Role of vitamin D in reducing number of acute exacerbations in chronic obstructive pulmonary disease [COPD] patients

Background and Objective: Chronic obstructive pulmonary disease [COPD] is characterized by chronic incompletely reversible poor airflow and air trapping and usually this debilitating disorder limits the outside activities of the patients depriving them of sunlight which is a rich source of Vitamin D. The objective of this study was to determine the effect of vitamin D supplementation in reducing number of acute exacerbation in COPD patients

Methods: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore from January to December 2015 as exacerbations of COPD are season dependent. Diagnosis was confirmed by performing Pulmonary Function Tests [PFTs]. Basic demographical information was obtained and baseline PFTs of the patient was done. Only Group A patients was treated with oral vitamin D intake of 2000 IU daily for 6 months. Vitamin D level was measured at 0, 2, 4, and 6 months and exacerbation of COPD, FEV1 and FVC was measured weekly. Both the groups were given standard treatment for exacerbation of COPD. Spirometry was repeated at each visit. Blood samples were collected every 2 months for vitamin D. Supplementation was stopped if vitamin D level exceeded 100ng/ml

Results: The mean age of the patients was 46.28 +/- 8.83 years, the male to female ratio was 1.8:1. The mean 25[OH] level at baseline was 24.08 +/- 2.58 and at 6th month was 29.60 +/- 8.74. The mean FVC at baseline was 77.83 +/- 5.49 and at 6th month was 91.34 +/- 5.52. The exacerbation at baseline was present in all 120[100%] patients and at 6th month was reduced to 4[3.3%]

Conclusion: Vitamin D supplementation has significant effect in reducing number of acute exacerbation in COPD patients when it is given for prolonged period

Frequency of group B streptococci in pregnant women in a tertiary care hospital

Objective: To determine the frequency and risk factors of Group B Streptococci [GBS] in pregnant patients in third trimester in a tertiary care hospital in Lahore

Study Design: Cross-sectional, prospective study

Place and Duration of Study: Lady Willingdon Hospital, Lahore, from October 2014 to March 2015

Methodology: Sterile lower vaginal swabs were taken from 200 women aged 20 years and over, in third trimester, with no history of vaginal bleeding, ruptured membrane, recent intake of antibiotics or chronic illness. These swabs were cultured for detection of GBS. The risk factors of GBS and its frequency were noted in the pregnant population. Quantitative and qualitative data was analyzed by SPSS version 20. Chi-square test was applied to see association between diagnosis of GBS and other categorical variables. P-value

Results: In this study, the mean age of all the females was 26.36 +/- 4.32 years and mean duration of pregnancy was 35.54 +/- 2.65 weeks. Frequency of GBS in pregnant women was found as 14%. We observed significant association of GBS with parity and previous history of miscarriage [p-value = 0.033 and 0.010 respectively]. Moreover, significant association between vaginal discharge and GBS was also found [p = 0.027]

Conclusion: GBS is present in a small but significant number of pregnant women in our setting and it has association with multiparity, vaginal discharge during pregnancy, and previous history of miscarriage

Causes of postmenopausal bleeding according to histopathological findings

Background: A prospective study carried out at Gynae Unit of Services Hospital Lahore during the period of 2005 to find out different causes of postmenopausal bleeding according to histopathological findings

Material and Method: The study included 100 patients aged 45-50 yrs. The women on hormonal replacement therapy were not included in study. Examination under anaesthesia and endometrial curretings sample taken in all the patients

Results: The histopathological findings of these patients showed cervical malignancy as most common cause [22% patients], followed by senile atrophic vaginitis [17% of patients] and endometrial carcinoma [12% of patients]

Conclusion: Effective clinical programmes should be launched; cervical smear should be taken in all patients attending gynae clinics above the ages of 30 yrs to detect any malignancy as early as possible

Fetal outcome in diabetic pregnancy

Background: Diabetes is the second commonest medical disorder [after hypertension] complicating pregnancy with an incidence of about 01 %. The aim of this study is to see the fetal outcome in diabetic pregnancy

Material and Methods: A prospective study was conducted in the Department of Obstetrics and Gynaecology of Services Hospital, Lahore during a period of July 2005 to July 2006, on 100 consecutive diabetic patients to see a fetal outcome

Results: The study includes all the patients who presented with impaired glucose tolerance test gestational diabetes. The patients were booked and had proper antenatal care, however [12%] had no antenatal care and were admitted directly into the labour room. The results revealed that the number of babies delivered alive were 96% and perinatal mortality was 4%. The major postnatal complication observed in our study was hypoglycemia seen in 34% of babies. Other complications were macrosomia in 32%, hyperbilirubinemia 28%, congenital anomalies in 4%, respiratory distress syndrome in 2% of babies

Conclusion: Elective screening programme should be introduced universally to improve pick up rate of diabetic patients and provide early booking along with meticulous control of blood sugar levels throughout pregnancy to reduce the morbidity and mortality both in the mother and the baby. A regular audit of outcome should be carried out to determine the perinatal mortality. Still birth and late fetal loss rates and to identify organizational and health care factors that effect outcome in diabetic pregnancy

Ectopic pregnancy; risk factors, pattern of presentation and management

Background: To determine the risk factors, pattern of presentation and management of ectopic pregnancy in our set up. This study is a descriptive study, from June 2005 to June 2006 at Gynae Unit-Ill, Services Institute of Medical Science / Services Hospital, Lahore

Patients and Methods: Sixty cases of ectopic pregnancy presenting at Gynae Unit-Ill Services Hospital. Lahore were included. An elaborate work up plan was formulated for all patients, which included history, clinical examination, investigation and treatment

Results: The most common risk factor for ectopic pregnancy was found to be pelvic inflammatory disease. The most common pattern of presentation in ectopic pregnancy was p/v bleeding and lower abdominal pain. 75% patients showed B-hCG levels more then 1500 mlU/ml and rest of them had less than 1500 mlU/ml. Adnexal mass was seen on transvaginal scan in 85% patients. 18.3% patients were given medical treatment. 81.6% patients were given surgical treatment

Conclusion: Ectopic pregnancy is a life threatening condition in early pregnancy. Timely diagnosis and appropriate treatment can reduce the risk of maternal mortality and morbidity related to ectopic pregnancy