Patient registry is a powerful tool for planning health care and setting groundwork for research. This survey reports a detailed registry of inherited bleeding disorders (IBD) and their management at a not-for-profit organization in a developing country to form the basis for planning development and research. We reviewed medical records of patients with IBD from 8 hemophilia treatment centers of Fatimid Foundation located in various cities. Information collected included sociodemographic data, diagnostic tests, severity of hemophilia A and B, number of bleeding episodes per year, site and frequency of hemarthrosis, and seropositivity for viral diseases. We analyzed 1497 patients from November 1, 2015, to April 30, 2016. There were 1296 (87%) males and 201 (13%) females with a mean age of 24.5 (11) years (range, 6 months to 65 years). Hemophilia A constituted the bulk of IBD (848, 57%) followed by von Willebrand disease (172, 11%), hemophilia B (144, 10%), platelet function defect (106, 7%), and rare bleeding disorders (70, 5%). Mucocutaneous bleeding (1144, 76%) and hemarthrosis (1035 patients, 69%) were the main complications. There were 1026 (69%) patients who received only blood components for treatment of any bleeding episode while the remaining 464 (31%) were on combination therapy (blood components and factor concentrate). Seroreactivity for hepatitis C was frequent (28%), while hepatitis B (1%) and human immunodeficiency virus (0.01%) were less commonly seen. This study was an important step toward a patient registry in a hemophilia treatment center in Pakistan. Hemophilia A is the most common bleeding disorder and hepatitis C is the most frequent treatment-related complication.

Objective: Over bearing, appendectomies have continuously been pushing the surgical wisdom to connote on non-operative option of treatment so this study was designed with an objective to assess the outcomes of antibiotics as primary therapy for un-complicated acute appendicitis. Methods: A total of 96 patients of both genders from 16 to 60 years of age having uncomplicated acute appendicitis enrolled in this study were treated with antibiotics and were discharged on third day with having oral treatment on ciprofloxacin (500mg) twice a day and metronidazole (400mg) thrice a day for 07 days. Routine follow up was taken on days 15, 30, 90 180 and 360 and outcomes were recorded. Results: Among 96 patients, 10 (10.41%) worsened in symptoms (pain on visual analogue scale) were confirmed with WBC & Ultrasound reports and under went for appendectomies during initial hospital stay. While within 9 months, during follow up 11 (11.45%) patients were readmitted in hospital and operated after confirmation on re-examination and re-investigations. Total of 21 (22%) patients were subjected to appendectomy. Conclusion: Under proper observation, antibiotic treatment can be safe and effective in un-complicated acute appendicitis with reduced recurrence.

Background: Outpatient hysteroscopy is a safe, reliable and cost-effective alternative to hysteroscopy under a general anaesthetic for the diagnosis of abnormal uterine bleeding. Objectives: The objective of this study was to introduce new technique of pseudo-vaginoscopy for better movement of hysteroscope and less procedural pain. Also to assess acceptability of patients for outpatient hysteroscopy when appropriate analgesia was given prior to the procedure. Methodology: A prospective study was conducted of 74 women attending for outpatient hysteroscopy at the West Cumberland Hospital over a period of one year. Selection criteria include very narrow and atrophic vagina and failed speculum examination in gynaecology outpatient clinics. Results: Of the women studied, 95.5% stated that they would recommend the procedure to friends in future, whilst 5.8% would not want to go through it again. The type of anaesthetic administered during the procedure seem to influence whether women would attend for outpatient hysteroscopy in future. Conclusion: Our pseudo-vaginoscopic approach allows more freedom for the scope movements not limited by the speculum with the advantage of prior cervical preparation.  It was certainly at value for operative outpatient hysteroscopy in patients with very high BMI where access was difficult owing to depth.

Introduction: Antenatal corticosteroids are recommended by Royal College of Obstetrics and Gynaecology for caesarean section planned before thirty-eight plus six weeks gestation. However, these steroids are, not suggested for labour induced electively after thirty four weeks. Objective: This study’s aim is to enumerate the possibility of respiratory morbidity in neonates for various deliberated approaches of delivery between thirty-five and thirty eight weeks gestation. Methodology: This study was carried out during June 2018 and December 2020 at a tertiary obstetric unit and analysed 3796 neonates delivered between thirty-five and thirty eight weeks gestation for neonatal admission due to respiratory morbidity. Results: The risk for respiratory problems in spontaneous labour was 9.9% (16/161), 5.0% (12/238), 1.2% (5/426) and 0.64% (6/930) at thirty five, thirty six, thirty seven and thirty eight weeks of gestation respectively. For induced labour, it was 25% (4/16), 4.8% (5/104), 4.1% (13/318) and 0.82% (4/485) at thirty-five, thirty six, thirty seven and thirty eight weeks respectively. While the risk of respiratory morbidity in elective caesarean section, was 13.8% (4/29), 27.1% (13/48), 4.1% (5/122) and 2.8% (9/318) at thirty-five, thirty six, thirty seven and thirty eight weeks respectively. Overall chance of respiratory morbidity in neonates was 6% after elective caesarean section, 2.8% after labour induction and 2.2% after spontaneous labour (p< 0.0001). The number of neonates with respiratory problems born by elective C-section was only 31 out of total 132 (23.5%). Whereas this risk was 2.8% at 35-38 weeks and 5.0% at 35-37 weeks after induced labour. Conclusion: Elective delivery at 35-38 weeks is linked to respiratory morbidity in new born babies. More research is required to assess the role of prophylactic corticosteroids preceding elective induction of labour.

Objective:  The objective of this study was to find out frequency of anastomotic leak at a hospital and deplore the morbidities, duration of hospital stay.Methods:  A total of 102 patients of both genders from 18 – 60 years in age underwent for bowel resection and anastomosis through laparotomy incision at surgical unit one of People’s University of Medical & Health Sciences, Nawabshah, from January 2013 to December 2016 were enrolled in this cross-sectional study. Every patient received appropriate antibiotics for duration according to need post-operatively. Follow-up was every fortnightly for four months to evaluate the primary outcome as prevalence of leak and secondary outcome as morbidities, length of hospital stay incisional hernia and mortality.Results:  The results showed that, out of 102 patients underwent open primary hand sewn gastro intestinal anastomosis, 16 (15.68%) were found with anastomotic leak. Among these 16 patients having anatomic leak, 11 (11%) were male & 5 (5%) were female. While, mortality occurred in 05 (5%%) patients.Conclusions:  Anastomotic leak following gastrointestinal anastomosis is less complication in this study. Further studies are requested with large data and more follow-ups to ensure the findings of this study at national level.