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Background: Midwives are essential providers of primary health care and can play a major role in the provision of health care that can save lives and improve sexual, reproductive, maternal, newborn and adolescent health outcomes. One way for midwives to deliver care is through midwife-led birth centres (MLBCs). Most of the evidence on MLBCs is from high-income countries but the opportunity for impact of MLBCs in low- and middle-income countries (LMICs) could be significant as this is where most maternal and newborn deaths occur. The aim of this study is to explore MLBCs in four low-to-middle income countries, specifically to understand what is needed for a successful MLBC. Methods: A descriptive case study design was employed in 4 sites in each of four countries: Bangladesh, Pakistan, South Africa and Uganda. We used an Appreciative Inquiry approach, informed by a network of care framework. Key informant interviews were conducted with 77 MLBC clients and 33 health service leaders and senior policymakers. Fifteen focus group discussions were used to collect data from 100 midwives and other MLBC staff. Results: Key enablers to a successful MLBC were: (i) having an effective financing model (ii) providing quality midwifery care that is recognised by the community (iii) having interdisciplinary and interfacility collaboration, coordination and functional referral systems, and (iv) ensuring supportive and enabling leadership and governance at all levels. Conclusion: The findings of this study have significant implications for improving maternal and neonatal health outcomes, strengthening healthcare systems, and promoting the role of midwives in LMICs. Understanding factors for success can contribute to inform policies and decision making as well as design tailored maternal and newborn health programmes that can more effectively support midwives and respond to population needs. At an international level, it can contribute to shape guidelines and strengthen the midwifery profession in different settings. [ABSTRACT FROM AUTHOR]

Worldwide protected areas (PAs) of various categories are established to address human-induced biodiversity losses. This emerging system of land use greatly influences peoples' attitudes, which has been used as an indicator and predictor to evaluate the success of conservation programmes. In this study, we have assessed conservation attitudes, by comparing self-reported practices and perceptions of people under two management regimes in northern Pakistan: (a) community-based conservation programme in village Khyber (CBC-only) and (b) co-management of Khunjerab National Park and its buffer zone in village Sost (CBC-NP). Located in the same geographical region, the two sites were demographically and socio-economically comparable. The data were acquired by quantitative (household survey) and qualitative (semi-structured interview) methods, involving adult respondents from 123 randomly selected households in Sost, 104 in Khyber and selected community representatives from both sites, respectively. The data was analysed through descriptive statistics, Chi-squared and t-tests. The results revealed that the communities at both sites were largely aware and appreciative of the conservation programmes. Despite drawing diverse economic benefits from the Khunjerab National Park, the people of CBC-NP showed lesser positive attitudes than those of the CBC-only. The study thus concluded that apart from economic benefits, the local attitudes are largely influenced by a greater sense of participation, ownership and level of engagement in conservation programmes. Since negative attitudes cause conflicts and subsequently failure of PAs, increase community engagement in policies and practices are highly essential for efficient management of PAs. [ABSTRACT FROM AUTHOR]

Preterm birth (PTB) poses great risk to neonatal health in Pakistan with few tertiary health care facilities. Role of intrauterine microbiome in maintaining healthy pregnancy has been highlighted. However, there is ongoing debate whether a true placental microbiome exist. We analyzed placental and vaginal microbiome through V3-V4 16srRNA sequencing and observed increased abundance of proteobacteria, with concomitant decline in the firmicutes population in preterm vagina. Simplistic placental microflora included many environmental microbes with PTB placenta carrying pathogenic microbes like ureaplasma and mycoplasma species. We observed contribution of environmental, vaginal and skin contamination in term versus pathobiome signatures in preterm placenta. [ABSTRACT FROM AUTHOR]

OBJECTIVE To find out the problems associated with the clinical utilization of Chapter 6 related to Mental & behavioural disorders of International Classification of Diseases 11(ICD-11) by the psychiatrists of Pakistan and also to understand the basic description of its utilization in clinical practice. STUDY DESIGN It is a cross-sectional descriptive study. PLACE AND DURATION OF STUDY The study was conducted through an online survey which was circulated to psychiatrists across the country during a period of two months. SUBJECT AND METHOD: A sample size of 130 Participants including psychiatrists and postgraduate trainees (psychiatry) responded to the e-mail and WhatsApp messages. The survey was on Google Docs, and it was an online survey with responses of "yes, no and don't know". The ethical approval for the survey was taken from the Pakistan psychiatric research centre(xxx). RESULTS Out of 130 psychiatrists, 65.4% were the residents who heard about ICD-11 mostly from academic activity conducted by the authors. 48.5% of psychiatrists believe that it is difficult to adjust to the new classification system. CONCLUSION ICD-11 is a new classification system. It requires training from the seniors and workshops related to its utility through the online mortality and morbidity statistics by WHO across various countries. [ABSTRACT FROM AUTHOR]

Objective. This study was designed to determine the antioxidant activity of the extracts of beetroot by using beetroot energy drink and flavored milk (products). Material & Methods. This experimental trial was conducted at Jinnah University for Women, Pakistan, under the approval of local institutional review board number JUW/DFST/RCB010/2020. All the materials such as beetroot, carrot, cucumber, and lemon were obtained commercially from which two products were formulated: beetroot energy drink (sample1) and flavored milk (sample 2). These formulated products were evaluated for quality analysis (pH and brix), phytochemical screening using the Keller-Kiliani test, Salkowski's test, Alkaline reagent test, lead acetate test, ferric chloride test, protein test, quantitative test of phenol, antioxidant activity, sensory analysis, and shelf life study. The paired t -test was applied to detect significant differences between two samples. Results. The phytochemical analysis revealed that cardiac glycosides, phytosterol, flavonoids, and terpenoids were found in both energy booster drink (EBD) and flavored milk (FM) except phenolic compounds that were found only in EBD. The antioxidant capacity of beetroot juice was far greater than FM. The statistical sensorial analysis of FM and EBD reported a significant mean difference between most of the groups with p < 0.0001. Conclusion. This study concludes that energy drinks having beetroot indicated higher antioxidant capacity than flavored milk. The nutraceutical products (energy booster drink and flavored milk) containing beetroot are enriched with optimum quantities of proteins and fats and low carbohydrates at a stable pH with an adequate total energy content. [ABSTRACT FROM AUTHOR]

Background: The oleo-gum resin of Commiphora wightii has been utilized for centuries in Ayurvedic medicine for the treatment of various diseases. Ruthless exploitation of this species with negligible conservation efforts has led to its inclusion in the International Union for Conservation of Nature assemblage of endangered plant species. Objectives: In this paper, the impact of plant aging and geographical variations of guggulsterone (GS) content in oleo-gum resin collected from different geographical regions of India has been examined. Materials and Methods: The oleo-gum resin samples of different age groups and geographical regions of India (Kutch, Morena, Jodhpur, Jaipur, and Pakistan border of Kutch) were collected directly from the site and examined to check the concentration of GS-E and Z by high-performance liquid chromatography. Comprehensive metabolomic profiling of samples was done through liquid chromatography–mass spectrometry. Results: The data showed that there is no significant variation was found in the concentration of GS-E and Z with the change in the age of C. wightti plant. The oleo-gum resin samples of Morena showed a high percentage range of GSs (0.88%–2.17% w/w), whereas Jaipur samples showed a lower percentage of GSs (0.56%–0.89% w/w). From metabolomics profiling, 11 high-intensity metabolites were identified in samples of all major regions of India. Conclusion: This study indicates that there is no impact of plant aging on the GS contents. The Indian regions such as Morena, Kutch, and Pakistan border near Kutch regions can be used as a potential source for mass multiplication of guggul plants to get the good quality of the oleo-gum resin. [ABSTRACT FROM AUTHOR]

Purpose: The role of specialized pharmacy services remains unexplored in clinical practice for hepatitis C patients in Pakistan. This study aimed to evaluate the impact of clinical pharmacy interventions on treatment outcomes, health-related quality of life (HRQoL), and medication adherence among hepatitis C patients. Methods: A randomized control trial was conducted at two tertiary-care teaching hospitals in Pakistan. Hepatitis C patients who attended the outpatient clinics between October 2015 and September 2018 were randomized to two groups [usual care (UC) and pharmaceutical care (PC)] in a 1:1 ratio, applying simple envelope method. The PC group received pharmaceutical care led by a clinical pharmacist. The care that patients received included education and counseling on medication compliance, labeling of medication packs, and monitoring of adverse drug events, led by a qualified clinical pharmacist during the 15- to 20-minute monthly sessions, while the UC group received standard care at hospital, which did not involve clinical pharmacist input. Outcome measures, such as sustained virological response, HRQoL, and adherence rate (pharmacy data) were assessed at enrolment and distinct time intervals: 4 weeks, 8 weeks, and end of treatment. Results: A total of 931 patients were included in the study (UC 466 and PC 465), with mean age 42.35±1.9 years. Sustained virological response at 12 weeks was achieved in 86.0% patients in the PC group, significantly (p<0.001) higher than the UC (69.3%) group. Fewer patients (9.9%) in the PC group reported mobility problems, significantly fewer (p<0.001) than the UC group (11.8%). Self-care, usual activity, pain, and depression were relieved significantly in the PC group compared to the UC group. The EuroQol visual analogue scale (baseline 56.1 of UC group versus 55.2 for PC group) was raised to 71.8 and 71.9 in the UC and PC groups, respectively. Medication adherence was significantly improved (p<0.001) in the PC group (88.6%) when compared to the UC group (77.9%, 95% CI 88.9%–91.9%). Conclusion: Pharmacist-led clinical pharmacy interventions as part of multidisciplinary care had a significant impact on improving cure rates, HRQoL, and medication adherence for hepatitis C patients. This study suggests that clinical pharmacists should be incorporated into the multidisciplinary health-care team for care of hepatitis C patients. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the correlation between risk management and citizenship in Pakistan. The study utilized literature on the vulnerability, social protection and citizenship in south Punjab and Sindh. It explored why Pakistan is said to have had economic growth without social development. It also described the relations between vulnerability and social protection, and social protection and citizenship.

The article discusses the continuing disastrous failure of the political class in Pakistan to develop a democratic settlement with India. Pakistan accuses India of creating trouble in its biggest province Balochistan, while Indians accuses Pakistan of dispatching terrorists to their country. The author urges Pakistani President Asif Ali Zardari or Prime Minister Makhdoom Syed Yousaf Raza Gilani to engage in dialogue with Indian Prime Minister Manmohan Singh since it will benefit their country in terms of political climate and international standing.

Analyzes the kind of democracy that is emerging in Pakistan. The world of Islamic ideas and concepts that influenced democratic processes in Pakistan; Western origins of Pakistan's democracy; The actual dialectical process of democracy.

The author comments on a paper which examined the challenges in adapting multi-order governance to make it incentive compatible with growth with equity and fiscal sustainability as they relate to the situation in Pakistan. The impact of globalisation on Pakistan was assessed. The author explores the glocalisation concept raised in the paper in the context of Pakistan. The author comments on the development model in the paper which favours the sub-provincial or local government.

Background: An outbreak of Candida auris began globally in 2014 including Pakistan and since then it has emerged as a nosocomial multi-drug resistant pathogen. The aim of this study was to assess the clinical spectrum and outcome of patients, from a single center in Pakistan, in whom C. auris was isolated.Methods: A retrospective study was conducted on 92 patients; ≥16 years with at least one culture positive for C. auris, at the Aga Khan University Hospital Karachi, Pakistan from Sept 2014-Mar 2017.Demographics, clinical history, management and outcome were studied. A logistic regression model was used to identify the risk factors for mortality.Results: We identified 92 patients with C. auris (193 isolates), of whom 52.2% were males. Mean age was 54.14 ± 20.4 years. Positive cultures were obtained after a median hospital stay of 14 days. Most patients had a history of surgery (57.6%), antibiotic use (95.6%), ICU stay (44.6%), indwelling lines (88.04%) and isolation of another multi-resistant organism (52.2%).Most patients were symptomatic (70.7%). Amongst these, 38 had candidemia while 27 had non-candidemia infections. Sites of infection included central lines (35), urinary tract (19), peritonitis (4), nosocomial ventriculitis (1), empyema (1), fungal keratitis (1) otitis externa (1) and surgical site (1). Fluconazole resistance was 100% while 28.5 and 7.9% were Voriconazole and Amphotericin resistant respectively. Overall crude mortality was 42.4% while 14-day mortality was 31.5%. Both infected and colonized cases shared similar mortality (46.2% vs 33.3%; p-value = 0.25). Among infected cases mortality was high in candidemia compared to non-candidemia (60.5% vs 25.9%) in which deaths related to C. auris were 34.2% vs 22.2% respectively. On multivariate analysis candidemia (AOR 4.2, 95% CI: 1.09-16.49; p-value = 0.037) was associated with greater mortality with source control being the only protective factor for mortality (AOR 0.22, 95% CI: 0.05-0.92; p-value0.038] while ICU stay, rapidity of blood culture clearance, DM, malignancy and MDR co-infection had no impact.Conclusion: Patients with C.auris from a single center in Pakistan have a wide clinical spectrum with line associated infection being the predominant site of infection. Candidemia leads to high mortality while source control improves outcome. [ABSTRACT FROM AUTHOR]

Background: Although international comparisons reveal large geographical differences in the incidence of breast and gynaecological cancers, incidence data for ethnic groups in England remains scarce.Methods: We compared the incidence of breast, ovarian, cervical and endometrial cancer in British Indians, Pakistanis, Bangladeshis, Black Africans, Black Caribbeans, Chinese and Whites between 2001 and 2007. We identified 357,476 cancer registrations from which incidence rates were calculated using mid-year population estimates from 2001 to 2007. Ethnicity was obtained through linkage to the Hospital Episodes Statistics database. Incidence rate ratios were calculated, comparing the 6 non-White ethnic groups to Whites, and were adjusted for age and income.Results: We found evidence of differences in the incidence of all 4 cancers by ethnic group (p<0.001). Relative to Whites, South Asians had much lower rates of breast, ovarian and cervical cancer (IRRs of 0.68, 0.66 and 0.33 respectively), Blacks had lower rates of breast, ovarian and cervical cancer but higher rates of endometrial cancer (IRRs of 0.85, 0.62, 0.72 and 1.16 respectively), and Chinese had lower rates of breast and cervical cancer (IRRs of 0.72 and 0.68 respectively). There were also substantial intra-ethnic differences, particularly among South Asians, with Bangladeshis experiencing the lowest rates of all 4 cancers.Conclusions: Our study provides evidence that the risk of breast and gynaecological cancers varies by ethnic group and that those groups typically grouped together are not homogenous with regards to their cancer risk. Furthermore, several of our findings cannot be readily explained by known risk factors and therefore warrant further investigation. [ABSTRACT FROM AUTHOR]

Objectives To determine the efficacy of brief Culturally adapted CBT (CaCBT) for depression when added to Treatment As usual (TAU)—delivered by trained therapists using a manual compared with alone TAU. Methods This was an assessor-blinded, randomised controlled clinical trial. Particpants with a diagnosis of depression, attending psychiatry departments of three teaching hospitals in Lahore, Pakistan, were included in the study. We screened a total of 280 patients and randomly allocated 137 of them to CaCBT plus Treatment As Usual (TAU) [Treatment group] or to TAU alone [Control group]. Assessments were completed at baseline, at 3 months and at 9 months after baseline. Reduction in depression score (Hospital Anxiety and Depression-Depression Subscale) at 3 months was primary outcome measure. The secondary outcome measures included anxiety scores (Hospital Anxiety and Depression-Anxiety Subscale), somatic symptoms (Bradford Somatic Inventory), disability (Brief Disability Questionnaire) and satisfaction with the treatment. Findings A total of 69 participants were randomised to Treatment group and 68 to Control group. Participants in Treatment group showed statistically significant improvement in depression ( p =0.000), anxiety ( p =0.000), somatic symptoms ( p =0.005) and disability ( p =0.000). This effect was sustained at 9 months after baseline (Except for disability). Participants in Treatment group also reported higher satisfaction with treatment compared with those in Control group. Conclusion Brief CaCBT can be effective in improving depressive symptoms, when compared with treatment as usual. This is the first report of a trial of Culturally adapted CBT from South Asia and further studies are needed to generalise these findings. [ABSTRACT FROM AUTHOR]