Objective-To compare the accuracy of the reported date of the last menstrual period (LMP) with that of symphysis-fundal height (SFH) in the estimation of gestational age (GA), using an ultrasound (US) scan as reference. Results-The mean GA was less by ultrasound than by SFH measurement or the reported LMP, and the mean differences with the US result were statistically significant (P <0.001 for both). At delivery, about 75% of the GA values estimated by SFH measurement were within 7 days and almost 91% were within 14 days of the estimation by ultrasound, compared with 65% and 82% for the GA estimated by the reported LMP. Moreover, using the US as reference, the SFH correctly classified 84% of the term, 68% of the preterm, and 86% of the post-term deliveries (weighted κ = 0.58) compared with the corresponding 79%, 61%, and 55% predicted by the reported LMP (weighted κ = 0.44). Methods-GestationalConclusion-The SFH measurement was found to be more accurate than the reported LMP as a tool to estimate GA and therefore date of delivery, but neither were as accurate as a US scan.

Objective-To determine stillbirth risk factors and gestational age at delivery in a prospective developing country birth cohort.Study Design-1369 Pakistani women were prospectively enrolled at 20 -26 weeks, the gestational age determined by ultrasound, and risk factors and pregnancy outcomes assessed.Results-The stillbirth rate was 33.6/1000 births despite 96% of women receiving prenatal care, 83% attended by skilled providers in hospital and a 20% cesarean section rate. 51% of stillbirths occurred ≥ 37 weeks and 19% from 34-36 weeks. Only 4% had congenital anomalies. Hemoglobin < 8 g/dL, vaginal bleeding and preeclampsia were associated with increased stillbirth risk.Conclusions-In this developing country with reasonable technical resources defined by hospital delivery and a high cesarean section rate, stillbirth rates were much higher than US rates. That most of the stillbirths were term, did not have congenital anomalies and the demise appeared to be recent, suggests that many Pakistani stillbirths may be preventable with higher quality obstetric care.

Cancer undoubtedly affects patients in all aspects.

Background: Immunization is one of the simplest and cost-effective ways to protect a child from infectious diseases and mortality worldwide, and while global immunization coverage has increased dramatically the impact is low in developing countries like Pakistan, where many children remain unvaccinated or partially vaccinated. Aim: To determine the potential factors related to parents that impact the uptake of immunization in children living in the peri-urban area of Karachi, Pakistan. Methodology: An analytical cross-sectional study was conducted between Oct 2020 to May 2021. Purposive sampling technique based on the inclusion and exclusion criteria was used and a total of 100 parents of children were interviewed using the self-developed structured questionnaire focusing on factors like socio-demographic, parental health-seeking behavior, parental knowledge and perception of immunization and the reasons why a child is partially immunized. The data was collected from two EPI centers from the peri-urban area of Karachi to determine the parental factors associated with child immunization. Results: The results of the study show association between Child immunization and father occupation (p=0.000), parental education (p=0.000) and household income (p-value=0.000). history of sibling’s complete vaccination 35(70%), frequency of maternal antenatal visits 41(82%) accompanied by the husband 37 (74%) and have delivered the child in hospital 50(100%) by an obstetrician 50 (100) and for medical treatment child is always taken to a hospital 47(94%). Parents who consider vaccination important 48 (86%) with the significance of (p=0.001) and they have awareness regarding the total number of immunizations 38(76%) have fully immunized children. Conclusion: According to the study, parental education, occupation, income, health-seeking behavior, father’s involvement, child birth-related factors, parental awareness on immunization, perception of immunization Keywords: Immunization coverage, EPI, Parental factors, Peri-Urban, Sindh, Fully Immunized, Partially Immunized

This review was carried out with the objective to study patterns of neurological, psychological and other physical consequences of COVID-19 in the long term. The guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) had been followed; 22 articles, published during January 2020 to September 2021, were selected. Original research, review articles, editorial and viewpoints were included. Google Scholar, Medline, and PubMed were searched through 2020 till 2021.Data collection in selected studies was performed mainly through the online survey, telephone survey, use of medical records, and patient interviews. This systematic review contains the studies conducted in the American, Asian and European countries. The major outcomes identified were the neurological, psychological, and other long-term chronic manifestations of COVID‐19. This review demonstrates that long-COVID has started to bring a huge wave of patients, the count of them being millions now, who can enter a phase of disability due to neurological damages if not treated during the early course of illness. Though more disabling than lethal, long-COVID patients with a neurological deficit is expected to overburden the healthcare system globally which is already been struggling to handle acute COVID-19 patients in this once-in-a-lifetime pandemic. Keywords: COVID-19, Neurological and Psychological symptoms, Physical Symptoms, Long-COVID.

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