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Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material & Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p

PurposeThe study aims to examine the impacts of management practices on innovation along with the mediating and moderating role of degree of competition, business environment and environmental policies.Design/methodology/approachData were derived from the World Bank Enterprise Survey 2019 for Greece, Italy, Turkey, Portugal and Jordan and analyzed by using PLS-SEM to find results.FindingsFindings revealed that management practices have positive significant relationship with the innovation among firms for Greece, Turkey, Portugal and Jordan but surprisingly insignificant relationship in Italy. Further, management practices have positive significant relationship with the environmental policies, business environment and degree of competition among firms in Greece, Italy, Turkey, Portugal and Jordan. In addition, environmental policies, business environment and degree of competition have positive significant relationship with innovation among firms in Greece, Italy, Turkey, Portugal and Jordan.Practical implicationsThese useful insights would enable practitioners and policy makers to develop and apply more influential management practices to boost up the level of innovation among firms.Originality/valueAlthough the topics of management practices and innovation have received a great concern of academia, but this is the first study that offers a comprehensive model of the relationship in these domains.

Objective: To determine the clinical features and echocardiographic findings among children presenting with Ebstein’s anomaly (EA). Study Design: Descriptive Case-series. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan. Period: July 2021 to June 2022. Material & Methods: Children of both genders aged above 1 month up to 18 years, having echocardiographic confirmed EA were analyzed. Demographic data along with clinical features, presenting symptoms and echocardiographic findings were noted in all case. Results: In a total of 48 cases of EA, 38 (79.2%) were female. The mean age was 8.4±4.21 years. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms reported in 31 (64.6%), 27 (56.3%), 26 (54.2%) and 24 (50.0%) patients respectively. Arrhythmias and heart failure were the most frequent clinical features noted in 29 (60.4%) patients each. Small atrial septal defect (ASD) was noted in 27 (56.3%) patients while ventricular septal defect in 19 (39.6%) cases. There were 11 (22.9%) patients who presented timely with diagnosis of EA while 37 (77.1%) patients had late diagnosis. Conclusion: Majority of the patients with Ebstein’s anomaly were female. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms whereas arrhythmias and heart failure were the most frequent clinical features observed. ASD was the most commonly noted associated CHDs observed in almost half of the Ebstein’s anomaly case. Almost 3/4th of the patients had late diagnosis.

We identified a novel homozygous disease-causing variant in TMC8 in a Pakistani family with epidermodysplasia verruciformis (EV). The phenotype of EV in the affected individuals was most probably caused by an aberrant splicing process. The molecular genetic findings in our patients expand the mutational spectrum of the disease.

Objective: To find out the prevalence of different types of arrhythmias in children with congenital heart defects (CHDs) presenting at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: A total of 120 children of both genders aged 1 day to 16 years and presenting to study setting with confirmed CHDs were evaluated. At the time of enrollment, demographical information and disease history were noted. Necessary laboratory investigations like complete blood count and serum electrolytes were analyzed while standard electrocardiography (ECG) was performed. Prevalence of different types of arrhythmias was noted. Results: In a total of 120 children with CHDs, 64 (53.3%) were boys. Mean age was be 2.7±2.1. Most common electrolyte abnormalities were noted to be hyponatremia and hypermagnesemia found in 39 (32.5%) and 26 (21.7%) children respectively. There were 31 (25.8%) children who were diagnosed to have arrhythmias. Out of these 31 children, first degree A-V block was the most common types of arrhythmias observed in 24 (77.4%) cases while ectopic A-V rhythm were found in 3 (9.7%). Conclusion: The findings of this research revealed that arrhythmias are quite common among children having CHDs. There is a need to routine assessment for the possible presence of arrhythmias among children presenting with CHDs.

In healthcare professionals should possess sufficient knowledge of ethics and they should practice ethics with positive attitudes. However, review of literature shows that the healthcare ethics are neglected inside Pakistan. Keeping this in mind, this study has examined knowledge level, attitude type and nature of practice regarding Healthcare Ethics among doctors working in selected hospitals of Pakistan. Using the Cross-sectional design, data was collected from (n=544) doctors through an online self-reported questionnaire. Data were analyzed over descriptive and inferential statistics. The results revealed that doctors possessed sufficient knowledge about healthcare ethics. For such reasons, the doctors had adopted good ethical practices. Knowledge level, attitudinal patterns & types of practices varied according to sociodemographic characteristics. Also, sociodemographic variables were significantly associated with three dimensions of Healthcare Ethics. Findings obtained from this study have provided valuable insights regarding status of healthcare ethics in Pakistan. This study concludes that continuous emphasis should be made on increasing awareness about the healthcare ethics in Pakistan.

Objective: To analyze children of congenital heart defect hospitalized with lower respiratory tract infections (LRTIs). Study Design: Cohort study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: Echocardiography confirmed known CHD cases of both genders aged 1 month to 10 years and hospitalized with LRTI were included. Demographic and clinical data were noted while relevant radiological examination and bacterial culture / respiratory virus panel from nasopharayngeal swabs examined. Types of CHD (acyanotic or cyanotic), types of bacterial causative agents and outcomes in terms of duration of hospitalization (days) and mortality or discharged were noted. Results: In a total of 63 children, 34 (54.0%) were male. The mean age was 1.56±1.42 years while 46 (73.0%) children were aged below 1 year. Assessment of causative agents revealed that 9 (14.3%) had viral involvement, 8 (12.7%) bacterial agents. Majority of the children, 44 (69.8%) had acyanotic CHD while remaining 19 (30.2%) had cyanotic CHD. Need for pediatric intensive care unit (PICU) admission was noted in 22 (34.9%). Although, need for PICU stay was more among children with acyanotic CHD when compared to cyanotic CHD, but the difference did not reach statistical significance (40.9% vs. 21.1%, p=0.1292). Likewise, duration of hospitalization was relatively more among children with acyanotic CHD when compared to children with cyanotic CHD but the difference did not reach statistical significance (17.65±8.21 vs. 14.3±6.84, p=0.1243). Conclusion: Majority of the children with CHD hospitalized with LRTI were below 1 year of age. Acyanotic CHD was the most common CHD type. Mortality was relatively low and most of the children with CHD hospitalized with LRTI were treated and discharged successfully.

A study was conducted to determine the prevalence and drug resistance of Escherichia coli present in urinary tract infected patients and hospital drinking water. A total of eighty urine samples from clinically suspected patients and thirty tap water samples from hospital vicinity were collected and analyzed for the presence of E. coli. The isolates were preliminary identified based on morphological characteristics, biochemical test and further confirmed by polymerase chain reaction (PCR) using uidA primer. Isolates were subjected to antibiogram studies and analyzed for the presence of drug resistance (ESBL blaCTX-M-15, tetA, and TMP-SMX dfrA1) and pathogenicity associated pyelonephritis-associated pili (PAP) and Heat-labile (LT) toxin genes. Urine samples 19/80 (23.75%) and water samples 8/30 (26.7%) were found contaminated with E. coli. It was found that 12/19 (63%) bacterial isolates were extended spectrum beta-lactamase (ESBL) producers in clinical and 6/8 (75%) in water isolates whereas tetracycline resistance in clinical and water isolates was 11/19 (58%) and 6/8 (75%), respectively. The trimethoprim resistance gene was confirmed in 12/19 (63%) in clinical and 2/8 (25%) in water isolates. All the clinical and water isolates were found carrying pili PAP gene. It was concluded that the presence of drug resistant and pathogenic E. coli in clinical and water samples is extremely alarming for public health due to cross contamination and bacterial transfer from clinical samples to water and vice versa.

Objective: To find out echocardiographic findings in patients with tetralogy of Fallot (TOF) prior to total corrective surgery admitted at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi. Period: January 2021 to December 2021. Material & Methods: A total of 197 echocardiography confirmed TOF cases of both genders and age up to any years were included. Physical examination, chest radiography and electrocardiogram were done in each patient prior to transthoracic echocardiography (TTE) using Toshiba Aplio i600 using 5 Hz and 6 Hz transducers. Standard protocols were followed in all TTE procedures. Results: In a total of 197 patients with TOF, there were 121 (61.4%) male. Mean age was 8.36±10.12 years. Hypoplastic pulmonary arteries was the most frequent pulmonary artery abnormality observed in 30 (15.2%) cases. Thickened and domed pulmonic valve was the most common pulmonary valvular anomaly noted in 89 (45.2%). Associated “atrial septal defect (ASD)” was observed in 47 (23.9%) cases while “patent ductus arteriosus (PDA)” was seen in 83 (42.1%) patients. History of past “Blalock and Taussig (BT) Shunt” performed was found in 20 (10.2%) cases, out of which, 15 were functioning. Conclusion: Echocardiography is an inexpensive and safe approach to cardiac evaluation among patients of tetralogy of fallot. Hypoplastic pulmonary arteries was the most frequent pulmonary artery abnormality observed in tetralogy of Fallot patients. PDA was the most frequent associated abnormality followed by associated ASD.

The benefits of large-scale genetic studies for healthcare of the populations studied are well documented, but these genetic studies have traditionally ignored people from some parts of the world, such as South Asia. Here we describe whole genome sequence (WGS) data from 4806 individuals recruited from the healthcare delivery systems of Pakistan, India and Bangladesh, combined with WGS from 927 individuals from isolated South Asian populations. We characterize population structure in South Asia and describe a genotyping array (SARGAM) and imputation reference panel that are optimized for South Asian genomes. We find evidence for high rates of reproductive isolation, endogamy and consanguinity that vary across the subcontinent and that lead to levels of rare homozygotes that reach 100 times that seen in outbred populations. Founder effects increase the power to associate functional variants with disease processes and make South Asia a uniquely powerful place for population-scale genetic studies.

The current study has been designed to observe the coloring efficacy of wild turmeric-based natural yellowish colorant for wool dyeing under microwave (MW) treatments. Extracts and fabrics have been exposed to MW treatment for up to 10 min. Surface morphology and changes in the fabric's chemical nature before and after radiation have been studied through SEM and FTIR, respectively. The results obtained after a series of experiments show that using 45 mL of aqueous extract (pH = 5) in the presence of 1.5g/100mL of table salt as an exhausting agent at 75°C for 45 min has displayed outstanding color depth (K/S) onto microwave-treated wool fabric. On applying biomordants, it has been found that acacia extract (1.5%), pomegranate (2%), and pistachio extracts (1.5%) before dyeing, whereas acacia (1%), pomegranate (1%), and pistachio extracts (2%) after dyeing, have shown colorfast shades of high strength. Comparatively, salts of Al (1.5%) and Fe (1%), and T.A (2%) before dyeing, while salts of Al (1%) and Fe (1.5%) and T.A (1.5%) after dyeing, have given the best results. Generally, it has been originated that salt of Fe (1.5%) as a post-chemical mordant and pomegranate extract (1.5%) as a post-bio-mordant have displayed wonderful color strength. It very well may be inferred that MW treatment, being naturally protected, has just superior the varying strength of colorants on wool fabric. Adding biomordants has transformed the strategy into a more sustainable one.

The revival of natural dyes in different walks of life is due to stringent environmental standards imposed by many associations. For current studies, flowers of haar singhar (Nyctanthes arbor-tritis) has been chosen for bio-dyeing of cotton fabric using microwave irradiation techniques. For this purpose, liquid extracts and fabrics were exposed to microwave for 5 min at various conditions. These treated and un-treated dye extracts obtained in respective media were employed to dye the radiated and non-radiated cotton fabrics. The characterization of extract and untreated and undyed irradiated fabrics samples was done through FTIR. Different dyeing variables were optimized under CCD response surface methodology as a statistical tool. With the introduction of new shades and improvement of colorfastness properties, different concentrations of sustainable chemical and bio-mordant were employed. All dyed cotton fabrics were exposed to CIE-color space system for estimation of color coordinates and color strength by using spectra flash SF600 and to rate colorfastness properties using ISO standard methods for light, dry and wet rubbing, washing fastness. Cotton fabric was dyed with haar singhar flower extract of 7 pH from 4 g of powder, using 1.5 g/100 mL salt solution at 60 °C for 30 min. To get acceptable shades, aqueous extract after microwave treatment for 4 min provided excellent color strength. Pistachio (K/S = 3.6342) is a bio-mordant with great results, and aluminum (K/S = 4.8205) is a chemical mordant with outstanding results. It is found that green methods for isolation of colorant and green mordants for getting new shades should be employed.

Purpose This study aims to observe the coloring efficacy of coffee-based natural brown colorant for cotton dyeing under microwave (MW) treatment. Design/methodology/approach The colorant extracted in particular (neutral and acidic) media was stimulated by MW treatment up to 6 min. Dyeing variables were optimized and 2–10 g/100 mL of sustainable anchors (mordants) have been used to get colorfast shades. Findings It has been found that un-irradiated acidic extract (RE) containing 5% of table salt at 80 °C for 50 min has given high color yield onto MW-irradiated cotton fabric (RC = 2 min). The utilization of 2% of Fe, 10% of tannic acid and 10% of sodium potassium tartrate before bio-coloration, whereas 4% of Fe, 10% of tannic acid and 6% of sodium potassium tartrate after bio-coloration has given good color characteristics. In comparison the application of 6% of pomegranate and turmeric extracts before bio-coloration and 6% of pomegranate and 10% of turmeric extracts after bio-coloration have given good color characteristics. New bio-mordants can be added to get more new colorfast shades. Research limitations/implications There is no research limitation for this work. New bio-mordants can be added to get more new colorfast shades. Practical implications This work has practical application for artisans, textile industry and handicrafts. It is concluded that colorant from coffee beans can be possible alternative of synthetic brown dyes and inclusion of MW rays for extraction and plant molecules as shade developers can make process more green. Social implications Socially, it has good impact on eco-system and global community because the effluent load is not carcinogenic in nature. Originality/value The work is original and contains value-added product for textiles and other allied fields.

Background Iron deficiency anemia is a common public health issue among women of reproductive age (WRA) because it can result in adverse maternal and birth outcomes. Although studies are undertaken to assess iron efficacy, some gaps and limitations in the existing literature need to be addressed. To fill the gaps, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the role of iron in reducing anemia among WRA in low-middle-income countries (LMICs). Methods A comprehensive search strategy was used to search Medline through PubMed, Embase, and Science Direct for RCTs published between 2000 and 2020. The primary outcome was the mean change in hemoglobin level. We used standardized mean differences and their respective 95% CI to estimate the pooled effect. We used I2 statistics and Egger’s test to assess heterogeneity and publication bias, respectively. This review was carried out in accordance with revised guidelines based on the Preferred Reporting Items for Systematic Review and Meta-analysis. Results The findings showed that iron therapy improved hemoglobin and ferritin levels, though the results varied across studies. An overall pooled effect estimate for the role of iron therapy in improving the hemoglobin levels among WRA was -0.71 (95% CI: -1.27 to -0.14) (p = 0.008). Likewise, the overall pooled effect estimate for the role of iron therapy in improving the ferritin levels among WRA was -0.76 (95% CI: -1.56 to 0.04) (p = 0.04). The heterogeneity (I2) across included studies was found to be statistically significant for studies assessing hemoglobin (Q = 746.93, I2 = 97.59%, p = 0.000) and ferritin level (Q = 659.95, I2 = 97.88%, p = 0.000). Conclusion Iron therapy in any form may reduce anemia’s burden and improve hemoglobin and ferritin levels, indicating improvement in iron-deficiency anemia. More evidence is required, however, to assess the morbidity associated with iron consumption, such as side effects, work performance, economic outcomes, mental health, and adherence to the intervention, with a particular focus on married but non-pregnant women planning a pregnancy in the near future. Trial registration Registered with PROSPERO and ID is CRD42020185033.

Objective: To categorize root canal configuration according to Vertucci’s classification and determine the frequency of second canal in mandibular lateral incisors of Pakistani subpopulation (Karachi based) by using Cone Beam Computed Tomography. Study Design: Cross sectional study. Place and Duration of Study: Out-patient department of Oral and Maxillofacial Surgery and the department of Radiology at Dow University of Health Sciences, Karachi Pakistan, from Jan to Jul 2019. Methodology: Study was conducted on 160 extracted permanent mandibular lateral incisors. After extraction, teeth were randomly arranged in wax models and imaged via CBCT. Each tooth sample was analyzed in axial and sagittal sections. The images were investigated by two blinded examiners and data on canal morphology was recorded. Results: The frequency of single canal mandibular incisors was recorded as 107 (66.9%) whereas 53 (33.1%) of teeth showed two canals. Females presented with a higher frequency of two canalled incisors, although the results were statistically insignificant. The most prevalent canal anatomy detected was Type I (105, 65.6%) followed by Type III (33, 20.6%), Type II (12, 7.5%) and Type V (10, 6.3%). Mandibular lateral incisors presenting with two canals anatomy, Type III (32, 97%) morphology was most commonly detected followed by Type II (12, 100%) and Type V (9, 90%). Conclusion: CBCT scans are an effective tool for identification of root canal morphology. Mandibular lateral incisors most frequently presented with Type I canal anatomy whereas incisors with two canals most frequently presented with Type III configuration.

Objective: To find out the prevalence and risk factors of systemic hypertension. Study Design: Cross Sectional study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: July 2020 to June 2021. Material & Methods: A total of 298 children of both gender aged 4-12 years, visiting pediatric outpatient department of the study institution were enrolled. A child was labeled as normotensive if blood pressure (BP) measurement was below 90th percentile, pre-hypertensive if BP between 90th to 95th percentile and hypertensive if BP more than 95th percentile. The data was analyzed using SPSS version 26.0. Results: In a total of 298 children, 171(57.4%) were male. Overall, mean age was found to be 7.6+2.1 years while 159 (53.4%) were below 7 years of age. Majority of the children, 166 (55.7%) belonged to rural areas of residence. Family history of hypertension was noted in 150 (50.3%) children. Hypertension was found in 56 (18.8%) children, pre-hypertension in 9 (3.0%) while remaining 233 (78.2%) children were normotensive. Age less than 7 years (p=0.0023), overweight/obesity (p=0.0026) or family history of hypertension (p=0.0118) were found to have significant association with hypertension. Conclusion: High prevalence of systemic hypertension was noted in children. Younger age, high body mass index and family history of hypertension were found to be significantly associated with hypertension.

Aim: To assess the quality of life, perceived social support, and death anxiety among people having cardiovascular disorders Study type: A Cross-sectional study Place and Duration: This study was conducted at Civil Hospital, BMCH Quetta Pakistan from June 2020 to June 2021 Methodology: This study was designed to evaluate the correlation between quality of life, hope, and death anxiety among people having cardiovascular disorders. We gathered data by using a convenience sampling technique for 4 months. We used the questionnaire method for our survey. Our questionnaire was based on five sections including basic demographic, the 17-item McGill QoL (MQoL) Questionnaire, Herth hope to score, Thorson-Powell Death Anxiety Scale (TPDAS), and Death depression scale (DDS). Results: Out of 500 participants half of them were female (52.4%), most of the participants were married with no formal education and belonged to poor or middle-class families. Participants with intermediate education levels who were financially dependent on the government had a better quality of life than others. We observed that patients with myocardial infarction (MI) had higher levels of anxiety. Furthermore, we observed that patients with a belief in life after death had higher death anxiety than those who don't believe. Conclusion: Our results concluded a positive association among quality of life and hope. We examined that social support plays a vital role in managing CVD disorders. However, patients with myocardial infarction had high levels of death anxiety than others. Keywords: Cardiovascular disorders, coronary artery disease, myocardial infarction, death anxiety, quality of life, social support.

In this article, complete synchronization and antisynchronization in the identical financial chaotic system are presented. The proposed control strategies depend on first-order sliding mode and adaptive integral sliding mode for complete synchronization and antisynchronization of the identical financial chaotic system. In the primary case, the system parameters should be known, and first-order sliding mode control is utilized for synchronization and antisynchronization while in the second case, the system parameters are considered unknown. An adaptive integral sliding mode control strategy is utilized for synchronization and antisynchronization of the system considering the parameters unknown. The error system is changed into a particular structure containing a nominal part and several unknown terms to utilize the adaptive integral sliding mode control. Then, this error system is stabilized using integral sliding mode control. The stabilizing controller is usually developed based on the nominal part plus the compensator control part. To suppress the high-frequency oscillation (chattering) phenomenon, smooth continuous compensator control can be used rather than conventional discontinuous control. The compensator controller along with the adapted law is derived such that the time derivative of the Lyapunov function becomes strictly negative. The effectiveness of the proposed method was tested through computer simulations. The proposed control strategies are verified for that Identical 4D hyperchaotic financial system to attain complete synchronization and antisynchronization along with the improved performance.

COVID-19 is having many impacts on health, economy and social life; some due to the indirect effects of closure of health facilities to curb the spread. Closures were implemented in Pakistan from March 2020, affecting provision of reproductive, maternal, newborn and child health (RMNCH) services.To appraise the effects of containment and lockdown policies on RMNCH service utilization in order to develop an early response to avoid the catastrophic impact of COVID-19 on RMNCH in Pakistan.Routine monitoring data were analysed for indicators utilization of RMNCH care. The analysis was based on Period 1 (January-May 2020, first wave of COVID-19); Period 2 (June-September 2020, declining number of cases of COVID-19); and Period 3 (October-December 2020, second wave of COVID-19). We also compared data from May and December 2020 with corresponding months in 2019, to ascertain whether changes were due to COVID-19.Reduced utilization was noted for all RMNCH indicators during Periods 1 and 3. There was a greater decline in service utilization during the first wave, and the highest reduction (~82%) was among children aged5 years, who were treated for pneumonia. The number of caesarean sections dropped by 57%, followed by institutional deliveries and first postnatal visit (37% each). Service utilization increased from June to September, but the second wave of COVID-19 led to another decrease.To reinstate routine services, priority actions and key areas include continued provision of family planning services along with uninterrupted immunization campaigns and routine maternal and child services.الآثار غير المباشرة لجائحة كوفيد 19 على خدمات الصحة الإنجابية، وصحة الأمهات، والمواليد، والأطفال في باكستان.فاران إيمانويل، أحسن أحمد، طاهرة رضا، خورام شهزاد، فضل الرحمن، محمد مالك، رضا زايدي، أليزا فاران، عثمان بشير، فرحان أسلم، أسعد حفيظ، جيمس بلانشارد.يُسبِّب كوفيد-19 آثارًا عديدة على الصحة، والاقتصاد، والحياة الاجتماعية؛ ويُعزى بعضها إلى التأثيرات غير المباشرة الناجمة عن إغلاق المرافق الصحية للحد من انتشار المرض. وقد نُفِّذت عمليات الإغلاق في باكستان اعتبارًا من مارس/ آذار 2020، وهو ما أثَّر على خدمات الصحة الإنجابية، وصحة الأمهات، والمواليد، والأطفال.هدفت هذه الدراسة الى تقييم التأثيرات الناجمة عن سياسات الاحتواء والإغلاق على الاستفادة من خدمات الصحة الإنجابية، وصحة الأمهات، والمواليد، والأطفال، لإعداد استجابة مبكرة لتجنُّب الأثر الكارثي لكوفيد-19 على خدمات الصحة الإنجابية، وصحة الأمهات، والمواليد، والأطفال في باكستان.حُلِّلَت بيانات الرصد الروتيني للتحقق من مؤشرات الاستفادة بخدمات رعاية الصحة الإنجابية، وصحة الأمهات، والمواليد، والأطفال. واستند التحليل إلى الفترة الأولى (من يناير/ كانون الثاني – مايو/ أيار 2020، الموجة الأولى من كوفيد-19) والفترة الثانية (من يونيو/ حزيران – سبتمبر/ أيلول 2020، انخفاض عدد حالات كوفيد-19) والفترة الثالثة (من أكتوبر/ تشرين الأول – ديسمبر/ كانون الأول 2020، الموجة الثانية من كوفيد-19). وقارنَّا أيضًا البيانات من مايو/ أيار وديسمبر/ كانون الأول 2020 مع الأشهر نفسها من عام 2019، للتأكد من أن التغييرات كانت بسبب كوفيد-19.لوحظ انخفاض الاستفادة من الخدمات في جميع مؤشرات الصحة الإنجابية، وصحة الأمهات، والمواليد، والأطفال خلال الفترتين الأولى والثالثة. وازداد الانخفاض في الاستفادة من الخدمات خلال الموجة الأولى، وكانت ذروة الانخفاض (حوالي 82٪) في صفوف الأطفال الذين تقل أعمارهم عن 5 سنوات، ممن عولجوا من الالتهاب الرئوي. وانخفض عدد العمليات القيصرية بنسبة 57٪، تلتها الولادات في المؤسسات الصحية ثم الزيارة الأولى بعد الولادة (37٪ لكل منها). وازدادت الاستفادة من الخدمات من يونيو/ حزيران إلى سبتمبر/ أيلول، غير أن الموجة الثانية من كوفيد-19 أدت إلى انخفاض آخر.حتى يتسنى إعادة العمل بالخدمات الروتينية، تتضمن الإجراءات ذات الأولوية والمجالات الرئيسية استمرار تقديم خدمات تنظيم الأسرة إلى جانب حملات التحصين المتواصلة والخدمات الروتينية للأمهات والأطفال.Effets indirects de la pandémie de COVID-19 sur les services de santé reproductive, maternelle, néonatale et infantile au Pakistan.La COVID-19 a de nombreux impacts sur la santé, l'économie et la vie sociale, certains étant dus aux effets indirects de la fermeture des établissements de santé pour freiner la propagation. Des fermetures ont été imposées au Pakistan à partir de mars 2020, affectant la fourniture de services de santé reproductive, maternelle, néonatale et infantile.Évaluer les effets des politiques d'endiguement et de confinement sur l'accès aux services de santé reproductive, maternelle, néonatale et infantile afin de mettre en place une réponse rapide pour éviter l'impact catastrophique de la COVID-19 sur ce type de services au Pakistan.Les données de suivi de routine ont été analysées pour l'utilisation des indicateurs relatifs aux soins de santé reproductive, maternelle, néonatale et infantile. L'analyse était basée sur la période 1 (janvier-mai 2020, première vague de COVID-19) ; la période 2 (juin-septembre 2020, nombre décroissant de cas de COVID-19) ; et la période 3 (octobre-décembre 2020, deuxième vague de COVID-19). Nous avons également comparé les données de mai et décembre 2020 avec les mois correspondants en 2019, afin de vérifier si les changements étaient dus à la COVID-19.Une utilisation réduite a été constatée pour tous les indicateurs de santé reproductive, maternelle, néonatale et infantile au cours des périodes 1 et 3. La première vague a été marquée par une baisse plus importante au niveau du recours aux services, et le nombre d'enfants âgés de moins de 5 ans, traités pour une pneumonie, a connu le déclin le plus significatif (~82 %). Le nombre de césariennes a chuté de 57 %, suivi par les accouchements en établissement et la première visite postnatale (37 % respectivement). L'accès aux services a augmenté entre juin et septembre, mais la deuxième vague de COVID-19 a entraîné une nouvelle baisse.Pour rétablir les services systématiques, les actions prioritaires et les domaines clés comprennent la prestation continue des services de planification familiale, l'organisation de campagnes de vaccination sans interruption et la prestation des services systématiques de santé de la mère et de l'enfant.

Objective: To find out efficacy of sildenafil for the treatment of persistent pulmonary hypertension of the newborn (PPHN). Study Design: Observational study. Setting: Department of Neonatology, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: May 2020 to April 2021. Material & Methods: A total of 22 neonates of both genders with diagnosis of PPHN were enrolled during the study period. Demographic characteristic along with information about perinatal and postnatal characteristics were recorded among all neonates at the time of admission. X-ray chest were asked. Oral sildenafil was administered as 2mg/kg per dose thrice a day to all study cases and continued till extubation. Outcome was recorded on the basis of difference in FiO2 need after initiating sildenafil, time required to get ventilator off or mortality. Results: Out of a total of 22 neonates, 13 (59.1%) were male. Majority of the neonates, 15 (68.2%) were term newborns. Mode of delivery was lower segment cesarean section in 17 (77.3%) cases. APGAR score at 5 minutes was between 7 to 10 in 13 (59.1%) newborns. There were 13 (59.1%) newborns who required immediate resuscitation following birth. Meconium aspiration syndrome was the commonest associated condition found among 8 (36.4%) neonates. As per echocardiographic findings, 13 (59.1%) neonates had severe PPHN, 5 (22.7%) moderate and 4 (18.2%) mild. Mean oxygenation index at the time of admission was noted to be 46+14. Inotropic support was administered to 19 (86.4%) cases. Mean length of neonatal intensive care unit was 15+5 days. Mortality was reported among 10 (45.4%) neonates. Conclusion: Oral sildenafil was found to be a promising option for the treatment of neonates having PPHN. Oral sildenafil was found to successfully improve oxygenation among neonates having PPHN.

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Objective: To find out the effectiveness of prophylactic parenteral paracetamol to minimize rates of ductus patency among preterm infants. Study Design: Case-control study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: March 2020 to February 2021. Material & Methods: A total of 70 neonates (35 cases and 35 controls) having gestational age less than or equal to 34 weeks were enrolled. All 35 cases were administered prophylactic parenteral paracetamol as 20 mg per kg stat and 7.5 mg per kg 6 hourly for 1st 3 days of life while all controls were given no drugs. Echocardiography was performed in all 70 neonates after 1st three post-natal days to identify PDA. Data was analyzed using SPSS 26.0. Results: In a total of 70 neonates, 37 (52.9%) were male and 33 (47.1%) female. Overall, mean gestational age was noted to be 32.1+1.47 weeks while mean body weight was recorded to be 1424.6+229.7 grams. There were 6 neonates (17.1%) among cases who were found to have PDA in comparison to 23 (65.7%) in controls (p

Aim: This purpose of this study was to compare the effects of clopidogrel and ticagrelor in cases of antiplatelet therapy for treating acute coronary syndromes Study design: retrospective longitudinal comparative study Place and duration: This Study was conducted at Sandeman Provincial Hospital Quetta, Pakistan over a period of two years, from February 2019 to July 2021 Methodology: A study population of 1002 patients was taken, each diagnosed with acute coronary syndrome. The inclusion criteria for these patients included that they had been previously treated with antiplatelet therapy and had been subject to invasive therapy and management. The multiplate analyzer was used to measure the platelet count for each patient. Patient history was taken and the response of each patient to the medication was recorded throughout the interval of one year. The outcome after one year on the medication was also noted and analyzed. Results: Ticagrelor was given to patients who were young and possessed a lesser chance of having diabetes. These patients also presented with an elevated ST segment or had previously suffered from a myocardial infarction, the p value was recorded to be greater than 0.05. It was noted that patients who were treated with ticagrelor had a lower risk score of bleeding. Patients who were treated with ticagrelor also showed a lower risk score for the global registry of acute coronary events (grace) where the results showed that patients treated with ticagrelor had a score of 121 ± 27 versus 127± 31.5 and the p value was equated as 0.002. There were greatly reduced results for the high platelet reactivity in patients treated with ticagrelor. When patients treated with clopidogrel were compared with patients treated with ticagrelor the high platelet reactivity results showed that it was 37.5% versus 16.7% respectively with the p-value of less than 0.0001. Conclusion: The results from the study concluded that in case of patients who were categorized as lower risk, ticagrelor was prescribed more frequently, but it was not prescribed as frequently in the case of higher risk patients. Ticagrelor was also discontinued in case of side effects such as bleeding, trouble breathing or bradyarrythmia. However, these side effects were not common. Discontinuation rates were higher after most cases of coronary artery bypass graft surgery. These higher discontinuation rates were noted in patients who were treated without the use of revascularization. There is a need for more research to be done on this and educating surgeons on the benefits and pitfalls of the medication and its effects is also needed. Keywords: Ticagrelor, clopidogrel, acute coronary syndromes. comparison

Background: Gestational diabetes (GD) is identified as a risk factor for increasing the onset of cardiovascular disorders (CVD). However, it is not clear whether this risk is linked with the intercurrent pathogenesis of type 2 diabetes mellitus. Thus, it is essential to identify markers and risk factors responsible for the pathogenesis of CVD and develop therapeutic strategies to decrease the cardiovascular health burden in affected women. Objective: The present study aims to evaluate the effect of GD on the future onset of CVD and assess the impact of type 2 diabetes mellitus in this context. Study Design: A cohort study was conducted in Karachi Institute of Heart Diseases Karachi Pakistan from June 2017 to June 2018. A total of 227 females who give birth to at least one kid were included in this study. Females with previous history of cardiovascular disorders and any other chronic disorders were excluded from this study. Using a biennial questionnaire behavioral, life style characters and health outcomes were evaluated. Multivariable Cox model was used to measure hazardous risk and ratio for cardiovascular disorders with 95 % confidence interval. Results: In this study, 11.8% of participants were diagnosed with gestational diabetes with a mean age of 31.6 ± 2.6 years. 28% of women with GD were developed hypertension later on compared to the non-GD participants (8%), indicating a positive association between GD and hypertension. A multivariate Cox analysis revealed that women with GD had a 28% increased risk of incidence of hypertension as compared to the non-GD group (HR. 1.24 [95% CI 1.13 – 1.65); P

PurposeThe purpose of the study was to evaluate the impact of Introduction of Smart Teaching and Learning (INSTAL) project on students' academic achievements in terms of students' science scores. Information and communication technologies (ICT)-based initiative was introduced in Sindh Education Foundation (SEF) schools at District Khairpur, Sindh, Pakistan. The aim of the study was to identify whether science test scores of students have been improved with the use of INSTAL facility at schools or remained the same at SEF-supported schools.Design/methodology/approachThe quantitative research approach has been used in the current study, and within it a quasi-experimental research design was employed. The descriptive (mean, standard deviation) and inferential statistics (independent sample t-test and paired sample t-test) were computed to find the pre- and post-difference in science scores of students. Both primary and secondary data were used. The primary data were gathered through questionnaire from 48 science teachers. Whereas, secondary data of 382 students who used ICT-based facility under INSATL project for two academic years were taken from quality assessment test (QAT) scores conducted by third party in SEF-assisted schools in District Khairpur.FindingsThe findings of the study revealed that the students' science scores improved by 10% in one year and 23% in two years with the use of ICT-based facilities under INSTAL project. Also, it can be concluded from the results that ICT has a positive as well as statistically significant impact on students' science learning by using INSTAL facility in schools. Results of the study show that students' level of interest toward learning science has been enhanced by the use of ICT.Practical implicationsAs the world is rapidly moving toward digitalization, the modes of teaching and learning have been changing. ICT plays a very significant role in the betterment of education. ICT helps to achieve socio-economic development of a country. However, Pakistan, being a developing country, has not that much resources, and ICT-based learning is not common in Pakistan. Therefore, it is very important to be aware people about the usage of technology in teaching and learning. The present study is an attempt to create such type of awareness. Moreover, the current study may be the first kind of study in the context of Pakistan which used TPACK as theoretical framework, and this study may contribute to the body of knowledge in the context of ICT.Originality/valueImplementing ICT-based software for teaching and learning in rural context of Pakistan was a challenging task, but it has brought positive results in terms of student's achievement. This may be the first study that has been conducted in the context of adopted schools of SEF.

Sustainable energy tools are nowadays giving popularity in all the fields particularly in textiles due to their effective mode of action. The current study has been aimed to apply these tools (ultr...

Diabetes is getting a common disease and is spreading rapidly, affecting 6.6 percent world's population. Metformin HCl is an effective pharmacological treatment for type 2 diabetic patients because of its lowering blood glucose level ability, better weight-neutral effects and reduced risk of hypoglycemia. Nevertheless, gastrointestinal (GI) sensitivities are a concern in many patients using its immediate-release formulations. This study aimed to develop extended-release (ER) formulations to control the release into the body and minimize the dosage-related side effects of metformin and to develop an effective method of coating Sitagliptin immediate-release (IR) formulation over the core tablet. This study evaluated different formulations of Metformin HCl ER tablet using hydrophilic polymers. Different concentrations of Sitagliptin were used to develop immediate release coating. The dissolution profile of the designed formulation was compared with the reference 50/500mg tablet. In vitro dissolution of Metformin HCl (MT5), containing Methocel K4M and Methocel K100 polymer, showed 37.62% release at 1hr, 53.46% at 2hr, 84.75% at 6hr and 94.81% at 10hr. The Sitagliptin (ST8) with 10% excess released 103.64% in 30min. Similarity factor values suggested that developed Metformin ER and Sitagliptin IR formulation were like the reference product.

Natural products have gained worldwide favor due to their sustainable and ayurvedic nature. In this study, rose containing anthocyanin was explored as a source of yellowish–pink natural colorant for wool dyeing using various solvents (aqueous, alkaline, acidic, and basified methanol). Dyeing of wool was performed by optimizing the following parameters: pH, temperature, time, and salt concentration. It was observed that aqueous extract with a pH of 3 employed at 80 °C for 35 min with the addition of 4 g/100 mL salt, acidic extract with a pH of 2 employed at 40 °C for 35 min with the addition of 2 g/100 mL salt, alkaline extract with a pH of 1 employed at 80 °C for 45 min with the addition of 3 g/100 mL salt, and methanolic extract with a pH of 2 employed at 80 °C for 45 min with the addition of 4 g/100 mL salt resulted in high tint (K/S) values. To improve the colorfastness properties, salts of iron (Fe+2), aluminum (Al+3), and tannic acid (Tn) were used as chemical mordant, whereas turmeric and pomegranate were used as biomordants. Iron (Fe+2) and pomegranate resulted in shades with good colorfastness characteristics. The plant extract and dyed fabrics were also evaluated against Gram-positive and Gram-negative bacteria Staphylococcus aureus and Escherichia coli, respectively, to observe their antibacterial potential. The results indicate that wool fabric dyed with naturally sourced rose petals can be used as valuable antibacterial fabric due to the presence of various bioactive compounds by dissipating the effect of allergy-causing synthetic dyed fabrics.

Objective: To find out characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital. Study Design: Observational Study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: February 2020 to February 2021. Material & Methods: A total of 71 children aged 1 month to 15 years admitted with acute myocarditis were enrolled. Acute myocarditis was labeled as short history of illness in otherwise healthy child, echocardiography evident of left ventricular dysfunctioning, cardiac biomarkers showing cardiac damage as well as electrocardiography showing acute myocarditis. Age was represented as mean and standard deviation whereas qualitative variables like gender, area of residence and clinical features were shown as frequency and percentages. Results: Out of a total of 71 children, there were 38 (53.5%) were male. Median age was recorded to be 16.6 months. Majority of the cases, 42 (59.2%) belonged to rural areas of residence. Tachycardia was the commonest clinical feature noted in 65 (91.5%) children, irritability was seen in 50 (70.4%), tachypnea in 48 (67.6%) while poor feeding was noted 44 (62.0%) children. Hepatomegaly was noted in 39 (54.9%) children. Hypotension was recorded in 35 (49.3%) children. Conclusion: Male predominance was seen among children presenting with acute myocarditis. Tachycardia, irritability, tachypnea and poor feeding were the commonest clinical features observed.

Environmentally friendly products are the need of the hour, particularly in this pandemic situation because synthetic products need such toxic chemicals for their formulation and finishing which are carcinogenic for the globe. The current study is the utilization of waste black tea leaf (BT)-based tannin brown natural colorant for silk dyeing using microwave treatment. Dye (tannin) has been isolated in various media before and after microwave treatment up to 6 min and applied at various conditions. It has been found that 30 mL of aqueous extract of 3.0 pH obtained from 6.0 g of powder containing 3.0 g/100 mL of salt as an exhausting agent after microwave treatment for 5 min, when employed at 55 °C for 45 min, has given good color yield onto silk. Iron (3%) and acacia extract (2%) as pre-chemical and bio mordant, iron (2%) and pomegranate extract (2%) as post chemical and bio-mordant, and Al (3 %) and pomegranate extract (3%) as meta chemical and bio-mordant have given new shades with good to excellent fastness ratings. It is inferred that waste black tea leaves (BTs) in an aqueous medium have an excellent potential to serve as a source of natural tannin brown dye for the coloration of surface-modified silk fabrics under the influence of cost, energy, and time-effective microwave treatment. Additionally, the utilization of a low amount of sustainable chemical and bio-mordants has valorized the dyeing of silk by developing soothing and sustainable shades with good fastness properties.

Objective: To find out pattern along with age and gender wise distribution of congenital heart disease (CHD). Study Design: Cross Sectional study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Narowal. Period: January 2019 to February 2020. Material & Methods: During the study period, a total of 151 children aged between 1 month to 15 years as confirmed case of CHD according to echocardiography were enrolled for this study. Gender, age categories, area of residence and types of CHDs were represented as frequency and percentages. Patients with different types of CHDs were distributed between both gender and different age categories. SPSS version 26.0 was used to handle and analyze all study related data. Results: During the study period, a total of 151 confirmed cases of CHD were enrolled. There were 82 (54.3%) male and 69 (45.7%) female representing a male to female ratio of 1.2:1. Most of the cases were aged less than 1 year. There were 118 (78.1%) children below 1 year of age while 22 (14.6%) between 1 to 5 years of age and 11 (7.3%) above 5 years of age. Ventricular septal defect (VSD) and ASD were noted to be the most frequent types of acyanotic heart lesions in 41 (27.2%) and 29 (19.2%) cases respectively whereas TOF was the most frequent type of cyanotic heart lesion in 23 (15.2%) cases. Conclusion: VSD followed by ASD and TOF were noted to be the most frequent types of CHD.

Sexual violence within the context of armed conflict is not a recent phenomenon. It has existed for as long as conflict has existed. According to international law, Bosnia and Herzegovina must compensate victims of sexual violence during war, thereby mitigating the effects of such war crimes. However, Bosnia and Herzegovina's failure to effectively implement reparations for victims of wartime sexual violence has a negative impact on their status. The Bosnia and Herzegovina reparation system are ineffective for a number of reasons, the foremost of which is the lack of a single legal structure that governs the victims' right to reparation in Bosnia - Herzegovina, which is why object laws govern their rights. However, the laws of the bodies that govern this matter vary greatly, starting with the recognition of the condition of victims of sexual assault during armed conflict as a distinct category of noncombatant victims of armed conflict, the requirements for requesting the privilege to reparation, and the categories of rights they may exercise. The main aim of this paper is to analyze sexual violence in an ongoing war. The qualitative research methodology has been used in the following article.