No abstract

Objective: To compare oral Nifidepine and IV labetalol in terms of rapidity of BP control in severe preeclampsia. Methods: All patients coming to Services Hospital from March 2017 to February 2019 with diagnosis of severe preeclampsia ≥ 24 weeks gestation were randomized to either receive Nifidepine or Labetalol. Primary outcome measure was time taken to control BP and number of doses required. Secondary outcome measures were side effects of drugs, APGAR score, NICU admission and perinatal mortality. Results: Two hundred four patients were included in trial with 102 patients in each group. Labetalol took 22.6± 13.5minutes and Nifidepine took 22.09± 11.7 minutes to achieve target BP (p>0.05). Labetalol required 2.3± 1.58 doses and Nifidepine 2.2± 1.58 doses to control BP ( p>0.05). No maternal side effects were seen in 86 (84.31%) and 92(90.19%) patients in both groups (p>0.05). Mean gestational age at birth was 34.8 ±2.73weeks in Labetalol and 35.2±2.48 weeks in Nifidepine group (p>0.05). In labetalol group, 43 (42.15%) babies had APGAR Score < 7/10 and 23(22.54%) babies required admission to NICU while in Nifidepine group 42 (41.17%) babies had Apgar score < 7/10 & 30(29.4%) babies were admitted to NICU(p>0.05). There were 21(20.5%) perinatal deaths in labetalol Group-And 19(18.6%) in Nifidepine group (p>0.05) Conclusion: Oral Nifidepine and IV labetalol are equally efficacious in controlling BP in patients with severe pre eclampsia without any significant side effects. doi: https://doi.org/10.12669/pjms.36.6.2591 How to cite this:Wasim T, Agha S, Saeed K, Riaz A. Oral Nifidepine versus IV labetalol in severe preeclampsia: A randomized control trial. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2591 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This study determines the impact of loneliness on creativity through a powerful and essential mediator of intrinsic motivation. The ability to motivate oneself leads towards the accomplishment of tasks and creative work. In recent years, workplace loneliness has become a more critical issue in both academic and practical debates. So, this study highlighted the significant cause of creativity which could help the organization to handle the problem of loneliness. The study assumes that when isolation at the workplace is high, employees are less approachable towards their tasks. So, their performance and creativity reduced. Because loneliness leads to stress, depression and anger, it reduces the creative skills of employees. To enhance creativity, lonely employees must be motivated to minimise their adverse outcomes. So, the research question arises: Does intrinsic motivation (IM) intervene in between the workplace loneliness (WL) and employees' creativity? This study is also significant because employees and employers' relations are the backbone of their respective organizations and directly affect the performance and growth of their respective organizations. A data collection survey method was held on employees of Banking Sector currently working in Vehari district of Pakistan. Sample space was the employees of Pakistani banks working on officer grades. There is a total of 124 bank branches in Vehari District of Pakistan. In these 124 branches, a total of 726 employees were working on managerial positions which were targeted for data collection. Simple random sampling technique was employed to collect the information from the respondents. Simple random sampling techniques were used to avoid from the busyness and undesirable unknown effects from the target population. Data were obtained from 400 banking officers. For data collection, validated and adapted questionnaires were used. Each variable of the survey was measured through a Likert scale of 5 points. For statistics evaluation, the statistical tools such as reliability of data, collinearity of data, the association of variable's, mediation and Regression were tested. For data reliability and validation, Statistical Package for Social Sciences (SPSS) was used while to measure the direct, indirect or mediation effect was measured through smart pls 3. Smart PLS3 is a landmark in latent variable modelling. It combines state of the art methods with an easy to use and in-built graphical user interface. Structural Equation Modeling (SEM) is utilized to quantify the power of essential philosophies with spotted data. Results showed Workplace Loneliness has a definite and meaningful relationship with employee's creativity. Results also supported the intervening role of Intrinsic motivation (IM) between the relationship Workplace Loneliness (WL) on Employees’ creativity (EC). The study provides significant implications in literature and for practitioners who are interested in measuring the profound effect of loneliness on creativity. Hypotheses are tested through mediation and for mediation analysis through the most commonly used approach of baron and Kenny. From results, it is stated that workplace loneliness is predicting the intrinsic motivation and creativity. Intrinsic motivation is the mediator in the current study, which partially intermediates the relation of WL and EC. So, it can be stated that employees can only be creative and able to utilize their cognition abilities for creativity when they are socially isolated from other works. The findings authenticate all hypotheses and their correspondence between the workplace loneliness, creativity and intrinsic motivation. In a nutshell, intrinsic motivation is the crucial element for creativity because when employees are internally satisfied with their work, they become energized and motivated and perform their work in a creative way. Keywords employees creativity, intrinsic motivation, mediation analysis, structural equation modeling, workplace loneliness.

JDUHSstudy to evaluate the rate of induced labor in nulliparous women and to compare delivery outcome between induced and spontaneous labor at term. METHODSThis descriptive study was carried out at Obstetrics and Gynaecology department, Patel Hospital, Karachi from April to October 2019. All women of age between 20-40 years presenting at gestational age between 37-42 weeks assessed on dating scan with singleton pregnancy confirmed on ultrasound, gestational hypertension (BP>140/90 mmHg), gestational diabetes (BSR>140 mgdl), intact membranes on examination, and active phase of labor with cervical dilation at least 4cm were consecutively enrolled. Whereas patients with non-cephalic presentation (on USG), previous scar, anemia (Hb<10g/dl), eclampsia (BP≥140/90mmHg with convulsions), placenta previa, cephalopelvic st disproportion, multiple pregnancy (with 1 noncephalic twin), have previous uterine surgery on history and were confirmed through discharge card, multiple gestation on ultrasound, gestational age less than 28 weeks, caesarean Section done for reasons like ABSTRACT Objective: To assess the delivery outcome in nulliparous women at term and to compare the outcomes among induced versus spontaneous labor. Methods: A descriptive study was conducted at Obstetrics and Gynecology department of Patel Hospital, Karachi from April to October 2019. All women with age between 20-40 years, gestational age between 37-42 weeks, and singleton pregnancy were consecutively included. Mode of delivery and Apgar score at 5 minutes were noted. Results: Of 172 women, the mean age of the women was 29.9±4.64. Vaginal delivery was reported in 102 (59.3%) and cesarean section in 70 (40.7%) women. Cesarean delivery was found to be significantly higher among women with >29 years of age (pvalue 0.006), >38 weeks of gestational age (p-value <0.001), obesity (p-value <0.001), and induction of labor (p-value 0.020). Mean APGAR score at 1 min was 7.45 ±0.69 and APGAR score at 5min was 8.84 ±0.41. Mean APGAR score at 5 minutes was significantly higher in women vaginal delivery than that of women with cesarean delivery (p-value 0.034). Conclusion:The frequency of vaginal delivery was found higher in nulliparous women presenting at term. Moreover, APGAR score at 5 minutes was found to be significantly different in both groups.

Background: Non-anemic iron deficiency precedes iron deficiency anaemia and has an estimated prevalence of 1-2 billion worldwide. Few studies have comprehensively researched the idea of treating non-anemic iron deficiency (NAID) with iron to improve the outcome of the mother and the offspring. Methods and Analysis: FAIR will be a multicenter randomized controlled trial that will be conducted in multiple clinical academic obstetrics units in Lahore (including Services Institute of Medical Sciences, Lahore, Allama Iqbal Medical College, Lahore and Fatima Jinnah Medical University). Pregnant women at gestational age <20 weeks with hemoglobin 11-13 g/L and ferritin below the threshold (<30 ng/ml) will be invited to take part in the study. Randomization will be done by computer based generated random numbers. One group (usual care or oral group) will be offered routine care prophylactic dose of oral iron (30-45 mg/day) and the other group (intervention arm or IV group) will be offered therapeutic dose of IV iron (dose calculated by Ganzoni formula) in addition to usual care. All patients will be followed up till delivery. Primary maternal outcome will be hemoglobin at 36 weeks’ gestation. Secondary outcomes are fetal birthweight or small for gestational age, preterm birth, preeclampsia, multidimensional fatigue inventory, breast feeding initiation, blood transfusion, and fetal cord ferritin and hemoglobin. Discussion: The study will generate evidence as to whether screening serum ferritin in non-anemic pregnant women and replenishing their iron stores will likely reduce the rate of predelivery anemia in pregnant women, improve birthweight and preventing perinatal complications. Roles and responsibilities: Tayyiba Wasim is principal Investigator and other members of data management team are Natasha Bushra, Shamsa Humayoun, Khalid Saeed Khan, Fatima Shehbaz, Saba Rasool, Anam Riaz and Sonia Irshad. Principal investigator will assume the full responsibility of Fair trial including training of research assistants, administration of informed consent and protecting participants confidentiality. Data management team will help in the management, development and execution of trial. Khadija Irfan Khawaja is the operational lead for fair trial´s technology team comprising of Aziz Fatima and Zubia Zafar, responsible for gathering requirements from study teams and supporting the operational implementation of technology to drive the collection of high-quality study data. Protocol contributors are Gynae unit I of Services Institute of Medical Sciences/ Services hospital, Lahore, Gynae Unit II of Allama Iqbal Medical College/ Jinnah hospital, Lahore and Gynae unit 1 of Fatima Jinnah Medical College/ Sir Ganga Ram hospital, Lahore. These coordinating centres will recruit patients (sample size=600) and will discuss their progress in trial management meetings quarterly. Steering committee has an independent chair Prof Samia Malik, one expert member Prof Faiza Bashir and Ms Neelam to represent patients, public and consumers. Trial steering committee with independent chair and member with a patient representative will oversee the study. Chair of steering committee has the authority to stop the trial whenever needed in case of positive or negative results. Steering committee meetings will be held on annual basis. Independent Data monitoring committee comprises of Dr. Shehnoor Azhar as chair and Prof Ejaz Hussain and Dr. Shehla Javed Akram as members. Data monitoring committee will assess the progress, data safety and if needed critical efficacy points of the clinical study and will show their results quarterly in data interim meetings. The committee will focus on integrity of the whole process and compliance of all sites with all aspects of the protocol. It will perform confidential interim analyses quarterly, which may be used to determine if an effect` is observed and if the study should continue to its planned sample size. Data monitoring committee will report to the Chair of the steering committee. Trial Registration No: NCT04228627 www.clinicaltrials.gov (Dated 14 January 2020) Version Date/ No: Version 1.3 Updated 06.05.2021 doi: https://doi.org/10.12669/pjms.39.1.6686 How to cite this: Wasim T, Bushra N, Tajammul A, Humayun S, Rasool S, Shahbaz F, et al. Ferritin screening and Iron treatment for maternal anemia and fetal growth restriction prevention - A multicenter randomized controlled trial (FAIR Study). Pak J Med Sci. 2023;39(1):---------.  doi: https://doi.org/10.12669/pjms.39.1.6686`This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.