Analysis of risk factors, impact of diagnostic delays on presentation and management of ectopic pregnancy

Objective: To analyze risk factors and impact of diagnostic delays on presentation and management of ectopic pregnancy

Study design: Descriptive case series

Place and Duration of Study: Department of Obstetrics and Gynecology Unit- I, Sir Ganga Ram Hospital [SGRH] and Nawaz Sharif Social Security Hospital Lahore, from January 2012 to June 2013

Methodology: Women diagnosed with ectopic pregnancy were included in the study. Data was reviewed from the charts of all patients diagnosed with ectopic pregnancy through structured proforma. The variables studied included age, parity; symptoms and signs, risk factors, treatment and associated delays contributing to increased morbidity

Results: Total number of patients studied were 100. The peak age of ectopic pregnancy was between 21 to 30 year. It was found more in primigravida [n=60 - 60%]. The common identifiable risk factors were previous cesarean section [n=30 - 30%], infertility [n=25 - 25%], pelvic inflammatory disease [n=25 - 25%] and history of previous ectopic pregnancy [n=6 - 6%]. Phase I delay was present in 30 [30%] patients while same number of women experienced delay in proper referral. In 20 cases [20%] phase III delay was noted at hospital level. Most of the patients presented with abdominal pain [n=90 - 90%], pallor [n=80 - 80%] and features of shock [n=40 - 40%]. Ultrasound [US] confirmed diagnosis in 60 [60%] cases. In 95 [95%] patients it was of tubal variety out of which 70 [70%] were already ruptured. Salpingectomy was performed in 88 [88%] patients. There was no mortality in this series

Conclusions: The clinical presentation in most of the cases was different from usual resulting in delay in diagnosis. Majority of the patients required laparotomy and salpingectomy was performed in 88% patients

To study the role of serum bilirubin and lipoproteins in prediction of ischemic heart disease

Objective: to determine if serum bilirubin, when combined with various risk factors like lipid and lipoprotein predicts ischemic heart disease [IHD]

Material and Methods: hundred patients with IHD were included in the study from in and out patient departments of Medicine. 25 normal subjects were studied as controls. The traditional risk factors like cholesterol, high-density lipoprotein cholesterol [HDL-C], cholesterol/HDL-C ratios, triglycerides as well as serum bilirubin, albumin and creatinine were determined by standard methods. Besides, age, cigarette smoking, and systolic blood pressure were also recorded

Results: it was observed that the bilirubin is negatively correlated with hemoglobin, albumin, HDL and LDL-cholesterol. On the other hand a direct correlation with total lipid, cholesterol and ratio of cholesterol/HDL-cholesterol is also observed. High level of serum creatinine level was also found in the patients as compared to normal subjects

Conclusion: no definite relationship between serum bilirubin and I HD was observed

To study the role of serum biliurbin and lipoproteins in prediction of ischemic heart disease

An inverse relationship between the bilirubin level and ischaemic heart disease was accounted. Cross Sectional Study. This study was conducted at Dept. of Biochemistry, Fatima Jinnah Medical College, Lahore from Feb. 2007 to July 2007. Study was performed to determine if serum bilirubin, when combined with various risk factors like lipid and lipoprotein predict ischemic heart disease [IHD]. It is observed that the bilirubin is negatively correlated with hemoglobin, albumin, HDL and LDL-cholesterol. On the other hand a direct correlation with total lipid, cholesterol and ratio of cholesterol/HDL-cholesterol is also observed. High level of serum creatinine level was also found in the patients as compared to normal subject. Our study observed not a definite relationship between serum bilirubin and IHD. Hence the relationships between bilirubin and lipoproteins [risk factors of IHD] require further clarification, although abnormal intermediary metabolism and antioxidant deficiency may be possible linking factors

Pleural fluid estimation and tubercular infection in the people admitted with pleural effusion

We prospectively conducted this study to evaluate the diagnostic value of Pleural fluid estimation and find the rate of tubercular infection in the people with pleural effusion in city of Lahore. Pleural TB is a common form of extrapulmonary disease and may occur in the presence or absence of pulmonary parenchymal disease on the chest radiograph. Prospective Study. This study was conducted in the Biochemistry Department, FJMC, Lahore from May 2010 to Nov. 2010. This study to evaluate the diagnostic value of Pleural fluid estimation and tubercular infection in the people with pleural effusion. All patients aged 22 years and older with clinical and radiographic findings consistent with pleural effusion due to TB admitted to the hospital were evaluated consecutively. The studies were performed on pleural fluid samples: glucose and protein were estimated. Specific gravity was calculated. Cell count, differential cell count, bacterial culture, acid-fast bacilli smear were performed using standard procedures. Specimen was cultured, if effusion contains more than 150 WBC/cumm. It was observed that the level of fluid glucose was increased in both sexes as compared to the normal reported values. Level of fluid protein was more in both sexes as compared to the normal reported values. However level of pH was neutral in both sexes. Present study found that pleural TB is still a major cause of pleural effusion in the city of Lahore, and microbiological and biochemical investigation may be helpful in diagnosing the disease

BMI and lipid profile: a serious health threat for middle aged women

Study tried to find out factors that associated with the weight gain or increased BMI in middle aged women and lipid profile that may become a cause of different disease in women in middle/later ages. Study tried to find out factors that associated with the weight gain in middle aged women and lipid profile that may become a cause of different disease in women in middle and also in later ages. Cross sectional Study. This study was conducted at the department of Biochemistry, Fatima Jinnah Medical College, Lahore from August 2010 to October 2010. 50 females with age range 40-50 years were included in the study. The proforma of questionnaire recorded the age, socioeconomic status, BMI, blood pressure, dietary pattern, Physical activity and family history of female subjects. Lipid profile included total lipid, serum cholesterol, triglyceride, HDL-chil and LDL-chol were also estimated. It was observed that mean age at which females gained the weight is 45.23 years. Most females belong to class B and Class C. Females were over weight when compared with the standard criteria of weight to height ratio. No change in blood pressure was seen. A positive family history of obesity was also seen in many females. It was observed that the level of total lipids, cholesterol, triglyceride and LDL-cholesterol was significantly increased in female subjects as compared to normal subjects. In view of this study, it is suggested that a diet is not simply a list of permitted food but it may include the total count of calorie a person consume in the form of food in addition to cut down some percent of sugar, salt and oil. A regular exercise may help to maintain the circulation of blood and maintain the level of lipid profile

Women with pregnancy induced hypertension; epidemiological differences between normotensive pregnant women

To identify the epidemiological differences between normotensive pregnant women and women in pregnancy induced hypertension. A descriptive analytical case control study. Department of Obs and Gynae of Sir Ganga Ram Hospital Lahore. From January to December 2004. 2 groups with 100 patients in each were studied. PIH is more common in young, obese, primigravidas with a family or past history of PIH or hypertension and in those with poor socioeconomic status and no regular dietary calcium supplementation