Gestational diabetes; sensitivity, specificity and diagnostic accuracy of glucose challenge test in diagnosis

To find sensitivity specificity and diagnostic accuracy of Glucose Challenge test in diagnosing Gestational Diabetes in Pregnant women. Due to poor socioeconomical and educational status, dietary habits and ignorance regarding pregnancy related problems probably increase the prevalence and burden of gestational diabetes mellitus [GDM] and its complications in pregnancy. Best and simple strategy to identify women with gestational diabetes is still lacking and unclear. Cross sectional study. This study was performed at Jinnah Hospital Lahore, from Nov 2005 to Dec 2006. A glucose challenge test [GCT] was performed on 500 selected pregnant women by giving 50-g glucose in water orally. A serum glucose level ?140 mg/dl after an hour was taken as positive test. To confirm GDM, 75 g glucose in 200 ml of water was given and sugar levels after 2 hrs by Glucometer, >200 mg/dl confirmed GDM. An increasing trend in age, gestational age and BMI and a significant difference regarding positive family history of diabetes and gravidity was seen in patients with GDM compared to normal pregnant. The maximum percentage of GDM 2 was noted in multigravida, between 25-29 years, BMI >28kg/m, and a gestational age of 28 weeks. The sensitivity of GCT was 80%, specificity 97.8%., and diagnostic accuracy was 96.4%. Screening is necessary to identify women with GDM. A 50-g glucose challenge test might be acceptable as a screening test for GDM as it has high sensitivity, specificity and diagnostic accuracy

Postnatal encephalitis: a diagnosis not to be missed

Viral encephalitis is a common condition but only a few studies are available on occurrence of viral encephalitis in postnatal women. The objective of this study was to determine the frequency of postnatal encephalitis among patients presenting with cerebral neurological complications during puerperium and to determine a response to 10 day course of acyclovir therapy and final outcome of the patients. This cross-sectional descriptive study was conducted at Department of Medicine, Unit A, Ayub Teaching Hospital, Abbottabad from Jan to Dec 2011. All patients presenting with encephalitis in their postnatal period were enrolled. Eclampsia patients were excluded from study. The diagnosis of encephalitis was made on clinical assessment, CSF routine examination, CT scan and MRI. Among patients 16 [84.2%] presented with fever, 13 [68.42%] with headache, 8 [42.1%] with meningeal irritation, 7 [36.84%] with hemiparesis, 18 [94.7%] with altered sensorium, 13 [68.42%] with seizures, and 7 [36.84%] with coma. Cerebrospinal fluid of 16 [84.21%] patient had the changes consistent with viral encephalitis. It was normal in 2 [10.52%] patients and showed picture of pyogenic meningitis in 1 [5.26%] cases. On CT scan of brain, 3 [15.78%] had normal scans, 3 [15.78%] had cerebral oedema, 4 [21.05%] had ischemic infarct, 3 [15.78%] had meningo-encephalitis, 2 [10.52%] had infarct plus cerebral oedema, 1 [5.26%] had encephalitis and 3 [15.78%] had infarct plus haemorrhage. On MRI brain 15 out of 17 [88.2%] had lesions consistent with encephalitis. All 19 [100%] patients were treated with 10 days course of acyclovir and a broad spectrum third generation antibiotic. After hospitalisation 11 [57.8%] patients were discharged with complete recovery, 5 [26.31%] were discharged with partial recovery and 3 [15.78%] patients expired. Clinical presentation of the patient is most important in diagnosing viral encephalitis in postnatal women especially when patient presents with fever, altered sensorium and convulsions. Acyclovir therapy should be started without delay while awaiting other investigations.

Pattern of gynaecological malignancies in tertiary hospital

To analyze the pattern of genital tract tumour in terms of their age, mode and stage of presentation, histological subtypes and treatment modalities. Gynae Unit-1 Jinnah Hospital/Allama Iqbal Medical College, Lahore from Oct 2007 to Oct 2009. All cases of genital tract malignancy admitted through OPD, emergency or referred to the unit were included in the study. A proforma was designed for each type of genital tract cancer and its details entered through history, examination and investigations. The staging and grading systems as designed by FIGO[7] were used. The data was collected and analysed through SPSS version 10. During the two years, 63 cases of genital tract malignancies were recorded. The most frequent cancer was ovarian seen in 35 [55.6%] with mean age 48 years. Among them two third of cases were with stage 3 and 4 disease. Epithelial ovarian cancer was seen in 26[41.3%] and abdominal hysterectomy and bilateral salpingoophrectomy and nodal dissection was carried out in 16 patients. Fertility preserving surgery was done in young patients with germ cell tumors and were given chemotherapy post-operatively. Cervix cancer was seen in 14 [22.2%], with mean age of 45 years. Among them five patients [35.7%] presented with stage 2 were given radio chemotherapy. Endometrium cancer was seen in 12[19%], with mean age of 50 years. Among them nine patients [75%] presented with stage 1 and 2, and were treated by radical surgery followed by radiotherapy and three patients [25%], in stage 3 and 4 were treated with radiotherapy. One patient [1.6%] of vulval carcinoma was 55 years of age with stage 2 squamous cell carcinoma. She was given radiotherapy. One patient [1.6%] of choriocarcinoma was 40 years of age and was given chemotherapy. Ovarian cancer was the most frequent gynaecological malignancy, which presented at an advanced stage due to late referral. A strong referral system should be developed between primary, secondary and tertiary health centres for screening of general population and high risk group and treatment of affected cases. Awareness about modification of risk factors, and management guidelines also need to be adopted

Use of internet by medical students in their basic and clinical skills

The potential of using internet for medical education is widely accepted in enhancing their knowledge, skill and attitude. To assess the ability, accessibility and attitudes of medical students about use of information technology for e-learning in improving their basic and clinical skills. A qualitative descriptive study carried out at Gynae Unit II and ENT Unit I, Allama Iqbal Medical College/Jinnah Hospital, Lahore from January 2007 to April 2007. One hundred and fifty medical students each from last three years of MBBS were included in the study. A self-administered questionnaire was applied to them which included their demographic details and perceived level of IT [information technology] ability and accessibility. Four hundred fifty undergraduate students participated in the survey. There were 49% females and 51% males with similar average age. Among students 88.5% were using internet for educational purposes either at home or in college computer lab. However, the average use per week was 3.4 hours. Google, Yahoo and Ask were three most commonly used search engines. Majority [90%] of the students said that they are not getting input from their teachers on e-medicine should be the part of education from first year onwards. Undergraduate medical students have a reasonable access and perception for internet based learning and this should become a part of medical curriculum from the first year of MBBS. Medical teachers should facilitate the use of internet as an important tool of learning. Internet facilities should made widely available in the medical colleges to help them in enhancing their skills

Crimean congo hemorrhagic fever in hazara division

Background: Crimean-Congo Hemorrhagic fever [CCHF] is endemic in certain areas of Pakistan with 14 outbreaks in addition to many sporadic cases so far. It is highly fatal zoonotic disease caused by bite of infected tick. The objective of our study is to describe clinical features, treatment and outcome of CCHF positive cases during its outbreak in Hazara division, with the intention to bring focus to this fatal emerging disease. Methods: This study was conducted in Medical A Unit of Ayub Teaching Hospital, Abbottabad for a period of three months. All patients presenting with fever and platelet count less than 50, 000/mm3 were included in the study. Apart from baseline investigations their blood samples were sent for the detection of CCHF virus. All patients were given supportive treatment including fresh frozen plasma and were started on oral Ribavirin. All patients were isolated and barrier personal precautions were observed by health care givers Results: Eighty-eight patient with fever and thrombocytopenia were included. Among these, 8 were found to be positive for CCHF. Supportive treatment with oral Ribavirin was given to all patients. One patient with CCHF died. One left against advice and six patients recovered completely. Conclusions: All patients presenting with acute fever and thrombocytopenia should be suspected and evaluated for CCHF. Oral Ribavirin is safe and effective in the treatment of CCHF. Keywords: Crimean Congo Hemorrhagic fever, Pakistan, Ribavirin

Pregnancy induced rhinitis

Objective of this prospective study was to evaluate the occurrence of nasal congestion during pregnancy. Nasal congestion during pregnancy in 54 patients was evaluated at 12, 20, 28 and 36 weeks and was correlated to age, parity and body mass index. Results were recorded on the basis of subjective experience of patients. The prevalence of nasal congestion increased during pregnancy and occurred in 16% of women at 12 weeks of gestation, in 25% at 20 weeks, in 29% at 28 weeks and in 30% at 36 weeks. It was more common in multiparous women. Age and body mass index were not associated with nasal stuffiness. More than half of the patients reported nasal congestion for more than two weeks during pregnancy. Nasal congestion should be recognized and referred for treatment to improve the quality of pregnancy

Experience with pelvic masses following hysterectomy for benign diseases

This observational analytic study was carried out in gynae unit II, Jinnah Hospital, Lahore from January 2001 - Dec 2003 to evaluate nature, clinical presentation and treatment of pelvic masses which appear after hysterectomy. The ages of patients ranged from 30-65 years. In a total of 43 cases, 34 [79.1%] patients were operated abdominally and 9 [20.9%] patients underwent vaginal hysterectomy at least 1 year ago. Nine [20.9%] patients had lost operation record so ovarian conservation or removal could not be ascertained. According to sonographic appearance 24 [55.8%] patients had simple unilocular cyst, 8 [18.6%] had complex mass and 11 [25.6%] presented with solid mass. Eleven [22.58%] patients were managed conservatively with spontaneous resolution. Twelve [27.9%] patients were treated with USS guided aspiration. Nineteen [44.18] patients with complex and solid masses were managed surgically. Masses were benign/malignant ovarian tumours, hydrosalpinx, fluid loculation with bowel, retroperitoneal tumours and broad ligament cyst. Among these 19 patients two sustained small bowel injury intraoperatively. Postoperative complications of wound included infection in two and deep vain thrombosis in one patient

Septic induced abortion- the prevalence, logics and complications

This study was conducted at Jinnah Hospital, Lahore during the period of one year from January 2003 to December 2003. The purpose of the study was: to determine the prevalence of the problem in gynaecological patients, to identify the reasons for seeking abortion, and lastly to assess the range of complications. Out of 6036 gynaecological patients, 102 [1.69%] were presented with a septic induced abortion. Among these, 68 patients [66.6%] had more than 3 children, 10 women [9.8%] were unmarried, 12 patients [11.76%] had contraceptive failure, whereas 22 women [21.57%] were totally unaware of the contraceptive measures. Fifteen patients [14.7%] were cured by medical treatment, 63 [61.7%] required evacuation and curettage for retained product of conception, whereas 24 patients [23.5%] required laparotomy and one necessitated hysterectomy for irrepairable damage for the uterus. The common reason was found to be the lack of adequate contraceptive awareness

Management and perinatal consequences of pregnancy induced hypertension

The prevalence of pregnancy Induced hypertension [PIH] and its characteristics were studied among the deliveries conducted between November 94 and October 95. The prevalence of PIH was 8.66% It was related to parity, 58.63% patients were primigravida. About half of the multigravida patients had PIH In their previous pregnancy. About 3/4 of the patients came without antenatal visit and 43.6% patients had severe PIH. perinatal complications were more common in patients coming through emergency

Epidural analgesia and labour mechansms

The impact of f-pidural Analgesia on labour rnechanisms was studied in eighty primigravida The age group varied between 19-31 years. At term 22 cases [27.50%] underwent induction of labour while others presented with spontaneous onset of labour. Duration of labour in 69 parturients [86.25%] was normal. Prolonged labour inspite of oxytocin augmentation encountered mainly in induction, group. Spontaneous vaginal delivery occurred in 46 [57.50%] parturients. In 26 parturients [32.50%] instrument delivery dug to fetal distress, malrotation of head and prolonged second stage was done. Eight cases [10%] delivered via caesarean section. No ontoward effect was seen on apgar score of neonates due to epiduarl block