Nida Zahid

Association of tobacco use and other determinants with pregnancy outcomes: a multicentre hospital-based case–control study in Karachi, Pakistan

Objectives The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan. Design A multicentre hospital-based case–control study. Setting Four leading maternity hospitals of Karachi. Participants A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery. Primary and secondary outcome measures Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, low Apgar score) and obstetric complications (antepartum haemorrhage, caesarean section, etc). Results Final multiple logistic regression analysis revealed that with every 1 year increase in age the odds of being a case was 1.03 times as compared with being a control. Tobacco use (adjusted OR (aOR): 2.24; 95% CI 1.56 to 3.23), having no slits in the kitchen (proxy indicator for indoor air pollution) (aOR=1.90; 95% CI 1.05 to 3.43), gravidity (aOR=0.83; 95% CI 0.73 to 0.93), non-booked hospital cases (aOR=1.87; 95% CI 1.38 to 2.74), history of stillbirth (aOR=4.06; 95% CI 2.36 to 6.97), miscarriages (aOR=1.91; 95% CI 1.27 to 2.85) and preterm delivery (aOR=6.04; 95% CI 2.52 to 14.48) were significantly associated with being a case as compared with control. Conclusions This study suggests that women who had adverse pregnancy outcomes were more likely to have exposure to tobacco, previous history of adverse birth outcomes and were non-booked cases. Engagement of stakeholders in tobacco control for providing health education, incorporating tobacco use in women in the tobacco control policy and designing interventions for tobacco use cessation is warranted. Prenatal care and health education might help in preventing such adverse events.

Aggressive fibromatosis in pediatric population—A case series

Highlights • Desmoid tumor or aggressive fibromatosis (AF) is a benign tumor of borderline malignant condition, it is infiltrative, deep-seated and muscoloapo neurotic in nature.• AF is commonly found among children below 15 years of age, affecting males more as compared to females.• Primary surgery is not the treatment choice among patients with positive margins as the risk of recurrence is higher after surgery. However, radiation and chemotherapy may assist in maintaining local control of these tumors in such patients.• Primary surgery with negative margins is the treatment choice for children with AF.

Recurrent renal cancer in Birt–Hogg–Dubé syndrome: A case report

Highlights • BHDS is a rare hereditary syndrome with a higher increased risk of, multiple lung cysts predisposing to recurrent pneumothorax, increased risk of renal cancer and fibro-folliculomas in the skin.• Renal Cell Carcinoma (RCC) is one of the most dreaded complication of BHDS and its diagnosis and management is very crucial.• Identification of FLCN defects in families with BHD has led to new insights in the penetrance and clinical variability of this syndrome.• FLCN sequencing should also be considered in patients and their families because incidence of renal cancer in BHD patients is very high and detection at early stages can prevent its metastasis.

An unusual presentation of diffuse large B-cell lymphoma with ureteric involvement: A case report

Non‐Hodgkins lymphomas are a heterogeneous group of malignancies in the lymphoid system and ureteric involvement by non‐Hodgkins lymphoma is very rare.

Association between leptin, obesity, hormonal interplay and male infertility

Male infertility is a major health problem worldwide. We investigated a possible association between leptin, obesity, hormonal interplay and male infertility. This cross‐sectional study of 313 males (178 infertile and 135 fertile) was carried out in 2017. The subjects were categorised by body mass index (BMI) and body fat percentage (BF%) into normal weight, overweight and obese. Significantly higher levels of BMI and BF% (p‐value < 0.001) and lower levels of FSH, LH, testosterone, and SHBG (p‐value < 0.001) were found in infertile males. However, no significant difference was observed in leptin levels (p‐value = 0.35). Leptin levels were significantly higher, and all the sex hormones were significantly lower (p‐value < 0.001) in obese subjects, whereas according to BF% only leptin, FSH and SHBG were significantly different. Leptin showed a significant positive correlation with BMI and BF% (p < 0.001). A strong positive link to serum testosterone was found with age, FSH, and LH (p < 0.001) and a negative one with BMI and BF% (p < 0.001). In mutivariable anlaysis, after adjusting for the other covariates, a significant association between FSH and testosterone (p‐value <0.001) was found. Serum leptin levels did not differ significantly in fertile and infertile groups, and no association was found with infertility. Furthermore, male obesity was found to be associated with infertility with the decrease in levels of sex hormones.