Prevalence of abnormal cervical cytology among subfertile Saudi women

Since cervical cancer is reportedly the seventh most frequent cancer in women in Saudi Arabia and the eighth most frequent cancer among women aged between 15 and 44 years, we wanted to determine the prevalence of abnormal cervical cytology among subfertile women attending the reproductive medicine unit of a tertiary care center in Saudi Arabia. This was a retrospective, cross-sectional, hospital based study. A Pap smear was done for 241 of 493 [48.9%] subfertile women from January 2008 through February 2009. The Pap smear was normal in 166 of 241 patients [67.9%], abnormal in 71 [29.5%], and unsatisfactory for evaluation in 4 [1.7%]. According to the revised Bethesda system, epithelial cell abnormality was found in 7 [2.9%], inflammation in 55 [22.8%], and infection in 9 [3.7%] patients. Epithelial cell abnormalities were further classified as atypical squamous cells of undetermined significance [ASC-US] [n=3, 42.8%], atypical squamous cells of high grade [ASC-H] [n=1, 14.3%], low-grade squamous intraepithelial lesion [LSIL] [n=2, 28.5%], and glandular cell abnormalities [AGS] [n=1, 14.3%]. The high prevalence of abnormal cervical cytology in our subfertile women accentuates the need for screening in patients eligible for in vitro fertilization. In addition, a well-organized screening program for cervical cell abnormalities at the national level should be implemented to allow identification of subfertile women at risk so that potentially life-saving measures can be undertaken early

Ischemic stroke: prevalence of modifiable risk factors in male and female patients in Pakistan

Stroke is the commonest neurological cause of morbidity and mortality all over the world being the third leading cause of death. Estimation of stroke risks in population is not only helpful for healthcare providers but also important to identify persons at elevated risk and to select proper treatments in clinical trials. The aim of the present study was to identify the prevalence of common modifiable risk factors for ischemic stroke in Pakistan. Patients of either sex above the age of 25 yrs who were admitted to Neurology Ward or came to OPD in Jinnah Post Graduate Medical Centre were included in the study. Type of stroke was identified by brain CT scans or MRI and risk factors for stroke and other details were noted on a proforma. Out of 55 patients studied for present study, 78% were males and 22% were females. Most of them belonged to low socioeconomic status and almost 50% were having family history of stroke. Most of the patients had multiple risk factors which included: hypertension [65%], smoking [32%], diabetes mellitus [36.3%], dyslipidemia [32.7%], coronary artery disease [9%], obesity [18%], epilepsy [16.3%] and left ventricular hypertrophy [3.6%]. On the basis of these findings, it can be concluded that hypertension, smoking, dyslipidemia and diabetes mellitus are major risk factors for stroke and might be considered as main targets for primary and secondary prevention of stroke

ESBL producing Nosocomial Enterobacteria isolated from clinical specimens detected by double disc diffusion method

To identify extended spectrum betalactamases [ESBL] producing organisms of Enterobacteriacae family from clinical specimens. Simple descriptive study Setting: The study was carried out in Microbiology Department of Army Medical College, Rawalpindi from 1 Jan 02 to 31 Dec 02 on clinical samples received from admitted patients in Military hospital, Rawalpindi Samples consisting of urine, blood, high vaginal swabs, catheter tips, fluids including CSF, sputum, chest tube, [HVS] and IV canula central vascular line specimens received for routine culture from outpatient as well as indoor cases of Rawalpindi/Islamabad. The samples were inoculated on Blood agar and Mac Conkeys agar [chocolate agar was also used for sputum and CSF]. Urine samples were cultured on CLED agar. The samples were incubated at 37C under aerobic conditions. The organisms were identified by standard techniques. Confirmation to the species level was done by API 20 E and API NE where required. Sensitivity testing was carried out by Modified Kirby Bauer disc diffusion method on Mueller Hinton agar incubated at 37°C in ambient air for 24 hrs. ESBL producing strains were identified by double disc diffusion method test according to Jarlier et al [1988]. Clavulanate was applied as the inhibitor of beta lactamases [AMO/CLAY disc].The results were tabulated as frequencies. 1. Forty seven percent of clinical isolates yielded ESBL producing enterobacteria. 2. Enterobacter cloacae, Klebsiella oxytoca, Proteus mirabilis and Klebsiella pneuumoniae were the most frequent ESBL producing bacteria. These bacteria were frequently recovered in fluids, drainage tubes/ catheter tips and canulas

Hemiballismus and hemichorea following general anesthesia: report of a rare case

Hemiballism is an uncommon movement disorder occuring most commonly in elderly subjects with a history of hypertension or diabetes, or both. We present a 43 year old diabetic woman who developed hemiballism following lumbar disc surgery under general anesthesia. Because of the rarity of this complication following general anesthesia, the case is being presented to emphasize the issue

ESWL monotherapy of renal calculi

To study efficacy of extracorporeal shock wave lithotripsy [ESWL] monotherapy for renal calculi. Three hundred patients with renal stones less than 3.5 cm in diameter were selected. All were treated in supine position. Dornier HM4 machine was used for the study. JJ stent was placed in cases with complex and larger than 2.5cm size stones. Pregnant women and patients with pacemaker were excluded from the study. ESWL monotherapy was performed on three hundred patients and three hundred sixteen renal units between Jan. 98 and Dec. 98. Almost 50% of the stones were larger than 2 cm. Post ESWL complications were seen in 49 [16.2%] of the cases. Overall success rate of ESWL was 98.8%. Extracorporeal shock wave lithotripsy is a preferable treatment option for small and medium sized stones. Prophylactic JJ stenting helped in treating patients from far off areas. Complex renal calculi with low stone bulk could be treated with lithotripsy with JJ stent in situ

Methods of ureteric stent placement and removal: experience with 200 patients

Objective To study the advantages of ureteric stents in management of ureteric obstruction, injury or surgery. Methods Ureteric stents were inserted in 200 patients by endoscopic, percutaneous or open operation approach. Local anaesthesia, sedoanalgesia and general anaesthesia was used according to requirement of the patient. Removal of the stens was also endoscopic or in complicated cases by exploration. Results Ureteric stents were placed endoscopically in 190, by open operation in 6 and percutaneous approach in 4 cases. Conclusion Ureteral stent for managing ureteral injury is a safe and simple procedure in modern urology practice. Local anaesthesia was used in 143, analgesia in 31 and general anaesthesia in 26 patients. Endoscopic removal of stents was possible in 177 cases whereas 23 patients had to undergo open surgery due to fractured or upward migrated stents. Local anaesthesia was used in 150 analgesia in 21 and general anaesthesia in 29 cases