Rates of caesarean section and trials and success of vaginal birth after caesarean sections in secondary care hospital

We planned to investigate the rates of Caesarean Section [CS], potential Vaginal Births After previous Caesarean Section [VBAC], and successful VBAC in a secondary care hospital. We conducted an analytical retrospective study at Aga Khan Hospital for Women, Karimabad, Karachi, from October 2011 to September 2012. Data related to total deliveries, Lower Segment CS [LSCS], attempted VBAC and successful VBAC was retrieved from medical records. Total number of deliveries were 3266. Of these, 1021[31.26%] deliveries were conducted by CS. A total of 365[11.1%] had a previous history of one CS and VBAC trial was given to 33[9%] of these pregnancies. The success rate of VBAC was 21[63.6%]. Our results highlight that despite having limited resources, our rates of CS, VBAC trials and successful VBACs were within reasonable limits when compared with international rates

Meckel gruber syndrome: second trimester diagnosis of a case in a non-consanguineous marriage

Meckel-Gruber Syndrome [MKS] is a rare, autosomal recessive genetic disorder, incompatible with life. It is characterized by enlarged polycystic kidneys and post axial polydactyly. Foetal or neonatal death is caused by pulmonary hypoplasia. We report a case of a 35 year old woman who presented at 7 weeks of gestation of her sixth pregnancy. A transabdominal anomaly ultrasound performed for her current pregnancy at 18 weeks of gestation showed features consistent with MKS. The termination of pregnancy was declined and a live newborn female was delivered via an emergency caeserean section at 34 weeks of gestation due to previous history of lower segment caesarean section [LSCS] and leaking. Physical examination of the neonate confirmed the features of MKS. The neonate died within 4-5 hours of birth. This case represented a second trimester diagnosis of a recurrent case of MKS in a non-consanguineous marriage

Duhamel's procedure for adult Hirschsprung's disease

An adult presented with chronic constipation and abdominal mass. Clinical features, abdominal radiographs and barium enema revealed features consistent with Hirschsprung's disease. Full-thickness rectal biopsy was planned, but patient was lost to follow-up and presented 3 years later with intestinal obstruction. Exploratory laparotomy with resection of affected sigmoid colon and end colostomy were performed. Sequential rectal biopsies were obtained during the procedure to confirm the diagnosis. Later, Duhamel's procedure with a diverting loop ileostomy was successfully performed. Ileostomy reversal was done thereafter. There was complete resolution of symptoms and dramatic improvement in bowel function

Molecular confirmation of the causes of inherited visual impairment in northern Pakistan

Families with inherited visual impairment were identified and examined from January 2000 to December 2005 and given a clinical diagnosis. Known genes and loci were screened for mutations or linkage at Institute of Ophthalmology and Neurosciences, University of Leeds, in order to provide molecular confirmation. Inherited retinal disease was the most common cause of inherited visual impairment in 38 of 57 families [66.6%] with Leber's congenital amaurosis, rod-cone dystrophy and cone-rod dystrophy being the most common diagnoses in 22, 8 and 3 families respectively. Anterior segment dysgenesis was diagnosed in 8 families [14%]. Mutations in known genes or linkage to known loci were identified in 23 of 57 families [40%]. All families had molecular confirmation of autosomal recessive inheritance or a pedigree consistent with this mode of inheritance, with evidence of first-cousin marriage. Knowledge of carrier status and genetic counseling may allow families to make an informed decision regarding marriage, and thus begin to plan a way of reducing the incidence of inherited visual impairment

Age and symptomatology of menopause in Karachi, Pakistan

Menopause depicts end of woman's reproductive life usually occurring between ages 45 and 55. Many studies have been carried out to determine the mean age at menopause in different countries. In Pakistan, the greatest hurdle is ascertainment of correct age of women causing difficulty in determining the correct age at menopause. The objective of this study was to overcome this hurdle and to determine the mean age at menopause and occurrence of different symptoms at menopause in Pakistan. An observational cross sectional study was carried out in which the correct ages of 212 women from different hospitals, workplaces and housewives were estimated using Matriculation Certificates and/or National Identification Cards between February-November 2004. Age at menopause and associated symptoms were recorded. Menopausal age of the subjects' mothers was also documented. Epi Info Version 3.3 was used for data analysis. Mean age at menopause was determined to be 44.5 years [ +/- 0.8 years] ranging from 32-62 years. The predominant symptom experienced was hot flashes [82%]. There was no significant negative impact of menopause on libido in our subjects [p>0.05]. A significant similarity was observed between menopausal ages of 110 women and their mothers [p<0.001]. Mean age at menopause in Karachi, Pakistan is significantly lower than in West, which highlights need for studying social, economic and cultural basis of this difference. However, strong conclusions about menopausal age can only be made by large scale population-based studies. The symptoms experienced are similar as elsewhere in the world, although occurring with varying frequencies. There is a familial pattern to the onset of menopause