Prevalence of raised Alanine Amino transaminase (ALT) in pregnant mothers: A Cross-sectional Study

Objective: To determine the prevalence of raised ALT, common causes, and associated fetomaternal morbidity  in pregnant mothers presenting, at cantonment general hospital Rawalpindi Materials and Methods: This was a cross-sectional study conducted at cantonment general hospital Rawalpindi from July 2016 till June 2017. Results: Out of 1924 women, 102 were identified with raised ALT making a prevalence of 5.3%. Sixty-one (59.8%) were booked. The hypertensive group which included severe preeclampsia, chronic hypertension with superimposed preeclampsia/eclampsia were 55(53.9%), intrahepatic cholestasis of pregnancy(ICP) 32(31.7%), acute viral hepatitis 9(8.8%), Acute fatty liver of pregnancy(AFLP) 2(1.96%), and unknown cause in 4(3.92%). Mean ALT levels were 54.1±6.94, 71.28±23.25, 84.22±27.82, 231.5±47.37 respectively. In four cases no definitive cause could be identified with the available tests were labeled as an unknown group, having a mean ALT level of 79.25±10.07. (p=0.01). Term delivery occurred in 71(69.6%), while 31(30.39%) were preterm. There was one termination of pregnancy. Vaginal birth occurred in 42(42.2%), and 53(51.9%) underwent emergency cesarean. There was one peripartum hysterectomy. Meconium stain of liquor was 19(18.6%). The birth weight of most babies 73(71.5%) was between 2-3 kilograms only three were ≤ 1 kilograms. Eight cases of postpartum hemorrhage, three maternal deaths, and six perinatal/early neonatal deaths were observed. Conclusion: Raised ALT in pregnancy leads to increased fetomaternal complications. Severe preeclampsia and obstetric cholestasis were the commonest causes. Women of younger age groups were having acute viral hepatitis. Timely recognition and diagnosis are essential to institute appropriate management strategies

Laparoscopic Surgery in Gynaecology

Background: With the advent of technological advancements, the indications for gynecological laparoscopy are increasing. We evaluated the results of our experiences with gynaecological laparoscopies and assessed rate, indications, complications and benefits in a teaching hospital.Methods: In this retrospective observational study, a total of 137 patients had laparoscopic procedure done during the period January 2011 to December 2014 and were included in the study. Laparoscopic surgeries were performed under general anesthesia. Successful creation of the pneumoperitoneum was created with the help of Veress needle, mostly by closed access technique and occasionally with the open method. Secondary ports were introduced under direct vision. After completing the surgery laparoscope and secondary ports were removed under direct vision to minimize any iatrogenic insult.Results: During the study period, 874 major gynaecological operations and 137 laparoscopies were performed. This gave the rate of 15.6% laparoscopies per 100 operations. Diagnostic laparoscopies were 48 (35%), operative were 89 (65%) and 8 (5.8%) laparoscopies were converted into open surgery due to technical difficulties. Complications were 8 (5.8%), majority being of minor nature except one major complication being a bladder injury.Conclusion: Laparoscopic surgery offers unique benefits. These are establishing definite diagnosis, mobilization and speedy recovery, minimal complications, less cost and shorter hospital stay. In young patients, laparoscopy helps in preserving their fertility with better prognosis in contrast to open surgery

Acceptability of telephone-cardiopulmonary resuscitation (T-CPR) practice in a resource-limited country- a cross-sectional study

Background: T-CPR has been shown to increase bystander CPR rates dramatically and is associated with improved patient survival. Objective: To evaluate the acceptability of T-CPR by the bystanders and identify baseline quality measures of T-CPR in Karachi, Pakistan. Methods: A cross-sectional study was conducted from January to December 2018 at the Aman foundation command and control center. Data was collected from audiotaped phone calls of patients who required assistance from the Aman ambulance and on whom the EMS telecommunicator recognized the need for CPR and provided instructions. Information was recorded using a structured questionnaire on demographics, the status of the patient, and different time variables involved in CPR performance. A One-way ANOVA was used to compare diferent time variables with recommended AHA guidelines. P-value≤0.05 was considered signifcant. Results: There were 481 audiotaped calls in which CPR instruction was given, listened to, and recorded data. Out of which in 459(95.4%) of cases CPR was attempted Majority of the patients were males (n=278; 57.8%) and most had witnessed cardiac arrest (n=470; 97.7%) at home (n=430; 89.3%). The mean time to recognize the need for CPR by an EMS telecommunicator was 4:59±1:59(min), while the mean time to start CPR instruction by a bystander was 5:28±2:24(min). The mean time to start chest compression was 6:04±1:52(min.). Conclusion: Our results show the high acceptability of T-CPR by bystanders. We also found considerable delays in recognizing cardiac arrest and initiation of CPR by telecommunicators. Further training of telecommunicators could reduce these delays

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population