ASSOCIATION OF SHORT INTERPREGNANCY INTERVAL (IPI) WITH MATERNAL ANEMIA AT A TERTIARY CARE HOSPITAL

Background; The time interval between pregnancies is considered to be an important and modifiable risk factor in terms of adverse perinatal outcomes. This study was done to  determine the frequency of anemia in pregnant women having short interpregnancy interval. Materials and methods; All the pregnant women with short interpregnancy interval were registered from Department of Gynecology and Obstetrics, Nishtar Hospital Multan, Pakistan. Examination was done including general physical examination. Those with interpregnancy interval less than 6 months were included in study. Detailed history was taken regarding parity, duration of pregnancy. Duration of gestation was estimated according to patients last menstrual period. Three ml venous blood sample was drawn and sent to the pathology laboratory of Nishtar Hospital Multan for Hb levels analysis. Data was entered and analyzed by SPSS version 20. Results; Mean age of our study cases was noted to be 27.83 ± 4.95 years (with minimum age of our study cases was 21 years while maximum age was noted to be 38 years). Of these 90 study cases, 51 (56.7%) were from rural areas, 73 (81.1%) were normal weight 11(12.2%) were overweight and 6 (6.7%) were obese. Seventy eight (86.7%) were illiterate. Of these 90 study cases, 73 (81.1%) were having poor socioeconomic status, 11 (12.2%) were diabetic and 17 (18.9%) were hypertensive. Mean body mass index (BMI) of our study cases was noted to be 22.31 ± 2.07 Kg/m2. Mean gestational age of our study cases was noted to be 24.02 ± 8.31 weeks. Mean Hb level was noted to 10.67 ± 0.893 g/dl (with minimum Hb level was 9.6 g/dl while maximum Hb level was 12.5 g/dl). Mean interpregnancy interval was 4.23 ± 0.98 months (with minimum interpregnancy interval was 2.5 months while maximum interpregnancy interval was 6 months). Anemia was noted in 74 (82.2%) our study cases and only 23 (25.6%) of our study cases were taking iron supplements. Conclusion; Short interpregnancy interval less than 6 months is related with adverse pregnancy outcomes. Very high frequency of anemia was noted in our study cases having interpregnancy interval less than 6 months. Anemia was significantly associated with residential status, hypertension and iron supplementation. Birth spacing is an issue which women should have some control over. Educational interventions, including birth control, should be applied during prenatal visits and following delivery. Keywords; Short interpregnancy Interval, anemia, hemoglobin

ROLE OF PROSTAGLANDIN E2 FOR INDUCTION OF LABOR IN PATIENTS WITH PREMATURE RUPTURE OF MEMBRANES AT TERM.

Background; As the time between the rupture of the membranes and the onset of labor increases, so may the risk of maternal and fetal infection so this study was conducted to ascertain the role of prostaglandin E2 for induction of labor in patients with PROM at term.  Material and Methods; All the study cases (n = 161) presenting with premature rupture of membranes (PROM) having singleton were taken from Department of Gynecology and Obstetrics, Nishtar Hospital Multan in this descriptive case series. Pregnant women were examined in lithotomy position, leakage of fluid was inspected by sterile speculum.  Three mg of Prostaglandin E2 was kept in posterior fornix and women were kept in left lateral position for 30 minutes. If the uterine activity does not start and Bishop score remains unchanged (≤6), same dose was repeated after 6 hours. Data was analyzed by using SPSS Version 20. Results; Mean age of our study cases was 28.74 ± 5.03 years (with minimum age was 21 years while maximum age was 39 years). Our study results have indicated that majority of our study cases i.e. 112 (69.6%) were aged 20 – 30 years of age. Of these 161 study cases, 70 (43.5%) were from rural areas while 91 (56.5%) were from urban areas. Mean parity of our study 3.17 ± 0.81 and most of the study cases i.e. 105 (65.2%) had parity up to 3. Mean gravidity was 4.35 ± 0.81 and most of the study cases i.e. 91 (56.5%) had gravidity up to 4. Mean body mass index (BMI) was noted to be 24.21 ± 3.08 kg/m2 and obesity was noted in 28 (17.4%) of our study cases. Mean duration of hospitalization before delivery was noted to be 14.15 ± 4.67 hours while time taken for induction of labor was 4.24 ± 1.36 hours and mean gestational age was noted to be 39.43 ± 1.17 weeks. Cesarean section was noted in 31 (19.3%) of our study cases while 130 (80.7 %) underwent vaginal deliveries and poor APGAR score was noted in 11 (6.8%). Conclusion; Our study results support the use of prostaglandin E2 for induction of labor in women with premature rupture of membranes at term as it was safe, reliable and effective mode of treatment. No major side effects were noted in our study. Mode of delivery and poor APGAR score were significantly associated with parity, gravidity, obesity and prolonged duration of hospitalization. Keywords; Premature rupture of membrane, term, prostaglandin

ERG oncoprotein expression in prostatic acinar adenocarcinoma; clinicopathologic significance

Abstract Objectives T/E fusion results in constitutive expression of ERG oncoprotein resulting in enhanced proliferation and invasive potential of prostatic cancer cells. In the present study we aimed to evaluate the ERG overexpression in 78 cases prostate acinar adenocarcinoma and its association with other prognostic parameters. Results ERG protein expression was noted in 39.7% (31 cases), out of which 3 cases (3.8%) showed low ERG expression, 10 cases (12.8%) showed intermediate expression and 18 cases (23.1%) revealed high ERG expression. Significant association of ERG expression was noted with gleason score (p = 0.009), WHO grade group (p = 0.008) and perineural invasion (p = 0.043). We found a significant proportion of our patients of prostatic acinar adenocarcinoma to over-express ERG protein which can help in devising therapeutic protocols. Significant association of ERG protein expression with gleason score and perineural invasion signifies its prognostic significance in prostatic carcinoma. Moreover, we also suggest that molecular studies should be performed in patients with prostatic carcinoma to look for T/E fusion gene and its correlation with ERG protein expression

PakSurg 1: determining the epidemiology and risk factors of surgical site infections in Pakistan—a multicentre, prospective cohort study

Introduction Surgical site infections (SSIs) are among the the most common postoperative complications, despite being highly preventable. Multiple studies have explored the incidence and risk factors of SSIs globally. However, nationally representative data capable of informing evidence-based guidelines remain limited in Pakistan. Hence, the aim of this study is to identify the incidence and risk factors of developing SSIs following surgery and to explore existing SSI prevention practices in Pakistan.Methods and analysis This study is a multicentre, prospective cohort study across various sites in Pakistan. All consecutive adult patients undergoing inpatient elective surgery in a 1 month patient recruitment window from one or more of the nine eligible subspecialties will be included in the study. Patients with preoperative infections, emergency surgeries or intraoperative mortality are to be excluded. The following surgical subspecialties are included: breast surgery, cardiac surgery, colorectal surgery, cranial surgery, general surgery, obstetrics and gynaecology, orthopaedics surgery, spine surgery and vascular surgery. Each mini-team of up to three collaborators can select one of the nine subspecialties and a 1 month patient recruitment window from 20 September 2022 to 31 March 2023. Multiple mini-teams from the same sites can recruit patients across the same subspecialty in distinct patient recruitment windows. Additionally, multiple mini-teams from the same sites can recruit patients across different subspecialties in the same or distinct patient recruitment windows. The primary outcome is 30 day SSIs. Secondary outcomes include 30 day antibiotic-resistant SSIs, organ-space infections, other healthcare associated infections, reinterventions and all-cause mortality.Ethics and dissemination Approval was received by the Aga Khan University (AKU) Ethics Review Committee (ERC) and the National Bioethics Committee (NBC) Pakistan. The results from this study will be disseminated by the steering committee in journal publications, conference presentations and on other academic platforms. Evidence-based guidelines that result from these data will be disseminated to all surgical care providers in Pakistan through national networks