Knowledge and attitude of pregnant women regarding HIV transmission, prevention and associated factors in Karachi, Pakistan - A cross-sectional study.

OBJECTIVES: This study aimed to assess the misconceptions and attitude regarding HIV transmission and prevention among antenatal mothers, with regards to mother-to-child-transmission (MTCT) in three tertiary care hospitals of Karachi. METHODS: A cross-sectional study comprising 350 pregnant females was conducted at three tertiary care hospitals in Karachi for 4 months, in 2018. A structured questionnaire covering knowledge about MTCT, prevention of mother-to-child-transmission (PMTCT) and attitudes about HIV transmission was used and all collected data entered and analyzed via SPSS (Statistical Package for the Social Sciences) software version 25, owned by the IBM Company. PRINCIPLE RESULTS: Of the 350 pregnant females participating, around 66.7% (N = 232) were urban residents, lying in their mid-twenties and over 86% (N = 303) were Muslims. Over 14.3% (N = 52) of the participants had full knowledge regarding MTCT of HIV, with only 6% of the respondents having full knowledge related to PMTCT of HIV. Significant associations were found between knowledge about MTCT and residence (p = 0.001), education level (p = 0.001) and expected response from the partner (p = 0.001). While only 17% (60 out of 350) women agreed to invite their partner for testing, 84% showed an interest in looking after an HIV infected family member and 49% believed that all pregnant females should be tested for HIV. CONCLUSIONS: This study shows that majority of the pregnant women in Karachi are unaware of MTCT and PMTCT and they are reluctant towards routine HIV testing. Thus, we see the need for collective and focused efforts for educational programs and further research.

Diagnosis and management of patent foramen ovale.

The foramen ovale is a slit-like anatomical structure located in the interatrial wall of the fetal heart that enables right-to-left shunting during fetal development. Although this hole generally closes completely shortly after birth due to shifting pressures in the atrial chambers, it remains open, or 'patent', in about 25% of cases representing a potential substrate for right-to-left shunting during adult life. A patent foramen ovale (PFO) is usually haemodynamically insignificant, even when large, but is the most common cause of right-to-left shunt. Large-diameter PFOs may act as a pathway for passage of thrombus, air, fat, vegetation or vasoactive substances from the venous to the arterial circulation, potentially causing paradoxical emboli and stroke, inappropriate decompression sickness in divers, platypnoea-orthodeoxia syndrome and aural migraine. Over the past two decades, the association between PFO and the occurrence of migraine and cryptogenic stroke, particularly in younger adults, has been subject to considerable controversy and debate. Currently, semi-invasive contrast-transoesophageal echocardiography is accepted as the gold standard to detect right-to-left shunt across a PFO, but other imaging modalities utilising contrast such as second-harmonic transthoracic echocardiogram, transcranial Doppler sonography, CT and cardiac MRI have been shown to have similar sensitivity and specificity in detecting a PFO when compared with transoesophageal echocardiography. In this review the authors discuss embryological origins, diagnostic measures and evidence-based treatment options for the prevention of PFO-related paradoxical embolism, with emphasis on cryptogenic stroke and migraine.