A service for prenatal diagnosis of beta-thalassaemia was introduced in Pakistan in May 1994. Two renowned Islamic scholars, consulted before the service was introduced, ruled that a pregnancy can be terminated if the fetus is affected by a serious genetic disorder, and if termination is before 120 days (17 weeks) of gestation. During the first 3(1/2) years of the service 300 couples requested the test. Almost all the couples had been informed by their treating doctors. Most diagnoses were made between 10 and 16 weeks of gestation, and only 15 (5%) were reached after the 16th week. DNA analysis was by the amplification refractory mutation system (ARMS). A multiplex ARMS was developed in which three primer combinations identified the mutations in 91.5% of the couples. In 13 couples (4. 3%) linkage analysis was required for the fetal diagnosis. In 47/53 (88.7%) women carrying an affected fetus the pregnancy was terminated. In six cases it was declined principally on religious grounds. Postnatal confirmation of the prenatal diagnosis was possible in 117 unaffected children. One year after the start of the service, interviews with 141 couples with an affected child showed that 72% knew of the availability of prenatal diagnosis. Thirty-two of the informed couples had had a pregnancy, but only 18 (56%) used prenatal diagnosis. The main reasons for non-utilization of prenatal diagnosis were the cost of the test and fear of undergoing the test, though some gave no clear explanation. This study demonstrates that prenatal diagnosis is feasible and acceptable in a Muslim country such as Pakistan.

A service for prenatal diagnosis of beta-thalassaemia was introduced in Pakistan in May 1994. Two renowned Islamic scholars, consulted before the service was introduced, ruled that a pregnancy can be terminated if the fetus is affected by a serious genetic disorder, and if termination is before 120 days (17 weeks) of gestation. During the first 3(1/2) years of the service 300 couples requested the test. Almost all the couples had been informed by their treating doctors. Most diagnoses were made between 10 and 16 weeks of gestation, and only 15 (5%) were reached after the 16th week. DNA analysis was by the amplification refractory mutation system (ARMS). A multiplex ARMS was developed in which three primer combinations identified the mutations in 91.5% of the couples. In 13 couples (4. 3%) linkage analysis was required for the fetal diagnosis. In 47/53 (88.7%) women carrying an affected fetus the pregnancy was terminated. In six cases it was declined principally on religious grounds. Postnatal confirmation of the prenatal diagnosis was possible in 117 unaffected children. One year after the start of the service, interviews with 141 couples with an affected child showed that 72% knew of the availability of prenatal diagnosis. Thirty-two of the informed couples had had a pregnancy, but only 18 (56%) used prenatal diagnosis. The main reasons for non-utilization of prenatal diagnosis were the cost of the test and fear of undergoing the test, though some gave no clear explanation. This study demonstrates that prenatal diagnosis is feasible and acceptable in a Muslim country such as Pakistan.

Background: Surgical site infections causes significant morbidity and mortality of patients and causes more difficult to treat if unexpected cause behind the infection like tuberculosis. Delayed surgical site infection after initial healing are uncomfortable for both surgeons and patient.Methods: Wound tissue from 18 patients with delayed surgical site infection not responding to antibiotics used for pyogenic infection were collected and examined histopathologically.Results: Of the 18 patients, 9 revealed histologically tuberculosis, 7 non-specific chronic inflammation and others showed foreign body granulomma. Association between histopathological report and incidence of tuberculosis is significant (p<0.001) and association between onset of infection and incidence of tuberculosis also significant (p<0.05).Conclusion: A high degree of suspicion is required in case of delayed or recurrent surgical site infection to diagnose tuberculosis as a cause.J Bangladesh Coll Phys Surg 2014; 32: 186-189

Objectives: The study was conducted to compare intravaginal misoprostolwith extra amniotic prostaglandin F2 alpha (PGF2") for labour induction in therapeutic abortions from 10-28 weeksgestation. Design: A prospective study experimental. Setting At Military Hospital, Rawalpindi. Period: FromMarch–December 2002. Materials & Methods: 68 patients with indications for therapeutic termination. Groups wereassigned through non-probability convenient sampling procedure. In one group 200:g of misoprostol in the form ofTab Arthrotec 50 was administered every two hours up to three doses. Other group of patients had received extraamnioticPGF2" solution. Main outcome measures were induction-abortion interval, cost-effectiveness and thefrequency of side effects. Induction was considered successful where abortion was achieved within 24 hours. Results:The average induction-abortion interval in the misoprostol group was 16.09±9.38hours.Successful abortions wereachieved in 79.41 percent(27/34).Total failures were seven of 34 cases. In the PGF2" group, all women aborted within20.24±11.57 hours, 76.47 percent (26/34) of which aborted within 24 hours. Conclusion: The acceptable expulsiontime, clinically insignificant side effects and the abortion rate obtained, showed that misoprostol by vaginaladministration may be an alternative method for interrupting gestation of 10-28 weeks.