Ovulation induction using laparqscopic ovarian drilling in women with polycystic ovarian syndrome i predictors of success

Anovulatory infertility is prmmt in 75% of patients with polycystic ovarian syndrome [PCOS], in addition to oligomenorrhoea and signs and symptoms of hyperandrogenism. This study was performed to find the role oflaparoseopic ovarian drilling [LOD] in correcting anovulation, menstrual irregularities and failure of conception. Possible role of the factors as the predictors of success was also studied. This prospective cohort study included 49 women who were diagnosed with PCOS and anovulatory infertility. These patients had already tried various ovulation induction drugs for conception, and underwent LOD between January i, 2006 untill December 31, 2008 in the Department of Gynaecology and Obstetrics, at the Tertiary Care Hospital, Lahore. The major outcome measures spontaneous ovulation, menstrual regularity after LOD and influence of various pre-operative characteristics on pregnancy rates. Among 49 patients 33 [67.3%] started to menstruate regularly and ovulated spontaneously in 59.2%, of them 23 [46.9%] conceived. Younger age [less than 25 years], duration and infertility less than 5 years and higher LH [more than 12 lU/lit] emerged as clinically significant factors to have impact on successful outcome. BMI > 27 Kg / m[2], cycle pattern, morphology of ovary, LH / FSH ratios did not manifest significant role. Women with PCOS respond favour ably to LOD

Significance of appropriate sampling in the diagnosis of tuberculosis [TB] - a comparison of different techniques

After years of decline, tuberculosis [TB] has re-emerged as a serious public health problem worldwide causing significant mortality and morbidity in developing countries like Pakistan, where the estimated incidence of TB is 181 per 10000. The present prospective study was conducted in Shalamar Hospital Lahore from January 2007 to October 2009. The objective was to compare the PCR results of specific site samples and blood of the same TB patient to see the validity of PCR results based on blood samples. Clinical samples obtained from 205 patients of suspected TB [pulmonary or extra-pulmonary] were subjected to ZN smear examination, LJ medium culture, and PCR test by amplifying 541 fragment of Mycobacterium tuberculosis complex genome. A highly significant difference was seen in the test results clone on samples obtained from specific site according to disease and blood samples of the same patient infected with pulmonary or extra-pulmonary tuberculosis. The sensitivity of different tests was found to be significantly different, which was 67.32 percent for PCR test, 27.81 percent for LJ medium culture and 12.20 percent for ZN smear examination. However, there was no significant difference between different tests as far as specificity was concerned. PCR test sensitivity in pulmonary and extra-pulmonary clinical samples was 77.15 and 61.6 percent respectively, being significantly higher, when compared with sensitivity of other tests. The mean detection time for M. tuberculosis was 24 days by LJ medium culture and less than 1 day by .smear examination and PCR test. We concluded that the PCR test is more sensitive than ZN smear examination and LJ medium culture for the diagnosis of TB in pulmonary and extra-pulmonary clinical samples. To get more accurate results PCR for TB diagnosis should be done on specific site samples. Blood samples are not appropriate for the diagnosis of TB by PCR when the PCR is clone on TB genomic DNA

evaluation of pelvic mass

In female reproductive tract the differential diagnosis of pelvic mass is quite variable because abnormality may arise from gynaecological or non gynaecological origin. The present study was designed to evaluate the efficacy of clinical examination and abdomino-pelvic ultrasonography and find out the frequency of malignancy in patients diagnosed with pelvic mass. It was a cross sectional prospective study of one year duration. Cohort study design on 107 patients with complaints suggestive of pelvic mass underwent clinical examination including history, abdomino-pelvic examination followed by abdominal ultrasound were evaluated. Only the patients who underwent laparoscopy or laparotomy were included in the study. Final diagnosis was correlated with histopathological diagnosis. Overall sensitivity of clinical evaluation was 50% while ultrasound was 80% sensitive in diagnosing the type of pelvic mass. Positive predictive value of clinical examination 71.4% was higher than ultrasound 66.6%. Frequency of gynaecological malignancy was 84%, while 1.9% malignancies were of non gynaecological origin. Our study has supported the view that clinical evaluation and ultrasound are initial modalities and to increase the sensitivity for definitive diagnosis other imaging facilities and tumor marker are needed