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Background: Breast-feeding practice is one of the main determinants that influence Infant Mortality Rate (IMR). To adopt this practice, mothers’ attitude plays a pivotal role. Attitude depends upon socio-cultural and economical factors. Objective: To assess factors affecting the attitude of primigravida towards Breastfeeding in Ha’il City, Kingdom of Saudi Arabia. Method: In this cross-sectional study, 156 primigravida were recruited by using predefined inclusion and exclusion criteria. Data was collected by awell-structured, closed-ended questionnaire. Results: Majority (51.3%) of our respondents were working ladies (employed, labor, self-employed), and had a high educational level (40.3%). More than half (54.5%) of the primigravida were willing to breastfeed their newborns. Thirty percent of respondents had the intention to practice exclusive breast feeding until 6 months. Majority (43.6%) hadplanned to give mixed feed as a large percentage, considered breast-feeding practices embarrassing and old fashioned. Higher educational level was significantly associated with; number of antenatal visits (according to the prescribed schedule), willingness to breastfeed after resuming the job, right time to have the 1st antenatal visit and willingness to continue exclusive breast feeding until 6 months of the newborn’s age. Although 90% of respondents were breast fed by their own mothers but there was a highly significant association (p≤0.001) of willingness to breastfeed newborns in those respondents whose mother in law breast-fed. Conclusion: Education is found as a main determinant that affects the attitude of primigravida towards breastfeeding. Other variable that influences attitude is the attitude of surrounding people regarding breast-feeding practices. Hence, it is recommended that health education programs on breastfeeding should be incorporated in female adolescent education programs, which will result in the building up of a positive attitude of future mothers towards breastfeeding practices. Keywords: Attitude, Primigravida, Breast-Feeding

Abstract: The present study seeks to probe empirically into the Effects of Education on Women’s empowerment among Muslim Women, and also socio-cultural implications of higher Education for women in Islam. The study further seeks to focus on attitudinal change and changes in social practices brought about by Exposure of Muslim women to higher Education. The study reveals the opinion and attitude from the respondents about Aims after graduation, Job preference of the respondents, reading habits of news paper, marriage, religion, population control, purdha system, dowry, attitude regarding Mehar, reservation policies, Decision making process, female employment, aspiration of employment, role in politics, attitude towards social service etc. In the present problem the researcher has undertaken extensive field work to know the Effects of Education on Women’s empowerment among Muslim Women, and also socio-cultural implications of higher Education for women in Islam through systematic sampling from the students of four Degree colleges of Gulbarga city. &nbsp

Sehar-un-Nisa Hassan,1 Aqeela Zahra,2 Nuzhat Parveen,3 Fahmida Khatoon,2 Naseer Ahmad Bangi,4 Hassan Hosseinzadeh5 1Department of Public Health, College of Public Health and Health Informatics, University of Ha’il, Ha’il, 81451, Saudi Arabia; 2Department of Family and Community Medicine, College of Medicine, University of Ha’il, Ha’il, 81451, Saudi Arabia; 3Department of Obstetrics and Gynecology, College of Medicine, University of Ha’il, Ha’il, 81451, Saudi Arabia; 4Department of Respiratory Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madinah, 42353, Saudi Arabia; 5School of Haelth and Society, University of Wollongong, Wollongong, NSW, AustraliaCorrespondence: Aqeela Zahra, Department of Family and Community Medicine, College of Medicine, University of Ha’il, Ha’il, 81451, Saudi Arabia, Tel +966583675414, Email a.zahra@uoh.edu.saPurpose: To determine the relationship of various domains of quality of life (QoL) with healthcare adherence during the COVID-19 pandemic in Saudi Arabia.Methods: The study sample comprised 795 participants among which 203 had a current diagnosis of any major NCDs, including cardiovascular diseases, diabetes mellitus, asthma, chronic pulmonary diseases, and chronic psychiatric illnesses and a control group of 592 participants who had no NCD. Participants completed an online survey questionnaire which obtained data on socio-demographic variables, types of NCDs, and healthcare adherence during the year 2020, the period during which Saudi Arabia underwent the first two waves of the COVID-19 pandemic. World Health Organization Quality of Life (WHOQOL-BREF) assessed the QoL in four domains physical, psychological, social and environmental and used standard scores in the analysis. GraphPad Prism 5 and SPSS 25V were employed for the statistical analysis. Bar graphs and frequency distribution tables present descriptive data. Bivariate and multivariate logistic regression analyses were computed to determine the significance of the relationship between QoL and healthcare adherence.Results: Almost equal proportions of participants with NCDs (n=109/203; 54%) and without NCDs (n=327/592; 55%) demonstrated nonadherence to their regular healthcare during the COVID-19 pandemic (χ 2=0.14; p=0.71). Patients with NCDs experienced lower quality of life in the psychological, social and environmental domains of QoL (p< 0.05). Results from the multivariate regression analysis showed that female gender (AOR=1.52; p< 0.05) psychological QoL (AOR=1.99; p< 0.05), social QoL (AOR=1.98; p< 0.05) and environmental QoL (AOR=1.95; p< 0.05) significantly relate with adherence to healthcare.Conclusion: Psychological, social and environmental may influence healthcare adherence among patients with NCDs during pandemics and should be focused on while devising future healthcare policy and interventions.Keywords: quality of life, COVID-19 pandemic, healthcare, adherence, non-communicable diseases, behaviors

Objectives: The study was performed to identify the clinical manifestation of Covid-19 infection during pregnancy its impact on the pregnancy outcomes, and its presentation in completely/incompletely vaccinated women. Material and Methods: We conducted this cross-sectional study at Ha`il, a northern city in Saudi Arabia, starting from 15th Dec. 2021 till 15th Jan. 2022. The mean differences of background variables were computed by using the Independent-Sample t-test. A Chi-square test was applied to assess the presentation of the disease in pregnant/non–pregnant and vaccinated/ non-vaccinated women. P-value

Aim: To compare the frequency of recurrence of convulsions with Magnesium Sulphate loading dose versus loading dose plus maintenance regimen for management of patients presenting with eclampsia. Methods: In this Randomized Controlled Trial, 240 pregnant female admitted in department of Obstetrics & Gynaecology, LGH, Lahore. Half In group A, females were given MgSO4 in a single bolus dose i.e. 4 grams intravenously diluted in 100ml normal saline over 20 minutes and 10grams intramuscularly, while in group B, females were given complete standard regime according to the Pritchard i.e. 14 grams loading dose followed by 5gm intramuscularly every 4 hours on alternate buttock for 24 hours after the last episode of convulsion or delivery of the fetus whichever comes later. Results: In this study recurrence of convulsion was significantly higher in patients who were given MgSO4 loading dose as compared to patients who were given MgSO4 loading + maintenance regimen i.e. Group-A: 15.8% vs. Group-B: 5.8%, (p-value 0.013). The frequency of recurrence of convulsion was significantly higher in women who were given loading dose alone as that of women who were given MgSO4 loading + maintenance regimen but Age, gestational age and parity status of women although did not show any significant association.. Conclusion: Loading dose plus maintenance regimen had low frequency of recurrence convulsion when compared with loading dose of MgSO4 only. Keywords: Eclampsia, loading dose, Recurrence of convulsions, Magnesium Sulphate, Maintenance regimen

Sehar-un-Nisa Hassan,1,2 Aqeela Zahra,3 Nuzhat Parveen,4 Naveed Iqbal,4 Sarwat Mumtaz,5 Asma Batool6 1Department of Public Health, College of Public Health and Health Informatics, University of Ha’il, Ha’il, 81451, Kingdom of Saudi Arabia; 2Department of Behavioral Sciences, School of Social Sciences and Humanities, National University of Sciences and Technology (NUST), Islamabad, Pakistan; 3Department of Family and Community Medicine, College of Medicine, University of Ha’il, Ha’il, 81451, Kingdom of Saudi Arabia; 4Department of Obstetrics and Gynecology, College of Medicine, University of Ha’il, Ha’il, 81451, Kingdom of Saudi Arabia; 5Department of Health Management, College of Public Health and Health Informatics, University of Ha’il, Ha’il, 81451, Kingdom of Saudi Arabia; 6Obstetrics and Gynecology, Maternity and Children Hospital Ha’il, Ha’il, Kingdom of Saudi ArabiaCorrespondence: Sehar-un-Nisa Hassan, Department of Public Health, College of Public Health and Health Informatics, University of Ha’il, Ha’il, 81451, Kingdom of Saudi Arabia, Tel +966 5576 629 275, Email s.nisa@uoh.edu.sa; sehar_nisa@hotmail.com Nuzhat Parveen, Department of Obstetrics and Gynecology, College of Medicine, University of Ha’il, Ha’il, 81451, Kingdom of Saudi Arabia, Email n.parveen@uoh.edu.saAbstract: Background: Treatment tolerability and treatment environment are two major spheres of infertility care that may associate with women’s emotional health and coping mechanisms.Aim: The present study aimed at assessing the relationship between infertility treatment quality and various aspects of emotion-focus coping, problem-focus coping, and avoidance coping mechanisms.Method: The study was completed by using standardized tools and data from this descriptive, cross-sectional, correlational study were collected from 350 women undergoing infertility treatments in private reproductive healthcare centers in Quetta, Pakistan.Findings: Treatment tolerability was found to be positively associated with positive reframing (p < 0.02) and negatively associated with the use of emotional support (p < 0.03); acceptance (p < 0.01); humor (p < 0.03); behavioral disengagement (p < 0.01) and venting (p < 0.01). The quality of the treatment environment demonstrated a negative correlation between religious coping (p < 0.02) and behavioral disengagement (p < 0.01), whereas it showed a positive correlation with active coping (p < 0.03) and planning (p < 0.02). The linear regression analysis demonstrated that treatment tolerability significantly increased with positive reframing (R2 = 0.118, F(304) = 2.22, p < 0.03). Behavioral disengagement significantly decreased with better treatment environment (R2 = 0.111, F(304) = 2.09, p < 0.02).Discussion: We discussed the findings keeping in view the role of social, cultural, and economic factors related to infertility care in the context South-Asian culture, and recommendations are made to promote women’s mental health and coping by improving some specific aspects of infertility treatment quality.Conclusions: High treatment tolerability may associate with some useful aspects of emotion-focus coping, such as positive reframing, whereas low treatment tolerability may associate with avoidance coping, such as behavioral disengagement and venting. Besides, the quality of the infertility treatment environment enables women to use problem-focus coping mechanisms, such as planning and active coping.Keywords: infertility, treatment quality, FertiQol, coping mechanisms, mental health, reproductive healthcare, treatment tolerability, treatment environment, psychological well-being

Objectives: To determine the prevalence, risk factors for macrosomia and pregnancy outcome in women with gestational diabetes (GDM). Methods: In this prospective observational study, we included the data of 161 pregnant females diagnosed with GDM. The study was conducted from December 1st, 2020 to June 30, 2021, at the Maternity and Children Hospital (MCH) of Hail, Saudi Arabia. The data regarding risk factors of macrosomia was obtained from each patient. The patients were followed till the delivery of the baby. The data regarding the prevalence of fetal macrosomia and its associated outcomes was noted. Results: The prevalence of fetal macrosomia was 19.8%. Maternal obesity (OR 4.87), poorly controlled diabetes (OR 3.3), previous history of good-sized baby (OR 2.30), previous history of congenital abnormalities (OR 7.2) were the significant risk factors of fetal macrosomia. The prevalence of maternal and fetal complications was high among pregnancies complicated by fetal macrosomia. The prevalence of fetal macrosomia and other fetal complications was high in poorly controlled GDM patients in comparison to optimal control GDM patients. Conclusion: Fetal macrosomia is a common complication among GDM patients. Maternal obesity and poorly controlled diabetes are the common modifiable maternal factors contributing to macrosomia. doi: https://doi.org/10.12669/pjms.38.5.5809 How to cite this:Parveen N, Iqbal N, Batool A, Mahmoud T, Ali S. Macrosomia predictors and pregnancy outcomes in Gestational Diabetes patients: An observational study from Ha’il, Saudi Arabia. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.5809 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The promotion of physical activity (PA) in various subgroups of the population such as people with physical disabilities has been spotlighted in the revised guidelines of The World Health Organization (WHO), Geneva, Switzerland. In order to update public health interventions, there is a need to identify factors that may promote or prevent engagement in PA for special subgroups of the population. This study aims to calculate the PA levels of individuals with and without physical disabilities in Saudi Arabia, their assessment of the environmental (EQoL), and the predictive role of EQoL in PA. The International Physical Activity Questionnaire (IPAQ) and the EQoL domain in standardized WHOQoL Questionnaire were administered on both groups of the population. The study sample comprised 116 individuals with physical disabilities and 243 individuals without any form of disability as a control group. A regression analysis was performed to analyze the predictors of PA in both groups. Findings showed that among the individuals with disabilities, older people were more likely to engage in PA as compared to the younger age group (p < 0.05) and males were significantly less likely to meet the PA criteria. Some of the EQoL features such as safety increased the likelihood of PA up to 2.3 times (p < 0.05) in individuals with physical disabilities. In addition, opportunities for leisure activities were a significant predictor of PA among both groups of individuals with and without physical disabilities (p < 0.05). Our findings suggest that upcoming public health interventions should focus on improving various dimensions of EQoL for the promotion of physical activity among individuals with physical disabilities. Additional studies are needed to further explore various sociodemographic and environmental factors which can affect the PA status of disabled groups.

It is estimated that 6-12% of all the pregnancies are complicated by hypertension and even all improvements pre eclempsia is a significant reason of maternal and perinatal morbidity and mortality worldwide. Nifedipine, Labetalol and hydralazine are mostly being used in acute management of hypertension in pregnancy but so far there is no evidence that anyone drug is more effective. OBJECTIVE: To compare the mean time to achieve blood pressure control of oral Nifedipine with intravenous Labetalol for management of severe pregnancy induced hypertension. METHODOLOGY: This randomized control trial was done in Obstetrics and Gynaecology department of Hilal-e-Ahmer hospital, Faisalabad over a period of 6 months from 01-07-2016 to 31-12-2016. Total 100 patients (group-A and group–B having 50 in each) were included in study. In group A, females were given 40mg oral Nifedipine and in group, females were given 20ml intravenous Labetalol. Time at administration was followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 min. The total donation time to achieve B.P was noted (as per operational definition).The collected data was analyzed by using SPSS version 17.0. Baseline blood pressure were presented in the form of mean+SD. Both groups were compared for mean time to achieve blood pressure control by applying t- test and consider significant at p value

Lead and zinc are usually found at the same occupational places and occur as co-contaminants. Effects of lead toxicity are detrimental on human health as it is probable carcinogen and impairs normal growth and development. On the other hand, zinc is an important nutritional element, the deficiency of which causes debilitating effects on growth and development. The purpose of this study was to examine the possible association of blood lead and zinc levels and any influence of zinc over DNA damage, blood cell membrane aberration and oxidative stress among lead and zinc co-exposed workers. Atomic absorption spectroscopy was used for lead and zinc measurement and comet assay for DNA damage assessment. Haematological aberrations were studied using light and electron microscopy (LM and EM) followed by electron density X-ray spectroscopy (EDS) and elemental mapping. Occupational exposure was observed to cause significant elevation in blood lead levels among workers. This elevation in lead levels and associated DNA damage among workers was significantly high in comparison to controls. Further light and electron micrographs of red blood cells revealed significant morphological alterations associated with increased lead ions in workers. It was clear from SEM-based elemental maps and EDS graphs that elevated lead levels were associated with low levels of zinc. The results suggest that lead absorption is highly influenced due to zinc levels in body which has an impact over DNA damage, blood cell aberration and oxidative stress caused by lead exposure. Efforts are going on to understand the role of other trace metals on lead toxicity in order to develop a sustainably nutrition-based therapeutic intervention. Graphical abstract.

Objectives: To audit the obstetric hysterectomies in a tertiary care hospital during one year. Methods: It was an observational retrospective study design, where all the pregnant women were assessed for fetomaternal outcomes, indications and complications for peripartum hysterectomy. The records were retrieved from Jan 2015 to Dec 2015 by using hospital record system. The study duration was of one year. The venue of the study was Lahore General hospital, Lahore. The exclusion criteria included all unmarried women, women with chronic kidney disease or renal failure, past surgical history of heart disease, whereas all the women who delivered in hospital, private clinic or at home after atleast 28 weeks of gestational age and experience hysterectomy at the time of delivery or after delivery in the puerperium, were included in the study. Results: The data over 32 women were retrieved from the hospital record system. The mean age of the women was 30.34+2.23 with range 26-34. The average number of parity was 3 of all females. The range of parity was 2 to 7. The average gestational age was 36.18 weeks. All the deliveries were done by cesarean section whereas 4 (12.5%) were elective and 28 (87.5%) were with emergency indications. 13 (40.6%) of the deliveries were in private clinic, 9 (28.1%) were done by LHV/ mid wife, 5(15.6%) were in private hospitals, 4(12.5%) were in LGH and only 1(3.1%) was at home. 18(56.3%) of the women were having at least one abortion in previous history. Conclusion: We concluded that emergency peripartum hysterectomy is very vital procedure that saves lives and manage life threatening obstetrical hemorrhage when other methods failed to control it.The major indications for emergency peripartum hysterectomy were placental abruption, placenta praevia/accrete, uterine atony and ruptured uterus. Key Words: Uterine artery embolization, Emergency peripartum hysterectomy, maternal morbidity and mortality, healthcare providers How to Cite: Latif F, Ilyas S, Mehmood S. Arif H. Khawaja P. Nuzhat. Jawad Z. J Clinical audit of obstetrical hysterectomies for a period of one year in a tertiary care hospital. Esculapio.2020;16(04):50-53.

Background: Objective of the study was to identify the important causes of near miss cases and to evaluate the key interventions for the management and ultimate maternal outcome.Material and methods: In this case series study, critically ill pregnant, laboring or postpartum women who were admitted either directly or through referral to the National Medical College, Birgunj, Nepal, formed the study group. The women who escaped death due to medical or surgical interventions were categorized as Near Miss. These cases were defined based on WHO Criteria 2009.Results: There were 2424 births during this year and 33 were near miss cases. The bulk of these were directly admitted to our hospital (23 cases). The most common condition leading to this dreadful condition was hemorrhage, acute severe hypertensive disorder (preeclampsia/eclampsia) and sepsis. Disseminated Intravascular Coagulation was found to be the most common organ dysfunction. Emergency hysterectomy was the most frequent surgical intervention used to prevent mortality.Conclusion: Maternal Near Miss review is a viable review as it has potential to highlight the deficiency as well as positive elements of obstetric services in any health system. Hemorrhage followed by hypertensive disorders are the leading causes of near miss events.Med Phoenix Vol.2(1) July 2017, 44-47

The development of the respiratory system starts at 3 weeks of gestation, and aberrations in developmental processes may result in structural abnormalities collectively referred to as bronchopulmonary foregut malformations. These lesions include congenital cystic adenomatoid malformations (CCAMs), sequestrations and infantile lobar emphysema. Case presented is of right lung CCAM diagnosed at 23 weeks of gestation, followed during antenatal periods for complications, delivered at 39 weeks, planned thoracotomy with lobectomy done on 3rd day of life and followed up till 1 year. Detailed anomaly scan and close monitoring for structural abnormalities of fetus is needed for appropriate management. Relationship of CPAM with early pregnancy severe infections remains to be established.Med Phoenix Vol.2(1) July 2017, 63-66

Zinc is an element of great biological significance. Many biochemical processes cannot occur without zinc as it is required for large number of physiological functions. It plays an extensive role in protein functioning as they mostly contain zinc ion in reaction center. Zinc plays important role for the normal functioning of immune system and acts as ionic signalling in large number of cells. Various other functions like sensory stimulus, cognitive abilities, enzyme and protein transcription factors depend on zinc for their proper functioning. It helps in the treatment of large number of disease, including bacterial and viral infections. Despite vast importance, zinc is known to produce toxic effects rarely when present in excessive levels. Due to its rare toxicity, it is relatively considered non toxic, as it is an essential trace element. Its deficiency is wide spread which result in detrimental effects on growth, development, immunity, sexual health and alter large number of enzyme and protein functioning. The present review focuses on various aspects of zinc including recent advances in its biological role, treatment and its deficiency. A brief account on its toxicity is also included.

Iron is a ubiquitous constituent of cytochromes, oxygen-binding molecules and a variety of enzymes because of its property to transition from ferric (Fe3+) to ferrous (Fe2+) state, leading to change in the redox potential. However, the same property accounts for free radical injury. In order to overcome harmful effects of iron we investigated the possible protective effect of quercetin (QCT), a flavonoid with antioxidant property, against the oxidative DNA damage caused by iron sulfate in vivo. We show that QCT exerts efficient anticlastogenic action in the context of iron sulfate treatment up to a dose of 500 mg/kg while it induces DNA damage at higher doses. These findings show that QCT has a dual effect; at low doses it ameliorates the oxidative damage produced by iron, and it is genotoxic and cytotoxic at a higher dose.

Iron oxide nanoparticles (IONPs) are known to induce cytotoxicity in various cancer cell lines through the generation of reactive oxygen species (ROS). However, the studies on its potential to induce toxicity in normal cell lines and in vivo system are limited and ambiguity still exists. Additionally, small molecules are known to interact with the DNA and cause damage to the DNA. The present study is designed to evaluate the potential interaction of IONPs with DNA along with their other toxicological effects and subsequent attenuation by thymoquinone both in vitro (primary lymphocytes) and in vivo (Wistar rats). IONPs were characterized by TEM, SEM-EDS, and XRD. The results from DNA interaction studies showed that IONPs formed a complex with DNA and also got intercalated between the base pairs of the DNA. The decrease in percent cell viability of rat’s lymphocytes was observed along with an increase in ROS generation in a dose-dependent manner (50, 100, 200, 400 and 800 μg/ml of IONPs). The genetic damage in in vivo might be due to the generation of ROS as depletion in anti-enzymatic activity was observed along with an increase in lipid peroxidation in a dose–dependent manner (25, 50, 100 mg/kg of IONPs). Interestingly, supplementation of thymoquinone in combination with IONPs has significantly (P in vitro and in vivo. It can be concluded that thymoquinone has the potential to attenuate the oxidative stress and genetic toxicity in vitro and in vivo.

QUAL2E is modeling software which simulates up to 15 water quality parameters in branching stream system. The model uses mathematical equations like finite-difference solution of the adjective- dispersive mass transport and reaction equations. The program computes a series of steady- state water surface profiles and simulates changes in flow conditions along the stream. The model is applicable only to dendritic streams that are well mixed and it assumes that the major transport mechanism, advection and dispersion are significant only along the main direction of flow of the stream. QUAL2E can operate as either a steady state or a dynamic model and it simulates dynamic dial heat budget and water quality kinetics for a one dimensional and steady flow system. QUAL2E program performs dissolved oxygen balance by including source and sink terms in mass balance equation and is used to quantify the non point sources loading rate, determine the pollutants, calculate the phosphorus and estimate the natural conditions. It accommodates four types of hydraulic and mass load functions in addition to local climate factors: headwater-inputs, point sources, inflow/outflow and downstream boundary conditions.

Nimbolide is known to be an antioxidant found in neem plant. Hydroxyurea is a medication frequently used in sickle-cell disease, different cancers and HIV infection. The present study aimed to evaluate the adverse effect of HU and possible amelioration by nimbolide in Wistar rats. To test our hypothesis, we performed genotoxicity tests, biochemical assays, and histopathological studies. We observed that HU caused higher levels of genotoxicity in the treated animals. The observed genetic and oxidative damage might be due to the presence of reactive species as HU increased the level of the malondialdehyde-a biomarker of oxidative damage. Interestingly, co-treatment of animals with HU and nimbolide showed a lower level of damage. We conclude that nimbolide significantly protects the cells from the adverse effect of HU and could be considered as a potential adjuvant for the patients under HU therapy.

Vitamin C (VC) is a well-known antioxidant and strong free radical scavenger. Its antioxidant activity is useful for protection of cellular macromolecules, particularly DNA, from oxidative damage induced by different agents. This study was undertaken to evaluate the optimum level of VC in attenuating the chromosome aberrations (CAs) and DNA damage after iron sulfate (FeSO4) acute administration in Wistar rats. The results exhibited that the increase of CAs and DNA damage induced by FeSO4, 200 mg Fe/kg, could be reduced significantly by VC pretreatment at the dose of 500 mg/kg (p4 induced CAs and DNA damage. The possible mechanisms of VC may be attributed to its property as a free radical scavenger or to its indirect action in reducing the level of reactive oxygen species (ROS).

This screening study was carried out in Gynae Unit II, Sir Ganga Ram Hospital, Lahore. The aim of study was to find out prevalence of abnormal pap smears and its correlation to age & parity so that we can formulate a policy to screen at risk population with Utilization of minimum resources in our setup. Role of Pap smear in detection of cervical pre-malignant & malignant lesions can not be over emphasized. The Cervical smears of 310 women have been evaluated. The frequency of mild to severe cervical intraepithelial neoplasia was found to be 8% while smear positive for malignant cells was in 0.9% of cases. This study reveals 41-60 years of age and Para three and above a high risk group for Cervical Intraepithelial Neoplasia (CIN) and cytology positive for malignant cells. In view of the expenditure involved and technical constraints in mass screening, an approach of selective screening of high risk population could be an effective strategy for control of carcinoma of cervix in developing countries like ours. 524-5+7+F Bushra Zahid-Department of Obstetrics & Gynaecology, Sir Ganga Ram Hospital/Fatima Jinnah Medical College, Lahore Nuzhat Khawaja-Department of Obstetrics & Gynaecology, Sir Ganga Ram Hospital/Fatima Jinnah Medical College, Lahore+np_khawaja@hotmail.com Rakhshanda Tayyeb-Department of Obstetrics & Gynaecology, Sir Ganga Ram Hospital/Fatima Jinnah Medical College, Lahore

Childbirth is a natural process but with its` inherent risk of complications. Skilled birth attendant can provide timely emergency obstetrics services. Objective of this study was to analyze fetomaternal outcome of cases referred to our hospital after trial of labour and to identify factors, which could prevent adverse obstetric outcome. This study was conducted at Obstetrics & Gynae Unit II Sir Ganga Ram hospital, Lahore. One hundred patients who were admitted through emergency after trial of labour by TBA, LHV or doctors at home or private clinics were analyzed for fetomaternal outcome. Out of hundred patients in study group 49 were Primigravida while 10 were grandmulti. About 90% of patients never had any antenatal checkup. Maximum patients (94%) were under care of TBA & LHV. 54 patients had already prolong labour out of which 38 cases were of obstructed labour. Five patients had ruptured uterus. 49 patients were delivered by caesarean section while 29 had forceps delivery. Laparotomy was carried out in four patients due to ruptured uterus out of which two had hysterectomy. There was one maternal death due to ruptured uterus. Post partum hemorrhage occurred in ten patients, while 12 had puerperal pyrexia. Regarding perinatal outcome there were 23 stillbirths, while 45 had Apgar score below 5 at five minutes. Ten babies died in first 12 hours. This study concludes that complications of labour if not timely diagnosed and rectified results in adverse fetomaternal outcome. Provision of skilled birth attendant at doorstep will be an ideal solution.

Objective: To find out risk factors for hepatitis C infection in obstetric patients in a teaching hospital. Study Design -Observational study. Place and Duration At Sir Ganga Ram Hospital, Lahore during a period of one year. Subjects and Methods -Casesof hepatitis C infection, diagnosed on the basis of screening for antibodies for Hepatitis C were included in the study. A proforma was designedand details of each case including maternal demographics and associated risk factors were entered. Result Fifty three obstetric patients werepositive for Hepatitis C virus antibodies in one year of study period. Majority of women were among 25-29 years of age, belong to lowsocioeconomic status, illiterate and among parity range of 2-5. Previous history of surgical procedures was in 66% of subjects while 62% hadhistory of injections. Ear piercing in unsterilized conditions by non skilled person was also present in significant number (43%) while 17% hadhistory of blood transfusions. Conclusion: Hepatitis C infection is linked to surgical procedures, injections and ear piercing in this study.However, to identify all associated maternal risk factors, larger studies at multiple centres will be required and strategies should be made toprevent its' transmission.

The aim of present study was to evaluate the genotoxic effect of heavy metal in Channa punctatus through the micronucleus test, chromosomal aberrations and sister chromatid exchange. The fish were kept separately in 0.5, 1.0, 2.0 and 5.0 ppm cadmium chloride for 3 days. For micronucleus test blood was collected from caudal vein and smeared on clean slides fixed in methanol and stained with 2% Giemsa. Mean frequency of micronuclei observed was 0.10, 0.15, 0.24, 0.34 and 0.39 in control, 0.5, 1.0, 2.0 and 5.0 ppm CdCl2 respectively. In vivo chromosome preparation from kidney tissues was carried out. The mean frequency of cells with aberrations observed was 0.13, 0.20, 0.34, 0.60 and 0.95 in control, 0.5,1.0, 2.0 and 5.0 ppm CdCl2 respectively. Likewise the mean frequency of SCE observed was 0.05, 0.16, 0.36, 0.44 and 0.52 in control, 0.5, 1.0, 2.0 and 5.0 ppm CdCl2 respectively. It has been revealed from the results of this study that cadmium produced genotoxic effects in fish.

Background NLRP7 ( NALP7 ) has been identified as the major gene involved in the inherited predisposition to recurrent molar pregnancies, a rare recessive condition in which affected individuals have complete hydatidiform moles of diploid biparental origin (BiCHM). The role of NLRP7 in other types of molar pregnancy and reproductive wastage has not been conclusively demonstrated. The purpose of this study was to clarify this by identifying NLRP7 variation in two clinically well-defined groups of patients: women with recurrent BiCHM, and women with three or more recurrent complete hydatidiform moles of proven androgenetic origin (AnCHM). Methods Fluorescent microsatellite genotyping of molar tissue was used to establish a diagnosis of recurrent BiCHM (four novel cases) or recurrent AnCHM (nine women with multiple CHM). These two groups were subsequently screened for mutations in NLRP7 using DNA sequencing. Additional screening for non-pathological variants was performed in 21 previously published cases of recurrent BiCHM. Taqman genotyping was used to determine the frequency of novel NLRP7 variants in two control cohorts of Caucasian and Asian women with no adverse reproductive outcomes. Results Of the four novel cases with recurrent BiCHM, two were homozygous for mutations in NLRP7 while one was a compound heterozygote for a nonsense mutation and a pathological variant. No NLRP7 mutations or pathological variants were identified in the fourth case. None of the women with AnCHM carried any mutations or pathological variants of NLRP7 . A single case of AnCHM was found to be heterozygous for a novel variant (R413Q). Conclusion NLRP7 mutations do not represent a major cause of AnCHM.

To investigate a possible association between pre-eclampsia (PE) and the genotype for the angiotensin II type-1 receptor (AT1R) and the angiotensin type-2 receptor (AT2R) in various population groups.The study was retrospective in a case-controlled design.Two hundred thirty-six pregnant women with PE/eclampsia (E) and 426 non-hypertensive pregnant women were included.Polymorphic sites of AT1R (A1166C) and AT2R (A1675G) were amplified by polymerase chain reaction, digested with a restriction enzyme that differentiated between the alternative alleles, and analyzed.Maternal genotypes and their correlation with clinical parameters.The frequency of the AT2R-GG genotype (A1675G) in the PE group was significantly greater than in controls for Afro-Caribbean women (49.3% vs 26.9%, p=0.004), but the frequency difference in Asian or Caucasian women was not significant (23.0% vs 25.4%, p=0.63; 27.7% vs 14.8%, p=0.17, respectively). The highly significant difference in Afro-Caribbean women was maintained after controlling for the effects of age, BMI and parity (p=0.005). There was no significant association of the molecular variant of AT1R (A1166C) with PE in Afro-Caribbean, Caucasian or Asian women. However, in the whole PE group compared to the controls there was a higher proportion of the AT2R-GG genotype with AT1R-AC (56% vs 44%, OR 2.37; 95% CI: 1.06-5.32). In Afro-Caribbean women, the combination of AT1R-AC with AT2R-AG genotypes was significantly higher in controls compared to PE group (93.8% vs 6.3%, OR 0.11; 95% CI: 0.01-0.81).There is an association between PE/E and the GG-genotype of AT2R in Afro-Caribbean women.

To compare the efficacy and safety of oral versus vaginal administration of misoprostol for second trimester pregnancy termination.Interventional, quasi experimental study.The Department of Obstetrics and Gynaecology Unit-II, Fatima Jinnah Medical College/Sir Ganga Ram Hospital, Lahore, from August, 2003 to October, 2004.Sixty pregnant women at second trimester of gestation who were candidates for therapeutic termination of pregnancy were recruited for the study. Grandmultipara, women who had scarred uterus and history of hypersensitivity to prostaglandins were excluded. The subjects were assigned into two groups. Group 1 (n=30) had misoprostol orally, while the group 2 (n=30) received the drug by the vaginal route. Dosage regimen was similar in both groups that was 200 microg 4 hours apart till expulsion of fetus or maximum of upto 5 doses. Main outcome measures of the study were induction-expulsion interval, need for surgical evacuation and maternal complications.The mean induction-expulsion interval in the group 1 and 2 was 11.8+/-8.3 and 12.8+/-8.5 hours respectively, which was not different statistically. The process of expulsion was complete in 53.3% of subjects in both groups by misoprostol only, while 36.6% required surgical evacuation in oral group versus 33.3% in vaginal group. The rate of failed induction in groups 1 and 2 was 10% and 13.3% respectively. There was no reported case of nausea, diarrhea, headache, dizziness, shivering, pyrexia and hyperstimulation in both the groups. However, a case of vomiting (3.3%) was observed in the vaginal group.

Pakistan is one of the most populous nations in the world, with an annual growth rate of 2.8 and high total fertility rate, even among developing nations. The Pakistan Reproductive Health and Family Planning Survey highlighted the wide gap between knowledge (97%) and use of contraceptives (28%) among currently married women. Our actual need is to enhance contraceptive practice in our country. This study was designed to investigate contraceptive knowledge and practice in Pakistani women attending a tertiary care hospital. This questionnaire-based study was conducted at the Gynaecology Unit II of Sir Ganga Ram Hospital, Fatima Jinnah Medical College, Lahore, Pakistan. A total of 204 married women of reproductive age were interviewed by a registrar to record their age, occupation, educational status, number of children, knowledge about contraceptive methods, source of the knowledge, attitudes and practices of contraception. About 57% of women were between 26 and 35 years of age, while 52% of men were between 31 and 40 years. Educational status of the majority of females was below matriculation (33%), while 34% males were above matriculation; 88% of females were housewives and less than 1% of men were out of work. Regarding the social status of couples, 64% were living on income less than 5000 rupees /month (about 60 pound sterling). Of the women, 67% were para 2-5; 68% had some sort of awareness regarding contraception. The main source of information was television (26%) and relatives (24%). The majority knew about the pill (68%) and IUCD (55%). Only 47% were using some sort of contraception. The most common method chosen was the barrier method (15%), followed by IUCD (10%) and the pill (10%). The least common methods were sterilisation (2%) and the rhythm method (2%); 85% of the women and 74% of the men in the study group had a positive attitude toward contraception. In order to improve contraceptive use in Pakistan we need to use multiple media sources to educate couples and their parents regarding contraceptive services, strengthen the perceptions that religion not only allows but also recommends family planning and to create awareness among women to have their rights and opinions about the size of family. The concept of differentiation between sons and daughters should be discouraged. In addition government and non-governmental organisations (NGOs) should organise groups to provide counselling and promotion of contraceptive services at the doorstep. We must act as a team to control our growth rate for economic stabilisation of the country and to raise the living standards of our people.

To evaluate the performance of visual inspection of cervix (VIA) after application of 3% acetic acid in cervical cancer screening in comparison with Pap smear.Comparative study.This study was conducted at Sir Ganga Ram hospital, Lahore, from January 1996-December 1999.Speculum examination was carried out to see the cervix in 501 women. All subjects were screened simultaneously by Pap smear and VIA after application of 3% acetic acid. Positive cases by both screening methods and grossly abnormal cervix even with negative screen were subjected to colposcopy. In case of colposcopic abnormality of atypia or advanced lesions, biopsies were taken. Histology of colposcopically directed biopsy was taken as gold standard to evaluate the performance of the test.Out of 540 subjects, 356 were negative with both screening techniques. One hundred and fifty-six subjects were positive with VIA(28.9%) while Pap smear was positive in seventy-eight subjects (14.4%). The sensitivity of VIA was 93.9% and of Pap smear was 46.9%. Corresponding specificities were 30.4% and 69.5%. There was no significant difference between the positive predictive value (PPV) of both test (p0.05). The accuracy of VIA was 77.5% compared to 52.8% of Pap smear. The difference was highly significant (p0.01).These results indicate that VIA is more sensitive and has a higher accuracy as compared to Pap smear. It could, therefore, be valuable in detection of precancerous lesions of cervix. Low cost, easy applicability and immediate results make VIA a useful screening test in developing countries like Pakistan as compared to Pap smear.