Ectopic pregnancy; audit at Maula Bakhsh teaching hospital Sargodha

To find out the causative factors for rising rate of ectopic pregnancy in young women at periphery. Descriptive study. Maula Bakhsh Teaching Hospital [Obstetrical and gynaecological unit] Sargodha, from January 2008 -December 2008. All patients who were presented in labour room emergency and gynaecological out patients department with confirmed diagnosis of ectopic pregnancy on USG were included in the study. A pre-formed proforma was used to record the details about the demographic features, pre-existing risk factors for ectopic pregnancy, clinical features at presentation and management. Frequency of ectopic pregnancy was too high in our study compared to international studies. Majority of patients were young and nullipara. Leading risk factor is pelvic inflammatory disease due to septic induced abortion. 92% of patients had acute presentation. Rising rate of ectopic pregnancy was found in young, nulliparous women secondary to pelvic inflammatory disease. The frequency can be reduced by awareness of reproductive health care, liberal contraceptive utilization, acceptable adequate planned family. Early diagnosis and timely referral may be helpful in treating the patients prior to tubal rupture with decreased morbidity and mortality

Goserline versus danazol in the treatment of endometriosis

The objective of this study was to achieve symptoms relief of endometriosis with a drug having better efficacy and least side effects. Experimental. Lady Willingdon Hospital, Lahore from March, 2003 to Feb. 2005. The trial was conducted on two groups; one group [n = 20] received goserline and other group [n=20] received danazol for 6 months. Patients were followed for relief of symptoms including dysmenorrhoea, dyspareunia, lower abdominal pain and menstrual irregularity and appearance of side effects. The results depicted that in Danazol group 50% pain relief was found in 5 patients [25%] while in goserline group in 4 patients [20%]. 75% pain relief was seen in 7 patients [35%] in danazol group and 8 patients [40%] in goserline group. 100% of improvement in pain found in equal number of patient that is 8[40%] in both groups. Both drugs were effective in pain relief [P >0.05], Goserline had less side effects as compared to Danazol [P<0.05]. Goserline and Danazol are equally effective in symptomatic relief of endometriosis while side effects favoured use of GnRH agonist

Vesico vaginal fistula: prevention is possible

A prospective study was conducted at Lady Willingdon hospital Lahore from Jan,2002 to Dec, 2004. During the mentioned period 22 patients were admitted with the diagnosis of urinary tract fistula. Among these most of the patients [i.e, 45%] were young belonging to age group 20-30 years. According to the causes 72% were due to obstetrical causes, 23% due to surgical causes and 5% were due to malignant. Regarding to the location of the fistula 14% were juxtauretheral,28% low vaginal, 35% mid vaginal,09% high vaginal and 14% were vault fistulae.Out of 22 patients first surgical repair failure occurred in four patients

Vaginal prostaglandin E2 pessary versus gel in induction of labour at term

To compare the prostaglandin E2 Vaginal pessary and gel with respect to cervical ripening, labour out come, side effects and cost effectiveness in induction of labour at term. Experimental study. Lady Willingdon Hospital, Lahore February to July, 2005. The trial was conducted on two group of patient for labour induction such that one group [n=30] received PGE2 vaginal pessary 6 hourly to maximum of 3 doses. Other group [n=30] received PGE2 gel at 6 hourly interval upto 2 doses. Labour induction, number of doses applied, need of augmentation, side effects, induction to delivery interval, mode of delivery, neonatal outcome and cost effectiveness were the main outcome measures. Our results depicted that PGE2 gel produced favourable bishop score more rapidly and initiating uterine contraction simultaneously than PGE2 pessary. Few patients required oxytocin augmentation in gel group [P<0.05]. There was no statistically significant d ifference in number of patients delivering vaginally with in 24 hours, the neonatal outcome and cost effectiveness in two groups [P>0.05]. However, more side effects such as uterine contractions, abnormalities, and fetal distress observed in gel group [P<0.05]. The PGE2 pessary was safe and easily applied, but PGE2 intracervical gel was more effective as it achieved greater changes in mean bishop score. However, more side effects encountered with gel catego

Laparoscopy versus lapartomy in the treatment of benign ovarian cyst

To compare laparoscopy with laparotomy in the treatment of benign ovarian cyst in women under 40 years of age. Experimental. The study was conducted over a period of one and half year from June 2003 to Nov 2004 in Obstetrics and Gynaecology Department, Unit-III, Lady Willingdon Hospital, Lahore. The sixty consecutive patients of benign ovarian cysts who required surgical treatment underwent either Laparoscopy[group I]. or laparotomy [group II]. The laparoscopic fenestration, aspiration and cystectomies were performed in group I [30 patients]. However, ovarian cystectomies, salpingo-oophorectomy and oophorectomy were performed by laparotomy in group II [30 patients]. The comparison was done with respect to duration of surgery intra-operative blood loss, time of mobilization, duration of hospital stay and amount of analgesia used, time to return to normal activity. The amount of analgesics used, time of mobilization, duration of hosp ital stay and time to return to normal activity was less [P<0.05] in Laparoscopy as compared to Laparotomy. There was statistically no significant difference in the duration of surgery, blood loss and post operative morbidity [P>0.05]. With appropriate preoperative evaluation, laparoscopic surgery is safe and effective in treating benign ovarian cyst in women under 40 years of age where the risk of malignancy is low. It is associated with early mobilization, less use of analgesia, shorter hospital stay

Medical intervention in adolescent menorrhagia

To find out causative factors of adolescent menorrhagia and success of various treatments. Descriptive cross sectional study Lady Willingdon Hospital, Lahore from May 2004 to April 2005. Fifty unmarried patients at 12-19 years with menorrhagia selected by non-probability convenience sampling. Blood loss was determined by duration of bleeding extending beyond seven days, passage of clots and presence of anaemia. The most common cause of menorrhagia was DUB [92%] followed by bleeding and endocrinal disorder. Non-steroidal anti-inflammatory drug and antifibrinolytic agent produced 75% subjective improvement in complaints. However, combined oral contraceptive produced 66% improvement. NSAIDS and antifibrinolytic drugs were found to be effective in reducing menstrual loss and should be used as first line of treatment

Similar nature of ionic imbalances in cardiovascular and renal disorders

Background: Several studies have reported improper ionic environment in cardiovascular and renal patients but how the diseases are associated on ionic basis is still not clear

Objective: The present study was aimed to investigate sodium and potassium concentrations and their transport abnormalities in cardiovascular and renal patients

Patients and Methods: Thirty patients of various cardiovascular and thirty patients of various renal disorders [53.33% males, 46.67% females] were selected. Erythrocytes were isolated from freshly drawn blood samples, washed and used for the estimation of sodium and potassium levels using flame photometer [Corning 410]. Serum sodium and potassium were measured by flame photometer. RBC membranes were prepared for the estimation of Na[+] -K[+] -ATPase activity in terms of inorganic phosphate released/mg protein/hour

Results: Intra-erythrocyte and serum sodium and potassium concentrations and Na[+] -K[+] -ATPase activity were different in cardiovascular and renal patients from controls. Intra-erythrocyte sodium level was increased significantly [P<0.01] in cardiovascular patients and non-significantly in renal patients as compared to controls. Na[+] -K[+] -ATPase activity and serum sodium level were decreased significantly [P<0.01] in both the groups as compared to controls. Serum potassium was found to be decreased significantly [P<0.01] in cardiovascular patients whereas it was raised significantly [P<0.01] in renal patients as compared to control subjects

Conclusion: The results indicated similar nature of ionic and electrolyte imbalances in cardiovascular and renal disorders resulting from impaired Na[+] -K[+] -ATPase system. Further investigations in the same area, may be of help to establish an understanding of the progression of diseases, associated complications and the preventive steps that should be taken to arrest the progression of these disorders