World Health Organization (WHO) recommends at least 6 months interpregnancy interval after an abortion. Pakistan has a low contraceptive prevalence rate and a high unmet need for contraception. Post-abortion women are the potential clients for contraception but national data reveal low uptake of the contraceptive methods by these clients. This study aimed to explore the barriers to adopting contraception among post-abortion clients in the district of Sargodha, Pakistan. A qualitative research design was used. Study participants were recruited from three private and three public sector hospitals in the district of Sargodha, Pakistan. The study was conducted from July 2018 to November 2018. Ninety-nine in-depth interviews (IDIs) of post-abortion women were conducted using an unstructured interview guide within the period of one month after abortion. Detailed field notes were made. Interviews continued until thematic saturation had reached. The content was organized into a matrix based on themes and sub-themes. A descriptive thematic analysis using both inductive and deductive coding was conducted. Reasons for not adopting contraceptive methods were explored Although many clients expressed a desire to limit fertility, some barriers were found to be hindering the uptake of contraception. Major barriers expressed by clients were the unwillingness of the husband, the resistance of other family members and real or perceived fear of side effects of contraceptive methods. Lack of adequate knowledge about fertility and contraception was another factor which contributed to the decision not to adopt contraception. Socio-cultural norms to have large family sizes were also reported by some clients. Other barriers include religious beliefs, focus on other health issues, financial unaffordability, infrequent intercourse and plan for tubal ligation. The study concluded that without addressing the barriers post-abortion contraceptive uptake is unlikely to improve. Identification of barriers is the first step to addressing the existing unmet need for contraception.

Background: Dysmenorrhea is an important health issue of young adult females that badly affects their quality of life and academic performance. This study aimed to determine prevalence, impact, management practices and factors associated with dysmenorrhea among medical students. Methods: This analytical cross-sectional study was conducted in Akhtar Saeed Medical & Dental College Lahore from August 2020 to December 2020. Using Cochran’s sample size calculator and rounding off, sample size of 400 female students was calculated. Convenience sampling technique was used. A self-constructed questionnaire was used which was designed after extensive literature search. Pain intensity was estimated using Visual Analogue Scale (VAS). Data were entered and analyzed in SPSS version 23. Chi square test was applied to find association between variables. A p-value of < 0.05 was considered statistically significant. Results. Mean age of participants was 21.07 ± 2.58 years. Prevalence of dysmenorrhea was 79.5%. Statistically significant association was found between dysmenorrhea and participant’s age (p value=0.002),  marital status(p value=0.001), family income(p value=<0.001), age of menarche (p value=<0.001), days of  bleeding (p value=0.009) and regularity of cycle(p value=<0.001). Mostly participants used combinations of remedies. Rest was the most commonly used remedy to relieve pain.  Impact of dysmenorrhea included social withdrawal, inability to prepare for exam, difficulty in carrying out daily activities and absence from college. Conclusion. Prevalence of dysmenorrhea was 79.5%. Statistically significant association was found between dysmenorrhea and participant age,  marital status, family income, age of menarche, days of  bleeding and regularity of cycle. Alone or together, taking rest was the most commonly used remedy to relieve pain. Dysmenorrhea negatively affected quality of life.

Objective:  The most prevalent type of skeletal TB, which accounts for nearly half of all cases, affects the spinal column. Regarding pain, neurological deficit, and spinal instability, the study sought to determine the surgical outcome of spinal tuberculosis. Material and Methods:  This study was conducted in the Department of Neurosurgery, Ayub Teaching Hospital. A total of 42 patients with ages ranging from 24 – 66 years were included in the study. Information about the patient was gathered to determine indications (neurological impairments) about the ASIA Grading Scale and frequently affected areas. Results:  Commonest location was a thoracolumbar junction in 42.8%, followed by the lumbar spine in 23.8%. The pain was found in all subjects. The main indication of surgery was neurological deficit which is seen in 57% of patients followed by spinal instability or deformity in 16.6% of patients and patients with failed chemotherapy in 4.7% of patients. The preoperative KA was between 30 – 60º with a mean of 43.06 ± 4.11 degrees and 9.45 ± 3.99 degrees for postoperative KA (p-value < 0.0001). Most fixations of the cord were done through a posterior approach that was in 83.3% of patients. The neurological improvement according to ASIA grading was seen in 95.2% and no improvement was seen in 4.7% of patients upon 3 months follow-up. Conclusion:  Surgical treatment of the caries spine improves pain, lowers neurological compression, and successfully reverses deformities like kyphosis, resulting in better clinical results. It also helps to remove the Tuberculous burden from the body.

Background: Diarrhea is the second major cause of mortality in children worldwide. Timely interventions by caregivers who are mainly mothers, can contribute towards a favorable prognosis of this condition in children. Aim: The purpose of conducting this study was to assess maternal knowledge and the practices regarding prevention of diarrheal diseases in children under the age of 5 years. Setting: This study was carried out in three hospitals at Lahore, Pakistan. Methods: An analytical cross-sectional study was conducted from January to July 2020 and a convenience sampling technique was used for data collection. Data was collected from 158 mothers of children under 5 years of age by using a self-structured, pre-tested questionnaire. Chi square test was applied and p-value <0.05 was taken as significant. Results: A total of 158 mothers responded to the study questionnaire; mean age of the participants was 28.4+ 7.6 years, 22.8% were illiterate, 84.2% were housewives, and 37.4% had income more than 31000 rupees/month. The majority (43.1%) had ‘poor’ knowledge, 24% had’ poor’ attitudes and practices while 12% had better practices. Significant associations were observed between mother’s knowledge with education (p-value=0.004), income (p-value=0.001), frequency of diarrhea in a child (p-value=0.053) and practices with education (p-value =0.039). Conclusion: This study showed the direct relationship between mother's literacy level and family income with better knowledge and feeding practices of children regarding prevention of diarrhea. It has highlighted the role of mothers in the management of acute diarrheal diseases.

Objective: To assess the knowledge of epidemiology, transmission, prevention and control of rabies and to find the effect of an educational intervention in paramedical students of HITEC-IMS, Taxilla. Study Design: Quasi-experimental study. Place and Duration of Study: HITEC-IMS, Taxilla, from Mar to Sep 2019. Methodology: Study was carried out among paramedical students enrolled in 2 years diploma course in HITEC-IMS, Taxilla. Students were included by non-probability consecutive sampling. Results: Out of the total of 89 participants, the fatality of rabies was identified by 63 (70.8%) respondents in pre-test and by 84 (94.4%) respondents in post-test (p<0.001). Less than half of the participants knew about bats as a reservoir of rabies (22, 24.7%) in pre-test that raised to 59 participants (66.3%) in post-test (p<0.001). The proper sequence of protocol for postexposure prophylaxis (PEP) in un-vaccinated persons was identified by 42 (47.2%) respondents with an improvement of 27% in post-test (p<0.001). Proper order of rabies post-exposure prophylaxis (PEP) vaccine schedule in humans were identified by 16 (18.0%) respondents with an improvement of 6% in post-test (p=0.031). Conclusion: Knowledge of reservoir, mode of transmission, prevention and control of rabies after educational intervention showed a significant increase in the students.

Objectives:  The study determined the radiological outcomes of short-segment vs. long-segment fixation of thoracolumbar spine fractures. Materials and Methods:  A total of 322 patients (18 – 60 years) with thoracolumbar spine fractures were included. Preoperative X-rays and CT scans were performed on all patients to determine the integrity and orientation of the pedicle. Cobb's approach was also used to estimate the kyphotic angle on x-rays. The posterior pedicle 65 screw fixation was used in all instances. Group A (N = 161) received long segment fixation at least two levels above and below the fractured vertebra, while Group B (N = 161) received short segment fixation with pedicle screws placed in the broken level as well as one level above and below the fractured level. Results:  In Group A, the mean age was 38 years, and the mean length of fracture was 45 hours; in Group B, the mean age was 43 years, and the mean duration of fracture was 46.354 hours. A good radiological outcome was observed in 115 (71.4%) patients in group A as compared to 103 (64%) patients in group B. A radiological outcome (p-value: 0.049) of a duration greater than 8 hours was observed in both groups (A: 75.5%; B: 58.1%). Conclusion:  Short segment fixation using a pedicle screw at the level of fracture provides comparable correction to long segment fixation. Keywords:  Thoracolumbar Fractures, Short Segment, Long Segment, Radiological Outcome.

Objective: To determine the prevalence of refractive errors among medical students and identify associatedfactors.Study Design: Analytical, cross-sectional study.Place and Duration of Study: The study was conducted in the Department of Community Medicine at AkhtarSaeed Medical and Dental College, Lahore from September 2020 to December 2020.Materials and Methods: The study included 300 medical students using convenience sampling technique. Aself- structured pre- tested questionnaire was used. All medical students including MBBS, BDS, Pharm –D andallied health sciences were included in the study. Those students who did not give consent were excluded fromthe study. Data analysis was done with SPSS version 23. Chi square test of significance was applied to findassociation between the variables and p-value < 0.05 was considered statistically significant.Results: Refractive error was observed in 203 students (67.7%). The commonest refractive error was myopia(37%) followed by hypermetropia (23.7%) and astigmatism (7%). The prevalence of refractive errors wassignificantly associated with positive family history (p value=<.001), family income per month (p value=0.01)and mobile use per day (p value=0.001). Higher percentage of refractive error (70.6%) was reported byparticipants who were comfortable with light in which they study (p value=0.03).Conclusion: The prevalence of refractive error was 67.7% among medical students, and myopia was the mostprevalent refractive error. Refractive errors were significantly associated with positive family history, familyincome and mobile use per day.

Background: Maternal depression and anxiety can predispose the women to higher risk of complications. The COVID-19 pandemic is a unique stressor which may affect the mental and psychological well-being of pregnant women. Aim: To determine prevalence of depression and anxiety and related factors in pregnant women during COVID-19. Methods: This multicenter analytical cross-sectional study was carried out from August 2021 to December 2021 in six cities of Pakistan. Two stage sampling technique was used to include sample of 400 pregnant women. Patient Health Questionnaire-9 (PHQ-9) and Corona virus Anxiety Scale (CAS) were used to measure depression and anxiety level along with self-constructed questionnaire to record socio-demographic profile. Data entry and analysis was done in SPSS version 23. Association between variables was assessed by applying Chi square test and strength of association was measured by binary logistic regression. p-value ≤ 0.05 was taken as statistically significant. Results: Mean age of participants was 27.25±5.22 years. The mean gestational age was 23.5±9.6 weeks. About 37.1% had mild depression. Moderate depression was found in 7.8% and moderately severe depression in 0.5% participants. Significant association was found between depression and no physical activity (p value=0.02), not having spouse support (p value=0.03), perceived vulnerability to get COVID (p value=0.004) and fear of infection to baby (p value=0.05). Only 3.25% participants had dysfunctional anxiety. Conclusion: Findings of the study would be helpful for policy makers to launch health awareness campaigns about regular physical activity, role of social support and seeking medical advice for mental well-being during pregnancy. Keywords: COVID-19, Anxiety, Depression, Mental health, Pregnancy