Background:Maternal infections are responsible for maternal mortality and can lead to adverse pregnancy outcomes such as stillbirth, maternal sepsis, and spontaneous abortion as well as dire outcomes for the neonate. The impact of obstetric infections is largely felt in low- and middle-income countries, with Pakistan being one such country.Objectives:To assess the frequency of maternal infections, the common sources responsible for their progression and their resulting impact on pregnancy, maternal, and neonatal health outcomes.Design:An observational cross-sectional study was conducted in a tertiary care, public sector hospital in Pakistan.Methods:A total of 439 women, either antenatal or postnatal, with symptoms of infection were enrolled. Case report forms were used to collect data on clinical characteristics, type of infection, investigational and diagnostic profile, and pregnancy, maternal, and neonatal outcomes. Frequency and percentages were computed for categorical variables. Comparisons of pregnancy and neonatal outcomes were analyzed by the chi-square test or Fisher’s exact through categorization of patients as per the severity of their condition.Results:The observed frequency of maternal infections was 12% in pregnant or recently pregnant women admitted during the study period. Respiratory tract infection (16.9%) and chorioamnionitis (14.4%) were more prevalent among antenatal women, whereas wound/skin infection (15.5%) and puerperal/genital tract infection (12.3%) were the most common infections observed in postnatal women. Blood transfusion was the most common complication observed in the included women (26.9%). Among the study population, 13.9% had organ dysfunction, primarily cardiovascular (42.6%) and neurological dysfunction (40.9%). Women with severe infection had adverse pregnancy outcomes such as a high number of still births (17.5%). The total number of maternal deaths recorded was 19 (4.32%). Regarding neonatal outcomes, APGAR score, suspicion of infection, and low birth weight were significant across the severity groups. There was no significant difference for neonatal deaths across the three groups.Conclusion:Infections from various sources contribute significantly toward adverse maternal, pregnancy, and neonatal outcomes. Enforcing infection prevention measures, equipping primary healthcare units with adequate resources and emphasizing antenatal and postnatal care can prevent infections and their related complications. Early detection and management of maternal infections is equally necessary.

Background: Invasive fungal infections (IFIs) in patients with COVID-19 contribute to significant morbidity and mortality, with reported incidence between 5% and 26.7%. COVID-19-associated pulmonary aspergillosis (CAPA), candidiasis (CAC), mucormycosis (CAM), and Pneumocystis jirovecii pneumonia (PJP) are the most common IFIs in this population. Methodology: We conducted a case–control study in the ratio of 1:2 between March 2020 and April 2022 using institutional COVID-19 registry data. The cases were severe COVID-19 patients with IFIs, and the controls were severe COVID-19 patients without IFIs. Multivariate logistic regression was used to identify independent risk factors, with adjusted odds ratios (aOR) and 95% confidence intervals (CIs). The outcomes for the study were to assess the clinical outcomes, i.e., in-hospital mortality and length of hospitalization in a subgroup of severe COVID-19 patients who had IFIs. A p-value < 0.05 was considered significant. Results: Among 5368 COVID-19 patients admitted to hospital during the study period, 1333 had a severe infection. Of these, 158/1333 (11.8%) met the criteria for IFIs, with a median age of 65 years and 71% male predominance. Diabetes (53.8%) and hypertension (57.6%) were the most common comorbid conditions. Acute respiratory distress syndrome (ARDS) developed in 55% of patients. Overall mortality was 48%. For the case control analysis, 119 patients with IFIs were selected as cases and 240 patients without IFIs were selected as controls. On univariate analysis ARDS was significantly associated with IFIs (OR: 1.91; 95% CI: 1.23–2.99, p-value = 0.004). Patients with IFIs had higher odds of being on hemodialysis compared to those without IFIs (OR: 2.17; 95% CI: 1.18–3.99; p-value = 0.013). Mechanical ventilation was found to be independently associated with IFIs in multivariate logistic regression analysis (OR: 2.5, 95% CI: 1.58–3.96, p-value < 0.001). The odds for in-hospital death in patients with IFIs were 2.19 (95% CI: 1.35–3.56; p-value < 0.001) compared to patients without IFIs. The median hospital stay for patients with IFIs was markedly longer (14 days) compared to 8 days in patients without IFIs. Conclusions: IFIs significantly worsened outcomes in severe COVID-19 patients, leading to increased mortality and prolonged hospital stays. Mechanical ventilation was an independent risk factor for IFIs.

Background: Stunting, a form of chronic malnutrition, is a global health concern, especially in South Asia. Stunting remains a significant public health issue in Pakistan, particularly in remote regions like Gilgit-Baltistan and Chitral, where geographic isolation and socioeconomic challenges exacerbate malnutrition. The Aga Khan Development Network is leading the implementation of a program, Central Asia Stunting Initiative (CASI), with an aim to reduce stunting through community-driven maternal and child health interventions in the targeted areas of Gilgit Baltistan and Chitral. This study aimed to evaluate the effectiveness of CASI in improving child nutritional outcomes in Gilgit-Baltistan and Chitral. Methods: In this study, a single-group pre–post evaluation design was employed using baseline and midline cross-sectional surveys among households with children aged 0–59 months in Gilgit-Baltistan and Chitral. Data on child anthropometry, household food security, maternal education, and child feeding practices were collected from over 500 households using stratified sampling. Results: Results showed improvement in child health indicators between baseline and midline. Between baseline and midline, stunting declined from 40.9% to 35.4% in GBC (p = 0.02), with severe stunting dropping significantly (17.8% to 10.9%, p < 0.001). Wasting and underweight rates also showed marked reductions. Improvements in breastfeeding rates (71.3% to 88.3%) and dietary diversity (4.0% to 26.8%) were observed. However, food security declined sharply from 95.2% to 11.9%, underscoring persistent economic stress. Conclusions: CASI interventions yielded substantial improvements in child nutrition and maternal behaviours. However, sustained progress requires integrated strategies addressing food insecurity, economic empowerment, and long-term resilience. Future programs should adopt a multi-sectoral approach to tackle chronic malnutrition comprehensively. Despite this, results indicated an overall improvement due to CASI interventions, signifying the importance of integrated, community-based approaches in addressing stunting.

BackgroundA peer education programme was developed in response to the tendency of high school students in Rwanda to seek sexual and reproductive health information from peers who are often inadequately informed.AimTo assess the effect of Sexual and Reproductive Health Peer Education Programme (SRH PEP) on knowledge and the attitudes of SRH among high school adolescents in Rwanda.SettingThe study was conducted at selected high schools in Rwanda.MethodsThis pre-test and post-test design study was conducted in two selected high schools. The pre-test data were collected in February 2020, followed by the post-test data in May 2022. A total of 536 students participated in this study. The effect on SRH knowledge and attitudes was measured using a paired t-test.ResultsOf the total 536 questionnaires administered, only 508 were well completed (response rate of 94.7%). After the intervention, there was an increase in knowledge and attitude regarding SRH (M = 15.87 vs 19.9, p < 0.001; M = 7.95 vs 10.66, p < 0.001, respectively). The proportion of correct responses to knowledge and attitude was also significantly improved after the intervention (p < 0.05).ConclusionThis study underscored the pivotal role of peer-led SRH education programmes as an effective modality for educating adolescents and young adults about SRH. There is a need for integrating structured peer education initiatives into school-based programmes to ensure adolescents receive accurate and reliable SRH information.ContributionThis study contributes to the field of adolescent SRH by demonstrating the effectiveness of peer education programmes (PEPs) in enhancing knowledge and attitudes among high school students.

BackgroundAutism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social, communication, and cognitive domains of brain function. The unexpected challenges and specific needs related to caring for children with ASD often have a detrimental effect on the Quality of Life (QoL) of caregivers. In Tanzania, there is growing recognition of ASD, yet research on its impact on caregivers remains limited. This study seeks to assess QoL among caregivers of children and adolescents with ASD, and the associated sociodemographic factors. Findings from this study will help inform comprehensive interventions aimed at improving both, caregiver wellbeing and overall outcomes for families of children with ASD.MethodsA cross-sectional study was conducted among 106 caregivers of children with ASD. Caregivers were recruited at two tertiary hospitals in urban Dar es Salaam from May to July 2023. The WHOQOL-BREF self-administered questionnaire was employed to assess caregivers’ QoL. Sociodemographic data for both children and caregivers were analyzed using medians (interquartile range) and frequency (percentages). The WHOQOL-BREF results were summarized into four distinct domains, with each domain score compared across sociodemographic characteristics using independent t-tests and Analysis of Variance (ANOVA). Simple and multiple linear regression analyses were conducted for each QoL domain to evaluate significant associations between sociodemographic variables and QoL outcomes.ResultsThe majority (79.2%) of caregivers reported having poor or average QoL, with impairments noted across all domains, particularly in the environment and social relationships domains. Significant negative predictors of caregiver QoL included older age (> 35 years), being separated or widowed, unemployment, and lack of formal education. Child-related factors associated with poorer caregiver QoL were older age (> 12 years), longer duration since diagnosis, and absence of school placement.ConclusionBy focusing on this fundamental yet overlooked aspect of ASD research, this study addresses an important gap in literature, highlighting the repercussions on wellbeing of caregivers as they play a critical role in nurturing children with ASD. This study calls for scaling up interventions and support programs aimed at addressing environmental and societal challenges faced by caregivers, in addition to thorough exploration of caregiver QoL through qualitative study designs.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-06154-x.

Vectorcardiography (VCG) enables measurement of voltages and directions of resultant spatial vectors in the heart that are altered by myocardial ischemia. To validate the ability of VCG to detect electrophysiological effects of regional myocardial ischemia and identify blood vessels that obstruct blood flow significantly, VCG records of 37 patients who presented with unstable symptoms of ischemia requiring coronary angiography (CA) were processed and analyzed. The difference in magnitude and direction of electrical vectors were measured before and after percutaneous coronary intervention (PCI) to study the significance of changes after revascularization. Bio amplifiers recorded 3 simultaneous orthogonal lead ECG signals with low-pass frequency of 150 Hz without electronic filtration. The analogue signals were digitized and recorded for analysis. The numerical output was processed by algorithms to calculate and display the state of vectors. 36 of 37 patients showed congruence between VCG and CA results: 34 of the 36 showed changes in electrical vectors and insufficient blood supply. 2 showed no changes in electrical vectors and non-obstructive arteries on CA. 1 patient had ischemia detected by VCG, but CA was negative. Blood vessels that were opened with PCI corresponded with regions of myocardial ischemia and expected coronary blood supply on VCG interpretation.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-18313-2.

IntroductionThe mini clinical evaluation exercise (Mini-CEX) is one of the well-known tools of workplace-based assessment (WPBAs) used in medical Education. The effectiveness of this method needs to be determined for undergraduate learning, just as it is already in use for post graduate training.ObjectiveTo study the effect of Mini-CEX as formative learning tool for clinical skills in undergraduate medical students in a private medical university in Karachi, Pakistan. Material and methodsSetting is Bahria Medical and Dental College with a total duration of one year. This study is a quasi-experimental design with simple random sampling. A total of 143 final-year MBBS students were recruited after obtaining informed written consent. Participants were randomly allocated into four groups, with each group completing a two-month clinical rotation in the Pediatrics Department during the academic year. Randomization was performed using an online random selection generator (Berman H.G., “Random Number Generator”). Students assigned to the Pediatrics rotation were randomized into two control groups and two intervention (case) groups. Weekly, students were further randomized and assigned to different faculty members to minimize instructor-related bias. The random number was generated by producing 146 unique random numbers within the range of 1 to 146, ensuring that no duplicates were included. The Pediatric faculty was trained on how to use Mini-CEX form during daily teaching sessions. One briefing session was followed by personalized hands-on training on how to use the form and also to provide step by step feedback to students. Another questionnaire form sent to the students to ask about their opinion and concerns regarding the effectiveness of this process. The ward test marks evaluated. Analysis done on SPSS version 22. Data collection after approval from IRB.ResultOut of 143 students, 76 (53.1%) received Mini-CEX evaluations. Intervention groups achieved higher ward test (72.3 ± 7.5 vs. 65.4 ± 8.2; p = 0.002; d = 0.65) and OSCE scores (75.6 ± 6.9 vs. 68.1 ± 7.8; p = 0.001; d = 0.71) than controls. Among 61 respondents (80.3%), 85.2% reported improved clinical skills and confidence, with limited faculty availability noted as a barrier.ConclusionMini-CEX improved clinical competence, confidence, and assessment scores, confirming effectiveness as a formative tool, though faculty training and time limitations remain notable implementation barriers.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-07962-6.

BackgroundObesity and overweight represent significant global public health concerns. School-age adolescents are particularly at risk of experiencing obesity and overweight due to a sedentary lifestyle, electronic media use, and lack of physical activity (PA). This trend is linked to the development of non-communicable diseases in later life. Evidence on low physical activity levels is available in Pakistan; however, a comparative analysis of PA levels between rural and urban adolescents is lacking. The study aimed to compare physical activity levels among school-age adolescents in rural and urban areas of Swat, KPK, Pakistan. The study also aimed to explore how gender, age, grade, and school type influenced the PA levels of adolescents.MethodsA cross-sectional analytical study was carried out with a sample size of 287 school-age adolescents (aged 10 to 14 years) selected from eight governmental and private middle schools in rural and urban areas of district Swat, KPK, Pakistan. The data about physical activity was collected using a researcher-administered questionnaire adapted from the Physical Activity Questionnaire for Older Children (PAQ-C).ResultsThe mean PA score for rural adolescents was 3.65 ± 0.38 out of a total score of 5, whereas the mean PA score for urban adolescents was 2.22 ± 0.47 with a significant difference (p < 0.001). In addition, a significant difference between private and government school-age adolescents’ PA levels was found (p < 0.001). However, there was no significant difference in PA levels in terms of gender and school grade. Further, a very low negative correlation was found (r = − 0.1) between school-age and PA scores.ConclusionThe place of residence has an impact on the PA level of adolescents. The study found a significant difference in the mean PA levels of school-age adolescents in rural and urban areas. Future research is recommended to identify the factors contributing to disparities in PA among adolescents residing in urban areas.

Primary pancreatic Hodgkin lymphoma (PPL) is an exceptionally rare condition often misdiagnosed as pancreatic adenocarcinoma or pseudocyst. Early histopathological diagnosis is crucial for prognosis and appropriate chemotherapy.We report a case of a 50-year-old male presenting with low-grade fever, chills, abdominal pain, and 30-pound weight loss over 10 weeks. Examination revealed significant epigastric tenderness without icterus. Laboratory findings showed leukopenia (1.2K/UL), low absolute neutrophil count (238), hyperbilirubinemia, and elevated AST/ALT (185/165), with normal lipase and amylase. Imaging revealed a 4.7 × 5.1 × 6.6 cm solid heterogeneous pancreatic head mass with multiple prominent retroperitoneal, gastro-hepatic, para-aortic, and portacaval lymph nodes. Retroperitoneal lymph node biopsy confirmed nodular sclerosis Hodgkin lymphoma with positive CD15, CD30, MUM-1, and EBV stains. Bone marrow biopsy revealed lymphoma infiltration, prompting initiation of A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine) chemotherapy for stage IV disease based on Karnofsky Performance Status.Hodgkin lymphoma, a malignant B-cell neoplasm, constitutes 11% of lymphomas and is characterized by Reed-Sternberg cells. PPL is extremely rare, often mimicking pancreatic adenocarcinoma. Features such as absent pancreatic atrophy, tumor necrosis, calcification, and vascular invasion may aid differentiation. Treatment depends on disease stage, with early stage managed by ABVD (Adriamycin, Bleomycin sulfate, Vinblastine sulfate, Dacarbazine) chemotherapy and radiation, while advanced cases require extended A+AVD chemotherapy. PPL accounts for <2% of extra-nodal lymphomas but remains a potentially treatable entity. This case underscores the importance of obtaining tissue diagnosis in the setting of a pancreatic mass before embarking on definitive treatment.