Improving safe post-abortion care practices: A study on interventions implemented by Ipas Pakistan.

An estimated 50 million induced abortions occur in developing countries annually, and an estimated 7 million women are treated for complications associated with unsafe abortions. According to a 2012 estimate, 15 per 1,000 women aged 15-49 years seek treatment for abortion-related health complications in both private and public sectors. A high unmet need for family planning in Pakistan and a low percentage of women adopting a contraceptive method in the post-partum period led to unwanted pregnancy becoming one of the reasons for unsafe abortion. Post-abortion care (PAC) is an integrated service delivery model that includes both maternal health and family planning interventions. The study aims to examine improvement in abortion-related practices through the implementation of the PAC model at all tiers of public health service delivery systems in the two most populous provinces-Punjab, Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory (ICT) region-of Pakistan. The improvement model comprises clinical training of healthcare providers, community engagement, and counseling of community women on safe post-abortion practices. It was a descriptive study utilizing data of 27,616 PAC clients recorded and reported by the service providers on the logbooks from 104 selected public health facilities from March 2018 to December 2021 in ICT, Punjab, Sindh, and Khyber Pakhtunkhwa provinces of Pakistan. Women who received PAC services were older than 25 years, 22,652 (82%), with a mean age of 29 years. Most of these women were in their first trimester, 26,110 (95%), and the majority diagnosed with PAC (incomplete, missed, or threatened abortion), 26,838 (97%). The majority of women, 25,324 (92%), received safe methods for post-abortion care that included the use of misoprostol, 15,804 (58%), and manual vacuum aspiration, 8,898 (32%). In total, 17,105 (72%) of women opted for a contraceptive method that included long-acting reversible contraceptives, 2,313 (10%); short-term excluding condoms, 3,436 (27%); and condoms, 8,113 (34%). The key predictors identified for uptake of the post-abortion family planning method indicated that women more than 25 years of age, in the early second trimester, and who were counseled on post-abortion family planning were more likely to adopt the contraceptive method than others. Increased access to post-abortion care and family planning could potentially reduce the incidence of unsafe abortion, unintended pregnancies, and associated maternal mortality. The experience of Pakistan suggests that the integrated post-abortion care service delivery model can be effectively implemented across the public health systems.

Juvenile Alexander Disease: A Rare Leukodystrophy.

Alexander disease is an uncommon autosomal dominant leukodystrophy that influences the white matter of the central nervous system (CNS), predominantly affecting the frontal lobe bilaterally. The most obvious pathogenic hallmark is the extensive deposition of cytoplasmic inclusions known as "Rosenthal fibers" in perivascular, subpial, and subependymal astrocytes throughout the CNS. The hereditary cause is mutations in the glial fibrillary acidic protein (GFAP) gene. Infantile, adult, and juvenile onsets are the three subtypes. Psychomotor retardation, mile-stone regression, spastic paresis, brain stem symptoms (swallowing, speech, etc.), and seizures define the juvenile variety, which emerges between the ages of three and 10 years. Macrocephaly has a lower likelihood of being a juvenile type. It is generally diagnosed based on clinical and magnetic resonance imaging findings. A five-year-old girl is presented as a case of juvenile Alexander disease, with typical clinical and MRI features.

Probing the Synergistic Effect of Antibacterial Drug and Oleic Acid in Lipid-based Gastroretentive Matrices by Melt Molding Method.

INTRODUCTION: Clarithromycin (antibiotic), due to its narrow absorption window in the gastrointestinal tract, was taken as a model drug. MATERIALS AND METHODS: Focusing on the efficient drug delivery system, floating tablets that remain buoyant over gastric fluid for 24 hrs were produced by adopting the melt mold method using beeswax, gelucire, and oleic acid. To modulate the release pattern, a different concentration of 48/16 of beeswax and gelucire was used. RESULTS: To evaluate and characterize the final product, several tests, including the percentage recovery, in-vitro release studies, clarithromycin loading, scanning electron microscopy, differential scanning calorimeter, X-ray powder diffractometry, fourier transform infrared spectroscopy, weight variation, hardness, and friability, were carried out. Regarding the results, the encapsulation efficiency of the floating tablets was 39.5% to 59%, having weight variation with and without gelucire as 48/16 0.09525±0.0032g, and 0.09527±0.00286g to 0.0957±0.00321g, respectively. Clarithromycin release was controlled by using hydrophobic beeswax and hydrophilic gelucire 48/16. X-ray powder diffractometry, differential scanning calorimeter, and fourier transform infrared spectroscopy confirmed the absence of drug-polymer interaction, and exhibited amorphous and crystalline form of the drug after encapsulation. Drug release kinetics was determined by applying different models, such as zero-order, first-order model, Higuchi, and Korsemeyer-Pappas model. All formulations followed the Korsmeyer- Peppas model at 1.2 pH. CONCLUSION: Gastroretentive drug delivery systems were produced by using melt molding technique. In vitro dissolution represents the sustained release of the drug from the formulation.

Mesenteric Ischemia due to Thrombosis Involving the Aorta, Celiac Artery, and Superior Mesenteric Artery in a Young Female with Protein C Deficiency.

An arterial thrombus affecting the descending aorta, celiac artery, and superior mesenteric artery at the same time, resulting in mesenteric ischemia and splenic infarction, is a very rare phenomenon. We report a case of a 35-year-old, unmarried female, gravida 0 para 0, who presented with abdominal pain, vomiting, and constipation for two days. Computed tomography (CT) scan showed thrombi in the descending aorta to the celiac axis and superior mesenteric artery with splenic infarction, bowel ischemia, hepatic portal venous air, and uterine fibroid. The diagnosis of arterial thrombotic mesenteric ischemia was made. An exploratory laparotomy was performed. Gangrenous intestine resection was done with ileojejunostomy and feeding ileostomy.