Background: Iron deficiency anemia is a common health problem during pregnancy in developing countries. The objectives of this study were to determine the frequency, distribution & determinants of iron deficiency anemia among third trimester pregnant women in our population. Materials & Methods: This cross-sectional study was conducted in Department of Gynecology and Obstetrics, Hayatabad Medical Complex, Peshawar, Pakistan from October 2015 to March 2016. Sample size was 360 calculated through an online calculator. The inclusion criteria was third trimester pregnant women. Demographic variables were age in years, age groups and social class. Research variables were Hb in mg/dL, presence of iron deficiency anemia, grades of iron deficiency anemia (mild/ moderate/ severe) and iron intake (yes/no). Numeric variables such as age in years and Hb were analyzed as mean and SD, whereas rest of the variables being categorical as count and percentages. Chi-square tests of association was computed. Result: The mean age of the sample was 29.31 ±6.99 and CI of 27.92-30.70. The mean hemoglobin level was 10.33 ±1.7 and 95% CI of 9.99-10.67. The overall frequency of iron deficiency anemia was found out to be 52%, in which 25% were mild, 22% moderate and 5% were severely anemic. Women with middle class had higher frequency of 145 cases. Association of iron deficiency anemia with social class (χ2=7.95, p

Objective:  This study is aimed to discuss the challenges in dealing the infertile male and advances in the treatment of male infertility. Material and methods: The study included infertile male patients who presented to andrology outpatient as primary or secondary infertility between December 2018 and January 2021. The data detailed different aspects of challenges and advances in male infertility treatment. The data analysisone with SPSS. Results: Total 289 patients included, most of them (74%) presented as primary infertility and a quarter presented as secondary infertility. The mean delay in presentation was 6.8 years which were due to treatment from non-andrologist doctors of different specialities (53.9%), hakims (15.2%), quacks (13.8%), gynaecologists (10.3%) and some were reluctant to tell their problem (6.5%). The diagnosis was N.O.A (42.9%), unexplained infertility (24.2%), varicocele (22.8%), OA (6.2%), OAT syndrome (2.7%) and CABVD (1%). Different treatment option opted were vasography plus vasovasostomy or vasoepididmostomy (31.1%), ART (23.9%), MSV (22.8%) and medical treatment (22.1%). Vasography plus vasovasostomy or vasoepididmostomy and medical treatment were the available options provided. There was no ART facility and those who were counseled for referral either their unwillingness or cost resulted in a hurdle in their provision. Conclusion: There are still a number of challenges in treating infertile men. Recently provision of medical and microsurgical treatment at andrology clinic resulted in proper treatment of a large number of infertile men who previously received treatment from un- related facilities.

Purpose: We investigated Patients presenting with chronic orchialgia at Andrology in institute of kidney and diseases Peshawar, from 2003 August up to when were included. Materials and Methods: A thorough history and physical examination was undertaken including description of pain by the patient in terms of site, severity, radiation and associated pain. Extensive workup, directed by history and phsical examination, was done to rule out reversible causes of orchalgia. All patients had urinalysis, culture and ultrasound scrotum with color Doppler. Further investigations like semen analysis, culture and hormonal workup were done if indicated. The intensity of the pain was noted according to visual analogue scale. Patients were subdivided into three groups as mild pain (group A, pain score=1 - 3), moderate pain (group B, pain score=4 - 6) and severe pain, (group C, pain score=7 - 10). Site of pain and radiation/association to any other region was recorded. Finding: Results of the study indicated that 92 patients reported at institute of kidney diseases Peshawar with chronic orchialgia had their mean age at 37+/-4years. Five patients lost to followo 92 were included in final analysis (table 01). Pain was partially relieved in 14 patients and not relieved in another 9 patients which is almost 76% of total patients. These non-responders were compared with the remaining in which pain was completely relieved. There was no difference in etiology among responders and non-responders, however pain severity was more in non-responders at initial presentation (table 2). Conclusions: Patients with pelvic floor muscle spasm are more likely to experience treatment failure following microscopic subinguinal spermatic cord denervation for chronic scrotal content pain, even with a favorable response to spermatic cord block. A history relating to pelvic floor muscle spasm should be taken for all patients presenting with chronic orchialgia or chronic scrotal content pain, and digital rectal exam should be performed if the history is suggestive. If underlying pelvic floor dysfunction exists, pelvic floor physical therapy can be offered to patients prior to spermatic cord denervation. History of prior vasectomy, epididymectomy, prior inguinal or scrotal surgery or other patient demographic factors were not associated with treatment failure.

Purpose: Varicocele is a common type of male genital disease and can occur in men of any age, especially young people. Clinically venous enlargement or varicocele are found in about 15% of the general male population, up to 35% of men with primary fertility, and 75% of men with secondary fertility dysfunction. Varicoceles are known to be the most common cause of male infertility and can be corrected surgically, but the exact mechanism of sperm formation caused by varicocele-induced impairment remains controversial. Most men with varicocele are asymptomatic and infertile, with only 15% – 20% suffering from physical discomfort or other fertility-related problems. With therefore systematically evaluated the RCTs published together and summarized evidence evaluating the benefits of testicular delivery and ligation of gubernacular vein in microsurgical varicocelectomy. Methodology: Comprehensive electronic search using the keywords "microsurgical varicocelectomy", "gubernacular vein", "testicular delivery", "infertility" and "varicocele" was done in databases of Cochrane, PubMed, Embase, CINAHL and Web of Science databases. English language used to search databases. Some studies were taken from studies references. Result: Two studies reported grade II and III of varicoceles in patients that participated in the study. Overall sperm count in microsurgical resection with testicular delivery compared to microsurgical resection without testicular delivery, increased significantly (SMD = 0.23, 95% CI = 0.07-0.39, p =<.05), but sperm motility, sperm concentration and gradual increase have no difference in between the two microsurgical methods (p> 0.05). Conclusion: In conclusion, as a result of this systematic review and meta-analysis, compared with microsurgical varicocelectomy without testicular delivery, delivery of the testicles during microsurgical varicocelectomy to further to further ligate the gonadal veins leads to epidydemo orchitis and oedema, and longer surgery. In addition, testicular delivery may not improve parameters of sperm, serum testosterone, and incidence of varicose veins, wound inflammation and spontaneous pregnancy compared to non-delivered testicles. However, a higher level of research is needed to determine if testicular delivery is an important surgery in microsurgical venous ligation.

About almost 5- 6% of men who had vasectomy surgery come back to doctors for its reversal in the form of microsurgical vasovasostomy or simplified Loupe Assisted vasovasostomy. Vasovasostomy is a technique which is used to regain fertility in men. This technique, over the years, has gone through many advancements with better results, including one layer, two layers and now three layers microsurgery with equipments and techniques to form a meticulous anastomosis. While, on the other hand, simple Loupe Assisted technique is done using Prolene Stent. During vasovasosotomy it is extremely important to maintain normal blood supply to the tissues and muscle to build a tension free anastomosis. In this modern age of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), it has become immensely important to clearly identify the outcomes of both the surgery procedures to void future issues after vasectomy reversal. Little data is present in comparison of the outcomes of both the vasectomy reversal methods. Therefore, this paper is compiled up to throw some light on case studies to better evaluate the best methods of reversal. A study was carried out in the hospital of bahawalpur from January 2017 to January 2019.