Culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan: feasibility randomized controlled trial.

BACKGROUND: Cognitive behaviour therapy (CBT), self-help and guided self-help interventions have been found to be efficacious and cost effective for victims of trauma, but there are limited data from low- and middle-income countries on culturally adapted interventions for trauma. AIMS: To investigate the feasibility and acceptability of culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan. METHOD: This randomized controlled trial (RCT) recruited 50 participants from shelter homes in Karachi and randomized them to two equal groups. The intervention group received GSH in nine sessions over 12 weeks. The control group was a waitlist control. The primary outcomes were feasibility and acceptability. Secondary outcomes included Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHO DAS 2). Assessments were carried out at baseline and at 12 weeks. RESULTS: Out of 60 clients who met DSM-5 criteria for post-traumatic stress disorder (PTSD), 56 (93.3%) agreed to participate in the study. Retention to the intervention group was excellent, with 92% (23/25) attending more than six sessions. Statistically significant differences were noted post-intervention in secondary outcomes in favour of the intervention. CONCLUSIONS: A trial of CatCBT GSH was feasible and the intervention was acceptable to Pakistani women who had experienced domestic violence. Furthermore, it may be helpful in improving symptoms of PTSD, depression, anxiety and overall functioning in this population. The results provide a rationale for a larger, confirmatory RCT of CatCBT GSH.

Correlation between oligohydramnios and anaemia in the third trimester of pregnancy: A study in a tertiary care hospital in Pakistan.

Background: Maintaining normal amniotic fluid index and normal hemoglobin level is crucial for normal fetal development. Their reduction can lead to maternal and fetal morbidity in the form of operative delivery and poor perinatal outcome such as, low birth weight. There is an association between oligohydramnios and anaemia, although there is scarcity on this correlation in literature. Early detection of oligohydramnios can improve maternal and perinatal outcome. This study aimed to investigate the association between oligohydramnios and anaemia during the third trimester of pregnancy. Methodology: This retrospective cohort study was conducted at NESCOM Hospital, Pakistan. The study spanned from August 1, 2021, to July 31, 2022. Results: The study included 109 pregnant individuals with oligohydramnios, resulting in an incidence of 22% among the total of 551 deliveries during the study period. The average age of participants was 29.75 years. The average gestational age was 33.52 weeks, with a range of 28 to 38 weeks. The analysis indicated that 44.03% of cases with oligohydramnios were associated with anaemia, followed by idiopathic causes (41.28%). Pearson's correlation revealed a significant association between oligohydramnios and anaemia (r = 0.307, p = 0.001), supporting the hypothesis of a potential interconnection between these two conditions. Regarding delivery outcomes, 81.6% underwent cesarean section, emphasizing the need for careful management in cases of oligohydramnios and anaemia. Neonatal outcomes indicated that 1.8% and 44.5% of neonates were extremely low birth weight and low birth weight, respectively. Conclusion: This study provides empirical evidence supporting a significant association between oligohydramnios and anaemia in the third trimester.

Bilateral pneumothorax in a patient with angiosarcoma of the scalp: a case report.

BACKGROUND: Angiosarcoma is a rare, vascular malignancy that arises from endothelial cells of blood vessels. This case report aims to create the awareness of its existence in the region and its mode of presentation. CASE PRESENTATION: A 63-year-old Pakistani man presented to the emergency department with sudden bilateral chest pain and shortness of breath for 2 days. On examination, a scalp lesion was seen which had been increasing in size over the last 6 weeks. The lesion was 8 × 10 cm in size with an irregular border, non-tender, violet and dome-shaped in elevation on the right occipito-parietal lobe of the skull. Chest computed tomography (CT) showed multiple cystic lesions on both lungs, patchy areas of ground-glass opacities, nodules of variable sizes and bilateral pneumothorax. Bilateral tube thoracostomy was performed which provided symptomatic relief for shortness of breath. His bronchoalveolar lavage (BAL) was negative for infection. He underwent biopsy of scalp lesion which was positive for aggressive angiosarcoma. CONCLUSION: Bilateral spontaneous pneumothorax can be the initial manifestation of aggressive cutaneous angiosarcoma and frequently leads to respiratory failure. Early recognition is essential to prevent delay in diagnosis and management.

Comparison of the Effect of Injection Enoxaparin Versus Conventional Treatment on Amniotic Fluid Index in Borderline Oligohydramnios in Third Trimester of Pregnancy: A Randomized Control Trial in a Tertiary Care Hospital.

Background: Oligohydramnios is defined as amniotic fluid index (AFI) less than or equal to 5cm. A borderline AFI has been defined as an AFI of 5.1cm to 8cm. The incidence of borderline AFI compared with a normal AFI (8.1cm to 18cm) is 6% to 44% in different studies. A decrease in amniotic fluid leads to serious complications for the mother and fetus. The study objective was to evaluate if an injection of Enoxaparin improves the amount of liquor in oligohydramnios in the third trimester of pregnancy. Methodology: A randomized controlled trial was conducted at a tertiary care obstetric center, involving a total of 130 participants. Inclusion criteria include participant in 3rd trimester of pregnancy, singleton pregnancy, intact amniotic membranes, and no known medical disorder. Patients with multiple pregnancies, ruptured amniotic membranes, anomalous fetuses, and known medical disorders were excluded. These participants were divided into two groups, each consisting of 65 participants. Group A received conventional treatment (intravenous fluid, tablet Aspirin, and rest in lateral position), while Group B received an injection of enoxaparin in addition to conventional treatment. AFI measurements were performed in the radiology department by radiologists using standard 4 quadrant measurements, twice weekly after the initiation of the treatment. The weight of the baby noted at birth and admission to neonatal intensive care was noted to assess the health of the neonate. Data was analyzed on SPSS (statistical package for social sciences) version 23. Results: In group A, the AFI increased after treatment in 47(72.3%) patients, remained static in 6(9.2%) patients, and decreased in 12(18.4%) patients. Whereas in group B, AFI increased in 31(68.8%) patients and decreased in 14(31.3%) patients, p= 0.334. Conclusion: The findings in the current study did not demonstrate any significant effect of the use of injection enoxaparin in improving borderline oligohydramnios. Further research is needed to apply this research to the general population.

Femtosecond Laser Assisted Crystallization of Gold Thin Films.

We propose a novel low temperature annealing method for selective crystallization of gold thin films. Our method is based on a non-melt process using highly overlapped ultrashort laser pulses at a fluence below the damage threshold. Three different wavelengths of a femtosecond laser with the fundamental (1030 nm), second (515 nm) and third (343 nm) harmonic are used to crystallize 18-nm and 39-nm thick room temperature deposited gold thin films on a quartz substrate. Comparison of laser wavelengths confirms that improvements in electrical conductivity up to 40% are achievable for 18-nm gold film when treated with the 515-nm laser, and the 343-nm laser was found to be more effective in crystallizing 39-nm gold films with 29% improvement in the crystallinity. A two-temperature model provides an insight into ultrashort laser interactions with gold thin films and predicts that applied fluence was insufficient to cause melting of gold films. The simulation results suggest that non-equilibrium energy transfer between electrons and lattice leads to a solid-state and melt-free crystallization process. The proposed low fluence femtosecond laser processing method offers a possible solution for a melt-free thin film crystallization for wide industrial applications.