Comparison of pre and post Foley catheter Bishop's Score: A retrospective record review at Aga Khan University Hospital Karachi, Pakistan.

Objective: To compare pre and post Foley's catheter Bishop Score during labour induction. Methods: This study was a retrospective study conducted at the Aga Khan University Hospital Karachi, Pakistan after approval from ethical review board. All women who underwent induction of labour with Foley's Catheter at gestation of 37 weeks or more from September 2014-October 2015 were included. Data was entered and analyzed in Statistical Package for Social Sciences (SPSS) version 19.0. The comparison between pre and post Foley's catheter Bishop Score during labour induction will be calculated by Wilcoxon sign test. Results: There were 981 cases of inductions of labour, 749 (76.3%) received Foley's catheter, in combination with prostaglandins and oxytocin. About 68% were vaginal deliveries while 32% underwent C-section. Two third of women had bishop <4. Overall, Bishop score improved significantly in all patients with the catheter however, maximum benefit was seen in patients where the catheter was placed for 10-12 hours. Conclusion: Foley's is the better and safer option. In view of our results, It has been recommended to keep the Foley's for 10-12 hours to get significant improvement in bishop score.

Subchorionic hematoma and pregnancy outcomes in patients with threatened miscarriage.

Objective: To compare maternal and perinatal outcomes in patients with threatened miscarriage with or without subchorionic hematoma (SCH) at a tertiary care hospital. Methods: This retrospective cohort study was conducted at Aga Khan University Hospital. The study included 200 patients of <20 weeks singleton pregnancy with threatened miscarriage from January 2016 till December 2018. These patients were divided into two groups based on the presence (study group) or absence of subchorionic hematoma (control) on ultrasound imaging. Baseline demographic data, and obstetric outcomes were compared for the two groups. Results: The incidence of subchorionic hematoma was observed to be 30.5% (61/200). Most of the patients of SCH and non SCH groups presented in first trimester. Age and BMI were similar for both groups however there were more multigravida patients in the SCH group (63%versus 46.7%, P=0.12). A higher number of patients in the SCH group ended up in spontaneous miscarriage in contrast to patients with no SCH (13%versus6.1%, P=0.07) and also had a greater proportion of small for gestational age (SGA) babies (8.9%versus3.9%) though no statistical significance was observed. There were more preeclamptic patients in SCH group as compared to non SCH group (4.8%versus0.7%) and the trend was statistically significant(P=0.05). However, no significant correlation of hematoma size and adverse pregnancy outcomes was found in SCH group. Conclusion: Our study shows that women with threatened miscarriage having SCH are at a higher risk of having preeclampsia and SGA and hence these pregnancies warrant greater surveillance.

Impact of pregnancy on cancer survival: Experience at a tertiary care hospital.

OBJECTIVES: To assess the overall survival of pregnant women diagnosed with cancer during pregnancy or became pregnant thereafter. METHODS: A retrospective medical record review of 90 patients who were diagnosed with cancer when pregnant or who became pregnant thereafter between 1996 and 2015 in Aga Khan University Hospital, Karachi. RESULTS: A total of 90 patients were analyzed. The malignancies that expectant mothers had were, breast cancer 38 (42.2%), hematological cancers 29 (32.2%), brain cancer 10 (11.1%), and other malignancies 13 (14.4%) that included thyroid cancers, gestational trophoblastic disease and synovial tumor of foot. We observed only four deaths out of 90 patients and mean survival time in pregnant patients with malignancies was 17.98 years [CI 16.35-19.31]. CONCLUSIONS: The diagnosis of most cancer types before or during pregnancy does not influence on overall survival of patients.

Hybrid simulation training: An effective teaching and learning modality for intrauterine contraceptive device insertion.

Background: Hybrid simulation training (HST) is a teaching modality that combines patient interaction using simulated patient (SP) with pelvic model. This provides realism to learners, lacking in manikins alone. This study was designed to compare knowledge, procedural, and communication skills of medical students regarding intrauterine contraceptive device (IUCD) insertion before and after introducing HST and to assess learner satisfaction with this methodology. Methods: This quasi-experimental mixed-method study was conducted at Aga Khan University Hospital, Karachi, from October 2016 to September 2017, for third-year medical students (n = 90). IUCD insertion was introduced to students through interactive session and provision of literature/video clip on IUCD insertion. Students were pretested on objectively structured clinical examination -station (IUCD insertion) using SP and manikin simultaneously. This was followed by practice on manikin and subsequent posttest on same OSCE-station. Learner evaluation of activity was through validated pro forma with both, Likert scale and open-ended questions. Results: Out of the 90 students, 73 completed pre/posttest and evaluation survey. There was significant increase in pre- and post-simulation mean scores for all clinical skills; history taking (5.1 pretest, 8.8 posttest, P ≤ 0.0005), counseling (40.11 pretest, 57.85 posttest, P ≤ 0.0005), procedural (15.16 pretest, 49.09 posttest, P ≤ 0.0005) and total scores (60 pretest, 115.6 posttest, P ≤ 0.0005), when compared using two-sided Wilcoxon signed rank sum test. Overall, activity was assessed as "very good" to "excellent" by 83.5% participants. Themes generated from open-ended questions of evaluation forms were "Process-descriptors," "Teaching-utility," "Pedagogic-efficacy" and "Way-forward." Discussion: HST is an effective teaching strategy with potential to improve competency of medical students. Students acknowledged it, as innovative learning strategy that increased their satisfaction and confidence in performing IUCD insertion.

Natural osmolytes alleviate GRP78 and ATF-4 levels: Corroboration for potential modulators of unfolded protein response.

AIMS: Osmolytes are small organic molecules which play a significant role in maintaining functional homeostasis of proteins under extreme hostile stresses. Any imbalance to cell homeostasis leads to Endoplasmic Reticulum stress (ER-stress) to which a set of cellular responses both at transcriptional and translational level are initialed for restoration of cellular homeostasis called Unfolded Protein Response (UPR). In the present study we evaluated the role of Sarcosine, Betaine, Hydroxyectoine and Ectoine as potential modulators of UPR. ER-stress was induced by Tunicamycin, a prototypic experimental ER-stress inducer. MAIN METHODS: The endogenous cellular levels of UPR markers Glucose-Regulated Protein 78 (GRP78) and Activating Transcription Factor-4 (ATF-4) were evaluated in presence and absence of these osmolytes after inducing UPR with tunicamycin. As a prelude to this, IC50 values of these osmolytes were determined by using cell viability assays like MTT and Trypan Blue exclusion assay. KEY FINDINGS: We found that these osmolytes in a dose-dependent manner increased the rate of restoration of homeostasis as was evident by the decreased endogenous levels of GRP78 and ATF-4. SIGNIFICANCE: These natural osmolytes can thus be useful in therapeutic intervention to mitigate the pathophysiological state resulting from ER-stress.