Pap smear, an important screening tool to detect precancerous stage of carcinoma of cervix

Many women can be saved from carcinoma of cervix by detecting and treating its precancerous stage. Pap smear is cheap and easily available in majority of institutes. The objective of this study is to determine the frequency of abnormal Pap smear and role of Pap smear in detecting precancerous stage of cancer cervix in women. This is retrospective descriptive study was conducted in gynaecology outpatient department of Isra University Hospital, Hyderabad, Sind from Nov 2006 to Oct 2009. All women who presented in OPD with gynaecological complaints were included in the study. Pregnant women were excluded from the study. Smear was collected with an Aryes spatula and relevant information was obtained from the patient's record and recorded on pre-designed Performa. Slides were then sent to pathology department. Data were analysed through SPSS-15 and presented as frequency and percentage. Total 981 women underwent Pap smear screening. Majority [63.3%] of the patients belonged to age group of 31-40 years. One hundred and eighty [18.34%] smears were normal and 792 [80.7%] were abnormal. Among these abnormal smears, 739 [75.33%] smears were inflammatory while 4 [0.40%] women had Ca in situ and 4 [0.40%] had squamous cell carcinoma. Pap smear is an important screening tool to detect precancerous stage of carcinoma of cervix. It should be done periodically in all married and high risk women for early detection of a precancerous stage

Laparoscopic evaluation of female infertility

Sub-fertility is inability to ensure child bearing when it is wanted. Prevalence of sub-fertility in industrialised countries has been quoted as 20%, and seems to be on the rise. Traditional way to assess the uterine cavity, tubal structure and tubal patency was hysterosalpingography but it has now been largely superseded by laparoscopy and hysteroscopy. The objective of this study was to highlight the role of laparoscopy in establishing diagnosis of female infertility. This descriptive study was conducted in Gynaecology Unit of Liaquat University of Medical Health Sciences, Hyderabad, Pakistan from 28[th] August 2000 to 1[st] July 2001. Total 200 sub-fertile patients attended the gynaecology OPD. Out of these 30 patients were selected for laparoscopy and dye test who were suspected cases of endometriosis, abnormal HSG and unexplained infertility. Those patients who had medical disorders and contraindication for laparoscopy were excluded from study. Detailed history of every patient was recorded on a proforma and physical examination was performed. Laparoscopy was scheduled in proliferative phase of menstrual cycle. Data were analysed using SPSS 11. Frequency and percentages were calculated to describe the results. Out of 200 sub-fertile patients total 30 patients were selected for laparoscopy. Twenty [66%] patients were in primary infertility group while 10 [33%] patients were in secondary infertility group. Eleven [55%] patients of primary infertility belong to age group of 18-25 years while 6[60%] patients of secondary infertility belong to age group of 26-33 years [TABLE 1]. Mean duration of sub fertility at time of presentation in primary infertility group was 1.95 years while in secondary infertility was 2.70 years [Table 2]. In primary infertility group main associated symptoms were dysmenorrhoeal in 8 [40%], irregular cycles 5 [25%], and dyspareunia in 4 [20%]. In secondary infertility group 3 [30%] patients had dysmenorrhoeal and dyspareunia while 2 [20%] had irregular cycles. The commonest cause observed in patients with primary infertility was endometriosis spots which accounted for 11 [55%]. In secondary infertility tubal occlusion was more common which accounted for 3 [30%]. Laparoscopic procedures are less invasive, more convenient and more precise for diagnosis of sub-fertility in women

Silent uterine rupture at 24 weeks in twin gestation

Scar dehiscence is a preventable condition. If recognized earlier, the lives of the woman and child may be saved. We present a case of twin pregnancy with a previous lower segment caesarean section. The uterus ruptured at 24 weeks of gestation without uterine contraction

Presence of postgraduate students in gynecology outpatient department: how do patient feels?

Objectives: the purpose of this study was to document the views of patients about presence of postgraduate students during gynecology consultation, to highlight the reasons of acceptance or refusal of student's participation in outpatient care and to make implications for both patient satisfaction and medical training

Design: descriptive study

Place and duration of study: conducted on patients who attended gynaecology outpatient services at Isra university hospital from 1st April to 1st June, 2007

Patients and methods: total 115 patients were selected randomly. 20-40 year aged patients were included in this study while pregnant women and unmarried girls were excluded. Total number of postgraduate students was 15. No more than six students were present at a time during consultation. All were female trainees for fellowship of College of Physicians and Surgeons Pakistan [FCPS] trainees. These trainees were present to observe and discuss management of patients with consultant. Written informed consent was taken from all women for participation in this study. Information was collected through questionnaire

Results: mean age of the patients was 33.35 years. Out of 115 patients, 78.3% [90] patients felt comfortable in the presence of post-graduate students and accepted their presence, while 21.7% [25] patients refused their presence. Among 78.3% [90] women who accepted the presence of students, 96.7% [87] were willing to be examined in front of students in future, if they come to hospital for any other problem. While 3.3% [3] patients refused to be examined in front of students

Conclusion: majority of patients were willing to have postgraduate students presence during their consultation. Women who refused their presence, had reasons of previous bad experience, shyness, no privacy, diversion of doctor's attention from patient to trainee and because number of trainees were more during examination . Reducing number of trainees during consultation and doing discussion with post graduate students at the time when patient have left the room will further increase the willingness of patients for students presence. Information brochure should be distributed to patients highlighting the benefits of clinical teaching may help to persuade some unwilling patients to reconsider the presence of post graduate students

Innovation in teaching strategies for undergraduate medical students at Isra University Hyderabad, Sindh-Pakistan

Objective: to evaluate the academic performance and to assess the experience of 4th year MBBS students before and after introduction of Problem Based Learning Curriculum [PBLC]

Study design: a comparative study

Place and duration of study: academic session of 2006-2007 at Isra University Hyderabad, Sindh-Pakistan

Subjects and methods: one-hundred and nine students of 4th year MBBS were taught Obstetrics and Gynecology by Traditional curriculum [TC] and Problem Based Curriculum; both for 150 hours. Their academic performance was evaluated by 06 continuous assessment tests [CATs] scheduled fortnightly. At the end of every curriculum their experiences were recorded on a questionnaire. Data were analyzed and Chi- square test and student's t-test were used to obtain significant values

Results: study detected statistically significant difference of class test attendance [p<0.001] and marks obtained in each test [p<0.001] after PBLC and TC. Students liked PBLC more and their experience was excellent and good [p<0.001] with PBLC than with TC. Classroom attendance was not different in both curriculum as 75% of attendance was required by student to be eligible to appear in the end-semester examination as per rules of examination department of the university

Conclusion: PBLC introduced in the 4th year MBBS at Isra University with traditional curriculum significantly improves the academic performance of students. Students' experience of PBLC was good and they liked it because of more understanding of the subject, feeling of independence and confident

Obstetric hysterectomy

A review of 83 cases of obstetric hysterectomy performed at Liaquat Medical College Hospital over a period of 30 months from January 1992 to June 1994. During same period 9685 deliveries were conducted, giving an incidence of 1 obstetric hysterectomy per 116 deliveries. The most common indication for obstetric hysterectomy was uterine rupture 42[17%], leiomyoma 2[2.4%] and established uterine infection 6[7.2%]. In 62% of hysterectomies performed for uterine rupture, the etiological factors appeared to be obstructed labour or oxytocin augmentation. In 48% of hysterectomies performed for placenta accrela there were one or more previous Caesarean sections