Spectrum of gynecological malignancies at Jamshoro

Objective: To describe the frequency and spectrum of different types of gynecological malignancies. Study Design: An observational study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, from January 2014 to December 2015

Methodology: All patients with gynecological malignancies, admitted at the study place, whether previously diagnosed or need to establish the diagnosis on the basis of EUA, biopsy, staging and for surgery during the study period were included. All patients with benign gynecologic masses were excluded. Studied variables were age, marital status, parity, education, socioeconomic status, clinical presentation, clinical diagnosis, tumor site and surgical procedure. The diagnosis and type of malignancy was confirmed on the histopathology report of the specimen taken

Results: There were a total of 65 patients [6.39%] with gynaecological malignancies. The median age was 15 years [46.26%]. Ninety-four percent were married. Seventy-one percent had a poor socioeconomic status. Cervical cancer was most common as seen in 27 [41.5%] followed by ovarian malignancy in 21 [32.3%] of cases, uterine caners in nine [13.8%], vaginal cancer in six [9.2%], and vulval cancer in three [4.6%] of cases. The common histopathological type of cervical cancer was moderately differentiated squamous cell carcinoma [n=19, 29.2%], papillary serous cyst adenocarcinoma in ovarian [n=13, 20.0%], and squamous cell carcinoma in vagina and vulva. There was no case of primary fallopian tube malignancy

Conclusion: Gynecological malignancies are common in younger age group. The need is to strengthen screening practices, making it easy and cost-effective for all the general and at risk population, so that early detection and treatment can be possible to control the female genital tract cancers

Abdominal pregnancy

Abdominal pregnancy is a rare form of ectopic pregnancy associated with high maternal [0.20%] and perinatal [40-95%] mortality; surprisingly we had three consecutive cases of this condition. Case 1: Was referred from Taulka hospital where the patient presented as, four months gestational amenorrhea with acute diarrhea vomiting and severe anemia. She was treated symptomatically, transfused two units of blood and referred to Liaquat University Hospital with Ultrasound report showing suspicion of abdominal pregnancy. Case 2: Was newly married primipara who presented with four months gestational amenorrhea and severe lower abdominal pain. Ultrasound report showed a complex mass of 8.0cm just below the anterior abdominal wall [over the uterus] with alive fetus. The uterus was empty, so the diagnosis of abdominal pregnancy was made. Case 3: Was a young 19 years old lady, initially admitted in surgical unit as case of acute abdomen with history of five months pregnancy followed by D and C two weeks back by LHV [Lady Health Visitor], they collaborated with gynae unit due to this history. Examination showed septic, tender on palpation, on P/V examination some dry shrunken cord like structure with foul smelling discharge hanging out from vagina, identified a gut loop with uterine perforation. In this case abdominal pregnancy was diagnosed on surgery as ultrasound report could not give the clear picture. All cases were managed with surgical intervention. In first two cases fetuses were delivered alive but non viable, in third case fetus was dead macerated found within abdominal cavity in right side. In first case placenta was removed completely and in second case, it was adherent with adjacent structures not actively bleeding so left in situ and post operatively three doses of injection methotrexate were given. First two cases recovered completely while in third case patient required ICU care after surgery. All three cases who had different clinical presentations were diagnosed and managed successfully

Presentation of predisposing factors of pregnancy induced hypertension at Isra university hospital, Hyderabad

Objective: to determine the predisposing factors of pregnancy induced hypertension in women of our community

Methods: an observational study was conducted at Gynecology and Obstetrics Department of Isra University Hyderabad from July 2007 to June 2008. Women with pregnancy induced hypertension were recruited in this study by convenient sampling from antenatal outpatient department, admitted patient in the ward and prelabour room. A restructured proforma was filled in which their age, BMI, parity, gestational age and gestational age when PIH [pregnancy induced hypertension] was diagnosed, regarding diabetes, multiple gestation, cardiac and liver disease, history of PIH in previous pregnancies and positive family history of PIH were recorded

Results: one hundred pregnant women were included in the study. We found 59% of women in age group of 30-40 years, 52% were overweight, 50% were multiparous and 15% were of grand-multiparous, 43% of women had history of PIH in previous pregnancies, 9% had positive family history and 12% were with diabetes. Twin pregnancy was seen in 3% , cardiac disease in 2% , renal disease in 1% , and hepatic disease in 1%

Conclusion: the observations of present study indicate that women between 30-years and 40-years of age, overweight [BMI >25-kg/m2], multipara, diabetic and who had history of PIH in previous pregnancies are at higher risk of developing pregnancy induced hypertension

Evaluation of breast feeding practices

The best first food for babies is breast milk. This study was conducted to assess the percentage of population having knowledge regarding benefits of breast feeding, exclusive breast feeding and ratio of mothers practicing it. This observational study was carried out from January 2008 to June 2008, in the vicinity of Isra University Hyderabad. A sample of 285 women who attended the Gynaecology antenatal clinics, living in the vicinity of Isra University, also lady doctors working there were enrolled by convenient sampling. A pre-designed questionnaire was filled by interviewing these women. The data collected was statistically analyzed and percentages recorded. Breast feeding was practiced in 278[97.54%] of the study population and only 7[2.45%] women did not practice it. 130[44.56%] of women were knowing about benefits of breast feeding and 155[54.38%] were not aware about the benefits. Among those knowing about the benefits, only 3.2% were fully aware, 67% were feeding for health of babies and 29.8% for prevention from diseases. Information regarding exclusive breast feeding was collected, 198 [68.70%] were practicing it and 87 [31.29%] were not exclusively feeding their babies. Time duration of breast feeding noticed that 28 [9.82%] of mothers feed their child for <6 months but most of women 104 [36.49%] for 2 years and some of them even feed for >2 years. Breast feeding is well practiced in this community but the ratio of exclusive breast feeding is low. Mothers have poor knowledge of benefits of breast feeding

Familial predisposition of dysmenorrhea among the medical students

To evaluate familial predisposition of dysmenorrhea among the medical students of Isra University Hyderabad. An observational study was carried out at Isra University Hyderabad, from June to November 2007 in which a total number of 197 students participated.A pre designed questionnaire was administered to the female medical students in which their age, menarcheal age about menstrual cycle, presence or absence of dysmenorrhea, severity of symptoms and positive family history of dysmenorrhea in mothers and in sisters were asked. Exclusion criteria of the study were amenorrhea, irregular menstrual cycle and whose mothers and sisters had secondary dysmenorrhea as this study basically was concerned with primary dysmenorrhea and to observe familial risk. In this study dysmenorrheal was observed in 76%, the mean age of students was 20.9 SD +/- 1.7, mean age at menarche with dysmenorrhea was 13.2 SD +/- 1.1 and without dysmenorrhea was 12.7 SD +/- 0.9. Positive family history of dysmenorrhea was seen in 33% of mothers and 43% in sisters and there was a group of students who had positive history in both mothers as well as in sisters. We found significant correlation of positive family history with dysmenorrhea in the present study. This suggests that genetic factor is involved in the pathogenesis of primary dysmenorrhea and increases the familial tendency. Therefore positive family history could be the strong predictor for occurrence of dysmenorrhea in offspring and in siblings

Frequency of vaginal candidiasis in pregnant women attending routine antenatal clinic

To determine the frequency of vaginal candidiasis in clinically symptomatic and asymptomatic cases of pregnant women attending routine antenatal clinic. A descriptive cross-sectional study. The antenatal clinic of Gynaecology and Obstetric Department at Isra University Hospital, Hyderabad, from April to October 2005. A total of 110 pregnant women were nonrandomly recruited by convenient sampling. The studied variables included the demographic data information on parity, trimester of pregnancy, presence of vaginal discharge and the presence or absence of diabetes. Vulva and vagina were inspected for signs of inflammation and discharge with sterile speculum and vaginal specimens were collected with sterile cotton tipped swabs. Swabs were subjected to Gram staining and examined microscopically for the diagnosis of candidiasis. The frequency of vaginal candidiasis during pregnancy was found to be 38%, in which 27% were symptomatic and 11% were asymptomatic group. Increased ratio of infection was observed in multigravida and diabetic women. There was no marked differences in results with respect to age and trimester of pregnancy. Although there is generally a high frequency of vaginal candidiasis, an increased ratio of vaginal candidiasis in multigravida and diabetic pregnant women requires these women to be routinely screened for vaginal candidiasis regardless of symptomatic status

Efficacy of aloe vera gel in the treatment of vulval lichen planus

To compare the efficacy of aloe vera gel and placebo in the topical management of vulval lichen planus. Randomized, double-blind, placebo-controlled trial. Department of Dermatology, Isra University Hospital, Hyderabad, from January 2007 to January 2008. Thirty-four female patients were randomized into two groups to receive aloe vera gel or placebo for local application for 8 weeks. Clinical data and treatment response was graded according to Thongprasom criteria. Z-test was used for comparing response between the groups. Thirty-four consecutive patients participated in the study. We found erosive and ulcerative lesions in 83% and 17%, respectively. The most common site of vulval lichen planus was the labia minora. Fourteen [82%] out of 17 patients treated with aloe vera had a good response i.e. clinically improved by at least 50% after 8 weeks of treatment, while one [5%] of 17 placebo-treated patients had a similar response [p < 0.001]. Furthermore, one patient [5%] treated with aloe vera had a complete clinical remission. No side-effects were found in both groups. Aloe vera gel was a safe and effective treatment for patients with vulval lichen planus

Risk factors of birth asphyxia

Birth asphyxia is a serious clinical problem worldwide. There are many reasons a baby may not be able to take in enough oxygen before, during, or just after birth. Damage to brain tissues is a serious complication of low oxygen that can cause seizures and other neurological problems. This study was designed to asses the risk factors of birth asphyxia in neonates. This descriptive, prospective study was conducted in the Department of Paediatrics, from April 2005 to April 2006. 125 newborn [75 males and 50 females] admitted to the neonatal care unit, who were delivered with delayed cry or low apgar score [<7] were included. Detailed maternal history was taken, regarding their age, gestational age, and complications, if any. Out of 125 neonatal encephalopathy cases, 28% were diagnosed as suffering with moderate or severe encephalopathy, whereas 36% had mild encephalopathy. Risk of neonatal encephalopathy increased with increasing or decreasing maternal age. Antepartum risk factors included non-attendance for antenatal care [64%]. Multiple births increased risk in 4.8%. Intrapartum risk factors included non-cephalic presentation [20%], prolonged rupture of membranes [24%] and various other complications. Particulate meconium was associated with encephalopathy in 9.6%. 60% mothers were anemic. Vaginal bleeding was strongly associated with birth asphyxia in 34.44% of neonates. 56% of mothers delivered at home, while 28% delivered at a private hospital or maternity home. Only 12% delivered at a tertiary care hospital. Lack of antenatal care, poor nutritional status, antepartum hemorrhage and maternal toxaemia were associated with higher incidence of asphyxia. Improvements in the public health of women with associated gains in female growth and nutrition must remain a longer-term goal. Early identification of high-risk cases with improved antenatal and perinatal care can decrease such high mortality. Safe motherhood policy is recommended

Hyperhomocysteinaemia and acute myocardial infarction in patients admitted at Isra Uneversity Hospital, Hyderabad

Myocardial infarction is a major consequence of coronary artery disease. Recently many reports have been suggested that hyperhomocysteinemia had an important role in myocardial infarction. Plasma homocysteine level was determined in 60 myocardial infarction patient [Group A] and 35 healthy controls [Group B]. Statistically significant difference was observed in plasma homocystine concentrations between the patients of acute myocardial infarction [Group A] and in normal healthy individuals [Group B]. The level of homocystine in patients of myocardial infraction is significantly increased when compared with controls. This indicates a strong association between hyperhomocysteinemia and acute myocardial infraction in the peoples of Hyderabad, thus showing plasma homocysteine as a risk factor for myocardial infarction