMUP scores of 1684 women (70.6%); 1290 women (59.1%) reported no health actions in preparation for pregnancy. In multivariable analyses, planned pregnancies were more likely in all age groups than for women aged 24 years or younger (30-34 years: adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.76-3.66; 35-39 years: aOR, 2.91; 95% CI, 1.95-4.33). The likelihood of planned pregnancy declined with increasing parity (v no previous births: three previous births: aOR, 0.25; 95% CI, 0.16-0.40; four or more previous births: aOR, 0.10; 95% CI, 0.05-0.19). CONCLUSION: Seven in ten women who completed the LMUP had planned their pregnancies, but fewer than half had undertaken health-related actions prior to conceiving. Higher parity was associated with unplanned pregnancy, indicating the importance of postpartum contraception advice. Overcoming barriers to implementing the LMUP more widely would enhance preconception health monitoring.

Surgical outcomes and prognostic factors associated with emergency left colonic surgery.

BACKGROUND: Mortality from emergency left-sided colorectal surgery can be substantial due to acuteness of the presentation and the urgent need to operate in the setting of a limited preparation in a morbid patient. OBJECTIVES: Determine the 30-day postoperative outcomes and identify risk factors for complications and mortality following emergency colorectal operations. DESIGN: Retrospective SETTINGS: Three tertiary hospitals in three countries. PATIENTS AND METHODS: Factors that were studied included age, sex, ASA score, type and extent of the operation, and presence/absence of malignancy. Unadjusted 30-day patient outcomes examined were complications and mortality. Differences in proportions were assessed using the Pearson chi-square test while logistic regression analyses were carried out to evaluate the correlation between risk factors and outcomes. MAIN OUTCOME MEASURES: 30-day postoperative morbidity and mortality SAMPLE SIZE: 104 patients. RESULTS: Among 104 patients, 70 (67.3%) were men, and 34 (32.7%) were women. The mean (SD) age was 57.2 (17.1) years. The most common indication for emergency colonic surgery was malignant obstruction in 33 (31.7%) patients. The postoperative complication rate was 24% (25/104), and the mortality rate was 12.5% (13/104) within 30 days of the operation. The ASA status (P=.02), presence of malignancy (P=.02), and the presence of complications (P=.004) were significantly related to mortality in the multivariable logistic regression analysis. CONCLUSIONS: The 30-day mortality of emergency colorectal operations is greatly influenced by the presence of malignancy in the colon and physiological status at the time of the procedure. LIMITATIONS: The retrospective design and small sample size. CONFLICT OF INTEREST: None.

Influence of Disorder on the Bad Metal Behavior in Polar Amalgams.

The two new ternary amalgams K1-xRbxHg11 [x = 0.472(7)] and Cs3-xCaxHg20 [x = 0.20(3)] represent two different examples of how to create ternary compounds from binaries by statistical atom substitution. K1-xRbxHg11 is a Vegard-type mixed crystal of the isostructural binaries KHg11 and RbHg11 [cubic, BaHg11 structure type, space group Pm3̅m, a = 9.69143(3) Å, Rietveld refinement], whereas Cs3-xCaxHg20 is a substitution variant of the Rb3Hg20 structure type [cubic, space group Pm3̅n, a = 10.89553(14) Å, Rietveld refinement] for which a fully substituted isostructural binary Ca phase is unknown. In K1-xRbxHg11, the valence electron concentration (VEC) is not changed by the substitution, whereas in Cs3-xCaxHg20, the VEC increases with the Ca content. Amalgams of electropositive metals form polar metal bonds and show "bad metal" properties. By thermal analysis, magnetic susceptibility and resistivity measurements, and density functional theory calculations of the electronic structures, we investigate the effect of the structural disorder introduced by creating mixed-atom occupation on the physical properties of the two new polar amalgam systems.

An Uncommon Case of Peripheral Osteoma of the Maxilla: A Case Report.

Facial bone osteomas are uncommon, with only a few cases reported in the literature. Osteomas are benign neoplasms that are composed of well-differentiated, mature bones. There are three types of osteomas: central osteomas that develop from the endosteum, peripheral osteomas (PO) that develop from the periosteum, and extra-skeletal soft tissue osteomas that develop from the muscle. Both central and peripheral osteomas of the facial bones have been described. Peripheral osteomas have been reported in the frontal, ethmoid, and maxillary sinuses, but they are uncommon in the jawbone. It occurs at a younger age but is most prevalent in the sixth decade, with a female-to-male ratio of 1:2. The purpose of this case report was to examine the clinical manifestation and management protocol of such lesions using electrocautery.

Wearable Printed Temperature Sensors: Short Review on Latest Advances for Biomedical Applications.

The rapid growth in wearable biosensing devices is driven by the strong desire to monitor the human health data and to predict the symptoms of chronic diseases at an early stage. Different sensors are developed for continuous monitoring of various biomarkers through wearable and implantable sensing patches. Temperature sensor has proved to be an important physiological parameter amongst the various wearable biosensing patches. This paper highlights the recent progresses made in printing of functional nanomaterials for developing wearable temperature sensors on polymeric substrates. A special focus is given to the advanced functional nanomaterials as well as their deposition through printing technologies. The geometric resolutions, shape, physical and electrical characteristics as well as sensing properties using different materials are compared and summarized. Wearability is the main concern of these newly developed sensors, which is summarized by discussing representative examples. Finally, the challenges concerning the stability, repeatability, reliability, sensitivity, linearity, ageing, and large-scale manufacturing are discussed with future outlook of the wearable systems.

Are globalization, urbanization, and energy consumption cause carbon emissions in SAARC region? New evidence from CS-ARDL approach.

This study examines the impact of energy consumption, urbanization, and globalization on environmental degradation proxied by carbon emissions (CO2) in the South Asian Association for Regional Cooperation (SAARC) countries, namely Sri Lanka, Pakistan, Maldives, Nepal, Bhutan, Bangladesh, and India using data over the period 1990-2018. The cross-sectional autoregressive distributed lag (CS-ARDL), pooled mean group (PMG), and Dumitrescu and Hurlin (D-H) Granger causality techniques are employed for the empirical analysis. First and second-generation panel unit root tests are used to determine the stationary level of all data series which reveals mixed order of integration. The empirical findings show that urbanization, gross domestic product (GDP) per capita income, energy consumption, industrial growth, globalization, and financial development cause CO2 emissions, while the other variables, namely arable land and innovation, put negative effects on CO2 emissions. Moreover, the D-H heterogeneous test results exhibit that bi-directional relationship exists between CO2 and arable land, urbanization, industrial growth, and financial development, while a unidirectional causality exists between CO2 emissions and GDP per head income. These findings suggest that planned urbanization, investment in renewable energy sources, and effective strategies regarding the economic and financial integration with the global economies are required for a clean and green environment.

Aberrant expression of myeloid antigens in patients of acute lymphoblastic leukaemia.

OBJECTIVE: To determine the immunophenotypic pattern and aberrant expression of myeloid antigens in newly diagnosed patients of acute lymphoblastic leukaemia(ALL). METHODS: This descriptive cross-sectional study was carried out in Haematology / Pathology department, Army Medical College, National University of Medical Sciences (NUMS) in collaboration with Immunology and Haematology departments of Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st January, 2019 to 31st December, 2019. Seventy-three (73) recently diagnosed patients of Acute Lymphoblastic leukaemia of all age groups and both genders were included in the study. A proforma was used to note demographic data. CBC, cytochemical stains and bone marrow examinations were carried out and assessed for morphology and percentage of blasts using a microscope. Flow cytometry was used to perform immunophenotyping on samples of peripheral blood and bone marrow, using a standard panel. RESULTS: The most commonly expressed markers were weak CD45, TdT, CD19, CD10 and HLA-DR. Weak CD45 was present in almost all blast cells and there was no remarkable difference in its positivity among various subtypes of ALL. Myeloid expression was observed in 13 (17.8%) cases. CD13 and CD33 were aberrantly expressed in 11 and 12.3 of all cases of ALL respectively. CONCLUSIONS: Expression of aberrant myeloid CD markers in acute lymphocytic leukaemia has prognostic significance and should be documented during lineage assignment of acute leukaemias while performing immunophenotyping.

Cassia artemisiodes attenuates nociceptive and diabetes-induced neuropathic pain modalities apropos antioxidant and anti-inflammatory mechanisms.

Cassia plants have a considerable position in conventional systems of medicine. The possible anti-nociceptive, anti-inflammatory, and anti-neuropathic properties of Cassia artemisiodes (CAD) extract were tested using the standard animal models. In this study, in vitro antioxidant, cyclooxygenase (COX-1 and 2), and 5-lipoxygenase (5-LOX) inhibitory assays were performed. The anti-inflammatory activity was evaluated using carrageenan, histamine, and serotonin-induced paw edema models. Antipyretic activity, thermally and chemically-induced nociception, and naloxone antagonistic activities were carried out. The CAD extract was tested for anti-neuropathic activity in the streptozotocin-induced diabetic neuropathy model. Suppressing the effect of CAD extract on the mRNA level of inducible nitric oxide synthase (iNOS), COX-2, and pro-inflammatory cytokines (TNF-α, IL-1ß, IL-6) was determined by performing RT-PCR. The CAD extract inhibited COX-2 and 5-LOX enzymes, paw inflammation, and reduced nociceptive behaviors. The mRNA gene expression of iNOS, COX-2, and inflammatory cytokines was reduced significantly with increased DPPH scavenging activity. The extract significantly reduced the diabetes-induced neuropathic pain. In a nutshell, these results recommended that the CAD extract has anti-nociceptive and anti-neuropathic activities due to inhibition of inflammatory and oxidative signaling.

Knowledge and awareness of human papillomavirus infection and human papillomavirus vaccine among Kazakhstani women attending gynecological clinics.

Cervical cancer remains one of the top causes of cancer-related morbidity and mortality all over the world. Currently, however, there are no published studies to assess the knowledge of HPV and cervical cancer in Kazakhstan. This study aimed to assess the awareness of HPV, the knowledge of HPV as a cause of cervical cancer, and the awareness of HPV vaccination among Kazakhstani women visiting gynecological clinics across the country. In addition, the study aimed to identify the factors associated with the awareness of HPV and the HPV vaccine and knowledge of HPV as a major cause of cervical cancer. This was a cross-sectional survey-based study with 2,272 women aged between 18-70 years attending gynecological clinics, who were administered paper-based questionnaires. Data analysis included descriptive statistics consisting of mean values, standard deviations, and frequencies, where applicable. Differences in categorical variables between groups were analyzed using the Chi-square test with a significance value of <0.005. Crude odds ratio (OR) and adjusted odds ratio (AOR) with 95% corresponding confidence intervals were calculated in regression analysis using univariate and multivariable logistic regression models. The mean age of participants was 36.33±10.09 years. More than half (53%) of the participants had been screened for cervical cancer. Among those who were aware of HPV, 46% knew that HPV causes cervical cancer and 52% were aware of the HPV vaccine. The key factors related to outcome variables were age, ethnicity, education, family, number of deliveries, and menarche. From a subgroup analysis, results from the HPV test and Pap smear test were factors related to dependent variables such as awareness of HPV and awareness of HPV vaccination.

Post-thyroidectomy complications in southwestern Saudi Arabia: a retrospective study of a 6-year period.

BACKGROUND: Thyroidectomy is the surgical removal of all or part of the thyroid gland for non-neoplastic and neoplastic thyroid diseases. Major postoperative complications of thyroidectomy, including recurrent laryngeal nerve injury, hypocalcemia, and hypothyroidism, are not infrequent. OBJECTIVE: Summarize the frequency of surgical complications of thyroidectomy. DESIGN: Retrospective. SETTING: Secondary health facility in southwestern Saudi Arabia. PATIENTS AND METHODS: We collected data from the records of patients who were managed for thyroid diseases between December 2013 and December 2019. MAIN OUTCOME MEASURE: Complications following thyroidectomy. SAMPLE SIZE: 339 patients, 280 (82.6%) females and 59 (17.4%) males. RESULTS: We found 311 (91.7%) benign and 28 (8.3%) malignant thyroid disorders. Definitive management included 129 (38.1%) total thyroidectomies, 70 (20.6%) hemithyroidectomies, 10 (2.9%) subtotal thyroidectomies and 5 (1.5%) near-total thyroidectomies with 125 (36.9%) patients treated non-surgically. The overall complication rate was 11.3%. There were 4 (1.9%) patients with recurrent laryngeal nerve palsy, 16 (7.5%) patients with temporary hypoparathyroidism, 1 (0.5%) patient with paralysis of the external branch of the superior laryngeal nerve and 3 (1.4%) patients with wound hematoma. CONCLUSION: The rate of complications following thyroidectomy is still high. There is a need for emphasis on comprehensive measures to control the high rate of complications. LIMITATIONS: Retrospective design and no long-term follow up to monitor late complications. CONFLICT OF INTEREST: None.

An experience with 124 cases of fanconi anemia: clinical spectrum, hematological parameters and chromosomal breakage analysis.

BACKGROUND: Fanconi anemia is an inherited bone marrow failure syndrome characterized by somatic abnormalities and an increased predisposition to malignancies. OBJECTIVE: To determine the clinical spectrum and evaluate the hematological parameters as well as highlight diagnosis by chromosomal breakage analysis of Fanconi anemia patients. MATERIAL AND METHODS: A total of 124 patients were diagnosed as having Fanconi anemia from August 2014 to May 2020 at Armed Forces Institute of Pathology, Rawalpindi, Pakistan. Clinical details, somatic abnormalities, radiological findings, lab parameters and result of chromosomal breakage analysis were noted and analyzed. RESULTS: One hundred and twenty four (14.29%) were diagnosed as having Fanconi anemia (FA) on chromosomal breakage test. Median age was 09 years 06 months. Male to female ratio was 1.9:1. Six of these patients exhibited mosaicism and were classified as FA mosaic. Somatic abnormalities were detected in 74 (59.7%) patients; the most common being skeletal abnormalities and short stature. CONCLUSION: Chromosomal breakage analysis is a cost-effective method for diagnosis of Fanconi anemia. Early diagnosis is pertinent for proper treatment and long term prognosis.

Experimental and Computational Analysis of MnO2@V2C-MXene for Enhanced Energy Storage.

Herein, we studied the novel and emerging group of 2D materials namely MXene along with its nanocomposites. This work entails detailed experimental as well as computational study of the electrochemical behavior of vanadium carbide (V2CTx) MXene and MnO2-V2C nanocomposite with varying percentages of MnO2. A specific capacitance of 551.8 F/g was achieved for MnO2-V2C nanocomposite in 1 M KOH electrolyte solution, which is more than two times higher than the gravimetric capacitance of 196.5 F/g obtained for V2C. The cyclic stability achieved for the MnO2-V2C nanocomposite resulted in a retentivity of 96.5% until 5000 cycles. The c-lattice parameter achieved for MXene is 22.6 Å, which was 13.01 Å for MAX phase. The nanocomposite resulted in a c-lattice parameter of 27.2 Å, which showed that the spatial distance between the MXene layers was efficiently obtained. The method of wet etching was used for the preparation of pristine MXene and the liquid phase precipitation method was opted for the synthesis of the MnO2-V2C nanocomposite. Density functional theory calculation was exercised so as to complement the experimental results and to understand the microscopic details, such as structure stability and electronic structure. The current report presents a comprehensive experimental and computational study on 2D MXenes for future energy storage applications.

Prevalence of high-risk human papillomavirus infection among Kazakhstani women attending gynecological outpatient clinics.

OBJECTIVES: To conduct a nationwide high-risk human papillomavirus (HR-HPV) infection genotyping analysis of women attending gynecological clinics and identify factors associated with HR-HPV infection. METHODS: A cross-sectional survey-based study with 759 participants. Demographics, lifestyle, and medical history data were collected by questionnaire completed by gynecologists during patients' visits. Cervical swabs were used for HPV genotyping using AmpliSens kit. Data analysis included descriptive statistics consisting of mean values, standard deviations, and frequencies, where applicable. Ordinal logistic regression was performed to identify factors associated with HPV infection status. RESULTS: The mean age of participants was 36.51 ± 10.09 years. The majority of participants were aged 26-35 years. Less than half of the women (39%) were HPV positive; 26% had single HR-HPV, and 13% had multiple HR-HPV infection. The most prevalent HR-HPV genotypes were HPV-16 (54%), HPV-51 (7%), HPV-68 (7%), and HPV-18 (6%). Ordinal logistic regression demonstrated that older age, not being single, and having a history of sexually transmitted infections, decrease the odds of HPV infection. CONCLUSION: This study identified high prevalence of HR-HPV among Kazakhstani women. Our results showed that adding HPV testing to compulsory cervical cancer screening in Kazakhstan could improve the screening program and decrease cervical cancer rates.

Perception of peer teaching on learning anatomy: A qualitative study.

The aim of this study was to identify the effectiveness of peer-assisted learning while giving presentation on assigned anatomy topics in class by medical students for enhancement of their learning and communication skills. Sixty top performing students were selected for the study. They were given assigned topics related to anatomy to be presented in the class after taking their consent. The duration of the study was 32 weeks. At the completion of the projects by the students, each of them was interviewed for three to five minutes; the questions were very precise and few in number and were then analysed. Focus group discussions were conducted from the rest of the class who were the audience and enjoyed the activity. The study showed that by conducting such an activity among medical students their knowledge about the subject, communication and teaching skills and confidence are enhanced. It is a fun activity for them and can be added in the routine timetable for its beneficial outcomes.

Can disseminated intravascular coagulation scores predict mortality in COVID-19 patients?

OBJECTIVES: Complications related to coronavirus disease 2019 (COVID-19) may lead to disseminated intravascular coagulation (DIC), which has been reported to be among the known causes of mortality in such patients. This study aims to analyse the incidence of DIC in COVID-19 non-survivors and to assess the association between DIC and its comorbidities. METHODS: The medical records of 154 non-survivors of COVID-19, hospitalised between April 2020 and July 2020, were retrospectively analysed. The International Society on Thrombosis and Haemostasis (ISTH) criteria for DIC were applied to identify the occurrence of coagulopathy. The receiver-operating characteristic (ROC) analysis was used to assess the association between DIC and its comorbidities. RESULTS: Out of 154 non-survivors, non-overt DIC was observed in 94.8% of the patients, whereas only 5.2% fulfilled the overt criteria of DIC with a mean age 64.6 years. The mortality rate was 4.5 times higher among men than women. The D-dimer level was >250 ng/ml in 68.8% of the patients including 88.9% of the non-overt and 100% of the overt DIC patients. Prothrombin time (PT) in non-overt and overt DIC cases was 17.3 s and 24.4 s, respectively. Thrombotic event and chronic kidney disease were found to be the main predictors of DIC (p < 0.0001 and 0.03, respectively) followed by diabetes mellitus (DM) and hypertension (statistically insignificant). CONCLUSIONS: Our study concludes that the ISTH DIC score cannot predict mortality as the COVID-19 related DIC differs from the sepsis-induced DIC. Among the seriously ill, older patients with comorbidities, increased levels of D-dimer and prolonged PT are more reliable parameters among COVID-19 non-survivors.

Factors associated with cervical cancer screening behaviour of women attending gynaecological clinics in Kazakhstan: A cross-sectional study.

OBJECTIVE: Although cervical cancer could be prevented through medical screening, it remains one of the top causes of cancer-related morbidity and mortality all over the world. A number of factors may contribute to cervical cancer screening behaviour of women. The aim of this study was to investigate factors related to cervical cancer screening behaviour of women in Kazakhstan. METHODS: This was a cross-sectional survey-based study with a total of 1189 participants. Women attending gynaecological clinics aged between 18 and 70 years were administered paper-based questionnaires about their awareness of cervical cancer, the associated risk factors, and cervical cancer screening. Student t test or Wilcoxon rank-sum test and chi-square test or Fisher's exact test, where appropriate, were used to determine associations with categorical independent variables. RESULTS: The mean age of participants was 36.5 ± 10.1 years. Less than half (45.7%) of the participants had been screened for cervical cancer. The key factors related to the cervical cancer screening behaviour of women in this study included age, having a larger number of children, regular menstrual function, awareness of Pap smear test, and free screening programme for cervical cancer, and the causal association of human papillomavirus with cervical cancer. CONCLUSION: This study revealed several significant factors predicting screening behaviour in Kazakhstani women. To improve the rate of screening, there is a need to increase public knowledge and awareness of cervical cancer and opportunities for the free screening programme in the female population of Kazakhstan.

Dissemination of NDM-1 in pseudomonas aeruginosa and klebsiella pneumoniae isolated from pus samples in tertiary care hospitals of Quetta, Pakistan.

OBJECTIVE: To highlight the prevalence and epidemiology of New Delhi metallo-ß-lactamase-1. producers in pus samples. METHODS: The cross-sectional study was conducted from April to August 2018 at the Biotechnology Laboratory, Balochistan University of Information Technology Engineering and Management Sciences, Quetta, Hi-tech Laboratory, Centre for Advance Studies in Vaccinology and Biotechnology, University of Balochistan, Quetta and Microbiology Laboratory, Bolan Medical Complex Hospital, Quetta, Pakistan. Biochemical and molecular approaches were used for the identification of the isolates and Modified Hodge Test for the phenotypic detection of class-A carbapenemase activity. Minimum Inhibitory Concentration was performed using E-test and broth microdilution method. Molecular basis of carbapenemase activity was ascertained by the recognition of blaNDM-1 gene in the isolates. RESULTS: Of the 300 pus samples taken from surgical/burn units, 6(2%) blaNDM-1 harbouring isolates were found; 3(50%) each being Klebsiella pneumoniae and Pseudomonas aeruginosa. Klebsiella. pneumoniae isolates were extensively drug-resistant. The Pseudomonas aeruginosa isolates displayed resistance against 21 antibiotics of tetracyclines, quinolones, b-lactams, aminoglycosides, monobactams, sulphonamides, macrolides, cephalosporins, phosphonic acid and polypeptide groups, suggesting pan-drug resistance. CONCLUSIONS: The resistance pattern of the bacterial isolates poses a significant clinical threat in the region.