Trend analysis of multi-level determinants of maternal and newborn postnatal care utilization in Pakistan from 2006 to 2018: Evidence from Pakistan Demographic and Health Surveys.

BACKGROUND: Postnatal care (PNC) is crucial for maternal and newborn health. Healthcare-seeking practices within the postpartum period help healthcare providers in early detection of complications related to childbirth and post-delivery period. This study aims to investigate trends of PNC utilization from 2006 to 2018, and to explore the effects of multi-level determinants of both maternal and newborn PNC in Pakistan. METHODS: Secondary data analysis of the last three waves of the nationally representative Pakistan Demographic and Health Surveys (PDHSs) was conducted Analysis was limited to all those women who had delivered a child during the last 5 years preceding each wave of PDHS Bivariate and multivariate logistic regression was applied to determine the association of maternal and newborn PNC utilization with multi-level determinants at individual, community, and institutional levels. RESULTS: In Pakistan, an upward linear trend in maternal PNC utilization was found, with an increase from 43.5 to 63.6% from 2006 to 2018. However, a non-linear trend was observed in newborn PNC utilization, with an upsurge from 20.6 to 50.5% from 2006 to 2013, nonetheless a decrease of 30.7% in 2018. Furthermore, the results highlighted that the likelihood of maternal and newborn PNC utilization was higher amongst older age women, who completed some years of schooling, were employed, had decision-making and emotional autonomy, had caesarean sections, and delivered at health facilities by skilled birth attendants. Multivariate analysis also revealed higher odds for women of older age, who had decision-making and emotional autonomy, and had caesarean section deliveries over the period of 2006-2018 for both maternal and newborn PNC utilization. Further, higher odds for maternal PNC utilization were found with parity and size of newborn, while less for ANC attendance and available means of transportation. Furthermore, increased odds were recorded for newborn PNC utilization with the number of children, ANC attendance, gender of child and mass media exposure from 2006 to 18. CONCLUSION: A difference in maternal and newborn PNC utilization was found in Pakistan, attributed to multiple individual (socio-demographic and obstetrics), community, and institutional level determinants. Overall, findings suggest the need to promote the benefits of PNC for early diagnosis of postpartum complications and to plan effective public health interventions to enhance women's access to healthcare facilities and skilled birth assistance to save mothers' and newborns' lives.

Wastewater-Irrigated Vegetables Are a Significant Source of Heavy Metal Contaminants: Toxicity and Health Risks.

Water contaminated with heavy metals constitutes an important threat. This threat is a real problem with a negative impact in some developing countries where untreated industrial effluents are used for irrigation. The present study examines heavy metals in wastewater-irrigated vegetables (apple gourd, spinach, cauliflower, sponge gourd, and coriander) water, and soil from Chenab Nagar, Chiniot, Pakistan. In particular, the metals quantified were cadmium (Cd), chromium (Cr), cobalt (Co), nickel (Ni), lead (Pb), and manganese (Mn). Among them, Cr and Co in crops irrigated -wastewater exceeded the levels recommended by the World Health Organization (WHO). In contrast, Ni, Cu, Pb, and Mn concentrations were in line with WHO standards. Compared with the limits established by the Food and Agriculture Organization of the United Nations (FAO), all the study vegetables presented higher (thus unsafe) concentrations of Cd (0.38 to 1.205 mg/Kg). There were also unsafe concentrations of Cr in coriander, sponge gourd, and cauliflower. Pb was found at an unsafe concentration (0.59 mg/Kg) in cauliflower. Conversely, Ni and Mn concentrations were below the maximum permissible limits by WHO, and FAO in all of the analyzed samples. The contamination load index (CLI) in soil, bioconcentration factor (BCF) in plants, daily intake of metals (DIM), and health risk index (HRI) have also been evaluated to estimate the potential risk to human health in that area. We have found an important risk of transitions of Pb, Cd, Cr, and Co from water/soil to the edible part of the plant. The highest HRI value associated with Cd (6.10-13.85) followed by Cr (1.25-7.67) for all vegetable samples presented them as high health risk metal contaminants. If the issue is not addressed, consumption of wastewater-irrigated vegetables will continue posing a health risk.

Consanguineous marriages and their association with women's reproductive health and fertility behavior in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990-2018.

BACKGROUND: Pakistan has been showing consistently the highest prevalence of consanguinity. The popularity of consanguineous marriages is not declining in the country, because of social, cultural, and religious beliefs as well as economic advantages. However, couples also face various health-related implications, such as poor pregnancy outcomes or multiple reproductive and fertility consequences, having adverse effects on mothers and their children. This research investigated the trend of consanguineous marriages and their association with women's reproductive health and fertility behavior in Pakistan from 1990 to 2018. METHODS: This study is based on secondary data analysis, using all four waves of the Pakistan Demographic Health Surveys carried out from 1990 to 2018. The analysis is limited to women aged 15-49 years, who had given birth in the previous five years preceding each survey. Sampling weights were calculated and subsequently weighted analysis was conducted. Descriptive statistics, bivariable and multivariable logistic regression analysis were performed to determine the association of consanguinity with multiple characteristics related to socio-demographics, co-variates, and women's reproductive health and fertility behaviors. RESULTS: The findings revealed a high but overall stable trend of consanguinity prevalence of about 63% during the last three decades. Consanguineous marriages were more prevalent amongst young and uneducated women, living in rural areas, with poorer wealth status and having less exposure to mass media to access information. A strong association of consanguinity was observed with women's reproductive health and fertility behavior, particularly for women who gave first birth at a younger age, had multi-gravida pregnancies, multi-parity, pregnancy termination, ANC visits, and higher fertility. CONCLUSION: Consanguineous marriages are predominant in the patriarchal society of Pakistan. Findings revealed that consanguinity contributes significantly to women's reproductive health and fertility behaviors. Appropriate counseling, educational, and health promotional programs related to consanguinity should be designed and launched at the community level to raise awareness about risks towards women's reproductive health and fertility.

Synthesis of 2-Aminopyrimidine Derivatives and Their Evaluation as ß-Glucuronidase Inhibitors: In Vitro and In Silico Studies.

Currently the discovery and development of potent ß-glucuronidase inhibitors is an active area of research due to the observation that increased activity of this enzyme is associated with many pathological conditions, such as colon cancer, renal diseases, and infections of the urinary tract. In this study, twenty-seven 2-aminopyrimidine derivatives 1-27 were synthesized by fusion of 2-amino-4,6-dichloropyrimidine with a variety of amines in the presence of triethylamine without using any solvent and catalyst, in good to excellent yields. All synthesized compounds were characterized by EI-MS, HREI-MS and NMR spectroscopy. Compounds 1-27 were then evaluated for their ß-glucuronidase inhibitory activity, and among them, compound 24 (IC50 = 2.8 ± 0.10 µM) showed an activity much superior to standard D-saccharic acid 1,4-lactone (IC50 = 45.75 ± 2.16 µM). To predict the binding mode of the substrate and ß-glucuronidase, in silico study was performed. Conclusively, this study has identified a potent ß-glucuronidase inhibitor that deserves to be further studied for the development of pharmaceutical products.

Predictors of parental mediation in teenagers' internet use: a cross-sectional study of female caregivers in Lahore, Pakistan.

BACKGROUND: The internet has become the most widely used medium among teenagers, who spend much of their time online, which raises parental concerns. Notwithstanding teens' increased internet use and exposure to online risks, little is yet known about parental internet mediation in local settings. The present research aimed to assess the various dimensions of parental mediation to regulate teens' use of the internet and their predictors. METHODS: A cross-sectional survey was conducted in the district of Lahore, Pakistan, among mothers/female caregivers of teens (aged 13-19 years). Only women were interviewed because they are more frequently engaged as primary caregivers than fathers or male caregivers. Furthermore, only qualified and working mothers from the top two professions among women, i.e. academia and medicine, were interviewed. A stratified random sampling technique was adopted, and 347 mothers were interviewed using face-to-face interviews at 11 universities and 11 hospitals/medical colleges. Data were entered and analysed using descriptive, bivariate and multivariate logistic regression analyses. RESULTS: The findings highlighted that more than 65% of respondents applied highly active mediation of internet safety, around 60% used highly active co-use mediation and more than 56% applied restrictive mediation. In addition, 36% of respondents monitored and 15.3% technically mediated to regulate their teens' use of the internet. The results of the multivariate logistic regression revealed that the majority of respondents were more inclined to adopt active internet safety mediation if they had teens aged 16-19 years, with medium internet addiction, possessed good digital skills, felt confident about their teens' coping appraisal to perform online protection, and considered their teens to have high self-esteem and resilience. CONCLUSIONS: This research found that parental internet mediation is a multifaceted concept used to regulate teens' online activity and enhance a resilient approach to reduce the risks associated with use of the internet. The researchers recommend developing parental guidelines, e-safety resource material, local support networks and community programmes to educate parents, teachers and teens in order to raise awareness and promote resilient pathways amongst teens.

Determinants of overall knowledge and health behaviours in relation to hepatitis B and C among ever-married women in Pakistan: evidence based on Demographic and Health Survey 2017-18.

BACKGROUND: In 2019, around 5 million and 10 million people were affected by hepatitis B virus (HBV) and hepatitis C virus (HCV) respectively in Pakistan. On World Hepatitis Day 2019, Pakistan's Government announced the Prime Minister's Plan to eliminate HBV and HCV from the country by 2030. In order to achieve this goal, adequate knowledge about HBV and HCV regarding mode of transmission, symptoms of the disease, and awareness about available treatments and vaccines is imperative. The present study aims to investigate the determinants related to overall knowledge about and behaviour in relation to HBV and HCV amongst married women in Pakistan. METHODS: Secondary data analysis was carried out using the Pakistan Demographic and Health Survey (PDHS) 2017-18. A series of questions regarding women's knowledge about how to avoid HBV and HCV and their health behaviour in relation to HBV and HCV were posed to 12,364 ever-married women of reproductive age (15-49 years). Bivariate and multivariable logistic and linear regression was applied to examine the effects of sociodemographic characteristics and covariates on women's overall knowledge and health behaviour regarding HBV and HCV. RESULTS: The findings highlight that the majority of women (88.3%) have heard of HBV and HCV. Nonetheless, only 34.8% had comprehensive knowledge about how to avoid HBV and HCV. Few women (11.3%) had been tested for HBV or HCV during the year preceding the survey. Furthermore, the results indicate that women living in urban areas, being older, and having more than 10 years of schooling, reported better knowledge and health behaviours regarding HBV and HCV. CONCLUSION: This study provides evidence that women's sociodemographic characteristics create differences in their overall knowledge about and attitudes towards HBV and HCV. This research emphasized that there is a need to create awareness about the causes and prevention of HBV and HCV in order to achieve the goal of eliminating these diseases in Pakistan by 2030.

Functionalised bicyclic tetramates derived from cysteine as antibacterial agents.

Routes to bicyclic tetramates derived from cysteine permitting ready incorporation of functionality at two different points around the periphery of a heterocyclic skeleton are reported. This has enabled the identification of systems active against Gram-positive bacteria, some of which show gyrase and RNA polymerase inhibitory activity. In particular, tetramates substituted with glycosyl side chains, chosen to impart polarity and aqueous solubility, show high antibacterial activity coupled with modest gyrase/polymerase activity in two cases. An analysis of physicochemical properties indicates that the antibacterially active tetramates generally occupy physicochemical space with MW of 300-600, clog D7.4 of -2.5 to 4 and rel. PSA of 11-22%. This work demonstrates that biologically active 3D libraries are readily available by manipulation of a tetramate skeleton.

Determinants of overall knowledge of and attitudes towards HIV/AIDS transmission among ever-married women in Pakistan: evidence from the Demographic and Health Survey 2012-13.

BACKGROUND: HIV/AIDS has emerged as a serious public health issue across the globe, and particularly in developing countries. Comprehensive knowledge and positive attitudes are cornerstones for the prevention, control and treatment of HIV/AIDS. However, there are various misconceptions associated with HIV/AIDS transmission, which lead to negative attitudes towards people living with AIDS. The present study aims to explore the effects of these determinants, related to socio-demographic characteristics and autonomy, on women's overall knowledge and attitudes regarding HIV/AIDS in Pakistan. METHODS: Secondary data analysis was carried out using the national representative dataset of the 2012-13 Pakistan Demographic and Health Survey. A series of questions related to HIV/AIDS was asked of 13,558 ever-married women aged 15-49 years to assess respondents' knowledge regarding modes of HIV/AIDS transmission and preventative measures, as well as their attitudes towards people living with HIV/AIDS. Descriptive and bivariate statistics were used to identify associations with socio-demographic and autonomy-related variables. Furthermore, bivariate and multivariate logistic regression analyses were performed to assess the association between multiple factors and overall HIV/AIDS knowledge as well as attitudes towards people living with AIDS. RESULTS: The results show that only 42% of Pakistani women have heard about HIV/AIDS. Amongst these women, the majority (68%) have good overall knowledge of HIV/AIDS and more than 55% have positive attitudes towards people living with AIDS. Furthermore, women residing in urban areas, having at least secondary-level education, with high autonomy, belonging to the richest wealth quintile and having exposure to mass media had high overall knowledge and positive attitudes towards people living with AIDS. CONCLUSION: The findings of this research support the relevance of women's autonomy, education and exposure to mass media, particularly in rural areas of Pakistan, to address the lack of knowledge and eliminate various myths and stigmatisation of people living with HIV/AIDS. Furthermore, it reveals a need to increase focused and targeted interventions to enhance women's knowledge and positive attitudes towards people living with HIV/AIDS. In this regard, the media can play a proactive role to gauge wider audience in creating awareness and eradicating the myths and misconceptions regarding HIV/AIDS.

Approaches towards improving the quality of maternal and newborn health services in South Asia: challenges and opportunities for healthcare systems.

BACKGROUND: South Asia is experiencing a dismal state of maternal and newborn health (MNH) as the region has been falling behind in reducing the levels of maternal and neonatal mortality. Most of the efforts are focused on enhancing coverage of MNH services; however, quality remains a serious concern if the region is to achieve expected outcomes in terms of standardised MNH services within healthcare delivery systems. This research consists of a review of South Asian quality improvement (QI) approaches/interventions, specifically implemented for MNH improvement. METHODS: A literature review of QI approaches/interventions was conducted using the PRISMA guidelines. Online databases, including PubMed, the Cochrane Library and Google Scholar, were searched. Primary studies published between 1998 and 2013 were considered. Studies were initially screened and selected based upon the selection criteria for data extraction. A thematic synthesis/analysis was performed to organise, group and interpret the key findings according to prominent themes. RESULTS: Thirty studies from six South Asian countries were included in the review. Findings from these selected studies were grouped under eight broad, cross-cutting themes, which emerged from a deductive approach, representing the most commonly employed QI approaches for improving MNH services within different geographical settings. These consist of capacity building of healthcare providers on clinical quality, clinical audits and feedback, financial incentives to beneficiaries, pay-for-performance, supportive supervision, community engagement, collaborative efforts and multidimensional interventions. CONCLUSIONS: Employing and documenting QI approaches is essential in order to measure the potential of an intervention, considering its cost-effectiveness, feasibility and acceptability to communities. This research concluded that QI approaches are very diverse and cross-cutting, because they are subject to the varied requirements of regional health systems. This high level of variability leads to implementation and knowledge-management challenges for MNH programme planners and managers in the countries of the South Asia region.

Carbohydrazones as new class of carbonic anhydrase inhibitors: Synthesis, kinetics, and ligand docking studies.

Discovery and development of carbonic anhydrase inhibitors is crucial for their clinical use as antiepileptic, diurectic and antiglaucoma agents. Keeping this in mind, we have synthesized carbohydrazones 1-27 and evaluated them for their in vitro carbonic anhydrase inhibitory potential. Out of twenty-seven compounds, compounds 1 (IC50=1.33±0.01µM), 2 (IC50=1.85±0.24µM), 3 (IC50=1.37±0.06µM), and 9 (IC50=1.46±0.12µM) have showed carbonic anhydrase inhibition better than the standard drug zonisamide (IC50=1.86±0.03µM). Moreover, compounds 4 (IC50=2.32±0.04µM), 5 (IC50=3.96±0.35µM), 7 (IC50=2.33±0.02µM), and 8 (IC50=2.67±0.01µM) showed good inhibitory activity. Cheminformatic analysis has shown that compounds 1 and 2 possess lead-like properties. In addition, kinetic and molecular docking studies were also performed to investigate the binding interaction between carbohydrazones and carbonic anhydrase enzyme. This study has identified a novel and potent class of carbonic anhydrase inhibitors with the potential to be investigated further.

Factors associated with infants' and young children's (6-23 months) dietary diversity in Pakistan: evidence from the demographic and health survey 2012-13.

BACKGROUND: Optimum nutrition and good feeding practices amongst infants and young children are the key determinants of growth for a healthy life. Dietary diversity is considered to be a reliable and easy-to-measure proxy variable to assess young children's feeding practices for dietary adequacy and nutritional intake. This research aims to examine the current practices of dietary diversity amongst infants and young children aged 6-23 months in Pakistan and the various associated factors at child, maternal, household and community levels. METHODS: Secondary data analysis was performed for this research using the nationally representative dataset of the Pakistan Demographic and Health Survey 2012-13. Data on the last-born infants and young children aged 6-23 months (n = 1102) was taken from their mothers' interviews, who reported on their child's consumption of 7 food groups during the 24 h immediately preceding the survey. Data was analysed, using IBM® SPSS® Complex Sample to measure the association between children's dietary diversity and various factors at child, maternal, household and community levels through multiple linear regressions. RESULTS: Our research uncovered positive associations between children's dietary diversity and other sociodemographic variables. Overall, a variation was observed in consumption of 7 food groups across the youngest, middle and oldest age-groups of children. Multivariate analysis revealed that the children's Dietary Diversity Score (scale from 0 to 7) increases to 0.56 (95% CI: 0.18-0.94) amongst children in the middle age-group (12-17 months). Furthermore, the children who were still breastfeeding, with mothers who had a primary level of schooling and whose mothers also received information/services from lady health workers (LHWs) on maternal and child health were found to be a statistically significant predictor of infants' and young children's dietary diversity. Nevertheless, amongst them, the DDS had a negative association with the children's status of still breastfeeding and mothers' primary level of schooling, whereas it had a positive association with children being in the middle age-group and with mothers who received information/services from LHWs. CONCLUSION: The dietary diversity of infants and young children aged 6-23 months has a modest, nevertheless statistically significant, relationship with sociodemographic characteristics in Pakistan. There is a need for practical efforts to change the behaviour of communities to encourage more diverse foods to promote the healthy growth of children.

Continuum of care in maternal, newborn and child health in Pakistan: analysis of trends and determinants from 2006 to 2012.

BACKGROUND: Pakistan, being a developing country, presents the dismal picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal deaths could be avoided if Continuum of Care (CoC) is provided in a structured pathway from pregnancy to birth and to the first week of life of the newborn child. This study aimed to analyse the trends of CoC at all three levels (antenatal care, skilled delivery and postpartum care) and to identify various factors affecting the continuation in receiving CoC in Pakistan during 2006 to 2012. METHODS: Secondary data analysis was performed on nationally representative data from the last two iterations of Pakistan Demographic and Health Survey (PDHS), conducted during 2006/07 to 2012/13. The analysis is limited to women of the reproductive age group (15-49 years) who gave birth during the last five years preceding both surveys. This leads to a sample size of 5,724 and 7,461 respondents from PDHS 2006/07 and 2012/13 respectively. The association between CoC and several factors, including individual attributes (reproductive status), family influences, community context, as well as cultural and social values was assessed in bivariate analyses in a first step. Furthermore, odds ratios and adjusted odds ratios with 95% confidence intervals using a binary and multivariable logistic regression were calculated. RESULTS: Our research presents the trends of a composite measure of CoC including antenatal care, delivery assistance and postpartum care. The largest gap in CoC was observed at antenatal care followed by delivery and postnatal care within 48 h after delivery. Results show that CoC completion rate has increased from 15% to 27% amongst women in Pakistan over time from 2006 to 2012. Women with high age at first birth, having less number of children, with higher education, belonging to richest quintile, living in Sindh province and urban areas, having high autonomy and exposure to mass media were most likely to avail complete CoC. CONCLUSIONS: The findings show that women in Pakistan still lack the CoC. This calls for attention to develop and implement tailored interventions, focusing on the needs of women in Pakistan to provide CoC in an integrated manner, involving both public and private sectors by appropriately addressing the factors hindering CoC completion rates.

Perceptions of adolescents' sexual and reproductive health and rights: a cross-sectional study in Lahore District, Pakistan.

BACKGROUND: Sexual and reproductive health (SRH) is a significant aspect of adolescents' growth, safeguarded by SRH rights (SRHR). Despite various global efforts to promote adolescents SRHR (ASRHR), the majority of adolescents still lack awareness and autonomy to access SRH related information and services. This research aimed to explore the knowledge and perceptions of adolescents' sexual and reproductive health rights and highlights key constraints hindering adolescents from accessing and exercising SRHR in the district of Lahore, Pakistan. METHODS: The research uses a mixed methods approach including both quantitative and qualitative methods. For quantitative component, household survey was conducted with 600 respondents including adolescents (15-19 years) and their parents/caregivers. A multistage cluster random sampling technique was performed, based on the population proportion of administrative towns in Lahore district, Pakistan. A structured interview schedule was used to collect data. Quantitative data were collected by a standardized quantitative questionnaire; analysis was performed using SPSS version 21. For qualitative data collection, 12 in-depth interviews with teachers and doctors and four focus group discussions with adolescents were conducted, and analysed using thematic areas. RESULTS: The research revealed a low level of perception of ASRHR amongst the respondents and identified socio-cultural and structural constraints as the major underlying issues. Although more than half of the respondents were found to be aware of ASRHR, agreed to their importance and were in favour for adolescents to have access to requisite information, nonetheless they believed that adolescents had limited ability to exercise these rights. CONCLUSIONS: The research found a low level of perception amongst adolescents and their parents/caregivers about ASRHR in Lahore district emphasising the rights-based approach. There is an urgent need to design specific policies and educational programmes to promote healthy practices. Research is recommended to inform and advocate Punjab Government and communities, including partners, teachers, doctors, religious scholars and media groups, to empower adolescents through health education. This can be achieved through the inclusion of SRH topics in educational curricula, establishing a virtual knowledge centre, encouraging debate competitions, and organising orientation sessions for professionals/experts and community etc.

Facile and Green Synthesis of Saturated Cyclic Amines.

Single-nitrogen containing saturated cyclic amines are an important part of both natural and synthetic bioactive compounds. A number of methodologies have been developed for the synthesis of aziridines, azetidines, pyrrolidines, piperidines, azepanes and azocanes. This review highlights some facile and green synthetic routes for the synthesis of unsubstituted, multisubstituted and highly functionalized saturated cyclic amines including one-pot, microwave assisted, metal-free, solvent-free and in aqueous media.

Bioremediation of Synthetic and Industrial Effluents by Aspergillus niger Isolated from Contaminated Soil Following a Sequential Strategy.

The present study aimed to assess and compare the ability to remediate synthetic textile and industrial wastewaters by Fenton treatment, a biological system and sequential treatments using Aspergillus niger (A. niger). All studied treatments were found to be effective in decolorization of the effluents under study. Fenton treatment followed by A. niger showed excellent potential for the maximum decolorization of the synthetic and industrial effluents under study. The effectiveness of sequential treatment was evaluated by water quality parameters such as total organic carbon (TOC), Biological Oxygen Demand (BOD5) and Chemical Oxygen Demand (COD) before and after each treatment. The results indicated that A. niger is an effective candidate for detoxification of textile wastewaters.

Chemoselectivity and stereoselectivity of cyclisation pathways leading to bicyclic tetramates controlled by ring-chain tautomerisation in thiazolidines.

Chemoselective Dieckmann cyclisation reactions on N-malonyl thiazolidine templates derived from cysteine and pivaldehyde or aromatic aldehydes may be used to access bicyclic tetramates, for which different pathways operate as a result of differing ring-chain tautomeric behaviour of the respective intermediate imines.

Dihydropyrimidones: As novel class of ß-glucuronidase inhibitors.

Dihydropyrimidones 1-37 were synthesized via a 'one-pot' three component reaction according to well-known Biginelli reaction by utilizing Cu(NO3)2·3H2O as catalyst, and screened for their in vitro ß-glucuronidase inhibitory activity. It is worth mentioning that amongst the active molecules, compounds 8 (IC50=28.16±.056µM), 9 (IC50=18.16±0.41µM), 10 (IC50=22.14±0.43µM), 13 (IC50=34.16±0.65µM), 14 (IC50=17.60±0.35µM), 15 (IC50=15.19±0.30µM), 16 (IC50=27.16±0.48µM), 17 (IC50=48.16±1.06µM), 22 (IC50=40.16±0.85µM), 23 (IC50=44.16±0.86µM), 24 (IC50=47.16±0.92µM), 25 (IC50=18.19±0.34µM), 26 (IC50=33.14±0.68µM), 27 (IC50=44.16±0.94µM), 28 (IC50=24.16±0.50µM), 29 (IC50=34.24±0.47µM), 31 (IC50=14.11±0.21µM) and 32 (IC50=9.38±0.15µM) found to be more potent than the standard d-saccharic acid 1,4-lactone (IC50=48.4±1.25µM). Molecular docking study was conducted to establish the structure-activity relationship (SAR) which demonstrated that a number of structural features of dihydropyrimidone derivatives were involved to exhibit the inhibitory potential. All compounds were characterized by spectroscopic techniques such as (1)H, (13)C NMR, EIMS and HREI-MS.

Determining the potential scalability of transport interventions for improving maternal, child, and newborn health in Pakistan.

BACKGROUND: Pakistan is far behind in achieving the Millennium Development Goals regarding the reduction of child and maternal mortality. Amongst other factors, transport barriers make the requisite obstetric care inaccessible for women during pregnancy and at birth, when complications may become life threatening for mother and child. The significance of efficient transport in maternal and neonatal health calls for identifying which currently implemented transport interventions have potential for scalability. METHODS: A qualitative appraisal of data and information about selected transport interventions generated primarily by beneficiaries, coordinators, and heads of organizations working with maternal, child, and newborn health programs was conducted against the CORRECT criteria of Credibility, Observability, Relevance, Relative Advantage, Easy-Transferability, Compatibility and Testability. Qualitative comparative analysis (QCA) techniques were used to analyse seven interventions against operational indicators. Logical inference was drawn to assess the implications of each intervention. QCA was used to determine simplifying and complicating factors to measure potential for scaling up of the selected transport intervention. RESULTS: Despite challenges like deficient in-journey care and need for greater community involvement, community-based ambulance services were managed with the support of the community and had a relatively simple model, and therefore had high scalability potential. Other interventions, including facility-based services, public-sector emergency services, and transport voucher schemes, had limitations of governance, long-term sustainability, large capital expenditures, and need for management agencies that adversely affected their scalability potential. CONCLUSION: To reduce maternal and child morbidity and mortality and increase accessibility of health facilities, it is important to build effective referral linkages through efficient transport systems. Effective linkages between community-based models, facility-based models, and public sector emergency services should be established to provide comprehensive coverage. Voucher scheme integrated with community-based services may bring improvements in service utilization.

1-(3-Meth-oxy-phen-yl)-2-(phenyl-sulfon-yl)ethan-1-one.

In the title compound, C(15)H(14)O(4)S, the dihedral angle between the benzene and phenyl rings is 88.74 (10)°. In the crystal, mol-ecules are linked into a three-dimensional network by C-H⋯O hydrogen bonds and π-π stacking inter-actions [centroid-centroid distances = 3.6092 (13)-3.8651 (13) Å].

An Overview of Synthetic Routes of Pharmaceutically Important Pyranopyrazoles.

Pyranopyrazoles are bicyclic nitrogen-containing heterocycles having broadspectrum bioactivities, which may act as anti-cancer, anti-inflammatory, antibacterial, antifungal, insecticidal and molluscicidal agents. Pyranopyrazoles have become an attractive scaffold for the discovery of new drugs due to the diverse range of bioactivities associated with this nucleus. In this review, we have focused on the medicinal importance of pyranopyrazole derivatives and highlighted different routes for the synthesis of pyranopyrazole derivatives using inexpensive and commonly available starting materials.