role of inflammatory markers following Ramadan Fasting

Objectives: The aim of present study was to investigate the effect of fasting during Ramadan on plasma adiponectin and TNF-alpha levels

Methods: This is a cross sectional study, conducted at Federal Urdu University of Arts, Science and Technology [FUUAST], Karachi, comprising a total of 55 [50%] females and 55 [50%] males whose ages ranged between 20 and 40 years, and fasted during Ramadan [June-July 2014] were enrolled in the study. Subjects were separated into normal weight, overweight and obese males and females. Anthropometric measurements and Fasting venous blood samples were taken at first and last [29th] day of Ramadan. Plasma adiponectin and TNF-alpha levels were assayed with ELISA kits. All values were calculated and presented as mean ± standard error of the mean [SEM] and by using analysis of variance [ANOVA] for repeated measures. P values < 0.05 were accepted as significant

Results: Body mass index [BMI] [Kg/m2] in over-weight and obese male subjects exhibited considerable reduction [P<0.05; P<0.05], post Ramadan when compared to their respective pre Ramadan fasting weights. Noticeable and significant reduction was also observed in BMI of obese females [P<0.05]. Post Ramadan Overweight Males [P<0.05] and Post Ramadan Obese Males [P<0.001] exhibited significantly elevated plasma adiponectin [?g/mL] values. While plasma adiponectin mean concentration of only obese females were significantly improved at last week of Ramadan [P<0.01]. Fasting in Ramadan significantly decreased TNF-alpha [pg/mL] levels of post obese males and females than Pre-Ramadan-groups [P<0.05; P<0.01] respectively

Conclusion: The study reports of noticeable changes with Ramadan fasting resulting increase of plasma adiponectin and decrease of TNF-alpha levels as well as body weight. The study strongly suggests further investigations on larger sample sizes with possible association of dietary restrictions and weight loss on mechanism of enhanced adiponectin and reduced TNF-alpha in obese and overweight persons who fast on Ramadan pattern

Effect of hyosine butylbromide on first stage of labour in term pregnancy

Objective: To determine the effect of hyosine butyl bromide on mean duration of first stage of labor in term pregnancy by comparing with control group

Study Design: Randomized, double-blind, controlled trial

Place and Duration of Study: Department of obstetrics and gynecology CMH Rawalpindi, from Oct 2012 to Sep 2013

Material and Methods: This was a randomized, double-blind, controlled trial, conducted at department of Gynecology and Obstetrics Combined Military Hospital [CMH] Rawalpindi. Total patients included in the study were 108. Patients were distributed in two groups on the basis of drug given to them. Group-A was labeled as drug Hyoscine Butyl Bromide [HBB] and Group-B was labeled as placebo. Patients selection was done by using a pre defined inclusion and exclusion criteria. Women were admitted with spontaneous and active labour [4cm or more cervical dilation with regular uterine contraction] between 37 to 40 weeks of gestation, with singleton pregnancy, vertex presentation and intact membrane. Laboring mothers were monitored in bed till full dilatation of cervix. The collected data was endorsed on patient's performa. Data entry and analysis was done by using SPSS 12 and analyzed accordingly to the statistical plan

Results: Mean age of patients in group A was 25.85 +/- 3.85 and in group B was 28.07 +/- 4.71 years. Mean gestational age in Group-A and group- B was 38.67 +/- 1.06 and 38.33 +/- 1.09 weeks. Mean duration of first stage of labor in Group-A was 178.98 +/- 92.44 and in group-B was 214.74 +/- 147.44 minutes. According to p-value mean duration of first stage of labor in both groups was statistically same. i.e. [p-value= 0.135]

Conclusion: Use of hyoscine butylbromide allows reduction in the mean duration of first stage of labour as compared to the control group. It not only minimizes the possibility of hastened delivery but also its use can prevent prolonged labour

Role of antiprogesterone on the endometrium receptivity- a review

Estrogen produces proliferation in the functional layer of the endometrium and the differentiation in the ciliated and secretory epithelium of the uterine tube. Progesterone produces differentiation in the functional layer of the endometrium and the produces mitosis in the stroma of the endometrium. These effects of the estrogen and progesterone are mediated through interactions with specific intracellular receptors1. Mifepristone [RU 486] is a steroid hormone with a chemical structure similar to natural hormone progesterone. It has been proposed that antiprogestins may be useful in the treatment of endometrial inflammatory disease and carcinoma +breast because these conditions are dependent on the ovarian receptors and have receptors for estrogen and progesterone. Anti-progesterone compounds can antagonize the biological action of the progesterone or inhibit the synthesis of progesterone. Mifepristone, [RU 486] has been found to be the most effective and is now used in practice

Obstetric and perinatal outcome in induction of labor compared with expectant management for prelabor rupture of the membranes at term

To compare the management outcome of induction of labor with expectant management in patients with term pre labor mpture of membranes [PROM]. Randomized controlled trial. This study was conducted in the department of Obstetrics and Gynaecology; Combined Military Hospital Rawalpindi from 25[th] July 2010 to 25[th] January 2012. A total of 384 patients were selected for this study, which were divided into two groups by lottery methoid. Patients in group A were induced with tablet prostaglandin E2 and group B patients were managed expectantly for 24 hours. The outcome of mothers and neonates was recorded on a pre-designed proforma, The mean duration between PROM to onset of active labor in group A was significantly less [8.4 +/- 2.3 hours] as compared to group B in which it was [9.6 +/- 2.1 hours] [p = 0.000]. The mean duration between PROM to delivery in group A was significantly less in group A [17.4 +/- 20] versus group B [22.2 +/- 2.0 hours] [p = 0.0000]. The spontaneous vaginal delivery [SVD] rate was considerably higher [p=0.056] in group A in which 161 [83.8%] patients delivered by SVD and 31 [16.1%] patients by LSCS. In group B, 146 [76.0%] patients delivered by SVD and 46 [23.9%] patients by LSCS. In group A, 8 [4.1%] patients developed chorioamnionitis and 13 [6.7%] patients in group B [p = 0.262]. In group A there were 178 [92.7%] neonates with APGAR score of > 5 at 1 minute in contrast to 173 [90.1%] in group B with [p = 0.363]. Similarly in group A at 5 minutes, there were 178 [92.7%] neonates with APGAR score of >7 and 173 [90.1%] in group B [p = 0.460]. There were 9 [4.6%] cases of neonatal sepsis in group A, in comparison with 12 [6.2%] patients in group B [p = 0.501]. The mean duration of labor in induced patients was less as compared to patients with expectant management

Outcome of laproscopies for subfertility military and combined military hospitals Rawalpindi

The purpose of the study was to determine the common causes of subfertility among patients reporting to Military and Combined Military Hospital [Rawalpindi] by means of diagnostic laparoscopy in a selected group and to compare our findings with other international data. Descriptive study. It was a conducted in two sister hospitals of Army; Military and Combined Military Hospital [Rawalpindi] from September 2010 to August 2011. A total of 120 women with primary, secondary or unexplained subfertility were carefully selected by purposive sampling according to inclusion and exclusion criteria of the study design. The patients were subjected to diagnostic laparoscopy and pathologic causes documented accordingly. Outcome measures were based on tubal, uterine and ovarian pathology. Results were recorded and then compared with international data. Out of a total of 120 sub fertile women who underwent diagnostic laparoscopy, 82.5% had revealed pathologic abnormalities and 17.5% were with normal pelvic findings. Among the patients with abnormal pelvic findings PID with tubal occlusion was found in 40% of the patients, simple ovarian cysts in 30% of the patients and 12.5% had endometriosis. Primary subfertility was present in 53.3% of patients and 46.7% of patients had secondary subfertility. Maximum number of patients [58.3%] were in age group of 20-25 years and maximum number of patients [59.2%] had duration of infertility of more than 5 years. The laparoscopic procedures are less invasive, more convenient and more precise for the diagnosis of subfertility. Indeed diagnostic pelviscopy is the standard means of diagnosing the tubal pathology, peritoneal factors, endometriosis and intraabdominal causes of infertility. Not only does this help in identification of unsuspected pelvic pathology but also contributes to decision making of infertility treatment. Therefore, because of its potential diagnostic as well as therapeutic benefits, all patients with subfertility should undergo pelviscopy

Commonest indication and complications in cases of hysterectomies performed in combined military hospital Rawalpindi

To outline major indications and post operative complications in patients undergoing hysterectomy with a benign condition in Combined Military Hospital [CMH] Rawalpindi. A descriptive study. The study was carried out in the department of obstetrics and gynaecology CMH Rawalpindi from January 2008 to January 2010. A total of 321 patients were selected for enrollment in study out of 510 hysterectomies done in Combined Military Hospital Rawalpindi for various indications. The age of the women ranged between 40-65years. Among the indications were dysfunctional uterine bleeding [DUB], uterine fibroids, post menopausal bleeding and uterovaginal prolapse. All other cases with advanced pelvic malignancies and endometriosis were excluded. Record was maintained with detailed profile of all the patients. Operative findings and complications were recorded in profile data by principal investigator and co-researchers. Dysfunctional uterine bleeding remained the top most indication of hysterectomy [45%] and the complication rate remained 8.7%.With DUB as the commonest cause of the hysterectomy, the researchers need to work more in medical conservative techniques to avoid surgical morbidity, associated with hysterectomy.

Comparison of heparin and low dose aspirin with low dose aspirin alone in improving theperinatal outcome in pregnancies with recurrent pregnancy losses

To compare the perinatal outcome of low dose Aspirin [LDA] alone and low dose Aspirin with Heparin in pregnancies with recurrent pregnancy loss [RPL] with or without positive antiphospholipid antibodies [aPL]. Randomized controlled trial. Departments of Obstetrics and Gynaecology Combined Military Hospital [CMH] Quetta, Lahore and Rawalpindi. 30 April 2009 to 30 April 2011. 60 women with recurrent pregnancy losses [RPL] fulfilling clinical criteria of antiphospholipid syndrome [APS] with or without aPL antibodies positive reporting to the antenatal clinic at the three hospitals were included. Convenience sampling was done and subjects were randomly allocated into groups A and B using random numbers table. GroupA received low dose Aspirin[LDA] 75 mg once daily starting from first trimester and GroupB received unfractioned Heparin [UH] 5000IU SC BD or low molecular weight Heparin [LMWH] 40mg subcutaneous along with LDA. In group A 26[86.7%] and in group B 25[83.3%] live births were attained. Significant side-effects were observed in groupB including bruising and injection site pain. Cost of drug for treatment over 28 weeks in groupA was Rs 300 and in groupB was Rs 6300. LDA alone have comparable perinatal outcomes with Heparin in cases of RPL, with an added benefit of no pain and bruising, low cost and more convenience of administration.