Correction: Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study.

[This corrects the article DOI: 10.7759/cureus.32533.].

Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study.

Background For the success of procedures such as caudal block, craniospinal irradiation (CSI), and management of lower back pain and to minimize the risk of dural puncture the exact level of dural sac (DS) termination should be known. Objective The evaluation of DS tip location in the Saudi population and exploring possible significant factors that could be used as predictors in clinical prognosis. Methods A total of 200 patients' lumbar sagittal Weighted T2 Magnetic Resonance Imaging (MRI) study were randomly selected from a single-center hospital in-between 2020 and 2021. The DS tip location was determined by generating a perpendicular line from the longitudinal axis of its termination to the corresponding level. Then naming it after an intervertebral disk or a corresponding vertebrate that is divided into three thirds (upper, middle, and lower). Results In most cases, the level of DS termination is at the middle part of S2 (26.5%), followed by the upper part of S2 (25.1%), and the lower part of S2 (20%). In Saudi nationals, the DS tip was in the middle S2 level at 21.5%, upper S2 level at 19.1%, and lower S2 level at 17%. Factors such as age, sex, cause of referral, and nationality had no statistical significance in relation to DS tip location. Conclusion The DS termination level in the Saudi population ranges from disk between L5-S1 to the lower third of S3. Moreover, nationality, age, and cause of referral were not significant in determining the DS termination level. Therefore, it is still important to individualize patients' treatment by using MRI for each case that requires it.

Protecting the unprotected: mixed-method research on drug use, sex work and rights in Pakistan's fight against HIV/AIDS.

OBJECTIVES: To investigate the nature and extent of human rights abuses against three vulnerable groups (injecting drug users (IDUs) and male and female sex workers), to understand the social and sexual linkages between them and to examine how protecting their rights could enhance the impact of HIV prevention policies. METHODS: In-depth interviews were carried out with 38 high-risk respondents (IDUs and female, male and transgender sex workers) and a bio-behavioural survey was performed of 813 IDU/sex worker respondents in Rawalpindi. RESULTS: People in all vulnerable groups interacted both sexually and socially. All groups experienced human rights abuses by state and non-state actors which increased their HIV risk. Non-state actors, including relations and sex worker clients, are responsible for verbal, physical and sexual violence. State actors (particularly police) perpetrate harassment, exploitation and abuse of all vulnerable groups with impunity. Health service providers fail to provide adequate services for vulnerable groups. CONCLUSIONS: High levels of discrimination and abuse of human dignity of all groups studied were revealed. This violates their physical and mental integrity and also leads to an increased risk of HIV. The sexual and social interactions between groups mean that human rights abuses experienced by one high-risk group can increase the risk of HIV both for them and other groups. The protection of human rights needs to become an integral part of a multisector response to the risk of HIV/AIDS by state and non-state agencies. The Government of Pakistan should work at both legal and programme levels to protect the rights of, and minimise discrimination against, groups vulnerable to HIV in order to reduce the potential for the spread of HIV before the epidemic takes hold.

Adaptation and validation of a portable steam sterilizer for processing intrauterine device insertion instruments and supplies in low-resource settings.

BACKGROUND: Difficulties with adequately processing intrauterine device (IUD) insertion instruments and supplies have led to use of potentially contaminated items, compromising the quality and safety of IUD insertion services in Bangladesh. A sterilization process for IUD insertion instruments and supplies by using a commercially available portable steam sterilizer was developed and validated. METHODS: Racks provided with the sterilizer were used during sterilization of wrapped supplies (gloves and cotton balls). Metal compartments to hold insertion instruments were built to fit into the sterilizer. After sterilization, supplies were transported to rural service sites in plastic bags, whereas instruments remained in the sterilizer, which was transported in a carrying case. To validate the sterilizer, laboratory testing was conducted by using chemical and biologic indicators for steam sterilization and field testing in Bangladesh with chemical indicators. RESULTS: Results indicated that sterilization cycles were effective in achieving sterility of IUD insertion supplies and instruments at sterility assurance levels of 10(-5) and 10(-6), respectively. CONCLUSIONS: Use of this sterilizer for IUD insertion supplies and instruments will improve the quality of service delivery in the Bangladesh family-planning program and has application for use in many other low-resource settings.

The need for prophylactic antibiotics after female sterilization: tetracycline in Bangladesh.

All female sterilization patients in Bangladesh receive five-day courses of tetracycline capsules every six hours as a postoperative prophylactic. A double-blind randomized study was conducted by the Bangladesh Fertility Research Programme (BFRP) to determine whether prophylactic antibiotics reduced infection after minilaparotomy, and to compare the prophylactic effectiveness of tetracycline and ampicillin. Women recruited from throughout Bangladesh (N = 1350) received five-day courses of 250 mg tetracycline, 250 mg ampicillin, or placebo. The infection rate was significantly lower with tetracycline than with placebo (6% vs 10% with placebo), but did not differ significantly between the ampicillin and placebo groups or between the tetracycline and ampicillin groups.

Is poor nutrition masking the effects of depomedroxyprogesterone acetate on bones in adolescent users?

INTRODUCTION: Research in the developed countries has documented bone loss in adolescents who use depomedroxyprogesterone acetate (DMPA) as a contraceptive for less than two years. DMPA use often begins during adolescence in Bangladesh, a South Asian developing country, where more than 50% of women are undernourished. Poor nutrition is also associated with low bone mineral density (BMD) in South Asian women. We investigated the effects of long-term (two or more years) DMPA use on BMD in Bangladeshi women who started its use in their adolescence. METHODS: Lumbar spine and femur neck BMD were acquired using dual energy X-ray absorptiometry for 100 adolescents (50 DMPA users and 50 non-users) in a cross-sectional study in Dhaka, Bangladesh. Multivariate analysis was used to determine the associations between BMD and DMPA use. Stratified analysis of DMPA use investigated the determinants of BMD in both groups. RESULTS: The participants (mean age 18 +/- 2 years) were generally below their ideal body weight. No significant differences in BMD were found between the two groups. Weight (odds ratio [OR] 0.96, 95 percent confidence interval [CI], 0.92-1.00) and height (OR 0.68, 95 percent CI 0.49-0.94) were independent determinants (p-value is less than 0.05) of lumbar and femur neck BMD, respectively. CONCLUSION: Poor nutritional status, indicated by a less-than-ideal body weight, may be masking the effects of DMPA on bone loss among adolescent users. Our findings suggest that nutritional supplementation may be required with DMPA prescription to promote bone health in adolescent users who are approaching peak bone mass.

Peripheral arterial disease: diagnosis and management.

Peripheral arterial disease is a common but underdiagnosed and undertreated disorder with substantial morbidity and mortality. The pathophysiology of peripheral arterial disease and the risk factors for developing it are similar to those for atherosclerotic disease occurring at other sites. Peripheral arterial disease can be diagnosed accurately with simple, noninvasive, office-based tests that measure the severity of the disease and provide valuable prognostic information. Optimal medical therapy includes a supervised exercise program, tobacco cessation, and modification of treatable risk factors. Cilostazol can improve pain-free and peak walking distances in patients with intermittent claudication. As a general rule, patients with lifestyle-limiting claudication who do not respond to medical management or those with critical limb ischemia should be referred to a vascular specialist for consideration of revascularization.

Migrant men: a priority for HIV control in Pakistan?

OBJECTIVES: To assess sexual risk behaviour and prevalence of treatable sexually transmitted infections (STI) in migrant male workers in Lahore, Pakistan. METHODS: Behavioural interviews were conducted on a representative sample of 590 migrant men aged 20-49 years. Biological samples were collected from a subsample of 190 and tested for chlamydia, gonorrhoea, and syphilis. RESULTS: Over half (55%) of single men were sexually experienced and 36% of married men reported premarital sex. The median ages at first intercourse and first marriage were 21 years and 28 years, respectively. In the total sample (including virgins), 13% reported any female non-marital partner in the past 12 months, 7% contact with a female sex worker, and 2% sex with a man. Only 10% reported using a condom during most recent contact with a sex worker. STI symptoms in the past 3 months were reported by 8% of men. Laboratory tests disclosed that STI prevalence was 3.2%. CONCLUSIONS: If and when HIV infection spreads among sex workers in Lahore, the reported behaviour of migrant men suggests that they may act as a conduit for further transmission to the general population. Condom promotion focused on the sex trade is likely to be the most effective way of reducing this risk.

Differentials in health-related variables among children at a diarrhoea training unit in Pakistan.

The study assesses gender differences and other variables related to diarrhoea in 500 children less than two years of age at a diarrhoea training unit (DTU). During the study period, 78% of the children (51% males and 49% females) who were brought for care had no dehydration. More female children were malnourished than male. Exclusively bottle-fed infants were malnourished in higher proportion than those breastfed exclusively or partially. With worsening of nutritional status, severity of dehydration increased but it had no effect on the frequency of dysentery which was seen in 11 females and 10 males. Appropriate supplementary feeding was alarmingly low. Eighty-seven per cent of children 9-24 months of age had received their immunisation against measles. All children were rehydrated at the DTU and not a single case required admission. The study does not show preferential care-seeking for male children and suggests that educational efforts be focused on exclusive breastfeeding, appropriate weaning and home management of those cases with no dehydration.

Low-tech innovation helps provide safer services.

PIP: The IUD is a highly popular contraceptive method, used by almost 500,000 women in Bangladesh alone. One concern with IUD use, however, is the potential risk of post-insertion pelvic inflammatory disease (PID), a serious disease which can lead to chronic lower abdominal pain, ectopic pregnancy, infertility, and death. An increased risk of PID exists for approximately 1 month after IUD insertion, presumably related to the introduction of bacteria into the uterus during the insertion procedure. Proper processing of IUD instruments and supplies and close attention to aseptic technique can help to reduce the risk of post-insertion PID. Concern over the ability to maintain aseptic technique is particularly high with regard to health care workers who travel between clinics in rural areas. In Bangladesh, providers in rural areas had problems transporting equipment, obtaining fuel and clean water, and finding the time needed to boil and cool instruments. A portable, easy-to-use steam sterilizer has now been developed and made available, allowing health workers to fully sterilize IUD instruments before visiting rural clinics, so that they no longer have to boil the instruments on site. AVSC was one of several organizations which worked with Bangladesh's National Task Force to develop the portable sterilizer for IUD instruments and supplies.^ieng

Improving family planning program performance through management training: the 3Cs paradigm.

PIP: Action research was conducted in Bangladesh to determine whether a high level of fertility control behavior can be attained in a country of very low socioeconomic status, including very low levels of literacy and women's status, and if management training help can improve the performance of service delivery systems. 20 family planning officials participated in a 14-week, non-degree, management training program conducted in Dhaka. The research found that competently executed determined effort is a far faster and more effective alternative to socioeconomic development-led contraception in a developing population. A carefully designed and executed intervention can achieve a high level of contraceptive use, and thereby control fertility, without waiting for significant improvement in a country's socioeconomic indicators. For example, in the 19 experimental thanas, the contraceptive prevalence rate increased by an average of approximately 10 percentage points within 12 months of training. These findings demonstrate how a task-focused, well-designed, and properly conducted management training, backed by well organized and managed follow-up, can effect major improvement in a system's effectiveness and productivity, even if that system is staffed by a demoralized and apathetic work force.^ieng

Underestimation of malnutrition among Pakistani infants weighed with clothes on

Many growth monitoring programmes at health facilities and in communities in Pakistan weigh children with their clothes on. The nutritional status of infants at the Rawalpindi General Hospital was estimated from weight without clothes on and showed that about 8% of malnourished children were being missed. This underestimation mostly affected children with grade II and grade III malnutrition. Generally, more boys have normal nutritional status than girls. Accordingly, weight with clothes on was found to underestimate the malnutrition status of girls more than that of boys. Children should be weighed without clothes on so as estimate their nutritional status and risk accurately