Patients and Methods: Two hundred cases were included in this study and divided into two groups (A & B) 100 in each group. Primigravidas presenting with engaged fetal head were included in Group A and those presenting with unengaged fetal head were included in Group B. The course of labor in all patients was recorded on partogram. Partogram was maintained according to departmental protocol. Cesarean section was decided if labour failed to progress or fetal head failed to descend after observing as per departmental protocol (12 hours). All patients were studied in detail with reference to mode of delivery regarding vaginal (spontaneous and instrumental) or cesarean section delivery. Results: Mean age was 23.65+3.72 years in Group-A and 24.96+4.12 years in Group-B, 31%(n=31) in Group-A and 38%(n=38) in Group-B between 37-39 weeks, 60%(n=60) in group-A and 51%(n=51) in Group-B between 40-41 weeks and 9%(n=9) in Group-A and 11%(n=11) in Group-B were with 42 weeks of gestation, mode of delivery in primigravida with engaged versus unengaged fetal head with spontaneous onset of labour at term was compared which showed that 19%(n=19) in Group-A and 39%(n=39) in Group-B were delivered with cesarean section, 65%(n=65) in Group-A and 42%(n=42) in Group-B were spontaneously delivered vaginally while 16%(n=16) in Group-A and 19%(n=19) in Group-B had assisted vaginal delivery. Conclusion: Cesarean section was more prevalent in unengaged fetal head in primigravida women at term.

Abstract Objective: To assess the prevalence of depression, anxiety and stress in medical students, and to analyse effects of demographics and nomophobia on depression, anxiety and stress. Method: The descriptive cross-sectional study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, from April 1 to May 23, 2019, and comprised male and female medical students aged 19-25 years. Data was collected using a demographic information form, the 21-item depression, anxiety and stress scale and the 20-item nomophobia questionnaire. Data was analysed using SPSS 20. Results: Of the 230 students, 108(47%) were boys and 122 (53%) were girls. The overall mean age was 21.93+1.80 years. Anxiety, depression and stress was reported in 168 (74.6%), 158 (70.2%) and 127 (55.9%) of the students. Extremely severe anxiety, depression and stress were self-reported by 92 (40.9%), 38 (16.8%) and 16 (7.04%) students. There was a significant difference in the distribution of subjects within different levels of anxiety across gender (p<0.05).  Higher anxiety and stress scores were observed in 78 (33.9%) students with severe nomophobia. Differences in the levels of anxiety and stress with regards to type of residence and nomophobia levels were significant (p<0.05). Conclusion: There was high prevalence of depression, anxiety and stress associated with gender, nomophobia levels and residence type. Key Words: Depression, Anxiety, Stress, Medical, Nomophobia.

It is now widely accepted that trial for vaginal delivery should be attempted unlessa genuine indication exists for C- section. Objective: To determine the efficacy of membranesweeping for onset of labor till 41 weeks of gestation and mode of delivery in patients withprevious one cesarean section (C-Section). Study Design: Randomized control trial. Setting:Department of Obstetrics & Gynaecology, Benazir Bhutto hospital, Rawalpindi. Period: Jan2008 to Dec 2008. Methods: Pregnant women with previous one C- section were randomlyallocated to Group-A (sweeping of membrane) and Group-B (no intervention) each having 55patients. There was no absolute indication of cesarean section in present pregnancy. Aftercomplete antenatal examination, tests like CBC, urine DR, BSR, urea, creatitnine, screening forhepatitis B and C were done. In group A, digital sweeping of fetal membranes was started a37 weeks and was done every 3rd day till she went into the labor or she reached 41 weeks. At41 weeks of gestation, if she did not go into labor, induction with prostaglandin or elective Csectionwas done depending upon the bishop score. In group B, patients awaited spontaneousonset of labor till 41 weeks. After 41 weeks induction with prostaglandin or elective C- cesareansection was done. Results: In Group A, 43 (78.18%) patients had onset of labour aftersweeping of membranes while 12 (21.82%) patients had no onset of labour. In Group-B, 28patients (50.90%) had spontaneous onset of labor while 27 (49.10%) had no onset of labours.In Group-A, 34 (61.82%) patients and in Group-B only 14 (25.45%) were delivered vaginally (pValue 0.001). In Group-A, lower segment cesarean section was done in 6 (10.91%) patientswhile in Group-B, 23 (41.82%) had cesarean section (p Value 0.001). Assisted vaginal deliverywas done in 15 (27.27%) in Group-A while 18 (32.73%) patients in Group-B had assistedvaginal delivery (p Value 0.533). Conclusions: In patients with previous one cesarean section,the efficacy of membrane sweeping in terms of onset of labor and normal vaginal delivery issignificantly higher as compared to patients who had no sweeping of membranes.

Background and Objective: A large number of university teachers in Saudi Arabia comprise of expatriates. Their experiences are unique in context of the challenges and benefits of academic expatriation. The purpose of this study was to describe the experiences of expatriate university teachers in Saudi Arabia. Methods: A qualitative descriptive design was used based on in-depth interviews with academic expatriates, recruited through snowball sampling in a Health Science University in Saudi Arabia. The study was conducted from 12 September 2019 to 20 October 2019 after IRB approval. Graneheimian inductive approach was used for content analysis of the data. Standard principles of trustworthiness were applied. Results: Three major themes emerged as ‘conscious venture’, ‘spirit at work’ and ‘coping strategies’. Each theme had 2-3 subthemes, populated by 14-23 statements. Conclusion: Expatriate faculty members described antecedents for their motivations at work. They shared their experiences regarding job adjustments, work environment and professional commitment. doi: https://doi.org/10.12669/pjms.36.4.1896 How to cite this:Asif U, Bano N, Al-Najjar H. Experiences of expatriate university teachers in a health science university in Saudi Arabia-A Qualitative study. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1896 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.

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