Survey of patient awareness and beliefs regarding emergency contraception

To investigate patient's knowledge and beliefs regarding emergency contraception and its use. Cross-sectional descriptive study. A six months cross-sectional descriptive study, from 1[st] July 2009 till 31[st] December 2009 carried out at Shifa international Hospital [SIH] and Shifa community health centre [SFCHC] Islamabad. All married women of reproductive age coming to SIH or SFCHC clinics after informed consent were interviewed regarding their knowledge of emergency contraception. A total of 770 women were interviewed, but the data was completed for 759 women. 131 women [17.3%] had knowledge about emergency contraception but only 79 [10.4%] had actually used this method for contraception. There is a very low awareness level regarding emergency contraception among women of developing countries even in the urban population

Association of computational ability and digit span in schizophrenia patients

Present study is an endeavor to assess the relationship between computational abilities and digit span in patients of schizophrenia. Schizophrenia is characterized by various executive function disabilities; working memory is one of few very important aspects among these. The construct being very significant in understanding the cognitive deficits associated with the schizophrenia, has been reported to be well assessed by various indices. Present study is an endeavor to study the performance of patients of schizophrenia on two of them that is, an Arithmetic test and a Digit span measure. It was assumed that the two set of scores will be highly correlated in patients of schizophrenia. For the purpose 101 individuals were included as participants in the study, 57 of them were the diagnosed patients of schizophrenia while the remaining 44 were the controls selected from the community. Both of the groups were tested on Arithmetic and digit span tasks. Results reflect that scores of schizophrenia patients on both measures were found significantly correlated [r=.610, p<.001], while in controls the association found was not significant [r=. 169, p>. 05]

Metformin therapy prevents early pregnancy loss in polycystic ovarian syndrome

The study was done to compare the early pregnancy loss rate in women with polycystic ovarian syndrome who received or did not receive metformin in pregnancy. A case control interventional study carried out at Civil Hospital Karachi, Hamdard University Hospital and Private Gynaecology clinics from January 2005 to July 2008. Eighty two non diabetic patients with polycystic ovarian syndrome who became pregnant were included in the study. A questionnaire was filled for all patients that included information on basic demography and mean age, parity, weight. Fasting blood sugar and serum insulin levels were done for all these women. Only patients with raised insulin levels [more than 10 mu/l] were included in the study and all were offered to use oral metformin throughout pregnancy as 500mg three times a day with folic acid supplements 5mg once daily. Those who agreed to take the drug throughout pregnancy and to comply with the therapy were taken as cases, while those who did not agree to take the medicine acted as controls. Patients with other causes of recurrent pregnancy loss were excluded from the study. All pregnancies were followed using serial ultrasound examination to see any pregnancy loss in the two groups. Eighty two cases of polycystic ovaries with pregnancy were seen during the study period. All cases had raised serum insulin levels. Fifty patients agreed to take metformin through out pregnancy while, 32 cases did not agree to take metformin during pregnancy and thus acted as controls. The two groups did not differ in mean age, parity, weight and mean fasting blood sugar levels. Fasting insulin levels were high in metformin group [18.40 mu/l] than in controls [12.53 mu/l]. Missed abortion rate was significantly lower [12%] in metformin group than in controls [28%] [p<0.028]. No congenital anomalies were found in both the groups on ultrasound at 16-19 weeks. Metformin treatment during pregnancy significantly reduced the rate of early pregnancy loss in women with polycystic ovarian syndrome. Metformin should be given during pregnancy in cases having polycystic ovarian syndrome with high insulin levels

Trauma scale for disaster situations

This paper presents the TSDS-Trauma Scale for Disaster Situations that was developed after the recent earthquake in Pakistan. The TSDS was developed for children and adolescents of 10-16 years i.e. 6-10 graders. Ratings from five experts were taken on items to determine scale content validity that is 0.72[cvi] with an inter-rater reliability of 0.9alpha with significant infra-class correlation. Scale was administered to 382 children to establish the scale reliability [0. 7alpha] and test re-test reliability [0.93alpha]. The scale has 10 items that explain 87% of the variability. The tests for TSDS were started in immediate post-disaster phase and completed in recovery phase thus can be used in late recovery phase to determine residual characteristics associated to trauma and PTSD. Scale covers the core criteria for diagnosis apropos DSM-IV

Management and maternal outcome in morbidly adherent placenta

To describe the management and maternal outcome in diagnosed cases of morbidly adherent placenta. Descriptive case series. Hamdard University Hospital and Two private hospitals, from May 2005 to June 2009. All diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay were recorded. Thirty cases of morbidly adherent placenta diagnosed on doppler ultrasound scan were identified. Scheduled caesarean hysterectomy without attempting placenta removal, was done. Sub total hysterectomy was performed in 26 cases and total hysterectomy in remaining 4 cases. Two patients sustained urinary bladder injury and two went into DIC. One needed ventilatory support. No patient died in this series. Significantly reduced maternal morbidity was observed. In diagnosed cases of morbidly adherent placenta, antenatal diagnosis and avoidance of placental separation and caesarean hysterectomy results in better maternal outcome

Comparison of different concentration of bupivacaine [0.1%] / 0.2% with fentanyl 2 micro gram/ml by epidural infusion for labor analgesia

To evaluate the efficacy of 0.1% Bupivacaine versus 0.2% Bupivacaine with fentanyl 2 microg/ml via epidural for analgesia in labour. Randomized study. Single centre study of 80 patients conducted at gynae unit of Imam Clinic and General Hospital Karachi. from Jan 2002 to April 2005. In a randomized study, 80 nulliparous parturients in labour had epidural analgesia initiated with 0.2% bupivacaine and fentanyl and were then randomized to receive either 0.1% Bupivacaine with fentanyl 2microg/ml at 10m1 /hr [Group B1.n = 38] or 0.2% Bupivacaine with fentanyl 2microg/ml at 8ml/hr [group B2 n= 39] as epidural infusions. Bupivacaine 0.2% 5m1 as an epidural bolus was provided on request as Supplementary analgesia. There were no significant differences between the visual analogue pain scores either with respect to motor or sensory block. The amount of local anaesthetic used was lower in 0.1% Bupivacaine group then in 0.2% Bupivacaine group [P = 0.001] Side effects, patient satisfaction, labor outcome and neonatal outcome were similar in both groups. Epidural infusions of 0.1% Bupivacaine with fentanyl 2 microg/mI at 10-m1/ hr provided adequate analgesia in the first stage of labour. The level of analgesia was similar to that obtained using 0.2% Bupivacaine with fentanyl 2 microg/ml and with no differences with regard to sensory or motor block

Discuss the effects of surgical ligation and percutaneous embolization of testicular varicocele on improvements in fertility parameters

Varicocele is term used to define as abnormal dilatation of testicular vein and or its collaterals with retrograde venous blood flow. It is treated by two techniques surgical ligation and percutaneous emblization. It is claimed in various international journal that varicocele is a leading cause of male infertility and shows significant improvement in fertility parameters and pregnancy rate after treatment of varicocele either by varicocelectomy or gondal vein embolization but we have disproved this claim in our study. A retrospective study with few prospective cases. It is retrospective study with few prospective cases. We have selected all those infertile male patients who under gone varicocele treatment. We obtained hormonal assay, seminal assay as pre-treatment baseline values as well as post-treatment values at 1,2,3 and 6 months intervals. Couples were also followed for pregnancy for up to 5 years. Total cases selected were pre-treatment and post-treatment. Results were analyzed and compared with those published in national and international journals. No significant improvement was observed in fertility parameters and pregnancy rate. This signifies that varicocele is not significant and leading cause of infertility in males. Treatment of varicocele either by surgical ligation or percutaneous embolization did not showed any significant improvement in fertility parameters and pregnancy rate. This signifies that varicocele is not significant and leading cause of infertility in males

role of amniotic fluid index in the management of postdate pregnancy

To evaluate the role of amniotic fluid index as a reliable fetal surveillance test in the management of postdate pregnancy. Cross-sectional analytical study. Hamdard University Hospital from May 2000 till May 2003. A total of 210 patients were studied. The antenatal fetal surveillance in these patients was based on ultrasound assessment of AFI twice weekly after 41 weeks. An abnormal AFI was defined as > 6 cm, between 6-8 cm as equivocal and more than or equal to 8 as normal. Delivery outcome and early neonatal complications were main outcomes. Rate of caesarean section [35.8%] in the women with AFI > 6 cm was found significantly higher than 8.9% rate of caesarean section of the women having AFI > 6 cm [p = 0.001]. Proportion of early neonatal complications was also significantly higher in the women with AFI > 6 cm [p = 0.03]. Out of a total 210 fetuses, 38 [18.1%] neonates were found with early complications, of these, 24 [63.2%] neonates were those whose AFI was > 6 cm. Sensitivity of AFI was 63.2% while specificity was 83.1% as the power of reliable fetal surveillance. AFI is a reliable fetal surveillance test. It may allow the conservative approach till 42 weeks to reduce the caesarean section rate due to failed induction of labour as well as perinatal morbidity and mortality

comparison of oral misoprostol tablets and vaginal prostagl and in E2 pessary in induction of labour at term

To compare the cost-effectiveness, mode of delivery, fetal and maternal outcome of oral Misoprostol and vaginal prostagl and in E2 pessary in induction of labour at term. R and omized clinical trial. Hamdard University Hospital, Imam Clinic and General Hospital from February 2002 to January 2003. The trial was conducted over two groups of patient for labour induction such that Group A received 50 micro g oral Misoprostol 4 hourly to a maximum of four doses. Group B received prostagl and in Es vaginal pessary at 6 hourly intervals up to two doses. Labour induction, number of doses, need of augmentation, induction to delivery time interval, mode of delivery and neonatal outcome were the main outcomes. Test of proportions was used to compare the significance between both managements. Out of a total of 214 women, 106 received oral Misoprostol and 108 received PGE2 vaginal pessary. Ninety-three percent women in misoprostol group were successfully induced compared with 91% in PGE2 group. A significant response of labour induction with the minimal dose [58%, p = 0.001] and earlier induction to vaginal delivery [74%, p=0.01] was observed in Misoprostol group. Rate of operative delivery was also less [16%, p = 0.16] compared with PGE2 group [25%]. Oral Misoprostol administration was more efficient and cost-effective than PGE2 vaginal pessary for induction of labour due to earlier response with minimal dose and less number of operative deliveries

Validity of visual analogue scale in assessment of anxiety: a comparative study in anesthesia clinic

To compare the level of Pre-Operative anxiety in patients reporting 24 to 72 hours before Surgery in Government Hospital, with patients assessed 24 to 72 hours before Surgery in Private Hospital. Comparative study. Out patient Anaesthesia clinic at Karachi Medical and Dental College, Abbasi Shaheed Hospital and Imam Clinic and General hospital North Nazimabad Karachi from January 2004 to October 2004. Two groups of 20 patients each were studied who underwent Abdominal hysterectomy. Group-A patients were assessed in Pre-Anaesthesia out patient Clinic 24 to 72 hours before admission in Abbasi Shaheed Hospital [Government hospital] and Group-B had Pre-Anaesthesia assessment 24 to 72 hours before surgery in private sector hospital. The visual analogue scale of anxiety [VAS] was used to assess anxiety in patients participated in study and p-value was derived by using independent t-test: The median anxiety score is 4[2-6] in Group A and 6[4-9] in Group-B. This anxiety score [VAS] is significantly lower Group-A when compared with Group-B [P< 0.01]. We conclude that Pre-Anaesthetic assessment in Anaesthesia clinic 24 to 72hours before Surgery in Government Sector hospital reduces Pre-Operative anxiety more when compared with an Pre-Anaesthesia assessment in private sector hospital

Outcome of obstructed labour

To evaluate the faetal and maternal morbidity and mortality associated with obstructed labour. Material and A prospective study of outcome of obstructed labour was conducted in Gynae 'A' Unit of Khyber Teaching Hospital, Peshawar, over a period of two years extending from 1st December 1996 to 1st December 1998. 6280 deliveries were conducted during this period and 284 cases of obstructed labour were found constituting an incidence of 4.52%. 94.8% patients came in emergency and 5.2% were booked patients. The most common cause of obstructed labour was cephalo-pelvic disproportion [47.5%] followed by fetal malposition and malpresentation [45.5%]. The majority of these patients were between 25-29 years of age and primigravida. Caesarean section was the most common mode of delivery. Maternal morbidity due to different complications accounted for 84.1% of the cases while fetal morbidity occurred in 47.8% of the cases. The maternal mortality in this series was 1% and perinatal mortality 38%. In our study the incidence of obstructed labour is very high. Improving the access to and promoting the use of reproductive and contraceptive services will help reduce the prevelance of this complication