Management of postmenopausal bleeding

To describe the appropriate management of women with postmenopausal bleeding [PMB]. Descriptive study in one year [Jan - Dec, 2012]. All patients with postmenopausal bleeding in one year were investigated and managed. Basic investigation was trans-vaginal sonography. Those with endometrial thickness more than 4 mm were further investigated by dilatation and curettage, then management strategy was planned according to the cause. A total of 23 patients were presented with postmenopausal bleeding [endometrial thickness > 4 mm] during one year. Among them 11 case were having first episode and the remaining had recurrent bleeding. Endometrial hyperplasia [simple] was the common pathology [52%], in whom surgical management [hysterectomy] was performed in 60% cases. Three cases [13%] were managed with MIRENA [levonorgestrel releasing intrauterine system]. Two case were diagnosed as endometrial carcinoma. Both of them were having advanced stage and were referred to Shaukat Khanum Hospital Lahore. Trans-vaginal sonography can reliably asses thickness and morphology of endometrium, thus risk group can be identified. Endometrial hyperplasia is the major cause of PMB. Dilatation and curettage, can provide sufficient diagnostic accuracy. Hysterectomy remained the main management of PMB patients

Outcome of teen age pregnancy

Teenage pregnancy is pregnancy in a female under the age of 20 [when the pregnancy ends]. A pregnancy can take place as early as two weeks before menarche [the first menstrual period], which signals the possibility of fertility, but usually occurs after menarche. Aim of the present study was to find out the fetal and maternal outcome of teenage pregnancy. It is a descriptive study carried out in one year, in District teaching hospital of Gomal Medical College D. I. Khan, Pakistan. Patients with pregnancy and aging below 18 years presenting to Gynae unit were followed up since 1[st] antenatal visit to delivery. Patient with teenage pregnancy and presenting first time in labour were also included in the study. They were looked for associated medical problems. The main outcome measures were health of mother, mode of delivery, weight of the baby, neonatal nursery admission and postnatal complications of mother. There is marked increase in hospital admission of the teenage pregnancies in last 3 years, probably because ofIDPS from Waziristan. The most common medical problems found was anaemia [HB < 10 gm] which was 67%. In a total of 92% of them delivered through. Normal vaginal delivery which shows close relationship of smaller babies, and laxity of the pelvic structure. Fifty four percent of the babies were weighing in 2.5 -3 kg range

Jervell and Lange Nielsen syndrome; prevalence in deaf children and its significance in relation to cousin marriages

This study was carried out to find out the prevalence of Jervell and Lange Nielsen Syndrome [JLNS] in deaf school children for impaired hearing and to correlate this with consanguineous marriages. Setup: Schools for deaf and dumb children and Sheikh Zayed Medical College, Rahim Yar Khan. Cross sectional, case control study. 2006-2007. Electrocardiographs [ECG's] of 114 congenitally deaf school children [ages 4-20 years] and also of 23 healthy children with normal hearing function of same age group were recorded. The corrected QT [QTc] interval of all 137 ECGs was evaluated by Bazett's formula. Mean QTc of healthy children was taken as reference of normal QTc interval. The deaf children with normal QTc were labeled as control group. Patients with long QTc were further evaluated for JLNS by applying Schwartz's criteria. We also calculated the relationship of the positive cases to consanguineous marriages. We found that 28 deaf children out of 114 cases had QTc intervals longer than 0.44 seconds. This interval was significantly longer [P=0.008] than the QT interval in control group. As per Schwartz's criteria, 15 out of 28 LQTs cases scored high points [3.5 to 5.5]. The presence of consanguineous marriage was 100% in first pedigree of these 28 children. JLNS [an alarming arrhythmic disease associated with congenital deafness] is significantly present [24.6%] in Rahim Yar Khan's deaf school children. The presence of cousin marriage was 100% in first pedigree of these children