Prevalence and management of anencephaly at Saidu teaching hospital, Swat

Anencephaly is a fatal congenital abnormality characterised by absence of cerebral hemisphere and cranial vault. Overall incidence of anencephaly is 3.8-6.0/1,000 births. This study was conducted to determine the prevalence, diagnosis and management of anencephaly in District Swat. This Prospective study was carried out over a period of one year from January 2007 to December 2007 at Saidu Teaching Hospital/Saidu Medical College Swat. Pregnant women having foetuses with neural tube defects [NTDs] admitted in Labour Room/Obstetric Ward of the Saidu Teaching Hospital Swat were selected as subjects. Those women who delivered normal babies were taken as control subjects. A proper history was taken from each subject and all the relevant information were recorded on a proforma. A total of 5,560 subjects were included in this study. Out of them, 69 were having NTDs, 63 had anencephaly, 4 had spina bifida, and 2 foetuses were having multiple neural tube defects. Prevalence of anencephaly was 11.33/1000 births and that of spina bifida was 0.72/1000 births. Eighty percent [80%] anencephaly and 50% spina bifida were diagnosed by ultrasonography. Most of the cases [52, 75.36%] were delivered through normal vaginal delivery after induction. Twelve [17.40%] had spontaneous vaginal delivery, 4 [5.80%] had caesarean section, and hysterectomy was done in 1 [1.45%]. Anencephaly is common congenital anomaly in Swat. Complications can be prevented by implementing screening program for early diagnosis, treatment, and management. Prevalence can be decreased by folic acid supplementation periconceptionally

Heterozygous beta thalassemia in parents of children with beta thalassemia major

Beta thalassemia is the most common single gene disorder causing a major genetic health problem in the world. Beta thalassemia is common in Pakistan. This study was conducted to find out the pattern of transmission of beta thalassemia in the affected families. One hundred families having children with beta thalassemia major were analyzed at Postgraduate Medical Institute, Lady Reading Hospital Peshawar, Pakistan, for detection of beta thalassaemia trait. Screening was performed in both maternal and paternal parents and grandparents. Four hundred and fifteen [69.2%] cases of heterozygous beta thalassaemia were detected in the survey of 100 families [600 subjects], having beta thalassaemia major children. Altered red cell morphology such as hypochromia, microcytosis and aniso-poikilocytosis were seen in all these cases. Haemoglobin A2 level ranged 4.0-6.9%, MCV of less than 77 fl and MCH of less than 26.4 pg were found in all the subjects with beta thalassaemia trait. The frequency of consanguineous marriages in parents was first cousin 72%, second cousin 5%, distant cousin 4% and un-related 19%. Consanguinity was found to be present in most of the parents of patients with beta thalassaemia major. This can be minimized by health education, nation-wide screening and provision of genetic counseling to the affected families

Detection of abnormal cervical cytology by Pap smears

Cervical intra-epithelial neoplasia and cervical cancer remain important health problems for women worldwide. Cervical cytology by Papanicolaou stained smears is an effective means of screening for cervical pre-malignant and malignant conditions. This study was designed to determine the prevalence of cervical intra epithelial neoplasia in this region and the role of pap smears for its detection. It was hospital based study on patients who attended the Out Patient Department of Lady Reading Hospital, Peshawar, Pakistan, from January to September 1997. Patients presenting with vaginal discharge, dyspareunia, post-coital bleeding, backache or pain hypogastrium were included. Patients having vaginal bleeding other than post-coital, were excluded from the study. Relevant information was obtained from the patients and recorded. Samples were collected and transferred to glass slides, fixed and stained by Papanicolaou stain. Each slide was carefully examined. Three hundred patients were included in this study. One hundred and twenty three [41%] patients had complaints of vaginal discharge, 39 [13%] post-coital bleeding, 108 [36%] dyspareunia and 30 [10%] backache and /or pain hypogastrium. Regarding contraception, 37 [12.33%] patients were pill users, 31 [10.33%] were on injectable contraceptives, 32 [10.67%] were using barrier method of contraception, 34 [11.33%] patients were having an intrauterine contraceptive device and 160 [55.33%] patients were not using any method of contraception. Pap smears revealed that 8 [2.67%] patients were having cervical intra-epithelial neoplasia. Among these patients, 1 [12%] had intra-uterine contraceptive device, 3 [38%] were on oral contraceptive pill, while 4 [50%] were not using any contraceptive method. One hundred and seventy eight [59.33%] patients were having past history of genital infection where as 128 [42.67%] patients had no such history. Age at first coitus was below 20 years in 268 [89.33%] patients whereas it was above 20 years in only 32 [10.67%] patients. All these patients belonged to poor socio-economic class. Cervical intra epithelial neoplasia is not uncommon in our set up. It can be diagnosed early by Pap smears