Pakistan has had a low contraceptive prevalence rate for the last two decades; with preference for natural birth spacing methods and condoms. Family planning services offered by the public sector have never fulfilled the demand for contraception, particularly in rural areas. In the private sector, cost is a major constraint. In 2008, Marie Stopes Society – a local NGO started a social franchise programme along with a free voucher scheme to promote uptake of IUCDs amongst the poor. This paper evaluates the effectiveness of this approach, which is designed to increase modern long term contraceptive awareness and use in rural areas of Pakistan.
We used a quasi-experimental study design with controls, selecting one intervention district and one control district from the Sindh and Punjab provinces. In each district, we chose a total of four service providers. A baseline survey was carried out among 4,992 married women of reproductive age (MWRA) in February 2009. Eighteen months after the start of intervention, an independent endline survey was conducted among 4,003 women. We used multilevel logistic regression for analysis using Stata 11.
Social franchising used alongside free vouchers for long term contraceptive choices significantly increased the awareness of modern contraception. Awareness increased by 5% in the intervention district. Similarly, the ever use of modern contraceptive increased by 28.5%, and the overall contraceptive prevalence rate increased by 19.6%. A significant change (11.1%) was recorded in the uptake of IUCDs, which were being promoted with vouchers.
Family planning franchise model promotes awareness and uptake of contraceptives. Moreover, supplemented with vouchers, it may enhance the use of IUCDs, which have a significant cost attached. Our research also supports a multi-pronged approach- generating demand through counselling, overcoming financial constraints by offering vouchers, training, accreditation and branding of the service providers, and ensuring uninterrupted contraceptive supplies.
In the title hydrate, C13H10N4O2S·H2O, the dihedral angles between the central pyrazole ring and its pendant phenyl and thiadiazole rings are 9.93 (8) and 4.56 (7)°, respectively. In the crystal, the components are linked by N—H⋯O, O—H⋯N and O—H⋯O hydrogen bonds, generating  chains incorporating R
4(10) loops. A weak C—H⋯O interaction helps to consolidate the packing.
Obstructive sleep apnea (OSA) is often not diagnosed in patients presenting for surgical procedures thereby increasing the incidence of adverse perioperative course. Early diagnosis of this disease is important in modifying anesthetic management as well as utilizing specific means which may decrease the complications and improve the patient outcome.
Patients greater than eighteen years of age, ASA I-III scheduled for elective surgical procedures under anesthesia were randomly selected. Their demographic data, diagnosis and nature of surgery were noted in a semi-structured performa. They were then screened for the presence of OSA with the help of a STOP BANG questionnaire.
This study included two hundred four patients randomly selected. Slight female predominance was seen in this sample (55.4%). Mean age of the subjects was 42.7 years (SD=15.08). 24.5% subjects were at high risk for OSA (STOP-BANG>3) with a male predominance (72% versus 37% in low risk group; X2=18.62; P<0.001). High risk OSA subjects had higher prevalence of cardiovascular risk factors (57% vs. 11.7% in low risk group; X2=33.35; P<0.001). Similarly, this group had a higher prevalence of asthma and chronic obstructive pulmonary disease (COPD) (14% versus 3.8% in low risk group; X2=6.54; P=0.03). Prevalence of diabetes mellitus (22%) and hypothyroidism (6%) was also higher in this group (5.2% and 1.9% in low risk group respectively; X2=15.42; P<0.001).
High degree of suspicion and knowledge of association of OSA and medical diseases may help in detection of such cases and decrease the rate of perioperative complications thus improving patients safety.
Anaesthesia; complication; obstructive sleep apnea; STOP BANG
In Pakistan, the uptake rate for the intrauterine device (IUD) is very low at 2.5%. The most popular modern contraceptive methods in Pakistan are female sterilization and use of condoms. The Marie Stopes Society established its mobile outreach service delivery program with the aim of increasing use of modern quality contraceptive services, including the long-term reversible IUD, by women living in hard-to-reach areas. The present study attempts to assess IUD discontinuation rates and associated factors, including switching behavior and level of satisfaction with this type of service delivery.
Using a cross-sectional approach, we contacted 681 women who had received an IUD from the Marie Stopes Society mobile outreach program during July and August 2009. Successful interviews were conducted with 639 of these women using a structured questionnaire. The data were analyzed with Stata 11.2 using simple descriptive Chi-square and Cox proportional techniques.
Analysis revealed that 19.4% (95% confidence interval 16.3–22.5) of the women discontinued use of their IUD at 10 months and, of these women, the majority (69.4%) cited side effects as the main reason for discontinuation. Other factors, such as geographical catchment province, age of the woman, history of contraceptive use before IUD insertion, and side effects following insertion of the device, were found to be significantly associated with IUD. Amongst the women who had their IUD removed, 56.5% did not switch to any other contraceptive method, while 36.3% switched to either short-term or traditional methods, such as withdrawal, rhythm, and folk methods. Degree of satisfaction with the device was also significantly associated with discontinuation.
Early discontinuation and not switching to another contraceptive method increases the risk of unplanned pregnancy. Health care workers should be trained in managing clients’ concerns about the IUD to prevent discontinuation and providing counseling services for clients to select an alternative contraceptive method if they decide to discontinue.
intrauterine device; mobile outreach services; discontinuation; Pakistan
Two independent molecules, A and B, comprise the asymmetric unit of the title compound, C21H18N2OS, with the difference in the angle of orientation between the naphthalene ring system and the mean plane of the cycloheptyl ring [16.13 (1) in A and 11.48 (5)° in B], being evident. The cycloheptyl ring adopts a distorted chair conformation in each molecule with r.m.s. deviations of 0.2345 (4) (A) and 0.2302 (4) Å (B). Intramolecular O—H⋯N hydrogen bonding generates planar six-membered S(6) loops with r.m.s. deviations of 0.0099 (1) (A) and 0.0286 (1) Å (B).
Binding features found in biological systems can be implemented into man-made materials to design nanostructured artificial receptor matrices which are suitable, e.g., for chemical sensing applications. A range of different non-covalent interactions can be utilized based on the chemical properties of the respective analyte. One example is the formation of coordinative bonds between a polymerizable ligand (e.g., N-vinyl-2-pyrrolidone) and a metal ion (e.g., Cu(II)). Optimized molecularly imprinted sensor layers lead to selectivity factors of at least 2 compared to other bivalent ions. In the same way, H-bonds can be utilized for such sensing purposes, as shown in the case of Escherichia coli. The respective molecularly imprinted polymer leads to the selectivity factor of more than 5 between the W and B strains, respectively. Furthermore, nanoparticles with optimized Pearson hardness allow for designing sensors to detect organic thiols in air. The ‘harder’ MoS2 yields only about 40% of the signals towards octane thiol as compared to the ‘softer’ Cu2S. However, both materials strongly prefer molecules with -SH functionality over others, such as hydrocarbon chains. Finally, selectivity studies with wheat germ agglutinin (WGA) reveal that artificial receptors yield selectivities between WGA and bovine serum albumin that are only about a factor of 2 which is smaller than natural ligands.
Bivalent copper ions; Organic vapors; Wheat germ agglutinin lectin; Escherichia coli; Quartz crystal microbalance
Fetus in fetu is a rare developmental aberration, characterized by encasement of partially developed monozygotic, diamniotic, and monochorionic fetus into the normally developing host. A 4-month-old boy presented with abdominal mass. Radiological investigations gave the suspicion of fetus in fetu. At surgery a fetus enclosed in an amnion like membrane at upper retroperitoneal location was found and excised. The patient is doing well after the operation.
Fetus in fetu; Teratoma; Abdominal mass
In the title compound, C18H21NO4S, the aromatic rings are almost normal to each other, with a dihedral angle of 89.27 (18)°. The molecular conformation is stabilized by an intramolecular C—H⋯O interaction, which generates an S(6) motif. In the crystal, N—H⋯O and C—H⋯O hydrogen bonds lead to the formation of chains propagating along . Neighbouring chains are linked via a C—H⋯π interaction. The –CH2CH2CH3 atoms of the butyl group are disordered over two sets of sites, with a refined site-occupancy ratio of 0.536 (16):0.464 (16).
The title compound, C8H7BrO3, is almost planar (r.m.s. deviation for the non-H atoms = 0.055 Å). In the crystal, O—H⋯O hydrogen bonds link the molecules into C(6) chains propagating in . Very weak aromatic π–π interactions [centroid–centroid distances = 3.984 (5) and 3.982 (5) Å] also occur.
The title molecule, C16H14N2O4S, adopts an L-shaped conformation, with the central C—S—N—C torsion angle being −69.1 (3)°. The two benzene rings form a dihedral angle of 89.94 (15)°. The molecular conformation may be influenced by a weak intramolecular C—H⋯O hydrogen bond which generates an S(6) ring motif. In the crystal, molecules are linked by N—H⋯O and weak C—H⋯O hydrogen bonds, forming chains propagating along the b axis. Weak C—H⋯N hydrogen bonds connect the chains into a two-dimensional network parallel to (011). The crystal studied was an inversion twin, the ratio of components being 0.7 (1):0.3 (1).
In the title compound, C17H19NO4S, the terminal ethyl group is disordered over two sets of sites, with refined site occupancies of 0.536 (7) and 0.464 (7). The dihedral angle between the two aromatic rings is 81.92 (12)°. The molecular conformation is stabilized by intramolecular N—H⋯O and C—H⋯O hydrogen bonds, which generate S(6) motifs. In the crystal, molecules are linked by C—H⋯O hydrogen bonds, forming chains along the b axis.
In the title compound, C17H18N2O5S, the dihedral angle between the aromatic rings is 68.59 (10)° and the C—S—N—C torsion angle is −81.84 (18)°. The molecular conformation is stabilized by an intramolecular N—H⋯O hydrogen bond, generating an S(6) ring. In the crystal, molecules are linked by C—H⋯O and O—H⋯O hydrogen bonds into a three-dimensional network.
Modern Intrauterine contraceptive device (IUCD) is very safe, highly effective reversible and inexpensive family planning method which offers 5-10 years of protection against pregnancy. The contraceptive use in Pakistan has been merely 30% for over a decade with IUCD being the least used method. Higher discontinuation rates are documented in developing countries; however no such data is available for Pakistan. Marie Stopes Society (MSS) established a social franchise outlets network branded as 'SURAJ' (Sun) in Pakistan to provide quality family planning services. This study attempts to determine IUCD discontinuation rates and its associated risk factors. Using a semi-structured questionnaire, a cross-sectional study was conducted with 3000 clients who availed IUCD services from Suraj provider 6, 12 and 24 month back,. Data were analyzed in SPSS 17.0; adjusted prevalence ratios were calculated to see associations between discontinuation and its risk factors.
We found that 22.7% of the IUCD acceptors experienced some health problem; while the overall discontinuation rate was 18.9% with average time of usage of 7.4 (SD ± 5.8) months before discontinuation. Half of them showed health concerns (49.8%); of which a majority (70.2%) returned to Suraj provider for IUCD removal. Women living in Punjab, residing at a travelling time of 30-60 minutes and no previous use of contraceptive are more likely to discontinue IUCD. However, among total women 81.7% still expressed willingness to avail IUCD services from Suraj provider in future, if needed.
The findings suggest a need for training the providers and field workers to prevent early discontinuation of IUCD among the Suraj clients and by addressing the health concerns through proper counseling, continued follow-up and immediate medical aid/referral in case of complications.
Intra-uterine contraceptive device; Clients' satisfaction; Contraception; Family planning counseling; Social franchising
In the title compound, C26H26ClNO4, the central phenylene ring is oriented at dihedral angles of 5.06 (14) and 64.14 (5)°, respectively, with respect to aromatic rings of the benzyl and chlorophenyl groups. The centroid–centroid distance between the central phenylene ring and the aromatic ring of the benzyl group is 4.028 (12) Å. In the crystal, intermolecular N—H⋯O hydrogen bond generate a chain along (100). C—H⋯O interactions are also observed.
The asymmetric unit of the title co-crystal, C8H12N+·C7H4NO4
−·C7H5NO4, contains two cations, two anions and two neutral 4-nitrobenzoic acid molecules. In the crystal, O—H⋯O, N—H⋯O and C—H⋯O hydrogen bonds connect the ions and molecules, forming a three-dimensional network.
In the title compound, C15H21NO5S, two crystallographically independent molecules are linked into a dimer by a pair of N—H⋯O hydrogen bonds, forming an R
2(8) ring motif. In the crystal, molecules are further linked by intermolecular O—H⋯O hydrogen bonds into a two-dimensional network parallel to (012). Additional stabilization is provided by weak intermolecular C—H⋯O hydrogen bonds.
The asymmetric unit of the title compound, C14H13NO5S, contains two independent molecules in which the dihedral angles between the aromatic rings are 83.45 (11) and 86.65 (9)°. In the crystal, the independent molecules are connected by N—H⋯O and O—H⋯O hydrogen bonds, forming a double-chain structure along . A weak π–π stacking interaction with a centroid–centroid distance of 3.7509 (13) Å and C—H⋯O hydrogen bonds are also observed.
The title compound, C15H21NO4S, crystallized with two independent molecules in the asymmetric unit in which the dihedral angles between the mean planes of the benzene and cyclohexane rings are 78.3 (2) and 67.6 (2)°. The substituents of the cyclohexyl rings are in equatorial orientations. In the crystal, both molecules form R
2(6) carboxylic acid inversion dimers via pairs of O—H⋯O hydrogen bonds. Further N—H⋯O and C—H⋯O interactions generate a three-dimensional network.
In the title compound, C14H13NO4S, the dihedral angle between the aromatic rings is 35.47 (10)°. In the crystal, adjacent molecules are connected by pairs of O—H⋯O hydrogen bonds, forming head-to-head centrosymmetric dimers typical for carboxylic acids. Adjacent dimers are further linked through C—H⋯O interactions on one side and N—H⋯O interactions on the other, generating  chains.
In the title compound, C15H14N2O5S, the dihedral angle between the aromatic rings is 63.20 (11) Å. The crystal structure displays classical intermolecular O—H⋯O hydrogen bonding typical for carboxylic acids, forming centrosymmetric dimers. These dimers are further connected by N—H⋯O and C—H⋯O hydrogen bonds to form an extended network.
In the title compound, C9H6Br3NO3S, a halogenated benzothiazine derivative, the thiazine ring adopts a sofa conformation. The crystal studied was a racemic twin with a contribution of 72 (1)% of the major domain.
In the title compound, C14H10Cl2N2O2, the dihedral angle between the two aromatic rings is 17.39 (4)°. An intramolecular O—H⋯O hydrogen bond forms a six-membered R(6)1
1 ring motif. In the crystal structure, intermolecular N—H⋯O and O—H⋯O hydrogen-bonding interactions occur.
In the title compound, C15H16N2O6S2, the dihedral angle between the benzene rings is 83.2 (3)°. The molecular conformation is stabilized by an intramolecular C—H⋯O interaction. In the crystal structure, molecules are linked by N—H⋯O and C—H⋯O hydrogen bonds and additional stabilization is provided by weak C—H⋯π interactions.
A piezoelectric 10 MHz multichannel quartz crystal microbalance (MQCM), coated with six molecularly imprinted polystyrene artificial recognition membranes have been developed for selective quantification of terpenes emanated from fresh and dried Lamiaceae family species, i.e., rosemary (Rosmarinus Officinalis L.), basil (Ocimum Basilicum) and sage (Salvia Officinalis). Optimal e-nose parameters, such as layer heights (1–6 KHz), sensitivity <20 ppm of analytes, selectivity at 50 ppm of terpenes, repeatability and reproducibility were thoroughly adjusted prior to online monitoring. Linearity in reversible responses over a wide concentration range <20–250 ppm has been achieved. Discrimination between molecules of similar molar masses, even for isomers, e.g. α-pinene and β-pinene is possible. The array has proven its sensitive and selective properties of sensor responses (20–1,200 Hz) for the difference of fresh and dried herbs. The sensor data attained was validated by GC-MS, to analyze the profiles of sensor emanation patterns. The shelf-life of herbs was monitored via emanation of organic volatiles during a few days. Such an array in association with data analysis tools can be utilized for characterizing complex mixtures.
quartz crystal microbalance; chemical sensor; molecular imprinting; herbs; terpenes
Colonic atresias are the rare malformations of the colon and constitute about 1.7 to 15% of all gastrointestinal (GI) atresias. A 6-month old infant presented with recurrent episodes of sub-acute intestinal obstruction since birth. During the index admission, patient had clinical signs of complete intestinal obstruction. The patient was operated and type I sigmoid-colon atresia found which on further exploration tuned out to be of perforated mucosal web variety. The resection of the involved part of colon and a primary end to oblique colo-colic anastomosis was performed.
Colonic atresia; Colonic stenosis; Perforated colonic web; Intestinal obstruction