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Background: Papillary lesions of the breast are a heterogeneous group of breast lesions that are difficult to diagnose as benign or malignant. These lesions have varied morphologic features that carry differing prognostic implications for affected patients. Accurate diagnosis is required to ensure that effective treatment is achieved. Papillary lesions can have increased risk of carcinoma and recurrence, in these patients even for lesions yielding a benign concordant diagnosis of papilloma at percutaneous biopsy, surgical excision may be warranted. Malignant lesions are usually surgically treated. Depending on stage-adjuvant chemotherapy and/or radiation therapy is given.Methods: A retrospective study was conducted at Shaukat Khanum Memorial hospital and Research Centre Lahore Pakistan. We reviewed the electronic records of diagnostic and registered patients from January 2007 till December 2017 in women imaging section, in age range of 25 to 75 years. Total 150 diagnosed patients with benign or malignant breast papillary lesions were selected and their conventional breast imaging (mammography and ultrasound) and histopathology was retrospectively analyzed on SPSS.Results: Patients were predominantly asymptomatic or on follow-up to an abnormal mammogram. Of the 150 cases most of the patients had intra-ductal papilloma followed by invasive papillary carcinoma and intra cystic papillary carcinoma. Few patients had intra-ductal papillomatosis and invasive micro papillary carcinoma.Conclusions: Conventional breast imaging remains the first main stay and quite sensitive in detecting breast papillary lesions leading to early detection and management.
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Background: The objective of our study is to check the incidence of various congenital fetal anomalies in antenatal period by ultrasonography in a subset of population.Methods: This cross sectional study was conducted in the department of Radiology, Bolan Medical Complex Hospital Quetta from November 2017 to October 2018. Total of 1323 second and third trimester pregnancies were analyzed for a period of one year. 34 fetal anomalies were detected making the prevalence of 2.5%. Information obtained from history, clinical examination and Ultrasound examination were recorded. The data was analyzed in SPSS 20.These patients were also interviewed for folic acid supplementation and consanguineous marriage.Results: 1323 patients were examined with congenital abnormalities detected in 34 fetuses. Among 34 fetuses, 20 were male and 14 were female fetuses. Out of 34, mother of 24 fetuses verified that they did not take folic acid supplementation. Consanguineous marriage recognized as the important risk factor as found in 22 congenital abnormal fetus. CNS anomalies were the most commonly occurring anomalies with prevalence of (0.9%) followed by gastrointestinal tract anomalies (0.3%) and Urinary tract anomalies (0.3%).Conclusions: The fetus prognosis largely depends on early detection of its any congenital anomaly on antenatal ultrasound as they can result in abortions, still births and other fetal defects. So antenatal ultrasound is very important and safe method for early detection and management of fetal anomalies.
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Background: In Asia, Pakistan has the highest incidence of breast cancer with 1 in 8 women will develop breast cancer at some stage of their life. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Pakistan.Methods: A cross-sectional study was done from June 2017 till October 2018 at Radiology department of Bolan medical complex hospital in Quetta, Pakistan. Patients with breast cancer above the age of 18 and below 70 years were interviewed who were diagnosed with breast cancer. The time interval between self-detection and deciding to seek care was defined as delayed if the woman presented to a health care professional three months or more after detecting an abnormalityResults: A total of 86 breast cancer patients fulfilling the criteria were included in the study. Of these, 34% presented to physician within 3 months of appearance of symptoms, 68% patients presented with a delayed of more than 3 months. Presentation delay was due to financial issues which were seen in 30 patients. 18 patients (20.9%) showed delayed to due difficulty in reaching hospitals, 16 patients (18%) stated delay due to prior use of alternative therapies. Embarrassment and spiritual belief constituted 4.6% cases. 51% and 36% presented with stage III and IV disease out of which majority belonged to poor socio-economic status.Conclusions: The findings suggest that majority of the patients with breast cancer presented late and this has significant effect on their disease prognosis. Most cases of breast cancer presented in advanced stage probably due to poor economic status, difficulty in reaching hospital, illiteracy and negligence by patient or family.
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Background: Afghanistan has the second lowest health workforce density and the highest level of rural residing population in the Eastern Mediterranean Region. Ongoing insecurity, cultural, socio-economic and regulatory barriers have also contributed to gender and geographic imbalances. Afghanistan has introduced a number of interventions to tackle its health worker shortage and maldistribution.
Aims: This review provides an overview of interventions introduced to address the critical shortage and maldistribution of health workers in rural and remote Afghanistan.
Methods: A review of literature [including published peer-reviewed, grey literature, and national and international technical reports and documents] was conducted.
Results: The attraction and retention of health workforce in rural and remote areas require using a bundle of interventions to overcome these complex multidimensional challenges. Afghanistan expanded training institutions in remote provinces and introduced new cadres of community-based health practitioners. Targeted recruitment and deployment to rural areas, financial incentives and family support were other cited approaches. These interventions have increased the availability of health workers in rural areas, resulting in improved service delivery and health outcomes. Despite these efforts, challenges still persist including: limited female health worker mobility, retention of volunteer community-based health workforce, competition from the private sector and challenges of expanding scopes of practice of new cadres.
Conclusions: Afghanistan made notable progress but must continue its efforts in addressing its critical health worker shortage and maldistribution through the production, deployment and retention of a fit-for-purpose gender-balanced, rural workforce with adequate skill mix. Limited literature inhibits evaluating progress and further studies are needed
Subject(s)
Humans , Male , Female , Medically Underserved Area , Rural Population , Public HealthABSTRACT
A 6 year-old girl with Down's syndrome presented to the paedriatic emergency department with sudden onset weakness of the left half of body. Evaluation leads to the eventual diagnosis of stroke secondary to Moyamoya syndrome. This is an unusual presentation of stroke and highlights the need to expand the differential diagnosis to include rare diseases in children with predisposing conditions. This case highlights the relationship between trisomy 21 and Moyamoya syndrome
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Objective: To analyze contemporary practices of cesarean section [CS] at a public sector hospital
Study design: A retrospective study
Place and Duration of study: A Department of Obstetrics and Gynecology Unit-4, Bolan Medical Complex Hospital Quetta, from January 2011 to December 2015
Methodology: In this study clinical records of all the patients who underwent cesarean section were reviewed. This included booked, un-booked or referred cases. Data regarding the indications, type of cesarean deliveries and demographic features as well as outcome were noted
Results: Out of 27791 total births, 2951 were cesarean deliveries, giving a cesarean section rate of 10.6%. The highest number of CSs were performed in multigravidas [54%] followed by primigravida [28.5%] and grand multigravida [17.5%]. The commonest indication for CS was previous cesarean section [50.1%] in which previous one LSCS was 29.9% and previous two or more LSCS were 20.2%. Other common indications were obstructed labor [12.1%], cephalo-pelvic disproportion [CPD - 6.1%], placenta previa [5%], labor dystocia [4.7%] and breech presentation [4.7%]
Conclusions: Previous ceserean section was the commonest indication for CS. Multigravida ranked highest among women who underwent CS. The ceserean section rate in this study was 10.6 indicating better obstetric care
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Backgroung: Diabetes Mellitus is a global problem caused by the deficiency of Insulin secretion either absolute or relative. Treatment options are Insulin and oral glucose lowering drugs. Current study was designed to find out the glucose lowering properties of S-allylcysteine a garlic derivative sulfur containing amino acid
Objective: To compare blood glucose lowering effects of S-allylcysteine with gliclazide in diabetic rat model
Study Design, Place and Duration: This 3 months animal study was carried out in animal house of ISRA University Hyderabad from August 2014 to Oct 2014
Material and Methods: 32 Male Wistar Rats were randomly divided into 4 equal groups A, B, C and D after selection through non-probability purposive sampling. Group A and B served as positive and negative controls respectively. Diabetes was induced in Group B, C and D by injecting alloxan at the dose of 120 mg/kg according to the weight of rats. Rats in group C and D were treated with S-allylcysteine [150 mg/kg], gliclazide [5 mg/kg] respectively. Random blood sugar levels of all groups were measured after weeks 1, 2 and 3. The data was analyzed by SPSS version 21.0
Results: Blood glucose levels after 2[nd] and 3[rd] week were 264.3 +/- 43.16 vs. 218.75 +/- 36.38 [p=0.0001] for SAC and 229.0 +/- 89.87 vs. 241.0 +/- 48.19 mg/dl for Gliclazide [p=0.001] while at the end of 3[rd] week results for two control groups were non-significant statistically [p-0.07 and0.09]
Conclusion: It is concluded that S-allylcysteine possess blood glucose lowering properties that are comparable to gliclazide
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Background: Syzygium aromaticum is commonly known as clove. It is being used since centuries for different purposes in different parts of the world
Objective: To explore the effects of Syzygium Aromaticum, its effects on the liver enzymes
Methodology: This Randomized Control Trial was conducted in Postgraduate Laboratory and Animal House of ISRA University. 30 Healthy Rabbits weighing 2kg on average were divided into 3 equal groups. Group A was taken as control group having no intervention while group B was given paracetamol 500mg BD for 10 days followed by Syzygium Aromaticum powder 100mg BD for next 10 days. Group C was given paracetamol 500mg BD and Syzygium Aromaticum powder 100mg BD for 20 days. Blood samples were taken from ear lobes through 24 gauge canula for liver enzymes at days 1, 10 and 20 and analyzed in ISRA Laboratory. Mean and standard deviation were calculated and p-value <0.05 was taken as significant. The data was entered and analyzed by using SPSS version 16. Results: There was no rise in liver enzymes in group A at any stage of the study. Liver enzymes ALT, AST, GGT, ALP and LDH markedly increased in group B in initial 10 days but declined in next 10 days. There was no significant rise in liver enzymes in group C at any level of the study. Conclusion: Syzygium aromaticum is an effective natural hepatoprotective agent
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The purpose of the study was to compare the complications of delivery in squatting and lithotomy position of mother. Randomized controlled trial. Gynecology/Obstetrics Unit-II, Sandeman Provincial Teaching Hospital, Quetta. 6 months [05 Oct, 2011 to 05 April, 2012]. Hundred and fifty one patients with lithotomy position in delivery were compared with hundred and fifty one patients with squatting position in delivery regarding risks of perineal tears, periurethral tear, extended episiotomy, instrumental delivery, caesarean section and primary postpartum hemorrhage. Data was recorded on a specially designed Performa and was analyzed by using SPSS.V. 10. Results were compared using Chi-square test by keeping the p-value of < 0.05 as significant. 151 patients in lithotomy position and 151 patients in squatting position were compared and studied for complications during delivery. Extension of the episiotomy was observed in [7%] of non-squatting groups. There were no extensions of episiotomy in squatting group. There were no second degree, or third degree perineal tears in squatting group which were encountered in [9%] patients in the lithotomy position group [P<0.05]. Forceps application was also less in squatting position group 11% patients, whereas 24% patients were delivered by forceps in lithotomy group, [P<0.05]. One patient in the lithotomy position had to have a caesarean section due to persistent occipito-posterior position. There was no case of retained placenta or postpartum hemorrhage in squatting group whereas there were 4% cases of retained placenta and 1 case of postpartum hemorrhage due to atony of the uterus in lithotomy position group. It appears that the routine use of lithotomy position may have some disadvantages in terms of more instrumental deliveries and episiotomies. Moreover women experience significant pain in this position. It is suggested that more trials should be conducted and the position at the moment of birth should be registered to measure its influence on birth outcome
Subject(s)
Humans , Women , Adult , Middle Aged , Parturition , Child , Postpartum Hemorrhage , Perineum/injuries , EpisiotomyABSTRACT
To investigate blood glucose regulaitng effects of Catharanthus Roseus [C.roseus] and Nigella sativa [N.sativa] in alloxan induced diabetic rats. Experimental study. Animal house Isra University Hyderabad. From April to Novermber 2013. 50 male rats were housed at normal température, 12 hour dark - light cycle with free access to chow and water. A single intraperitoneal bolus of alloxan [120 mg/kg] was given to induce diabetes mellitus. Glimepiride, C. roseus and N. Sativa were administered at doses of 0.1 mg/kg, 125 mg/kg and 50 g/kg respectively. Data was analyzed on SPSS version 21.0. Significant P - value was defined at
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Emphysematous pyelonephritis is an uncommon condition, with severe potentially fatal necrotizing pyelonephritis due to gas producing organisms [generally gram negative bacilli, esp. E. coli, proteus, pseudomonas, enterobacter and klebsiella].It occurs usually in elderly diabetics with poor glycemic control and frequently associated with ureteric obstruction. Though most of the patients still require nephrectomy albeit improvement in medical treatment, we present a case of successful conservative treatment of emphysematous pyelonephritis in a diabetic patient
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To find out the frequency, predisposing factors, maternal and fetal outcomes and mode of management of uterine rupture at a tertiary care hospital. Descriptive case series. Department of Obstetrics and Gynaecology Unit-4, Bolan Medical Complex Hospital Quetta, from January 2001 to December 2012. All patients who presented with ruptured uterus during labor were included in the study. Data on various variables were recorded. This included patient related demography, obstetrical history of previous and present pregnancy and care during labor, hospital course, surgical procedure performed and maternal and fetal outcome. Out of 38,747 deliveries, 201 cases of ruptured uterus were dealt with. This constitutes a frequency of ruptured uterus as 1 in 193 deliveries. Predisposing factors noted were lack of antenatal care [n=180, 90%], grand multiparity [n=100, 49.7%], injudicious use of oxytocin or misoprostol [62.7%], uterine scar [n=74, 36.8%] and residing more than 100 km from tertiary care hospital [n=69, 34.3%]. Of the total 41 [20.4%] patients had subtotal abdominal hysterectomy, 60 [29.8%] had repair of ruptured uterus with bilateral tubal ligation and 93 [46.3%] had repair of uterus only. Bladder repair was done in 7 [3.5%] patients. Eighteen maternal deaths occurred in this series. Perinatal mortality was 86.7% [n=185]. Uterine rupture remained one of the major causes of maternal and newborn morbidity and mortality. Use of oxytocin, misoprostol and herbs during labor and lack of monitoring were important observations
Subject(s)
Humans , Female , Disease Management , Tertiary Care Centers , Oxytocin , Misoprostol , Cesarean SectionABSTRACT
This study was designed to determine the frequency of uterine atony in cases of primary postpartum hemorrhage [PPH] and to point out risk factors for it and observe different ways of management for control of atonic primary [PPH]. Prospective cross sectional study. This prospective cross sectional study was conducted in Obstetrics and Gynecology Department unit-I, Bolan Medical Complex Hospital Quetta from 1st January to 31st December 2002 [one year]. The study was conducted on 80 patients. The study included all the pregnant women either booked or non-booked, who gave the inform consent. The sampling technique was convenience non probability. The patients were admitted through out-patient department and emergency, irrespective of age, place and mode of delivery, developing atonic primary PPH within twenty four hours and diagnosed as a case of uterine atony. All the cases of primary PPH other than due to uterine atony were excluded. Complete history, general physical examination, abdominal examination and pelvic examination was done. All the data was analyzed by SPSS version 10. Total number of deliveries during study period was 1438. Total number of patients with PPH were 155 out of which, the cases with primary PPH were 139, contributing about 89.7%. The incidence of primary PPH was 9.6 %. Out of 139 patients, the leading cause of primary PPH was uterine atony, contributing to 57.6%. The incidence of atonic uterus was 5.6 %. The highest incidence of uterine atony [37.5%] was found in women aged 26-30 years, followed by [27.5%] women aged 21-25 years.The highest incidence of primary PPH due to uterine atony was found in para 5-8 [56.3%], 6.3 % were primigravidas, 8.7% in para 1-4 and 28.7% in patients having more than eight children. Simple management included inj. Syntometrine, Oxytocin, uterine massage controlled bleeding in 53.7% cases. Prostaglandins [PGF2-alpha and PGE2] were administered in 32 cases and successful in 22 [68.7%] cases. Uterine packing was done in 8 cases, out of it, in 5 patients bleeding controlled [62.5%]. Ligation of uterine arteries was performed in 5 cases, it proved successful in 4[80%] and hysterectomy was done in 7.5% cases. Uterine atony is a major cause of primary PPH and major threat to the life of women in reproductive age. Uterine atony is more common in grand multipara, young women and in home delivery. Major risk factor for atony are previous history of primary PPH, grand multiparity, baby weight > 3.5kg and prolonged labour
Subject(s)
Humans , Women , Adult , Postpartum Hemorrhage/etiology , Risk Factors , Disease Management , Prospective Studies , Cross-Sectional StudiesABSTRACT
To analyze the cases of undiagnosed transverse lie presented in labour room of BMCH which were managed by IPV or LSCS, thus emphasizing the continuing importance of IPV in the developing countries. To study the role of internal podalic version in the management of undiagnosed transverse lie presenting in active labour. Retrospective case series study. This study was carried out at the Department of Obstetrics and Gynecology Unit-I, Bolan Medical Complex Hospital Quetta, Baluchistan, from January 2001 to December 2012. This is a retrospective case series study of 144 cases of transverse lie who presented in active labour. The relevant data of 11 years was collected from the labour ward register and was analyzed. There were total 144 cases of undiagnosed transverse lie that came to hospital out of which 74[51.38%] were managed by internal podalic version and cesarean section was performed in 70[48.62%] cases. None of them had any form of antenatal care. 44[30.55%] of them were 2[nd] twin. Internal podalic version still has a role in the management of transverse lie. It is almost always successful in the delivery of second twin but singleton pregnancies can also be delivered with this skill if proper patient selection is done. It has shown a good maternal and fetal outcome
Subject(s)
Humans , Female , Labor, Obstetric , Obstetric Labor Complications , Pregnancy , Retrospective Studies , Twins , Delivery, Obstetric , Cesarean SectionABSTRACT
Low dose fructose was used in hepatotoxic rats to assess its hepatoprotective role. The objective of this study was to assess the effect of fructose on liver function using enzyme assays and morphologic changes. Quasi-Experimental study. Departments of Biochemistry, Pharmacology and Pathology, Army Medical College and National Institute of Health from Jan 2007-Jan 2008. One hundred and twenty healthy male Sprague-Dawley rats were injected Acetaminophen [APAP] [650 mg/kg] to induce acute hepatotoxicity, fructose [1g/kg] and N-acetyl cysteine [NAC] [1200 mg/kg] intraperitoneally. Blood samples was taken after ten hours and serum was separated and centrifuged. Serum alanine aminotranferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase, albumin and total bilirubin were measured using kit method. Liver biopsy was taken to observe the necrotic changes. APAP had 200% elevation of serum ALT and AST [p<0.01]. Serum alkaline phosphatase, bilirubin and albumin were insignificant as compared to controls in all the groups [p>0.05]. Fructose and APAP co-administration [group III] had insignificant effect on serum ALT [p= 0.6] and AST [p= 0.9] as compared to APAP group [p>0.05]. NAC [group IV significantly decreased serum transaminases compared to groups II and III [p<0.01]. Fructose did not reduce centrilobular necrosis produced by APAP, while NAC had significant cytoprotection in this animal model. Low dose fructose [1g/kg] has no hepatoprotective role in acute APAP hepatotoxicity in vivo and NAC hepatoprotection. Additional studies are needed to understand the combined interaction of fructose and APAP, as fructose is being extensively consumed by general population in form of commercial beverages
Subject(s)
Animals, Laboratory , Male , Acetaminophen/toxicity , Chemical and Drug Induced Liver Injury/prevention & control , Rats, Sprague-Dawley , AcetylcysteineABSTRACT
PURPOSE: To evaluate retinal toxicity of varying doses of rapamycin when injected intravitreally in rabbits. Rapamycin is a potent immunosuppressive agent with significant antitumor and antiangiogenic properties, clinically approved for prevention of organ transplant rejection. METHODS: Twelve New Zealand albino rabbits were divided into four groups. Four different doses of rapamycin were prepared in 0.1 ml: 20 µg, 50 µg, 200 µg, and 1000 µg. Each concentration was injected in one eye of three rabbits, and 0.1 ml volume of sterile BSS was injected into the contralateral eye of the three rabbits. Slit-lamp and fundoscopic examinations were performed and the animals were observed for 2 weeks for signs of infection, inflammation, and toxicity. A baseline ERG was performed before drug treatment and at day 14, after which the rabbits were euthanized. Histology of the enucleated eyes was studied to look for retinal toxicity. RESULTS: ERG results showed some decrease in scotopic response; however this was not dose related. ERG results were normal at 20 µg. Histological results showed no retinal toxicity in all groups. CONCLUSION: Although ERG changes were identified at dosages between 50-1000 µg, the histology of all groups up to 1000 µg did not show any discernable abnormalities.
OBJETIVO: Avaliar a toxicidade da injeção intravítrea de diferentes doses de rapamicina para a retina de coelhos. Rapamicina é uma potente droga imunossupressora aprovada clinicamente para a prevenção da rejeição de transplantes de orgãos. MÉTODOS: Doze coelhos albinos da Nova Zelândia foram usados neste estudo. Foram divididos em quatro grupos. Quatro diferentes doses de rapamicina foram preparadas nas seguintes concentrações: 20 µg, 50 µg, 200 µg, 1000 µg. Foram realizadas injeções intravítreas de 0,1 ml de cada concentração em um olho de três coelhos e 0,1 ml de solução salina foi injetada no olho contralateral de cada coelho. Foram realizadas biomicroscopia e fundoscopia e observamos sinais de inflamação, infecção ou toxicidade durante duas semanas. Fizemos um ERG antes do tratamento e outro 14 dias depois da injeção intravítrea. Os animais foram sacrificados, fizemos a enucleação dos olhos e preparamos o tecido para a avaliação histológica. RESULTADOS: Os resultados do ERG e da histologia demonstraram diminuição da resposta escotópica, entretanto essa diminuiçãão foi dose dependente. A histologia foi normal em todos os grupos. CONCLUSÃO: A injeção intravítrea de rapamicina levou a alterações eletrorretinográficas nos grupos de 50-1000 µg, entretanto a histologia foi normal em todos os grupos até 1000 µg.