Treatment for symptomatic bacterial vaginosis: a randomized controlled trial

Objective: To compare the efficacy of multiple doses of vaginal clindamycin with a single oral dose of secnidazole for the treatment of bacterial vaginosis. Study Design: Double-blinded randomized controlled trial. Place and Duration of Study: Shifa Foundation Community Health Center, from March 2012 till February 2015

Methodology: After obtaining written informed consent, a pelvic examination was performed for the confirmation of symptoms of milky white vaginal discharge on speculum examination, positive Amine test and presence of clue cells on microscopy. Pregnant women, known diabetes or any immunocompromised condition, were excluded. Blinding of the patient, doctor, and the pharmacist was done. Study cohort was then divided into two groups, Group A received medicine pack A which contained active clindamycin and placebo oral preparation, whereas group B was given pack B which contained active 2-gm secnidazole with placebo vaginal cream. Primary outcome and therapeutic success were defined by correction of two out of three [normal Nugent score, negative Amine test, and no milky white discharge] on day 15

Results: At 15[th] day of treatment, 96.6% participants in vaginal clindamycin group [Group A], recovered from the bacterial vaginosis; whereas, [group B] 23% patients were cured in oral secnidazole group

Conclusion: Multiple doses of vaginal clindamycin are superior to single dose of oral secnidazole for the treatment of bacterial vaginosis

Comparison between metformin and insulin in treatment of gestational diabetes mellitus and effect on neonatal hypoglycaemia

To compare the efficacy of metformin in the treatment of gestational diabetes mellitus [GDM] with insulin and to compare the frequency of hypoglycaemia in neonates of the mothers treated with metformin and insulin. Randomized control trial to compare the efficacy of metformin with insulin in the treatment of GDM. Outpatient department and labour ward of Obstetric and Gynaecology department of Benazir Bhutto Hospital Rawalpindi from August 2012 to January 2013. A total of 110 pregnant ladies with GDM diagnosed after 20 weeks of gestation were included and divided into group A and group B with 55 patients in each group. Group A patients were treated with insulin and group B with metformin. Plasma fasting glucose and two hours postprandial glucose levels were determined on weekly basis for four weeks after starting the treatment to determine the efficacy of insulin and metformin. At birth plasma glucose levels of all the neonates were carried out two hourly, and more frequently depending upon the requirement, during first 24 hours in both the groups to determine neonatal hypoglycaemia. Fasting plasma glucose in group A and B were calculated as 5.96 +/- 0.58 and 5.76 +/- 0.46 mmol/L respectively [p=0.280], while two hours post-prandial plasma glucose levels were 7.34 +/- 0.48 and 7.28 +/- 0.58 mmol/L respectively [p=0.650]. Efficacy in group A was 78.18% and in group B was 70.91% [p=0.381] while frequency of neonatal hypoglycaemia was calculated as 61.54% in group A and 41% in group B [p=0.113]. The efficacy of metformin in treatment of gestational diabetes mellitus is similar as with insulin and the frequency of hypoglycemia in neonates of the mother treated with metformin and insulin is also similar

frequency of hyperuricaemia and perinatal morbidity and mortality in Pakistani patients of pregnancy induced hypertension

To determine the frequency of hyperuricaemia in patients with pregnancy induced hypertension and to compare the early neonatal outcome between patients with hyperuricaemia and those without hyperuricaernia among patients with pregnancy induced hypertension. This is a descriptive case series study which was conducted in the Department of Obstetrics and Gynecology, Benazir Bhutto Hospital Rawalpindi, Pakistan from March 2011 to August 2011. One hundred and fifty pregnant women with pregnancy induced hypertension [defined as a BP > 140/90 diagnosed at the gestational age > 20 weeks on two separate occasions] were included by non-probability consecutive sampling in the labour room and the out patient department. These patients had their uric acid levels measured by Beckman Coulter Cx 9, fully automated chemistry analyzer using Beckman's uricase enzymatic, calorimetric, end point assay reagent. All patients underwent antenatal ultrasound with doppler studies in the last trimester to identify Intra Uterine Growth Retarded [IUGR] fetuses. These patients were followed till the time of delivery. The birth weight, NICU admissions and stillbirths/ intrauterine deaths were documented. The mean age of the patients was 27.48 +/- 4.3 years and the mean gestational age was 35 +/- 2.85 weeks. The uric acid level of the patients ranged from 148 to 755pmo1/L. The mean uric acid level of the patients was 372 +/- 106 pmol/L. Keeping the cutoff limit for hyperuricaemia as serum uric acid level > 325 pmol/L; we had 103 [68.7%] patients with hyperuricaemia. In the babies of these 103 patients, IUGR was seen in 99 [96.11%], IUD in 18 [17.48%], stillbirth in 2 [1.94%] and 72 [69.9%] were admitted to NICU. In the babies born to 47 patients who had no hyperuricaemia, IUGR was present in 32 [68.08%], 9 [19.14%] had IUD, 1 [2.12%] was stillbirth and 16 [34%] were admitted to NICU. Hence IUGR and admission to NICU were significantly more frequent among those with hyperuricaemia; p< 0.05. The mean birth weight of babies was 1.73 +/- 0.48 and 2.02 +/- 0.55 kg, respectively, among hyperuricaemic versus non-hyperuricaemic mothers; p= 0.002. Hyperuricaemia is frequent among patients with pregnancy-induced hypertension. Babies of patients with hyperuricaemia had significantly more IUGR, admission to NICU and significantly low birth weight