Frequency of Causes of Female Infertility Diagnosed Through Laparoscopy in Females Presenting in a Tertiary Care Hospital

OBJECTIVE To report the frequency of causes of female infertility by laparoscopy in females presenting in a tertiary care hospital MATERIALS & METHODS Study design: Cross sectional study Setting: Department of Obstetrics & Gynecology, Shalimar Hospital, Lahore Duration of study: July 01, 2020, till July 31, 2021 DATA COLLECTION PROCEDURE: A total of 370 females fulfilling selection criteria were selected from operation theatre of Department of Obstetrics and Gynecology, Shalimar Hospital Lahore. Informed consent was obtained from each case. Demographic information (name, age, BMI, duration of marriage, type of infertility, and parity) will also be noted. Then females underwent laparoscopy under general anesthesia by researchers. On laparoscopy, the pelvis was inspected, including uterus, fallopian tubes, round ligaments, uterovesical pouch, uterosacral ligaments, and Pouch of Douglas. The tubes were inspected for any abnormality in their length and shape and patency was checked by retrograde dye test. Both ovaries were examined regarding their size, shape, thickness of peripheral follicles, evidence of ovulation and their relationship with fimbrial end of the tubes. Peritubal, periovarian and omental adhesions, tubo-ovarian masses, endometriotic deposits, fibroid, presence of fluid in the Pouch of Douglas or any other pathology, if present was noted. Data was entered and analyzed in SPSS version 21.0. RESULTS: The mean age of our cases was 33.93 ± 5.81 years with minimum and maximum ages of 18 and 45 years. According to the etiology of infertility, 5(1.4%) cases had unexplained infertility, 140(37.8%) cases had tubal infertility, 60(16.2%) cases had polycystic ovaries, 41(11.1%) cases had Peritubal and peri-ovarian adhesion, 71(19.2%) cases had endometriosis, 38(10.3%) females had fibroids and 20(5.4%) cases had an ovarian cyst. CONCLUSION: We conclude that on diagnostic laparoscopy the frequency of causes of female infertility was found to be tubal infertility (37.8%), followed by endometriosis (19.2%), polycystic ovaries (16.2%), Peri-tubal and peri-ovarian adhesion (11.1%), fibroids (10.3%), ovarian cyst (5.4%), unexplained infertility (1.4%)

China’s Policy towards South China Sea and its GeoPolitical Impact (2009-2020)

China‟s policy of strategic ambiguity towards the territorial dispute in South China Sea has altered the geopolitical architecture. China‟s use of delaying tactics to appease ASEAN states and methods of distraction in its bilateral relations with competing states has improved the security in the region. However, the Chinese leadership is simultaneously conducting domineering activities in the disputed waters of South China. In this context, the study explores China‟s policies in the South China Sea. Additionally, there is a general understanding of the external motives and domestic sources being behind China‟s policy towards South China Sea, however, these factors are often analyzed and studied in isolation. This research article examines both the factors simultaneously and draws conclusions on the potential of armed conflict in the region, especially with respect to the claimant littoral states and the American pivot

Position of Women in Iran: An Analysis of Pre and Post Islamic Revolution 1979

Socio, economic and political involvement of women as half of the total populace is important to reinforce society and state. In every sphere of life, women have been found under-represented one way or the other. The women of Iran are not exempted from this. This paper evaluates women‟s position in two different periods in the history of Iran, i.e., during the rule of the Pahlavi Dynasty, and during the period of the post Islamic Republic. The objective of the paper is, first, to highlight the treatment meted out to women in Iran and shed light on various spheres of social life while comparing the two periods. Secondly, to examine factors that have affected the position of women in Ira

A systematic review of observational studies, demonstrating smoking among school going adolescents

Objective: To characterize the methods of design and analysis currently adopted in survey research of school-based observational studies for smoking, and to identify the common pitfalls made by researchers.Methods: The systematic review was conducted in 2009 and consisted of observational studies in school settings published between January 2005 and January 2009. Smoking status was the main outcome of interest. Following Cochrane style, five steps were followed: setting selection criteria for studies and conducting a literature search; review of abstracts; review of complete articles; data extraction and quality assessment of included studies; and, finally, synthesis of studies.Results: Of the 292 abstracts retrieved, 45 (15.4%) articles were selected for the final review. Inconsistencies were found in the definition of smoking behaviour which impeded generalisability. Individual-level factors had importance, but environmental level factors were also important in studying the aetiology of smoking. Results showed that studies inappropriately reported sample size estimation and important confounding factors. Hierarchical linear modelling, random effects modelling and structural equation modelling were employed in comparatively few studies.Conclusions: There were concerns regarding data analysis of complex surveys. Fifty five percent of reviewed studies ignored environmental effects which may have produced unreliable inferences. Multi-level analysis assisted in understanding school-level effects

Hepatitis Associated Aplastic Anemia: A review

Hepatitis-associated aplastic anemia (HAAA) is an uncommon but distinct variant of aplastic anemia in which pancytopenia appears two to three months after an acute attack of hepatitis. HAAA occurs most frequently in young male children and is lethal if leave untreated. The etiology of this syndrome is proposed to be attributed to various hepatitis and non hepatitis viruses. Several hepatitis viruses such as HAV, HBV, HCV, HDV, HEV and HGV have been associated with this set of symptoms. Viruses other than the hepatitis viruses such as parvovirus B19, Cytomegalovirus, Epstein bar virus, Transfusion Transmitted virus (TTV) and non-A-E hepatitis virus (unknown viruses) has also been documented to develop the syndrome. Considerable evidences including the clinical features, severe imbalance of the T cell immune system and effective response to immunosuppressive therapy strongly present HAAA as an immune mediated mechanism. However, no association of HAAA has been found with blood transfusions, drugs and toxins. Besides hepatitis and non hepatitis viruses and immunopathogenesis phenomenon as causative agents of the disorder, telomerase mutation, a genetic factor has also been predisposed for the development of aplastic anemia. Diagnosis includes clinical manifestations, blood profiling, viral serological markers testing, immune functioning and bone marrow hypocellularity examination. Patients presenting the features of HAAA have been mostly treated with bone marrow or hematopoietic cell transplantation from HLA matched donor, and if not available then by immunosuppressive therapy. New therapeutic approaches involve the administration of steroids especially the glucocorticoids to augment the immunosuppressive therapy response. Pancytopenia following an episode of acute hepatitis response better to hematopoietic cell transplantation than immunosuppressive therapy

Effects of Host and virus related factors on Interferon-α+ribavirin and Pegylated-interferon+ribavirin treatment outcomes in Chronic Hepatitis C patients

<p>Abstract</p> <p>Background</p> <p>Current standard therapy commonly followed for chronic Hepatitis C Virus (HCV) in Pakistan is interferon alpha plus ribavirin combination therapy (IFN α/ribavirin) and pegylated interferon plus ribavirin (PegIFN/ribavirin). PegIFN/ribavirin has increased rate of sustained virological response than standard IFN α/ribavirin therapy. Objective of current study was to analyze rate of early and delayed response to antiviral treatment as well as rate of relapse response in patients following standard treatment IFN α/ribavirin and in patients following pegylated interferon treatment.</p> <p>Methods</p> <p>Baseline serum samples of 153 patients enrolled for IFN α/ribavirin and 50 patients for PegIFN/ribavirin were collected. After total RNA extraction, genotyping was and HCV RNA viral load was done. Subsequently HCV RNA viral load was estimated at 4 weeks of treatment, at 12 weeks, at 24 or 48 weeks and finally after 6 months follow up period. All the data was statistically analyzed using fisher's exact test.</p> <p>Results</p> <p>Total 86 patients out of 153 patients following conventional IFN α/ribavirin therapy completed treatment and 69% of them showed Rapid Virological Response (RVR). Whereas 50 patients following PegIFN/ribavirin treatment completed treatment and 80% of them achieved RVR. Total 64 out of 86 patients following IFN α/ribavirin therapy completed follow up period and 53.5% of them achieved Sustainded Virologcal Response (SVR). Forty-five out of total 50 patients who received PegIFN/ribavirin treatment completed 6 months follow up period and among these 70% achieved SVR. SVR rates were significantly associated with RVR (p < 0.001), age (p < 0.001) and gender (p < 0.01)</p> <p>Conclusions</p> <p>Rate of sustained virological response can be determined by factors like rapid virological response and age since they share significant association with one another. More over rate of SVR was more prominent in males than in females.</p

Hepatitis B virus in Pakistan: A systematic review of prevalence, risk factors, awareness status and genotypes

In Pakistan, there are estimated 7-9 million carriers of hepatitis B virus (HBV) with a carrier rate of 3-5%. This article reviews the available literature about the prevalence, risk factors, awareness status and genotypes of the HBV in Pakistan by using key words; HBV prevalence, risk factors, awareness status and genotypes in Pakistani population in PubMed, PakMediNet, Directory of Open Access Journals (DOAJ) and Google Scholar. One hundred and six different studies published from 1998 to 2010 were included in this study. Weighted mean and standard deviation were determined for each population group. The percentage of hepatitis B virus infection in general population was 4.3318% ± 1.644%, healthy blood donors (3.93% ± 1.58%), military recruits (4.276% ± 1.646%), healthcare persons (3.25% ± 1.202%), pregnant women (5.872% ± 4.984), prisoners (5.75% ± 0.212%), surgical patients (7.397% ± 2.012%), patients with cirrhosis (28.87% ± 11.90%), patients with HCC (22% ± 2.645%), patients with hepatitis (15.896% ± 14.824%), patients with liver diseases (27.54% ± 6.385%), multiple transfused patients (6.223% ± 2.121%), opthalmic patients (3.89% ± 1.004%) and users of injectable drugs (14.95% ± 10.536%). Genotype D (63.71%) is the most prevalent genotype in Pakistani population. Mass vaccination and awareness programs should be initiated on urgent basis especially in populations with HBV infection rates of more than 5%