Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper.

Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we revised the available evidence to present an expert opinion that could support physicians, patients and policy-makers for considering this approach in other populations. We revisited systematic reviews, randomized controlled trials and cohort studies from January 2018 to August 2021 using PubMed and Google scholar, regarding short and long term outcomes after ablation with focused ultrasound waves. In total, 33 studies, including 114,810 adult patients showed that outcomes of this approach depend on several parameters directly related with resistance to thermal ablation, especially fibroid size and vascularization. Two studies report satisfactory outcomes in Afro-American women. In accordance to the technique used, fibroid volume reduction showed to be higher in fibroids <300 cm3 after ultrasound guided HIFU than after MRI guided. Compared to myomectomy and uterine artery embolization, HIFU seems to have shorter hospital stay, higher pregnancy rates and similar adverse events rates, with skin burn being the most reported. Symptoms and quality of life improvement is similar to myomectomy but lower than embolization, however reintervention rate is higher after HIFU. Lacks evidence about long-term sarcoma risk after ablation. Available evidence shows that HIFU can be considered as a uterine sparing treatment for women of different ethnicities suffering of uterine myomatosis, especially for those wishing to preserve their fertility.

Assessing the adherence of obstetricians towards postpartum diabetes screening guidelines: a pre- and post-intervention study at secondary care hospital in Karachi, Pakistan.

OBJECTIVE: To assess the adherence level of obstetricians towards postpartum diabetes screening guidelines. METHODS: The quasi-experimental pre- and post-intervention study was conducted from May 2014 to April 2015 at Aga Khan Hospital for Women-Karimabad, Karachi, and comprised all obstetricians practicing at the time. All the booked women with gestational diabetes delivered in the 6 months before refresher lecture (group 1) and those delivering in the 6 months following the intervention (group 2) were included. Data was analysed using SPSS 19. RESULTS: Of the 550 cases, 275(50%) each were in groups 1 and 2. All pregnant women had live-birth. The intervention made it thrice likely (95% confidence interval: 7.83) that a physician advised postpartum oral glucose tolerance test. Caesarean section increased the chances of getting test advice almost 4 times (95% confidence interval: 1.70, 9.10) compared to women who delivered vaginally. Women managed on insulin with / without metformin were 4 times likely to being advised the test compared to women managed on diet (confidence interval: 1.00, 17.09). Full-time employees advised 7 times more than the visiting obstetricians (confidence inter val: 1.33, 35.16). CONCLUSIONS: It is time for more strategic planning regarding patient education the benefits of detection of abnormal glucose tolerance in early postpartum period.

Assessing The Role Of Education In Adult Women's Knowledge And Awareness Of Human Papillomavirus And Human Papillomavirus Vaccine.

BACKGROUND: Awareness and knowledge of Human Papillomavirus (HPV) and HPV vaccine among women are not satisfactory in developing countries. The aim of this study was to assess the role of education in adult women about knowledge and awareness of human papillomavirus (HPV) and HPV vaccine. METHODS: This cross-sectional study was carried out in women aged 19- 50 years attending the out-patient waiting area of a tertiary care hospital in Karachi from August 2014 to August 2015. Convenience sampling was applied. After their written consent, a selfadministered questionnaire was used to obtain information regarding role of education and awareness, knowledge of human papillomavirus (HPV) and HPV vaccine. A total of 600 women completed the questionnaire. RESULTS: Mean age of the study participants was 39±10.7 years. About 68% (n=405) had an education level intermediate or less, while 33% (n=195) had a bachelors or higher degree. A total of 56.3% (n=338) women were aged less than 40 years. CONCLUSIONS: Awareness among women varies with the level of education acquired. As shown by results, a lesser proportion of undergraduate women were aware about HPV and its related diseases as compared women at graduate level. Moreover, our study identifies significant gaps in knowledge about sexually transmitted infections, HPV, cervical cancer and its prevention. There is an urgent need to develop public awareness programs targeting the adolescent and young adult women of our country.