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1.
East Mediterr Health J ; 27(7): 672-678, 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34369581

RESUMO

Background: Pakistan and USAID have invested in improving the contraceptive supply chain data and commodity security. In 2011, the first digital contraceptive logistics management information system (cLMIS) was launched, enabling supply chain data visibility from the federal level to health facilities. The system has built-in modules on forecasting and supply planning, inventory management, consumption reporting, business intelligence tools, automatic email and SMS alerts. Using these features, policy-makers and health managers annually forecast needs, and procure contraceptives accordingly. Aims: The objective of this research was to understand the existing technological platforms for family planning (FP) supply chain data visibility and the potential impact on contraceptive commodity security. Methods: The authors reviewed available published and grey literature papers on contraceptives and supplies in Pakistan. We extracted data from the cLMIS, evaluated indicators including reporting compliance, reported stock-out rates, and contraceptive performance. The analysis was validated by reviewing supply chain and FP indicators, such as average monthly consumption, months of stock, and couple years of protection. Results: The cLMIS has resulted in improved distribution, early warning and accountability at the lowest tiers in the FP supply chain in the public sector. At the facility level, FP commodity availability increased from 40% in 2009 to 84% in 2018. Conclusion: Contraceptive supply chain has seen significant growth over the past decade to meet expanding reproductive health evidence to inform strategic decisions; cLMIS is a prime contributor to improvements registered in FP stock availability at public sector facilities.


Assuntos
Serviços de Planejamento Familiar , Setor Público , Humanos , Paquistão , Tecnologia
2.
Pediatr Emerg Med Pract ; 18(Suppl 8): 1-39, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34423962

RESUMO

Trauma is the leading cause of death in the pediatric population and is among the most common reasons for ED visits by children. Imaging is an important tool for the diagnosis and management of pediatric trauma, but there are risks associated with exposure to ionizing radiation. In pediatric head and neck injuries, clinical findings and clinical decision tools can help inform selection of the most appropriate imaging modalities for the trauma patient, while also reducing unnecessary radiation exposure. This supplement reviews evidence-based recommendations for imaging decisions and interpretations in skull fractures, traumatic brain injuries, abusive head trauma, cervical spine injuries, and facial bone fractures. Examples demonstrating imaging modalities and specific findings for the types of injuries are also provided.


Assuntos
Regras de Decisão Clínica , Traumatismos Craniocerebrais/diagnóstico por imagem , Lesões do Pescoço/diagnóstico por imagem , Variação Anatômica , Criança , Maus-Tratos Infantis , Traumatismos Craniocerebrais/complicações , Medicina Baseada em Evidências , Humanos , Lesões do Pescoço/complicações , Exposição à Radiação
4.
Life (Basel) ; 11(4)2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33805566

RESUMO

Rice plants often encounter high temperature stress, but the associated coping strategies are poorly understood. It is known that a prior shorter exposure to high temperature, called thermo-priming, generally results in better adaptation of the plants to subsequent exposure to high temperature stress. High throughput sequencing of transcript and small RNA libraries of rice seedlings primed with short exposure to high temperature followed by high temperature stress and from plants exposed to high temperature without priming was performed. This identified a number of transcripts and microRNAs (miRs) that are induced or down regulated. Among them osa-miR531b, osa-miR5149, osa-miR168a-5p, osa-miR1846d-5p, osa-miR5077, osa-miR156b-3p, osa-miR167e-3p and their respective targets, coding for heat shock activators and repressors, showed differential expression between primed and non-primed plants. These findings were further validated by qRT-PCR. The results indicate that the miR-regulated heat shock proteins (HSPs)/heat shock transcription factors (HSFs) may serve as important regulatory nodes which are induced during thermo-priming for plant survival and development under high temperatures.

5.
Trop Doct ; 51(3): 322-325, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33541244

RESUMO

Non-fermenting Gram-negative bacilli (NFGNB) are emerging as important cause of blood stream infections. We aimed to determine the prevalence and antibiotic susceptibility pattern of NFGNB isolated from blood of patients with sepsis. We found, in 176 patients, the most common to be Pseudomonas aeruginosa (74) and Acinetobacter baumanii complex (39) followed by Stenotrophomonas maltophilia (16), Sphingomonas paucimobilis (6), Burkholderia cepacia (5) and Ochrobactrum anthropic (1). Generally, organisms showed a good sensitivity towards colistin, carbapenems and fluoroquinolones, whereas cephalosporins were ineffective.

6.
J Genet Couns ; 30(1): 319-328, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32914913

RESUMO

Given the increasing demand for genetic counseling, implementation of innovative service delivery models (SDMs) has been proposed to improve access and increase the efficiency of genetic counseling services. This study investigated the key considerations in genetic counseling practices that impact the decision to implement innovative SDMs, as well as barriers and facilitators to implementation. A cross-sectional, qualitative research design was employed, using focus groups. Genetic counselors (GCs) were recruited from respondents to an online survey about SDMs and by posting an invitation to the National Society of Genetic Counselors (NSGC) listserv. A total of 30 participants participated in either in-person (n = 3) or online (n = 5) focus groups, facilitated by members of the Service Delivery Model subcommittee of the NSGC Access and Service Delivery Committee. Transcribed audio and written notes from the focus groups were coded, utilizing an inductive thematic analysis method. Five overarching themes that impact decisions to implement and use innovative SDMs were identified: (a) Patient volume and efficiency are key motivators in trying innovative SDMs; (b) the decision to change is facilitated by available resources; (c) the implementation of innovative SDMs is multidimensional and complex process; (d) there is concern about the impact on patient-provider relationships with the utilization of innovative SDMs; and (e) measuring outcomes of innovative SDM facilitates acquisition of additional resources and support. Approaches to innovative SDM selection and implementation vary by institution needs, resources, and population as demonstrated by the variety of approaches to similar barriers. Outcomes related to the implementation of innovative SDMs in genetic counseling practice should be measured to demonstrate the value of innovative genetic counseling SDMs, improvement of access to care, and to justify need for additional resources to support implementation of these models.

7.
Acad Emerg Med ; 28(1): 135-137, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32506567
8.
J Genet Couns ; 29(2): 192-201, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32227531

RESUMO

The size and reach of the genetic counseling profession have expanded on a global scale since the 1970s. Despite this growth, the profession of genetic counseling has remained demographically homogenous. Promoting a culture of inclusivity that supports visible and invisible diversity and leveraging that culture not only expands perspectives represented in the field, but also helps foster equity in genetic services. This report summarizes the formation, implementation, and outcomes of the 2019 Diversity and Inclusion Task Force (TF) of the National Society of Genetic Counselors (NSGC), including the group's responses to their allotted charges from the NSGC Board of Directors. The recommendations generated by the TF aim to aid in the (1) establishment of infrastructure for ongoing diversity, inclusion, and equity (DEI) work by collaborating with a DEI organizational expert and forming a DEI advisory group within the NSGC, (2) development of specific short-term DEI initiatives, and (3) identification of seven areas of focus areas that must be addressed in order to create meaningful and measurable DEI improvements. The efficacy of these recommendations will depend on the consistency and creativity of implementation, shared responsibility, sufficient resources allocated to DEI initiatives, and measurable outcomes.


Assuntos
Comitês Consultivos , Conselheiros , Aconselhamento Genético , Sociedades Médicas/organização & administração , Humanos , Relatório de Pesquisa
9.
Acad Emerg Med ; 26(7): 826-828, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30632653
10.
East Mediterr Health J ; 23(8): 559-563, 2017 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-29105047

RESUMO

Hepatitis E virus (HEV) is endemic in Pakistan. Although otherwise asymptomatic, HEV infection becomes fatal in pregnancy, with considerable maternal and fetal morbidity and mortality. We conducted a descriptive study from April to October 2015 in 10 tertiary care hospitals throughout Pakistan to determine maternal and fetal morbidity and mortality in HEV-positive pregnant women with acute jaundice or raised liver function tests. Twenty-one of 135 women were HEV positive and in 3rd trimester except for 1 in 1st trimester. Overall prevalence of HEV in pregnancy was 0.19%. Ten women were artificially induced, 3 had premature labour, 4 delivered spontaneously (full term), 3 died and there was 1 intrauterine death. One woman had a home abortion before coming to hospital. There were 7 perinatal infant deaths: 4 intrauterine, 3 stillbirths and 1 abortion. Maternal mortality was significantly associated with delivery, as 17 mothers who lived went into labour spontaneously or were artificially induced, whereas 3 women who continued their pregnancy and did not deliver, died. Case fatality rate of HEV infection in pregnancy was 14.2%.


Assuntos
Hepatite E/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Feminino , Morte Fetal , Hepatite E/mortalidade , Humanos , Recém-Nascido , Mortalidade Materna , Paquistão/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Resultado da Gravidez , Prevalência , Estudos Soroepidemiológicos
11.
Vaccine ; 35(18): 2489-2495, 2017 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-28325477

RESUMO

The use of Soluplus® polymeric micelles as a novel adjuvant for tetanus toxoid (TTxd) in transcutaneous immunisation was evaluated. TTxd was added to Soluplus® polymeric micelles to form TTxd-Soluplus® nano-aggregates with a size of 68nm. Non-adjuvanted TTxd commonly induces very poor antibody response by the transcutaneous route. However, in this study, the use of TTxd-Soluplus® resulted in a significant increase in the antibody response to TTxd, which was similar to that induced in the presence of CPG-oligodeoxynucleotides (CPG-ODNs) adjuvant. The toxin neutralising potency of the immune sera induced by TTxd-Soluplus® was also much stronger than that from TTxd alone, in a passive transfer experiment in mice. Soluplus® also enhanced the immunogenicity of the toxoid when TTxd-Soluplus® was stored at 4°C for 4weeks, but not at higher temperatures. Confocal microscopy imaging showed a much higher uptake of TTxd in the epidermis and dermis layers of the skin when it was associated with Soluplus®, suggesting that the mechanism for Soluplus® adjuvanticity is through enhanced uptake of the TTxd through the skin. Overall, our findings demonstrated that Soluplus® is an effective novel adjuvant for transcutaneous immunisation.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Formação de Anticorpos , Antitoxinas/sangue , Nanopartículas/administração & dosagem , Polietilenoglicóis/administração & dosagem , Polivinil/administração & dosagem , Toxoide Tetânico/imunologia , Administração Cutânea , Animais , Anticorpos Neutralizantes/sangue , Modelos Animais de Doenças , Feminino , Imunização Passiva , Camundongos , Ratos Sprague-Dawley , Tétano/prevenção & controle , Toxoide Tetânico/administração & dosagem
12.
J Pak Med Assoc ; 67(1): 92-96, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28065962

RESUMO

OBJECTIVE: To evaluate and increase the compliance of surgical hand scrubbing with periodic feedback. METHODS: This study was conducted at the Aga Khan Hospital for Women and Children, Karachi, Pakistan, from April to July 2014. A remote video auditing system consisting of human auditors was used for visualising surgical hand wash compliance of the surgical team. The equipment, which used motion sensor, was installed in the scrub area wall, visualising the scrub sink only. A clock was displayed for the healthcare professionals to aid in ensuring two-minute hand washing. All surgeons, technicians and surgical assistants were included in the study. Surgical scrubbing was measured during a 4-week period by remote video auditing without feedback and a 12-week period with feedback. SPSS 19 was used for data analysis. RESULTS: Of the 534 observations, 150(28%) were made during the pre-feedback period and 384(71.9%) during the post-feedback period. During the first 4 weeks, the overall compliance was 22(14.6%). The rate of compliance increased to 310(80.7%) during the 12-week post-feedback period. CONCLUSIONS: Video surveillance with feedback for hand washing was found to be an effective tool for measuring hand hygiene and improving compliance.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos , Pessoal de Saúde/estatística & dados numéricos , Gravação em Vídeo , Humanos , Controle de Infecções/normas
13.
J Pak Med Assoc ; 63(1): 60-4, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23865133

RESUMO

OBJECTIVES: To minimise irrational use of antibiotics by implementing guidelines for antibiotic usage in obstetrics and Gynaeocology. METHODS: The observational study was conducted from January to December 2010 at the maternity unit of Aga Khan Hospital for Women and children, Kharadar, a secondary care facility in Karachi, Pakistan. Data was collected from medical records related to the study period. Prophylactic antibiotics were given according to the American College of Obstetricians and Gynaecologists recommendation 2009. Surveillance was done by surgical site infection rates and infectious morbidity. Data was analysed on SPSS 13. RESULTS: Therapeutic antibiotic use was rationalized, reducing the use of therapeutic antibiotics from 97% (n = 160/165) in January 2010 to 8% (n = 10/125) in December 2010. Surgical site infection rates were less than 5%. Cost of antibiotics per patient decreased by 90%. Decrease in the length of stay and workload on nursing staff was also observed. CONCLUSION: Implementing guidelines for antibiotic use in obstetrics and gynaecology and translating it into our protocols was effective in decreasing the irrational antibiotic consumption and increasing the rational use of antibiotics in the hospital.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Uso de Medicamentos , Melhoria de Qualidade , Adulto , Criança , Feminino , Ginecologia , Humanos , Obstetrícia , Paquistão , Guias de Prática Clínica como Assunto , Padrões de Prática Médica
14.
Chem Pharm Bull (Tokyo) ; 58(7): 980-2, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20606351

RESUMO

4'-O-[beta-D-Apiosyl(1-->2)]-beta-D-glucosyl]-5-hydroxyl-7-O-sinapylflavanone (1), 3-(4-acetoxy-3,5-dimethoxy)-phenyl-2E-propenyl-beta-D-glucopyranoside (2), 3-(4-hydroxy-3,5-dimethoxy)-phenyl-2E-propenyl-beta-D-glucopyranoside (3), 5,7-dimethoxy-4'-O-beta-D-glucopyranoside flavanone (4), 4',5-dimethoxy-7-hydroxy flavanone (5), and 5,7-dimethoxy-4'-hydroxy flavanone (6), were isolated from the organic extracts of Viscum album L. (European Mistletoe). These compounds were studied for their anti-glycation and antioxidant properties. The structures of new compounds 1 and 2 were deduced on the basis of spectroscopic evidence.


Assuntos
Antioxidantes/química , Glucosídeos/química , Fenóis/química , Viscum album/química , Antioxidantes/isolamento & purificação , Antioxidantes/farmacologia , Flavanonas/química , Flavanonas/isolamento & purificação , Flavanonas/farmacologia , Glucosídeos/isolamento & purificação , Glucosídeos/farmacologia , Espectroscopia de Ressonância Magnética , Conformação Molecular , Fenóis/isolamento & purificação , Fenóis/farmacologia , Extratos Vegetais/química
15.
Bioorg Med Chem ; 17(6): 2447-51, 2009 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-19251423

RESUMO

A series of unsymmetrically disubstituted urea derivatives 1-28 has been synthesized and screened for their antiglycation activity in vitro. Compounds 26 (IC(50)=4.26+/-0.25 microM), 1 (IC(50)=5.8+/-0.08 microM), 22 (IC(50)=4.26+/-0.25 microM), 6 (IC(50)=6.4+/-0.02 microM), 5 (IC(50)=6.6+/-0.26 microM), 2 (IC(50)=7.02+/-0.31 microM), 3 (IC(50)=7.14+/-0.84 microM), 27 (IC(50)=7.27+/-0.36 microM), 4 (IC(50)=8.16+/-1.04 microM), 21 (IC(50)=8.4+/-0.15 microM), 23 (IC(50)=9.0+/-0.35 microM) and 13 (IC(50)=15.22+/-6.7 microM) showed an excellent antiglycation activity far better than the standard (rutin, IC(50)=41.9+/-2.3 microM). This study thus provides a series of potential molecules for further studies of antiglycation agents.


Assuntos
Glucose/antagonistas & inibidores , Ureia/análogos & derivados , Ureia/farmacologia , Glucose/química , Espectroscopia de Ressonância Magnética , Espectrometria de Massas por Ionização por Electrospray
16.
J Ayub Med Coll Abbottabad ; 21(1): 110-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20364756

RESUMO

BACKGROUND: Though diabetes and hyperglycaemia are well known risk factors for morbidity and mortality associated with Coronary Heart Disease, there are no studies published from Pakistan on the impact of non-diabetic hyperglycaemia on these indices. The present study was undertaken to fill the gap in knowledge related to this aspect of hyperglycaemia in Pakistani patients. METHODS: We studied 166 patients admitted to our coronary care unit from May 2008 to March 2009 with acute coronary syndrome and acute myocardial infarction. The patients were divided into three groups (a) Diabetic group (b) Impaired glucose group and (c) Normal glucose group according to the American Diabetic Association criteria. RESULTS: It was observed that with increasing level of hyperglycaemia there was an increase in the mortality, with a p-value of 0.058. Hyperglycaemia was also associated with impaired left ventricular function and clinical evidence of left ventricular failure. Insulin therapy was under utilized and may have contributed to increased morbidity and mortality.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Hiperglicemia/complicações , Infarto do Miocárdio/mortalidade , Síndrome Coronariana Aguda/tratamento farmacológico , Glicemia , Estudos de Casos e Controles , Unidades de Cuidados Coronarianos , Feminino , Teste de Tolerância a Glucose , Mortalidade Hospitalar , Humanos , Hiperglicemia/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Paquistão , Fatores de Risco
17.
J Pak Med Assoc ; 58(4): 209-11, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18655434

RESUMO

We discuss a case of 25 year old male who was evaluated for primary infertility following marriage. He had no previous history of urogenital complaints or abnormalities. In fact, his past medical history was unremarkable. On examination epididymal masses were found. Semen analysis showed azoospermia. Right epididymal mass was surgically excised. Histopathology showed an epididymal neoplasm composed of simple and complex papillary processes lining and filling the ducts. The tumor cells were clear and positive for cytoplasmic glycogen. Immunohistochemistry was also supportive. Diagnosis of clear cell papillary cystedenoma was made based on histopathological and immunohistochemical features.


Assuntos
Carcinoma de Células Renais/diagnóstico , Cistadenoma Papilar/diagnóstico , Cistadenoma Papilar/patologia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patologia , Adulto , Carcinoma de Células Renais/secundário , Cistadenoma Papilar/cirurgia , Diagnóstico Diferencial , Epididimo/patologia , Epididimo/cirurgia , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Masculino , Neoplasias Testiculares/secundário , Neoplasias Testiculares/cirurgia
18.
J Ayub Med Coll Abbottabad ; 19(1): 53-5, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17867482

RESUMO

BACKGROUND: To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopsies. METHODS: A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital (AKU), Karachi, in 2004. RESULTS: Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin's lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. CONCLUSION: Out of 20,000 biopsies, there were 4616 (23.08%) malignant neoplsms. Carcinoma of oral cavity is very common in our population in both sexes.


Assuntos
Linfoma de Células B/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma não Hodgkin/epidemiologia , Neoplasias de Células Escamosas/epidemiologia , Neoplasias da Próstata/epidemiologia , Feminino , Humanos , Linfoma de Células B/epidemiologia , Linfoma Difuso de Grandes Células B/epidemiologia , Linfoma não Hodgkin/diagnóstico , Masculino , Neoplasias de Células Escamosas/diagnóstico , Paquistão/epidemiologia , Prevalência , Neoplasias da Próstata/diagnóstico , Estudos Retrospectivos
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