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This article traces how the concept of educational inspection has evolved in Pakistan, especially in the province of Sindh, and discusses whether the existing inspection system helps to improve quality and establish accountability. The inspection system that originated in colonial days has evolved to incorporate the notion of using supervision to provide a range of support to school-based efforts to improve performance. The shift, however, has been in terminology only, since it has not signalled a major shift in how the job is carried out in practice. The article argues that as a strategy for establishing accountability and improving quality in education, inspection and supervision rely on several interdependent variables. Improvements in educational quality will require a balance among three factors: the availability of relevant and adequate physical, human, and financial resources; effective and empowered leadership; and functional monitoring, evaluation, and professional support for schools.

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3–4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR. [ABSTRACT FROM AUTHOR]

The 2030 Sustainable Development Goals call for both the elimination of violence against women and girls and disability-disaggregated data. However, few population-based, multi-country studies have examined how disability impacts intimate partner violence (IPV) in fragile settings. Demographic and Health Survey data from five countries (Pakistan, Timor-Leste, Mali, Uganda, and Haiti) were pooled and analyzed to assess the relationship between disability and IPV (N = 22,984). Pooled analysis revealed an overall disability prevalence of 18.45%, with 42.35% lifetime IPV (physical, sexual and/or emotional), and 31.43% past-year IPV. Women with disabilities reported higher levels of past-year and lifetime IPV compared to those without disabilities (AOR 1.18; 95% CI 1.07, 1.30; AOR 1.31; 95% CI 1.19, 1.44, respectively). Women and girls with disabilities may be disproportionately impacted by IPV in fragile settings. More global attention is needed to address IPV and disability in these settings. [ABSTRACT FROM AUTHOR]

Background: Sodium-Glucose-Co-Transporter 2 (SGLT2) inhibitor (Empagliflozin) is an effective drug in controlling blood glucose through predominantly glycosuria. Glycosuria increases the risk of genitourinary infections in diabetes. This study was aimed to establish the safety and efficacy of Empagliflozin (Group-A) versus standard care (Group-B) in Pakistani Muslim individuals with type 2 diabetes. Methods: A multicenter, randomized clinical trial was conducted in five cities across Pakistan from July 2019 to August 2020. Patients of both genders aged 18–75 years, body mass index (BMI) ≤ 45 kg/m2, glycosylated hemoglobin (HbA1c) 7–10% (53 mmol/mol to 86 mmol/mol) and treatment-naive to Empagliflozin were included. Treatment was given for 24 weeks, and allocation was done through randomization. Results: Out of 745 screened patients, 333 met the eligibility criteria, and a total of 244 (73.3%) patients were enrolled. More hypoglycemic events were reported in the standard care group, whereas positive urine culture, fungal infection, dehydration, and hypotension occurrence were comparable between the two groups. The 6 months mean HbA1c reduction was significant in both groups; (Group-A: 0.91 ± 0.15; p < 0.001 vs. Group-B2: 0.79 ± 0.14; p < 0.001). Efficacy comparison at 6 months revealed a significant reduction in weight and systolic blood pressure (SBP) in Group A only (Group-A: 1.4 ± 0.4 kg; p < 0.002 vs. Group-B: 0.01 ± 0.5 kg; p < 1.00), (Group-A: 5.1 ± 1.7 mmHg; p < 0.012 vs. Group-B: 2.3 ± 1.7 mmHg; p < 0.526). Conclusions: Empagliflozin was a safe drug compared to standard care in Pakistani Muslim patients with diabetes. It was as effective as standard care in the clinical setting but achieved glycemic control by reducing weight and SBP in type 2 diabetes patients. Trial registration: This study was registered in the NIH US National Library of Medicine clinical trials registry at Clinicaltrials.gov with the registration number: NCT04665284 on 11/12/2020. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of Pediatric Appendicitis Score (PAS) in predicting appendicitis in children presenting with acute abdominal pain to the Emergency Department (ED) of a private hospital in Pakistan. Methods: This validation study was through retrospective chart review of children between 4–18 years of age with clinical suspicion of acute appendicitis, presenting to the pediatric ED. Diagnostic accuracy was determined using sensitivity, specificity, predictive values, and area under the curve (AUC). Results: 104 children (76% boys) with mean (SD) age of 10.9 (3.5) years met the eligibility criteria. 91% (n=95) patients had moderate to high PAS (score ≥4), and 95% (n=99) had biopsy-proven appendicitis. The likelihood ratio calculated for low, equivocal and high-risk PAS was 0.10, 2.17 and 2.53, respectively. An equivocal PAS (score 4–6) showed a sensitivity of 96.8%, specificity of 80%, positive predictive value of 98.9% and AUC of 0.84 for predicting acute appendicitis. Conclusion: PAS showed good diagnostic accuracy in predicting acute appendicitis in children presenting to the ED. [ABSTRACT FROM AUTHOR]

Background: In Pakistan, for a decade or so, there has been a huge increase in body ideals, and thinness and eating disorders reported during pregnancy. The purpose of the present research was to study the lived experiences and behaviors characterized by pregorexia in Pakistani young women. Method: A phenomenological approach was used to study eating disorder-related behaviors among pregnant women. A criterion sample of 15 women (22–34 years of age) having difficulty with their body image, the decline in caloric intake, skipping meals, and extensive exercise from a private gynae clinic of Islamabad was selected. The participants were screened on the DSM-5 criteria of anorexia nervosa. They were also asked questions about their diet intake, behaviors executed to lose or maintain weight, use of any medical or chemical substance to control weight, any social activities/behaviors, type of exercise if any, duration or frequency of exercise, and behaviors that made them feel better. Results: The findings revealed that 93.33% of women met the complete criteria of Anorexia nervosa. 86.6% had never been diagnosed or treated with anorexia nervosa, however, 13.33% were diagnosed with anorexia nervosa comorbid with depression. Results indicated a likelihood of having anorexic tendencies in 40% of women and the other 60% developed the symptoms during pregnancy only. Behaviors related to pregorexia were found to be: skipping meals, eating small portions, control on calorie intake, following diet plans available on YouTube, taking fat burn tea, avoiding the presence of elders of the family while taking meals, eating alone to limit food portion, taking laxatives or medicine to control weight, induced vomiting after eating, eating to match the norm of eating (supervised eating by elders) being pregnant and later self-induced vomiting, or eating slowly and consuming more time, pretending to eat the suitable amount of food. Women also engaged in fast walking, light exercise, and intensive cardio to control weight and stay in body shape. Around 86% reported that controlling weight, calorie intake, and exercising made them feel better. Conclusion: There is a need to understand and differentiate pregorexia from other eating behaviors and problems among pregnant women with respect to cultural context. Plain English summary: Pregorexia is a term used to describe a condition where an individual displays a heightened fear of pregnancy-related weight gain. The present study is the first to examine this eating disorder in Pakistan. Some behaviors related to pregorexia were commonly identified to include skipping meals, eating small portions, following diet plans available on YouTube, eating alone to limit food portion, taking laxatives or medicine to control weight, induced vomiting after eating, and pretending to eat the suitable amount of food. We recommend clinicians interacting with pregnant women to screen for these behaviors when taking histories to provide better support, education and increased awareness. [ABSTRACT FROM AUTHOR]

Background: One of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes. Moreover, physiological factors like age, gender, duration of diabetes, other diabetic complications like neuropathy, autonomic neuropathy and glycosuria are also considered as predisposing factors for increased prevalence of UTI in diabetes which can be symptomatic or asymptomatic.Methods: This was a cross-sectional, multi-centre study including diabetic patients from 12 clinical sites spread across major cities of Pakistan. The inclusion criteria were adult Pakistani population of age between 18 to 75 years both genders and suffering from T2DM irrespective of duration. A detailed clinical history of the past 3 months was recorded and, biochemical investigations of blood samples were conducted. Urine culture analysis performed identified the type of pathogen present and was done only for asymptomatic patients.Results: A total of 745 type 2 diabetic patients were initially screened, out of 545 patients considered for final analysis 501 (91.92%) were negative and the rest 44 (8.08%) had positive urine culture. Female gender had a significantly higher proportion of positive urine culture (77.27%, p-value< 0.001). Body mass index and mean age had insignificant distribution among the two groups of positive and negative urine culture, with age 40-59 years having higher proportion (70.45%) in the positive group. Escherichia coli was detected in most of the positive samples (52.3%). All bacterial samples were found resistant to Ciprofloxacin.Conclusion: Diabetic Pakistani muslim female patients are identified to be at high risk of suffering from asymptomatic UTI and age more than 40 years is an important risk factor. Escherichia coli was the most common causative organism among people living in this geographical area. [ABSTRACT FROM AUTHOR]

This article interrogates whether we should consider 'religious marginality' as a qualifier much like the exploration of how gender, ethnicity, and class inequalities are explored when examining Covid-19-related vulnerabilities and their implications for building back better. Drawing on a case study of Pakistan as well as evidence from India, Uganda, and Iraq, this article explores the accentuation of vulnerabilities in Pakistan and how different religious minorities experience the impact of the interplay of class, caste, ethnicity, and religious marginality. The article argues that where religious minorities exist in contexts where the broader political and societal policy is one of religious 'othering' and where religious marginality intersects with socioeconomic exclusion, they experience particular forms of vulnerability associated directly or indirectly with Covid-19 consequences that are acute and dire in impact. Building back better for religiously inclusive societies will require both broad-based as well as more specific redress of inequalities. [ABSTRACT FROM AUTHOR]

He admitted that the state is involved, but he can't openly say this, because if they (the state) are killing 50 Shi as today, they will kill 200 Shi'as if the Shi'a ulama start naming the state's institutions. She argues that 'despite the ulama 's critiques of particular state bodies and even at times the entirety of the state apparatus, a false consciousness about the state persists' (208) in which they continue to be an active part of the state apparatus. [Extracted from the article]

The article analyzes the dynamics of the dhamal ritual at the shrine of Lal Shahbaz Qalandar in contemporary Pakistan. Topics discussed include what Qalandar symbolizes for Pakistanis, according to the author, explanation on the urs festival, the annual death anniversary of a Sufi saint, and notion prevalent in many quarters of Pakistan's media and rational discourse about Qalander festivals.

Aims: To explore the perceptions of community midwives about their work experiences after deployment in the rural settings of Chitral, Khyber Pakhtunkhwa, Pakistan. Methods: A qualitative descriptive approach was used, conducting indepth semi-structured interviews with 13 community midwives. Findings: The three major themes that emerged from the analysis of the data were: (1) rural community midwives’ perceptions of their role and competencies, (2) factors facilitating and hindering the rural community midwives’ ability to function, and (3) continuation of community midwives’ services in the future. Conclusions: The study findings highlighted the factors that empower and obstruct community midwives in providing services in rural areas. The majority of the community midwives felt empowered because of their increased earning capacity and enhanced competencies in performing their roles. However, some of them shared challenges in terms of socio-cultural and financial constraints. These findings have important implications for midwives working in rural areas. [ABSTRACT FROM AUTHOR]

Background and Objectives: Breast cancer is the most common malignancy and a leading cause of death in women. The objectives of this study were to compare the argyrophilic nucleolar organizer region (AgNOR) parameters and estrogen receptor status with grades of invasive ductal carcinoma of breast. Methods: 50 cases of invasive ductal carcinoma of breast diagnosed on trucut, core biopsy/incision/excision was collected from Lahore General Hospital, Lahore. Hematoxylin and eosin, AgNOR and estrogen staining was done. AgNOR parameters and ER status were compared with grades of invasive ductal carcinoma. Results: The mean age of the patients was 46.84 years ± 11.8 SD. A significantly greater proportion (p < 0.01) of grade III tumors showed a variation in AgNOR size of 3+ when compared with grade II tumors. AgNOR dispersion was predominantly of 3+ in grade II tumors, whereas all the grade III tumors had 3+ AgNOR dispersion. However, the difference was not statistically significant. All estrogen receptor positive tumors were of low grade as compared to ER -ve, and the difference was statistically significant. Conclusion: It is concluded that AgNOR size, dispersion and ER status correlate well with Bloom and Richardson grade of invasive ductal carcinoma of breast. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is the most common malignancy and a leading cause of death in women throughout the world. It is the most frequently reported malignancy and a major cause of cancer morbidity and mortality in Pakistan as well. Objective: To compare the Argyrophilic nucleolar organizer regions size and dispersion in estrogen receptor positive and ER-ve tumors of invasive ductal carcinoma of breast. Materials and Methods: Fifty cases of invasive ductal carcinoma of breast diagnosed on trucut, core biopsy/incision/excision were collected from Lahore General Hospital, Lahore. The slides prepared were stained with H&E, AgNOR, and ER immunostains. Results: The mean age of the patients was 46.84 years ± 11.8 SD. AgNOR size and dispersion were significantly of higher grade (p = 0.001 and p < 0.05) in ER-ve tumors than ER+ve tumors. Conclusion: It is concluded that AgNOR size and dispersion correlateinversely with ER status in invasive ductal carcinoma of breast and the results are statistically significant. [ABSTRACT FROM AUTHOR]

The article discusses the role of women's autobiography in the feminist intellectual history of Islamic societies. Particular focus is given to women's autobiographical writings published on the website "Pakistani Atheists and Agnostics" (PAA). The author argues that the intellectual content of women's autobiographical writing is often overlooked in favor of its narrative content. It is suggested that the women writers featured on the PAA website perform the intellectual work of affirming their Pakistani identity and emphasizing the validity of Pakistan as a space and concept separate from Islam. Topics discussed include Islamic feminism, bodily autonomy, ethics, and trust.

Faculty practice can promote a collaborative partnership mutually beneficial to both nursing education and service. However, little is known about its implementation in developing countries. The purpose of this study was to explore the potential for introducing faculty practice within the cultural milieu of Karachi, Pakistan. Focus groups of nursing faculty, staff and students were conducted in various settings: government, semigovernment and private institutions to elicit the data. Data analysis revealed that a more comprehensive definition of faculty practice is needed that will provide the foundation for a culturally acceptable model of faculty practice in Pakistan. Hierarchy dominates the current cultural milieu and must be addressed before faculty practice can be implemented. [ABSTRACT FROM AUTHOR]

The article presents a study which determines the effect of occupation exposure of steel mill workers' hair in iron (Fe), zinc (Zn) and copper (Cu) in Karachi, Pakistan. The study used hair samples from healthy workers and sex-matched control Pakistani men in the city to compare metals' nutrition and hair contamination. Results show the necessity of monitoring workers against the potential toxic levels of metals.