ABSTRACT
To compare the efficacy of metformin in the treatment of gestational diabetes mellitus [GDM] with insulin and to compare the frequency of hypoglycaemia in neonates of the mothers treated with metformin and insulin. Randomized control trial to compare the efficacy of metformin with insulin in the treatment of GDM. Outpatient department and labour ward of Obstetric and Gynaecology department of Benazir Bhutto Hospital Rawalpindi from August 2012 to January 2013. A total of 110 pregnant ladies with GDM diagnosed after 20 weeks of gestation were included and divided into group A and group B with 55 patients in each group. Group A patients were treated with insulin and group B with metformin. Plasma fasting glucose and two hours postprandial glucose levels were determined on weekly basis for four weeks after starting the treatment to determine the efficacy of insulin and metformin. At birth plasma glucose levels of all the neonates were carried out two hourly, and more frequently depending upon the requirement, during first 24 hours in both the groups to determine neonatal hypoglycaemia. Fasting plasma glucose in group A and B were calculated as 5.96 +/- 0.58 and 5.76 +/- 0.46 mmol/L respectively [p=0.280], while two hours post-prandial plasma glucose levels were 7.34 +/- 0.48 and 7.28 +/- 0.58 mmol/L respectively [p=0.650]. Efficacy in group A was 78.18% and in group B was 70.91% [p=0.381] while frequency of neonatal hypoglycaemia was calculated as 61.54% in group A and 41% in group B [p=0.113]. The efficacy of metformin in treatment of gestational diabetes mellitus is similar as with insulin and the frequency of hypoglycemia in neonates of the mother treated with metformin and insulin is also similar
ABSTRACT
To compare the effectiveness of nasal packing vs basting [quilting] suture in the control of postoperative bleeding and or haematoma formation and patient compliance of nasal packing after Submucoperichondrial Resection [SMR]. Comparative clinical trial with stratified randomization. Department CMH Kharian cantt from January, 2006 to March, 2007. A total of 200 patients were included in the study. One hundred cases had basting suture and 100 had nasal packing. Patients requiring other procedures like cautery, submucosal diathermy, turbinectomy and middle meatal antrostomy were excluded. The two groups were compared for postoperative bleeding, septal haematoma formation, discomfort in nose, and general well being. Patients with basting suture were free of any discomfort postoperatively which was seen in cases with nasal packing. The two methods were equally effective in preventing excessive bleeding and septal haematoma formation. We conclude that the basting suture technique avoids the patient from post operative discomfort caused by nasal packing and is equally effective in preventing post operative septal haematoma. As the post-op discomfort is significant in nasal packing we recommend quilting of the mucoperichondrial flaps.
ABSTRACT
Treatment for Benign positional vertigo has traditionally been pharmacological. However, physical methods of treatments are gradually replacing the former. Particle repositioning maneuver as described by Epley, has gained wide acceptance over the last decade. We present our experience with more than 100 cases treated with modified Epley's maneuver [no sedation given, nor mastoid vibrator applied]. The study was conducted at CMH Rawalpindi from Jun-2002 to May-2003. All patients with features typical of benign positional vertigo, confirmed by positive Dix-Hallpike test, were included. The patients were followed-up for 3 months. The success rate in our series was around 66%. We conclude that modified Epley's maneuver is indeed an effective method for treatment of BPV, but success rate is less than generally reported