Prevalence and clinical profile of insulin resistance in young women of poly cystic ovary syndrome: a study from Pakistan

Objective: The aim was to estimate the prevalence of Insulin Resistance [IR] in Poly Cystic Ovary Syndrome [PCOS] and analyze its clinical parameters

Methodology: This observational study was conducted at Dow University Hospital during June 2011 till May 2012. Patients of PCOS were selected, an anthropometric measurement, examination and fasting blood test for sugar [FBS] and insulin was performed. Data was collected on pre designed questionnaire, was analyzed by SPSS version 16

Results: Forty-six cases of PCOS were included in the study. Prevalence of IR was 34.78%. Mean age of patients was 23.72 +/- 4.37 years. Waist Hip Ratio [WHR] was raised in 42 [91.30%], acanthosis was found in 26[56.50%], impaired FBS was seen in 9 [19.6%] and raised fasting insulin in 16 [34.8%] patients. There was significant association between acanthosis and WHR [0.044] and between acanthosis and FBS [0.008]. Correlation studies between parameters showed a significant correlation between Waist and Hips [0.93], similarly Waist and WHR showed positive correlation [0.59], at p < 0.01. Significant positive correlation was also found between waist and FBS [0.32] and FBS and WHR [0.378]

Conclusion: Acanthosis nigrican, raised WHR and FBS are significant parameters for insulin resistance in cases of Poly Cystic Ovary Syndrome [PCOS]

Polycystic ovarian syndrome; acne is common presentation in women in relation to menstrual irregularity a study from hospital in Karachi

Polycystic ovarian syndrome is a common disease among the women in reproductive age group and more common in South Asian women. Clinical presentations include menstrual disorders, subfertility, obesity,hirsutism, acne vulgaris and acanthosis. The objective of study was to investigate co relation between acne and polycystic ovaries and its relation to menstrual irregularity. A total of 56women were enrolled in the study from Outpatient Department of Obs and Gynae and Dermatology, Dow University Hosptial, Ojha campus by convenient sampling. It was cross sectional study, conducted from July 2012 to November 2012.Verbal consent was taken. Sociodemographic information,Anthropometric measurement [height, weight, BMI] and acne severity with affected area, menstrual irregularities were administered on pre designed questionnaire.Pelvic ultrasound for polycystic ovaries and serum LH, FSH in follicular phase of menstrual cycle [2nd day] advised from Dow Radiology and Dow Lab respectively. A total of56 patients of PCOS were enrolled during five month period. The mean age of patient was 21.1 +/- SD 0.994. Frequency of acne was 32 [57.1%].The mean BMI was 19.66 +/- SD 4.54. Face was the commonest area involved in 24 [42.9%], menstrual irregularity was found in 50 [89.4%] women. There was no statistically significant relation seen between acne and oligomenorrhea. [X2 = 0.55, P = 0.45]. It was also determined that there was no co relation seen between the acne and serum testosterone level calculated by independent sample t test.[P = 0.17] but statistically significant association seen between severity of acne and serum LH/FSH ratio, [ttest =3.28, p= 0.004] Acne was found in 32 [57.1%] women with PCOS. The study results revealed a significant association seen between severity of acne and serum LH/FSH ratio. Relation between acne and serum testosterone level was statistically insignificant

Factors related to blood transfusion in placenta previa

To determine the frequency of blood transfusions in cases of placenta previa and to assess the factors influencing such a need. Descriptive case series. Department of Obstetrics and Gynecology, Civil Hospital Karachi, from January 2009 to December 2010. Clinical records of 88 cases of placenta previa were retrieved. Ten cases of placenta previa with multiple gestation, adherent placentae, placental abruption, maternal death on arrival and incomplete records were excluded. Seventy-eight cases were selected for the study. Structured proforma was used to collect information about transfusion of blood and blood products and the factors affecting need for transfusion. The mean age of the patients was 28.37+4.74 year; parity was between 2 to 4 in 34[44%] patients and 26 [34%] of the total cases were booked. A total of 177 [mean 2.3] transfusions were received by 59 [76.6%] patients. Seventy-five [97.6%] patients had anemia including 8[10.4%] cases of severe type. Patients aged below 25 or above 34 year, of un-booked status and parity below 2 or above 4, received more transfusions. Complete placenta previa, severity of anemia and signs of shock were significant determinants for transfusion. Majority of blood transfusions were given during the delivery or cesarean section. Pregnant woman with major placenta previa who presented with hemorrhage and already anemic, needed more replacement of blood

Maternal outcome in cases of vaginal deliveries after one Cesarean section

To evaluate maternal morbidity and mortality in cases of vaginal deliveries after one prior cesarean section. To reduce repeat cesarean rate in selective cases. To construct guide line for trial of cesarean scar. Descriptive prospective study. Department of obstetrics and Gynecology Unit 1 Civil hospital Karachi. Duration of Study: Two years study from 1st October 2005 to 30th September 2007. During two years period women with previous one cesarean delivery due to non recurrent cause were selected. Excluded cases underwent elective cesarean sections. Women with no medical disorder having singleton term pregnancy, vertex presentation and adequate pelvis were enrolled for trial of labour. All the women were allowed to go into spontaneous labour. No augmentation of labour was done. Careful monitoring was done during labour. During two years period One hundred and eighty eight women presented with previous one cesarean section for nonrecurrent cause .Out of one hundred and eighty eight women seventy eight decided to have elective cesarean section for some obstetric reason. One hundred and ten women were selected for study, Out of these One hundred and ten women thirty four [30.9%] ended in emergency cesarean section [Non progress of labour, 41.17%, fetal distress 29.41%, impending rapture 17.64%. where as seventy six [69.09%] women had successful vaginal deliveries. Of sventy six women delivering vaginally twenty [26.31%] women had instrumental vaginal deliveries and fifty two [73.68%] women had spontaneous vaginal deliveries. There was no maternal mortality. No case of uterine rapture occurred. Partial scar dehiscence was found in 2.6% cases. Postpartum hemorrhage occurred in 5.2%cases due to atonic uterus. Duration of hospital stay was 2-3 days following vaginal deliveries where as it was 7-8 days following cesarean section. With well defined protocol, trial of labor after one prior cesarean delivery is safe and most often successful and reduces the rate of repeat cesarean section

Current criteria for selection of abdominal versus vaginal hysterectomy at civil hospital, Karachi

To determine the frequency of abdominal and vaginal hysterectomies and to evaluate the categorization of hysterectomy cases for abdominal or vaginal route at Civil Hospital Karachi. A cross-sectional, 12-month [2008] prospective comparative study was designed at Civil Hospital Karachi involving abdominal hysterectomy [AH] and vaginal hysterectomy [VH]. Data were extracted on a specially designed proforma including fields for age, parity, menopausal status, indication and route for hysterectomy, uterine size, and previous history of caesarean section, puerperal sepsis, tubal ligation, and laparotomy for gynecological indications. In this study, 107 [18.3%] abdominal and vaginal hysterectomies were done for benign gynecological causes. There was no case of laparoscopically assisted VH [LAVH]. Mean age [57.61 years] and parity [8] for VH were greater than those of AH [48.11 years] and 5, respectively. VH was predominantly done on atrophic uteri [25 [75.76%]]. AH was performed on 20 [27.02%] bulky uteri; in 53 [71.63%], the uterus was larger. Uterovaginal prolapse was the sole [100%] indication for VH with concomitant dysfunctional uterine bleeding [DUB] in 4 [12.13%] cases. The main indications for AH were fibroids in 28 [37.84%], DUB in 30 [40.54%], followed by adenomyosis and endometriosis in 10 cases [31.51%] each. Factors predisposing to pelvic adhesion and uterine immobility were present in 16 patients [18.85%] who underwent AH and 3 [9.09%] with VH. AH was commonly performed on less parous and perimenopausal women with larger uteri while VH was chosen for elderly, more parous women with atrophic and prolapsed uterus

Belief in charity giving [Sadqa] and its role in healing: results of a survey conducted at a teaching hospital in Karachi, Pakistan

To study patients' belief and practice about Sadqa [charity] and its role in recovery from illness and restoration of health. This study will determine whether such belief and practice is related to any demographic factors such as sex, education, and religious sects. A questionnaire was designed that included the demographic profile of patients and questions in accordance to the study objective. It was administered to 400 patients or their attendants against the calculated sample size of 385. There were very few refusals to participate with response rate of around 98%. The study objective was explained to all participants, written consent was obtained and full confidentiality was assured. The mean age of the study population was 34.33 years, majority of the patients were males with 65.6% having grade XII or higher education. The practice of giving sadqa/charity for healing was significantly associated with females [p<0.001]; Ismaili sect [p=0.017]; educational level of grade V [p=0.03]; graduate [p=0.041]; being housewives [p<0.001], students [p=0.048] and employees in private services [p<0.001]. Approximately 85% of the study population gave sadqa/charity for healing diseases and 84.8% believed that sadqa/charity heals diseases. According to 97.5% of the participants, medical treatment should be combined along with sadqa/charity for healing. This study highlights the importance of the patients' attachment to charity giving and expectation that it will lead to recovery from illness. Future research in this area should be qualitative rather than quantitative to explore more about beliefs, attitude and behavior of the individuals. It is recommended that health care professionals should consider and also respect patients' and relatives beliefs about sadqa and charity; clashing with their beliefs during provision of medial care should be avoided

Belief in prayersand its role in healing among family practice patients visiting ateaching hospital in Karachi, Pakistan

To document the practice and belief in offering prayers to have a favorable impact on healing among family practice patients at a teaching hospital in Karachi. This study was conducted at Community Health Centre, Aga Khan University Hospital, Karachi, Pakistan in July 2008. A questionnaire was designed that included the demographic profile of patients comprising age, sex, marital status, religion, religious sect, ethnic group, education and occupation as well as questions in accordance with the study objective. It was administered to 400 patients visiting outpatient department of the hospital against calculated sample size of 385. Participants were explained the study objective, a written consent was taken and full confidentiality was assured. The mean age of the study population was 34.33 years, majority of the patients were males [65%] with 65.6% having grade XII or more education. The majority of subjects was Urdu-speaking [76.5%] and belonged to Sunni sect [81.3%]. The practice of offering prayers for healing was found statistically significant with Sindhi, Katchi, Haro and Kashmiri groups [p-value=<0.001 each]; religious sects of Sunni [p-value=0.002] and Ismaili [p-value=<0.001] and with students [p-value=0.005]. The number of "Shia" sect participants was small but they all had offered prayers for healing. This practice was not found statistically significant with gender, marital status and education. Prayers for healing is practiced by 96.5% of the participants and 95.8% believe that it does cause healing. Almost ninety three percent of participants believe that religion gives us the concept of healing through prayers. According to 97.5% of the participants medical treatment should be combined along with prayers for healing. Prayer, its practice and belief in having a favorable impact on healing and recovery from illness is widespread among family practice patients. Modern day clinicians must give due consideration to this practice and belief among their patients

Pre-eclampsia/eclampsia: the time taken to become study normotensive. a prospective study

1.To determine the time taken for pre-eclampsia / eclampsia patients to become normotensive. 2.To counsel the patient for regular postnatal follow up. 3.To select the patient with persistent hypertension Prospective descriptive study. Obstetrics and Gynaecology Unit III, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences. September 2000 to August 2001 All diagnosed cases of pre-eclampsia / eclampsia were followed after delivery till 6 weeks to see the time taken to become normotensive. Patients were selected from labour room, postnatal wards and postnatal clinic. Standardized performa were filled by trained researchers. Patients with raised B.P at or after 6 weeks were labeled as persistent hypertension and referred to medical specialty. 92 patients out of 1699 were diagnosed as pre-eclampsia / eclampsia. Most of the patients were 20-30 years old [61.96%], primigravida [51.09%]. Most of the patients presented at gestational age >34 weeks [72.83%]. In majority of patients B.P returned to normal within 1 week [41.30%] while 5.43% remained persistently hypertensive. All pre-eclampsia and eclampsia patients should be followed in post natal period till they are either normotensive without medicine or remain hypertensive beyond 6 weeks. They should be referred to expert physician for control of B.P on long term basis

Maternal morbidity in obstructed labour - retrospective descriptive study

I. To determine the frequency of maternal morbidity in obstructed labour. 2. To counsel the family about the seriousness of the condition. Retrospective descriptive study. Obstetrics and Gynaecology Unit III, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences. 1st January - 3rd December 2004. A total of 94 women with obstructed labour were included in the study. More than half of the study group were primigravida and aged below 25 years. A total of 61 [64.89%] were primigravida. Peak cases were between 20- 25 years of age that was 42 [44.7%]. Mode of delivery was Caesarean section in 82 [87.23%] cases, abdominal delivery with repair of ruptured uterus was done in 10 of cases [10.63%] and Caesarean hysterectomy in 5 cases [5.31%]. Maternal morbidity varies with Puerperal sepsis [34.04%], cystitis [25.53%], wound sepsis [22.34%], ruptured uterus [11.7%], primary postpartum haemorrhage [8.51%] and V. F. [1.06%]. Maternal mortality was one [1.06%]. The incidence of obstructed labour is almost unchanged in tertiaty level hospitals. This carries grave maternal morbidity and work load 011 the hospital

Risk factors for tubal ectopic pregnancy

To determine the risk factors for tubal ectopicpregnancy. A case control study. This study was conducted at the Gynaecology and Obstetrics Unit III. Civil Hospital Karachi from it January. 2003 to 31[st] May. 2005. All the patients diagnosed as a case of ectopic pregnancy during the twenty nine months period were included in our study. While the control group constituted pregnant women selected at random from the antenatal clinics and through person to person communication. All the relevant data was recordedon a questionnaire and the final results were analyzed. The incidence of ectopicpregnancy was found to be 1:90, when compared with normal deliveries. Age group of 25-