Comparison of Baseline Characteristics, Sociodemographics, and Gynecological Risk Factors Associated with Secondary Infertility of Females in Pakistan.

Introduction: Secondary infertility is characterized by the inability to conceive for a period of 1 year, after having previously conceived at least once. Objectives: To explore the risk factors of secondary infertility and compare sociodemographics and anthropometric variables of each studied group. Methods: Study was conducted at University Institute of Public Health, Faculty of Allied Health Sciences, The University of Lahore, collecting data from Gilani Ultrasound Center in 18 months after approval of synopsis. Total 690 females (345 cases and 345 controls) were enrolled. Participants were included in case group if they were 20-45 years of age, having any parity, and confirmed diagnosis of secondary infertility. Results: The mean age of cases and controls was 33.08 ± 4.17 years and 31.37 ± 4.36 years, respectively. The mean body mass index (BMI) in cases was 27.61 ± 4.27 kg/m2, and in controls the mean BMI was 25.52 ± 4.30 kg/m2. There was not a significant difference among religion that shows no association (p = 0.73) with secondary infertility as profession has association with it (p = 0.01). History of polycystic ovary syndrome, pelvic inflammatory disease, endometriosis, uterine fibroids, menorrhagia, intermenstrual bleeding, and history of abortion are associated with secondary infertility. Conclusions: While several sociodemographic features and medical disorders have been associated to secondary infertility, it is vital to stress that not all of these factors are controllable by medical therapy. Factors like age and certain medical issues may be unaffected by intervention. However, for controllable variables like BMI and certain medical diseases, focused therapies and lifestyle changes may reduce the chance of subsequent infertility.

Predicted risk factors associated with secondary infertility in women: univariate and multivariate logistic regression analyses.

Introduction: Infertile women are those who regularly engage in unprotected intercourse for a period of at least 1 year and are unable to become clinically pregnant. Primary infertility means the inability of couples to conceive, without any previous successful pregnancies. Secondary Infertility refers to the inability to get pregnant for 12 months, after having a previous pregnancy for one time at least. The objectives of the current study were to analyze risk factors for secondary infertility and compare the predictive accuracy of artificial neural network (ANN) and multiple logistic regression models. Methods: The study was conducted at The University Institute of Public Health collecting data from Gilani Ultrasound Center 18 months after approval of synopsis. A total of 690 women (345 cases and 345 controls) were selected. The women selected for the case group had to be 20-45 years of age, had any parity, and had a confirmed diagnosis of secondary infertility. Results: Multiple logistic regression (MLR) and ANN were used. The chance of secondary infertility was 2.91 times higher in women living in a joint family [odds ratio (OR) = 2.91; 95% confidence interval (CI) (1.91, 4.44)] and was also 2.35 times higher for those women who had relationship difficulties with their husband [OR = 2.35; 95% CI (1.18, 4.70)]. Marriage at an earlier age was associated with secondary infertility with ß being negative and OR being < 1 [OR = 0.94; 95% CI (0.88, 0.99)]. For the logistic regression model, the area under the receiver operative characteristic curve (ROC) was 0.852 and the artificial neural network was 0.87, which was better than logistic regression. Discussion: Identified risk factors of secondary infertility are mostly modifiable and can be prevented by managing these risk factors.

Audit of Operative Notes Against Royal College of Surgeons Guidelines in a Tertiary Health Care Surgical Unit in Lahore.

Operative notes are important documentation made by the surgical team after a surgical procedure. They outline what happened during the surgery and several aspects of post-operative instructions. The aim of this audit was to compare current practices regarding documentation of these operative notes in a tertiary care hospital in Lahore. The standards used were the recommendations made in the good surgical practice guidelines by the Royal College of Surgeons (RCS) of England in 2014. A prospective closed-loop audit was conducted using a checklist constructed using the RCS guidelines. In the first audit, which was done to analyze current practices, 44 consecutive handwritten operative notes were evaluated. The findings of this initial audit were presented to the surgical team in a local meeting and recommendations were made. Forty-eight consecutive operative notes were then analyzed in the re-audit done after an interval of one month. The findings of the re-audit were presented to the surgical team. An overall 35.7% improvement was noted in the documentation of operative notes after the completion of the audit cycle. Certain parameters analyzed, such as thromboprophylaxis, antibiotic prophylaxis, and anticipated blood loss, were much more frequently documented in the re-audit. In our study, implementation of recommendations such as restructuring of the operative notes pro forma and improving awareness regarding the RCS guidelines significantly improved the quality of operative notes that were being documented. Such audits should be conducted regularly to maintain and improve the standards of documentation in all surgical units.

Sonographic Presentation of the Geyser Sign.

A case of geyser sign with acromioclavicular (AC) joint cyst with underlying rotator cuff tear is presented. Ultrasound modality is used to diagnose the clinical case of the AC cyst with positive geyser sign. A 91-year-old male patient presented with a complaint of right-sided shoulder and neck pain. The physical examination revealed a large lump on his right shoulder with restricted shoulder movements. During ultrasound examination, a chronic supraspinatus tendon (ST) tear and AC joint cyst with a positive geyser sign was observed. The ultrasound diagnosis was also confirmed with magnetic resonance imaging (MRI). AC joint cyst with geyser sign is a rare condition. Few cases have been published with this type of pathology. To our knowledge, this is the first report of its kind from Pakistani population.