Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

BackgroundHuman Papillomavirus (HPV) is well known pathogen that can cause benign and malignant tumors in humans, yet there is very little information regarding HPV types prevalent in Pakistan.MethodsA total of 92 cervical secretions were collected from suspected married female patients and used for DNA isolation using a novel isolation method. The samples were tested through Polymerase Chain Reaction (PCR) using already reported primers MY09/MY11, GP5/GP6, GP5+/GP6+, CP65/CP70, CP66/CP69 and SPF1/SPF2 and with those developed in this study including HRT1 and HRT2 primer sets for typing HPV types and HACTB primer set for human beta actin gene as internal positive control. Sequencing and phylogenetic analyses were performed for two isolates to determine circulating HPV types.ResultsPCR with HRT1 and HRT2 indicated 2 (2.17 %) patients were positive for HPV type- 16 while 1 (1.08 %) with HPV type 18. Sequencing and phylogenetic analysis of isolates confirmed HPV type-16 in genus alpha 9 which have 99 % homology with already reported HPV from Japan and Costa Rica.ConclusionThis is the first report of HPV type-16 genus alpha 9 in Pakistan and the reported assay and sequence data will serve as valuable tools in further epidemiological studies for HPV surveillance to improve public health, especially of females in Pakistan.

This is case report of 40 years female who presented at term and was co-infected with COVID-19. She had history of previous 3 C-sections so another C-section was performed due to fear of uterine rupture. Her surgery went uneventful. She recovered after surgery from COVID-19. Her infant also tested negative for COVID-19.

The Society of Obstetricians & Gynecologist Pakistan Hypertensive Disorders of Pregnancy (SOGP- HDP) guideline is evidence based practical clinical guide to the management of pregnant women with hypertension. It defines hypertension, preeclampsia & severe hypertension, encourages measuring blood pressure (BP) accurately, preferably by automated/mercury blood pressure monitors. The guideline gives an approach to screening, risk prediction and prevention of preeclampsia and management of hypertensive disorders of pregnancy. The guideline emphasizes experienced team management approach and mandatory hospital protocols for the management of pregnant women with hypertension. The aim is to have locally tailored easy to follow protocols for preconception care, screening, prevention and management of women at risk of preeclampsia; management of chronic hypertension in pregnancy, antihypertensive therapy for severe and non-severe hypertension. In addition, it discusses post-partum management, contraception, follow-up, discusses risk of recurrence and long-term follow up for women with preeclampsia to mitigate future cardio-metabolic risks to maternal health associated with hypertensive disorders of pregnancy

INTRODUCTION: Chronic hepatitis C treatment has been transformed by advent of DAAs. Pakistan is one of worst affected country with hepatitis C with recent suggested prevalence of 4.9%. Current AASLD guidelines recommend treatment with daily sofosbuvir plus daclatasvir with or without addition of weight based ribavirin. However this regimen is not first line recommendation. These drugs are available free of cost in government run setups. However it has raised questions about treatment failure with them and need for other DAAs. METHODS: This cross-sectional study is being conducted at ABSTH Gujrat from Oct. 2018 after approval of IRB and informed consent of patients using non-probability consecutive sampling. No genotyping is being done. Cirrhosis is considered when abdominal ultrasound shows coarse echotexture of liver as either Shear Wave Elastography or Fibroscan are not available. Treatment naive chronic hepatitis C patients without cirrhosis are being included. Patients on PCR testing having viral load of <400000 IU/L are being considered to have low viral load and are being given 12 weeks regimen of daclatasvir plus sofosbuvir. Patients with having viral load of >400000 IU/L are being considered to have high viral load and are being prescribed 24 weeks regimen of daclatasvir plus sofosbuvir with weight based ribavirin. ETR and SVR24 at 24 weeks are being noted. Patients who fail to achieve SVR24 after achieving ETR are being declared as treatment failure. Data analysis is being done using SPSS 20.0. RESULTS: 1073 patients have been included this study till now. Mean age is 46.01 + 11.50 years. 712(66.4%) are female and 361(33.6%) are male. 729(67.9%) patients with low viral load received daclatasvir plus sofosbuvir for 12 weeks while 344(32.1%) patients with high viral load received daclatasvir, sofosbuvir and weight based ribavirin for 24 weeks. ETR and SVR24 have been reported of 163(15.2%) patients till now. All these patients achieved ETR however only 161 patients achieved SVR24. One patients had high viral load while other had low. Treatment failure rate is 1.23% till now but exact figure can only be predicted after completion of study as more results are awaited. CONCLUSION: Treatment failure rate in treatment naive chronic hepatitis C patients without cirrhosis with daclatasvir plus sofosbuvir with or without ribavirin is low. Similar results have been reported previously. However these preliminary results show that there is need to investigate the factors leading to treatment failures.

Abstract Objective: To evaluate the pregnancy outcome of human immunodeficiency syndrome-positive mothers. Method: The prospective observational study was conducted at the Department of Gynaecology and Obstetrics, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan, from June 2011 to March 2018, and comprised pregnant women screened positive for human immunodeficiency syndrome. Risk factors and perinatal outcomes were noted on a predesigned proforma. Data was analysed usingh SPSS 20. Results: Of the 74 subjects with a mean age of 29+5.27 years, 63(85.1%) were multiparous and 11(14.9%) were nulliparous. Major risk factors included unsterilized nasal or ear piercing in 70(94.6%) subjects, history of blood transfusion 57(77%) and history of dental procedure in unsterilized settings 23(31.1%). Spouses of 43(58.1%) subjects were positive for human immunodeficiency syndrome, 22(29.7%) were negative and 9(12.2%) had unknown status in this regard. In terms of outcome, 12(16.3%) subjects had spontaneous abortion, 11(12.2%) had intrauterine death of foetus, 6(8.1%) had preterm delivery and 45(60.8%) reached full term and were delivered. There were 2(2.6%) patients with stage 4 disease who died during pregnancy. Conclusion: Human immunodeficiency syndrome infection in pregnant women was found to be associated with poor pregnancy outcome. Key Words: HIV, Pregnancy, Pakistan, Perinatal, Risk factors. Continuous...

To determine the diagnostic accuracy of ROSIER scale in patients with ischemic stroke taking non-enhanced CT scan brain as gold standard. Materials and Methods: Cross-sectional study conducted at tertiary care hospital in Gujrat from October 2019 to December 2020. Patients of both sex groups aged 30- 75 years presented in emergency within 24 hours of onset of focal neurological deficit which is objectively present and suspected of ischemic stroke. 289 patients were included. Patient history and neurological examination done calculating ROSIER scale and ischemic stroke diagnosed after CT scan brain done 24 hours after onset of symptoms. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of ROSIER scale were calculated. Data analysis was done using SPSS 20.0. Results: In this study group 141(48.8%) were male while 148(51.2%) were female. Mean age was 62.1+11.02 years. 49(17%) patients were aged <50 years while 240(83%) were aged >50 years. 215(74.4%) presented within 12 hours while 74(25.6%) after 12 hours of symptoms onset. Sensitivity of ROSIER scale for diagnosing ischemic stroke was 98.86%(95%CI;95.96%-99.86%), specificity 5.31%(95%CI;1.97%-11.20%), PPV 61.92%(95% CI;60.82%-63.01%) and NPV was 75%(95%CI;38.13%-93.59%). LR+ was 1.04(95%CI; 1.00-1.09) while LR- was 0.21(95%CI; 0.04-1.04). Conclusion: ROSIER score can be used as initial screening test in patients with stroke. It has high sensitivity but low specificity and is a good test to rule in and rule out stroke patients.