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Objective Emotional instability during adolescence could make them susceptible to developing mental problems, and these problems could enhance in severity when left unresolved. Other life stressors like job competition, peer pressure, and parental unrealistic expectations could further deteriorate their mental health. Therefore, the present study is designed to investigate the impact of cognitive behavioral therapy (CBT) on adolescents to manage procrastination, burnout, self-handicapping behavior, and test anxiety to enhance academic motivation and achievement.Materials and Methods A total of 200 students were enrolled for eligibility assessment, and 129 participants met the eligibility criteria. Participants were divided into two groups, the experimental group, and the waitlist control group. All the students completed their demographics form and screening tool, the eligible participants were given assessment measures at pre-post-assessment stages (8 weeks intervals). We used different assessment measures to assess the outcome i.e. General Procrastination Scale (GPS), Maslach Burnout Inventory-Student Survey (MBI-SS), Self-handicapping Scale (SHS), Test Anxiety Inventory (TAI), and Living up to Parental Expectation Scale (LPES). Repeated measures ANOVA was used to analyze the results.Results The current RCT findings suggest that CBT substantially reduced emotional and behavioral problems and helped the students manage parental unrealistic expectations in the experimental group compared to the waitlist control condition. Further, CBT significantly reduced the degree of procrastination {F (1, 63) = 25.01, p η2 = .29} academic burnout {F (1, 63) = 11.08, p η2 = .16}, test anxiety {F(1, 63) = 88.17, p η2 = .59}, and self-handicapping {F (3, 56) = 10.17, p η2 = .16} among adolescents. Overall, CBT significantly helped the students to manage parental unrealistic expectations through providing relationship skills and training {F (3,56) = 546.46, p η2 = .89)}.Condition: It is concluded that CBT is an effective and evidence-based treatment intervention to address emotional disturbance caused by procrastination, burnout, test anxiety, and self-handicapping behavior among adolescents. Furthermore, it is concluded that CBT is also an effective intervention that helped students to manage peer pressure and parental unrealistic expectations.

Background Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cells exhibiting ineffective hematopoiesis and tendency for transformation into acute myeloid leukemia (AML). The available karyotyping and fluorescent in situ hybridization provide limited information on molecular abnormalities for diagnosis/prognosis of MDS. Next generation DNA sequencing (NGS), providing deep insights into molecular mechanisms being involved in pathophysiology, was employed to study MDS in Pakistani cohort. Patients and methods It was a descriptive cross-sectional study carried out at National institute of blood diseases and bone marrow transplant from 2016 to 2019. Total of 22 cases of MDS were included. Complete blood counts, bone marrow assessment and cytogenetic analysis was done. Patients were classified according to revised WHO classification 2016 and IPSS score was applied for risk stratification. Baseline blood samples were subjected to analysis by NGS using a panel of 54 genes associated with myeloid malignancies. Results The median age of patients was 48.5 ± 9.19 years. The most common presenting complaint was weakness 10(45.45%). Cytogenetics analysis revealed abnormal karyotype in 10 (45.45%) patients. On NGS, 54 non-silent rare frequency somatic mutational events in 29 genes were observed (average of 3.82 (SD ± 2.08) mutations per patient), including mutations previously not observed in MDS or AML. Notably, two genes of cohesin complex, RAD21 and STAG2, and two tumor suppressor genes, CDKN2A and TP53, contained highest number of recurrent non-silent somatic mutations in the MDS. Strikingly, a missense somatic mutation p.M272Rof Rad21 was observed in 13 cases. Overall, non-silent somatic mutations in these four genes were observed in 21 of the 22 cases. The filtration with PharmGKB database highlighted a non-synonymous genetic variant rs1042522 [G > C] located in the TP53. Genotype GG and GC of this variant are associated with decreased response to cisplatin and paclitaxel chemotherapy. These two genotypes were found in 13 cases. Conclusion Sequencing studies suggest that numerous genetic variants are involved in the initiation of MDS and in the development of AML. In countries like Pakistan where financial reservation of patients makes the use of such analysis even more difficult when the availability of advanced techniques is already a prevailing issue, our study could be an initiating effort in adding important information to the local data. Further studies and large sample size are needed in future to enlighten molecular profiling and ultimately would be helpful to compare and contrast the molecular characteristics of Asian versus global population.

Objective: Health care associated infections are those infections that patients acquire in hospitals during their treatment and health care workers are important source for it. The study was designed to evaluate the knowledge and attitude of Health care workers towards infection control. Materials & Methods: A cross sectional study conducted from December 2019 to February 2020 at NIBD & BMT. Approval was taken from NIBD Research Committee. A pre-designed questionnaire was given to staff that had given informed consent. The questionnaire was composed of two parts. The first part comprised of sociodemographic information and the second part comprising 37 questions of knowledge and 11 question of attitude. Data was analyzed by SPSS version 23. Frequencies and percentages were calculated for categorical variables and mean for quantitative data. Chi-square test was used for association with level of significance as P-value

Objective: Aplastic anemia (AA) is characterized by pancytopenia and hypocellular bone marrow. Several factors like infections, toxins, chemotherapeutics and radiations are known causes for the suppression of hematopoietic cells which results in bone marrow failure but the exact etiology is unknown. The current study was conducted to assess the baseline demographics, laboratory and clinical characteristics of patients presenting with aplastic anemia and evaluate their cytogenetic profile. Materials and Methods: A retrospective cohort study conducted at National Institute of Blood Diseases and Bone Marrow Transplantation after approval by Institutional Ethics Committee. In this study, AA patients were enrolled from January 2010 to December 2018. Data collection included demographic, laboratory and clinical characteristics including age, gender, symptoms, treatment, and blood counts. Cytogenetic analysis was performed on bone marrow samples. Data analysis was done by using SPSS version 23. Results: Based on camitta classification, a total of 362 aplastic anemia patients were enrolled in the study. The frequency of severe aplastic anemia was most common 199(55%). Median and interquartile range (IQR) age of overall patients was 17(11-26) years, for children and adult population it was 12(9-14) years and 28 (21-43) years respectively. Male predominance was observed i.e.251(69%). The most common presenting complaint was fever 202(55.8%). The median and IQR of hemoglobin (Hb) was 7.8(5.8-9.4)g/dl, MCV 90(83-91)fl, total leucocyte count (TLC) 2.6 (1.9-3.6) × 109/l, absolute neutrophil count (ANC) 0.64 (0.27-1.2)×109/l and platelet count 13 (5-27) ×109/l. Bone marrow cytogenetics was done and 76 (67%) patients were found to have normal karyotype. CMV was positive in 24(6.6%). Majority of patients were treated with blood transfusion and supportive care only 230(64%) and the survival rate was 84%. Conclusion: In conclusion, the study represents a large cohort of aplastic anemia in the country. Majority of cases were acquired aplastic anemia predominantly being severe aplastic. Limited numbers of patients opted for standard treatment options probably due to financial reservations to afford standard treatments like immune suppression therapy and hematopoietic stem cell transplant. Further, local studies with larger number of sample size and provision of standard treatment options are needed to explore the treatment response, etiological factors, prognosis and outcomes. Keywords: Aplastic anemia, Cytogenetics, Clinicohematological characteristics, Laboratory analysis, Survival outcome, Pakistan.

Introduction The objective of the study was to assess the impact of coagulopathy in risk-stratified acute promyelocytic leukemia (APML) patients irrespective of bleeding manifestation. Patients and methods This was a cross-sectional study design conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation (NIBDBMT) from November 2019 to December 2021. A total of 62 patients between three years to 74 years of age of either gender and treatment-naive cases of APML were included in the study. Morphological diagnosis was made on bone marrow samples, and confirmation was done by karyotyping/fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR). Complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen levels were done for bleeding risk assessment. Cases other than APML and cases on treatment were excluded from the study. Results A total of 85 APML patients were registered at our institute. Among them, 62 (73%) were included in the analysis as per the inclusion criteria of the study. The median age was 32 (3-74) years, with a male predominance of 34 (55%). According to the Sanz score, 18 (29%) patients were noted to have low risk; however, 22 (35.4%) patients were found to have an intermediate-risk disease and 22 (35.4%) patients had high-risk disease. There was positive bleeding history among 44 (71%) patients, followed by fever in 28 (45%) patients. Raised PT, APTT, and D-dimer were found in 46 (74%), 38 (61%), and 52(83.8%) patients, respectively. Low fibrinogen levels were observed among 16 (26%) patients. The association of risk stratification and bleeding history with CBC and coagulation parameters was observed. Platelet count and total leucocyte count were noted to be significantly associated with risk stratification. However, there was no association observed between the rest of the parameters with risk stratification and bleeding. Conclusion The results of our study suggest that regardless of bleeding symptoms, coagulation parameters must be investigated at the time of diagnosis in patients with suspected APML, and in addition to all-trans-retinoic acid (ATRA), transfusion of fresh frozen plasma should be done. It has clinical value, and adding it to the algorithm of treatment would be beneficial to the patients in the developing world, where resources are already meager.

Background: Major depressive disorders (MDD) is common worldwide, and it causes significant functional impairment. Evidence-based therapies significantly address MDD symptoms severity; therefore, we aimed to investigate the effectiveness of pharmacotherapy (PTh), cognitive behaviour therapy (CBT), and Islam-based interventions (IBIs) to treat symptoms severity of patients MDD-m. Methods: This RCT was conducted by the Department of Applied Psychology, Government College University Faisalabad, from December 20, 2020, to October 31, 2021, at different hospitals in Faisalabad, Pakistan. Patients with MDD-m were allocated to three different evidence-based treatment approaches (i.e. PTh, CBT, & IBIs). Patients Health Questionnaire; Positive & Negative Affect Scale, Digit Span Scale, Standard Progressive Matrices, Self-Esteem Scale and Decision-Making Questionnaire were administered. SPSS version 27 was used to analyze the data. Results: A total of 210 were approached, 159 were assessed for eligibility, and 118 met the inclusion criteria, including males 66(55.94%) and females 52(44.06%) with the age range of 22 to 46 years. Findings reported all the treatment interventions produced significant treatment outcomes to reduce the depressive symptoms and improve memory, reasoning ability, decision-making skills, self-esteem, and wellbeing. PTh was an effective supportive intervention, while CBT and IBIs played an effective role as reeducative constructive therapies. Conclusion: All three interventions seem to be effective for major depressive disorder with mild severity, and CBT and IBIs emerged as more efficient and constructive therapies for MDD-m.

BACKGROUND Myelodysplastic syndromes (MDS) are heterogeneous group of haematopoietic stem cell disorders and have variable reduction in the production of red cells, platelets and mature granulocytes. AIM We conducted a case-control study evaluating the environmental and occupational determinants as risk factors of MDS. METHODS A case-control study was conducted including 150 de novo MDS cases and 450 age and gender-matched controls. Disease characteristics, sociodemographics and exposure to environmental and occupational determinants were collected through a questionnaire. Chi-square test was applied to observe association, and binary logistic regression was applied to predict the odds of having MDS. RESULTS A total of 600 participants were analysed. Those who were exposed to arsenic (OR 31.81, CI: 19.0-53.0, P-value: .000), benzene (OR 1.564, CI: 1.07-2.27, P-value: .01) using natural source of water (OR 3.563, CI: 2.29-5.53, P-value: .000) and smokers (OR 3.1, P-value: .000) were more likely to have MDS. Unmarried were less likely to acquire MDS than married (OR 0.239, CI: 0.15-0.36, P-value: .000), Sindhi speaking were 1.419 times more likely to have MDS than participants speaking other languages. Uneducated participants were more likely to have MDS than educated and powder milk users were more likely to have MDS than dairy milk users. CONCLUSION Our results revealed that arsenic, use of natural source of water and benzene exposure might lead to higher risk of acquiring MDS. This study would be helpful to understand the aetiology of disease in Pakistani population.

Objectives: To evaluate the presence and characteristics of additional karyotype abnormalities in chronic myeloid leukaemia cases. Method: The cross-sectional study was conducted at the Department of Cytogenetics and Molecular Pathology, National Institute of Blood Diseases and Bone Marrow Transplant, Karachi, from May 2010 to September 2016 and comprised diagnosed chronic myeloid leukaemiapatients regardless of age and gender.Baseline cytogenetic evaluation was done on overnight, 24-hrs un-stimulated and 72-hrs stimulated bone marrow cultures, and karyotypes were defined according to the International System for Human Cytogenetic Nomenclature2013. Data was analysed using SPSS 23. Results: There were 222 cases with a median age of 38 years (range: 12-84 years). The male-to-female ratio was 1.8:1. Chronic myeloid leukaemiawas detected in 18(8.1%) patients havingadditional cytogenetic abnormalities. Among the patients found positive, cytogenetic type was minor in 10(55.55%), major 3(16.66%), complex 3(16.66%), and variant 2(11.11%). . Conclusion: Additional cytogenetic abnormalitieswere found in 8% of the sample. Key Words: Additional cytogenetic abnormalities, Chronic myelogenous leukaemia, Bone marrow, Cytogenetics.

The study was designed to investigate the quantity and reasons of wastage of blood products. This was an observational study conducted from February 2018 to February 2019 at the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD and BMT), PECHS campus. The study was approved by the institutional review board. Wastage and reasons of wastage for all the blood products were evaluated. Frequencies were calculated by using SPSS version 23.0. A total of 2,880 bags of blood products were available, including 960 each of platelets, packed red cells and fresh frozen plasma. The overall wastage rate was 3.5%. Packed red cells and platelets were fully consumed, yet shortage of supply was observed. However, highest wastage was observed in fresh frozen plasma i.e. 102 bags. Expiry of unused products 60 (59%) followed by broken bags 30 (29%) were two common modes of wastage. Wastage of blood products is a genuine issue in a hospital setup, strategies and plan of action should be discussed and implemented to ensure that they are available when and where they are needed most.

Objective: We performed a prospective analysis at our center to find out the most common organisms causing bacterial infections to establish pattern of antibiotic resistance, in order to combat febrile neutropenia effectively in the terms of outcome as well as cost. Methods: A hospital based observational study was conducted at National Institute of Blood Diseases and bone marrow transplantation from January 2017 to December 2017. Patients presented with absolute neutrophil count (ANC) of less than 500/ml were enrolled. Data were analyzed by SPSS version 21.0. P-value of

AIMS To assess the seasonal variations in hematological disorders among patients diagnosed on the basis of bone marrow biopsy, who attended National Institute of Blood Diseases (NIBD) clinics during 2006 to 2015. METHODS We retrospectively reviewed the 10-year records of hematological disorders among patients' NIBD clinics from year 2006 to 2015. All cases of aplastic anemia (AA), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), immune thrombocytopenic purpura (ITP), and acute promyelocytic leukemia (APML) were categorized on the basis of the seasons in which they were diagnosed such as winter (December-February), spring (March-May), southwest monsoon periods (June-September), and retreating monsoon period (October and November). Statistical analysis was performed by using SPSS and STATA. Inferential statistics were explored using the chi-square test for heterogeneity to evaluate seasonal variations. P-value

Objectives: Impact of eclectic therapy in treating irritable bowel syndrome. Aimsand Scope: To highlight the importance of Eclectic approach in order to form an ideal therapeuticplan to encounter specific needs of the patient with psychiatric illness. Background: Patientwas 22 years old young adult. Younger in family, raised in strict environment. Father had highexpectations with him, used to compare him with others. On his failures he used to discouragehim due to which client started to suppress his emotions. Client since two months began to havecomplaints of irritable bowel syndrome, his medical reports showed no signs of any physicalillness. Intervention and Plan: Client’s psychological evaluation through psychometrics placedhim in the category of “mild depressive disorder”. His emotional suppressions and low selfesteemwere the main reasons of “irritable bowel syndrome”. Eclectic therapy was utilized suchas: family psycho-education, individual therapy, ABC model of CBT, problem solving strategies.Results: Client gradually started to open up with his emotional problems, family counselingplayed a role in modifying his parents’ way of dealing with him. Both father and client began tohave healthy relations with each other. He started to sort his emotional complaints and otherlife problems. He gradually and efficiently became mentally relaxed and recovered his irritablebowel syndrome. Conclusion: It was concluded that eclectic therapy successfully helps clientsto achieve the solution of their psychological occurrence of symptoms and allows them toimprove successfully.

Introduction: Myeloproliferative neoplasms with PDGFRA, PDGFRB and FGFR1 rearrangements are reported to be very rare entities. Myeloid neoplasms with PDGFRB rearrangement have prominent eosinophilia, neutrophilia or monocytosis and presence of t (5;12)(q31~q33;p12-13) or variant translocation. Case Report: We report a 55 years old female patient who presented with eosinophilia along with predominant eosinophil precursors on bone marrow and concomitant isolated del (5q) and PDGFRB gene rearrangement which is an infrequent and rare finding. Conclusion: isolated acquired deletion of the long arm of chromosome 5 (del 5q) also known as 5q- syndrome, is a distinct hematologic disorder reported to be primary myelodys plastic syndrome which is found in females of middle age and usually presents with macrocytic anemia, oval macrocytes, with white blood cell counts normal or reduced, platelet counts normal or elevated and bone marrow exhibitery throid hypoplasia with megakaryocytes showing hypolobated nuclei

SUMMARYObjective The aim of the study was to determine the frequency and reasons for donor deferral prior to the blood donation process in our population. Background Transfusion is an irreversible event that carries potential risks as well as benefits to the recipient. Therefore, donor selection prior to blood donation is one of the most important steps in ensuring the safety of blood and blood products. Methods A cross-sectional study was carried out at the blood bank department in our hospital from January 2012 to December 2014. All the blood donors who visited our department in the study period were included in this study. Results A total of 25 901 potential donations were recorded during the study period, comprising 24 309 (93·8%) replacement and 1592 (6·2%) voluntary donations. Females accounted for only 222 (0·9%) of potential donations. Deferral occurred in 3156 (12·2%) of attempts; 280 (1·1%) were permanently deferred, while 2876 (11·1%) were temporarily deferred. The most common reason for permanent deferral was a history of hepatitis B infection (n = 147, 4·7% of all deferrals). Major reasons for temporary donor deferral were low levels of haemoglobin (n = 971, 30·76%), low levels of platelets (n = 611, 19·35%) and previous history of jaundice (n = 192, 6·1%). Conclusions This study reported a fairly similar pattern of donor deferrals as in other regional studies. Low haemoglobin levels and a history of hepatitis B infection were the most common factors for temporary and permanent donor deferrals, respectively.

Introduction: There are positive as well as negative impacts of general anesthesia on one’s health, negative aspect is that the general anesthesia is not recommended in most of the cases in which the patient have high blood pressure or a disorder that may accelerate on giving anesthesia. Objectives: The main objective of our study is to analyze the health aspects of different oral diseases treatment by using general anesthesia in local population of Pakistan. Methodology: This study was conducted according to the rules and regulations of Nishtar medical university, Multan during Jan 2018 to august 2018. For this purpose we select the 100 patients who was come at the hospital for oral treatment. They want general anesthesia because they do not some time bear pain.After that we take 5cc blood with the permission of patients for the purpose of analysis of level of antioxidants. Results: Mean values of investigated parameters (SOD and catalytic activities, lipid peroxidation and glutathione levels) upon treatment are summarized. Our data show that activity of SOD and levels of MDA and GSH are elevated in samples collected from patients subjected to drug administration. Interestingly, activity of catalases decreased by the value of 0.43 ± 0.39 U/ml (after 5 minutes of anesthesia). Conclusion: It is concluded that people who used general anesthesia as a pain killer suffer more from high level of antioxidants.

Objective In this study, we report acute blood transfusion reactions at our hospital, compare our analysis with the reported data and identify areas for improvement. Background Haemovigilance programmes have been implemented in many countries, and adverse events associated with blood transfusion are published in their annual reports. Pakistan has no current established programme. Material and methods A cross-sectional study was conducted, and all adverse reactions reported to the blood bank from January 2014 to March 2016 were included. An adverse response in the patient, related to administration of blood (within 24 h), was considered an immediate transfusion reaction. Results During the study period, 20 956 blood components were issued. A total of 32 (0·15%) adverse reactions were documented. Allergic reactions were the most common adverse event observed in 15 (46·8%) of the cases. Febrile non-haemolytic transfusion reaction (FNHTR) was the second most common reaction seen in nine (28%) followed by bacterial contamination in four (12·5%) and acute haemolytic reaction in two (6·2%) of the cases. Conclusion The low incidence indicates underreporting and the need for a formal haemovigilance system. International benchmarking between different medical systems is helpful to identify areas in the transfusion process that have to be changed to improve transfusion safety.

The objective of this study was to determine the prevalence of ABO and Rh phenotypes in the general Pakistan population. This information could be used to help reduce the rate of alloimmunization in patients with blood disorders, such as thalassemia major, who require frequent blood transfusions. A total of 242 patients with blood disorders requiring frequent blood transfusions were enrolled in the study. ABO and Rh typing was performed on samples from these patients using tube and gel methods. Of these 242 patients, 146 (60.4%) were male and 96 (39.6%) were female. The prevalence of ABO and D phenotypes was as follows: group O, D+ (38.8%), group O, D– (2.5%), group B, D+ (32.2%), group A, D+ (17.4%), group A, D– (1.7%), and group AB, D+ (7.4%). Of the 242 patients, 232 (95.8%) were D+ and 10 (4.2%) were D–. The most prevalent Rh antigen was found to be e (97%), followed by D (95%), C (89.6%), c (62.8%), and lastly, E (22.6%). The prevalence of Rh phenotypes was: R1R1 (37.7%), R1r (33.4%), R1R2 (19.4%), R2r (5.2%), and rr (4.3 %). All of the D– patients were rr. In our study, the highest prevalence of ABO phenotypes was group O and the most prevalent Rh antigen was e. Rh phenotyping, along with antibody screening and identification should be performed prior to transfusion of patients requiring multiple transfusions to reduce and possibly prevent the rate of alloimmunization. Immunohematology 2016;32:170–173.

Background Myelodysplastic syndromes (MDS) are clonal stem cell disorders exhibiting cytopenias, ineffective hematopoiesis and morphological dysplasia. Bone marrow cytogenetics, inspite of being incorporated as mandatory tool in diagnosis are done less frequently due to limited availability of this technique in Pakistan. The aim of the study was to study baseline clinicohematological and cytogenetic characteristics of patients presenting with de novo MDS. Results A retrospective cross sectional study was done at National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan from 2010 to 2016. Total of 177 patients were included in the study having median age 51 years and male to female ratio of 3:1. Pancytopenia was observed in 80 (45%) patients and bicytopenia in 74 (42%). Mean Hb% was 7.8 ± 2.18 g/dl, total leukocyte count (TLC) 8.8 ± 13.6 × 109/l, platelet count was 82 ± 95.7 × 109/l. Of total 170 (96%) were transfusion dependent. Refractory cytopenias with multilineage dysplasia (RCMD) was the most common world health organization (WHO) category. Karyotype was done in 98 (55%) patients out of which 44 (45%) had abnormal karyotype, complex karyotype (CK) was most commonly observed in 12 (12.2%) followed by monosomy 7 in 7 (7.1%). Conclusions We found younger median age at diagnosis, higher mean TLC and no significant history of recurrent infections. CK and monosomy 7 carry bad prognostic implications and early disease transformation to acute myeloid leukemia (AML). Monosomy 7 being associated with bad overall survival, such patients must be identified early with close clinical follow up and offered stem cell transplant. This is the largest cohort of patients of MDS evaluated for baseline clinical and cytogenetic characteristics in our country.

Objective: The objective of this study was to investigate prevalence of urinary incontinence at 3 months postpartum andto study how continence status during pregnancy and different factors influence urinary incontinence at 3 months postpartum inprimiparous women. Setting: Pregnant women attending routine antenatal clinic at Ziauddin hospital and Kharader general hospitalKarachi were recruited to this study. Methods: Urinary incontinence before and during pregnancy was assessed at study enrolment earlyin the third trimester. Incontinence was re-assessed three months postpartum. Logistic regression analysis was used to assess the role ofmaternal and obstetric factors in causing postpartum urinary incontinence. Results: Urinary incontinence was reported in 15 women(10.6% ) out of 141 women, mode of delivery, onset of labor weight of the baby, episiotomy, and the length of the second stage of labor,were not predictive of urinary incontinence after delivery. Adjusted RR for incontinence after spontaneous vaginal delivery compared withelective caesarean section was 2.200(95% CI .6-7.28) among women who were continent during pregnancy. Conclusions: Urinaryincontinence was prevalent 3 months postpartum. The association between incontinence postpartum mode of delivery, onset of labor,perineal trauma and weight of baby was not statistically significant.

Background Transfusion-transmitted infections threaten the safety of patients requiring blood transfusion, which in turn imposes serious challenges for the availability of safe blood products that are still affordable in health care systems with limited resources. The aim of the study was to determine the prevalence of transfusion-transmitted infections in blood donors and to evaluate the demographic characteristics of reactive and non-reactive blood donors. Methods A prospective cohort study was conducted at our institute in Karachi, Pakistan. Donors were required to fill a detailed questionnaire and were screened for Hepatitis B, Hepatitis C, Human immunodeficiency viruses, Syphilis and Malaria by ELISA and thick film (malaria). Results Of the 16,602 blood donors, 16,557 were males and 45 females (mean age 28.6 ± 2). Nine hundred and seventy three (5.8%) donations were reactive in any screening assay, with 58 (0.35%) donations reacting in more than one assay. The prevalence of Hepatitis B, Hepatitis C, Human immunodeficiency viruses, Syphilis and Malaria was found to be 1.84, 1.7, 0.04, 2.1 and 0.07% respectively. Characteristics among the infections were evaluated and it was found that unmarried donors had a higher chance to be infected by Hepatitis B virus and Syphilis as compared to the other infections. On the other hand, construction workers and married donors were at more risk to be infected by Syphilis rather than the other infections. In case of co-infections, personnel with different occupations and marital status were infected by more than one pathogen. Conclusion A substantial percentage of the blood donor’s harbored transfusion-transmitted infections. Prevention of TTIs should be the main goal right now. There is a need for stringent selection of blood donors with the emphasis on getting voluntary donations and comprehensive screening of donor’s blood for TTIs using standard methods to ensure the safety of blood recipient.