Frequency of hepatitis C in general surgical patients at teaching hospital Khairpur Sindh

Viral hepatitis is a global issue. Hepatitis C virus is worldwide public health problem. This is related to the continued occurrence of new infections and the presence of a large reservoir of chronically infected population. To observe the frequency of Hepatitis C virus [HCV] infection and find out the risk factors in general surgical patients. Prospective Observational type. This study was carried out in the Surgical Department of Ghulam Muhammad Mahar Medical College Teaching Hospital KhairPur Sindh during one year period from May 2012 to April 2013. All patients admitted in surgical department either for emergency or elective surgery was included in the study. All patients were screened for HbSAg and Anti-HCV by using immumochromatography [ICT] method. The data of sero-positive patients for hepatitis C were taken for further study. The data was collected through pre- designed Performa and analyzed through SPSS version 15. Total 1030 patients were admitted in surgical department for emergency or elective surgery. During screening Anti-HCV +ve was found in 165[16.0%] patients. Out of these, 95[9.2%] were male and 70 [6.7%] were female. Mean age of these patients was 40.7 years. Among positive patients, most belongs to rural area with poor socioeconomic status. Multiple injections by quacks, shaving by barbers, history of blood transfusion, previous surgery were found to be risk factors in male, while in female history of Gynae and obstetrics procedure, partner +ve for HCV, blood transfusion were found main risk factor. No any risk factor was found in 20 [12.1%] male and 35 [21.2%] females. In the absence of any vaccine for Hepatitis C virus, emphasis should be made on health education and about the risk factors for virus transmission. Health care providers must be committed in the formulation of policies and strict adherence to the safe practices

Fetomaternal outcome of pregnancies complicated by acute appendicitis

To observe the frequency and Fetomaternal outcome of pregnancies with acute appendicitis. Prospective / observational study. This study was conducted in gynecology and surgical department of Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur Sindh from January 2010 to December 2012. All pregnant ladies admitted in Gynae and surgical department with history of acute pain in abdomen and strong suspicious of acute appendicitis on the basis of history, clinical examination and ultrasound findings after exclusion of other gynecological and surgical causes of acute abdomen during pregnancy were included in the study for following variables: Presentation, duration of symptoms, operative findings and complications associated with disease and operative procedure were noted. Data was collected on pre-designed Performa and analyzed on SPSS version 15. During 3 year study period total 8700 Obstetric admission and cases with strong suspicious of acute appendicitis in. pregnancy was 20 [0.22%], most women belongs to age between 18-40 years. More cases seen 2[nd] trimester 11[55%], duration of symptoms < 24 hours seen in 85% and >24 hours seen in 15% of cases. Abdominal pain was leading symptom present in 80% of cases while lower abdominal tenderness was leading sign seen in 90%. On surgery signs of acute appendicitis seen in 75%, normal looking appendix in 10%, while perforated appendix with moderate pus in peritoneal cavity seen in 15% of cases. One maternal death was seen in study population due to septicemia, most probably because of late presentation. The evaluation of a pregnant woman presenting with acute abdominal pain warrants a careful workup due to the possible risks for the fetus and mother if appendix perforates

Eclampsia: still a major cause for adverse maternal and perinatal outcome

To determine the frequency of eclampsia and to investigate the maternal and perinatal outcome of the condition in order to identify whether further improvements can be made to the care of women by early interventions. A descriptive observational study. This study was conducted at the Department of Obstetrics and Gynaecology, Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur Mir's Sindh, during one year period from 1[st] January to 31[st] December 2010. All patients presenting with eclampsia in the labour room were included in the study. The diagnosis was based on case definition and was managed according to the set protocols. Data was recorded on pre-designed Performa. A total of 2796 patients were admitted in labour room during the study period and out of them total cases of eclampsia were 81 patients thus contributing 2.89% of the total admission. Most of the patients were unbooked only 11% patients were booked. 49% of women had first fit in the antenatal period, 37% in intrapartum while 13.5% had first fit in postpartum period. Headache and raised blood pressure was found in 85% of cases. 91% of women received magnesium sulphate, platelet count <150,000/m 3 were found in9.8%, deranged LFT in 14.8% women and abnormal renal function test were found in 34% . Mode of delivery was caesarean section in 57% patients, vaginal delivery in 34.2%. Two patient needed hysterectomies due to severe PPH, 4 maternal deaths were observed in study population. Regarding perinatal outcome 35 fetuses born with LBW, 26 were still born and 9 died in neonatal period. Eclampsia has strongly significant adverse impact on mother and fetus, which could be avoided by provision of integrated, adequate MCH services especially during antenatal period

Role of Foleys catheter for pre-induction ripening of cervix

The unripe cervix may present a problem when delivery is indicated prior to the Spontaneous onset of labour. To assess the role of Foleys, catheter in improving cervical score prior to Induction of labour. Observational type of study. This study was conducted in the Department of Obstetrics and Gynecology, Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur, Sindh during six months period from January to June 2012. Foley,s catheter was used for pre-induction cervical Ripening in fifty patients with medical and Obstetrical indication for induction of labour with unfavorable cervix. The study group comprised 35[70%] primigravida and 15[30%] multigravida. The mean maternal age was 20-35 years. Foleys catheter No: 18-22 was inserted in fully aseptic condition extra amniotic up to the level of Internal cervical os and was removed after 24 hours. Pre and post treatment cervical Condition was assessed by Bishop,s score. Foleys was inserted in 50 patients for pre-induction ripening of cervix. Thirty [60%] out of 50 patients delivered spontaneous vaginal delivery, 11[22%]Delivered by caesarean section due to failure to progress, fetal distress and CPD. Mean induction to delivery interval was 12.72hours.There were no cases of infection, Ruptured membranes, hemorrhage or other complications attributed to balloon Catheter used. Pre-induction cervical ripening with extra amniotic Foleys catheter Balloon has the advantages of being effective, simple, economical and free of Systemic serious side effects

Frequency, risk factors and complications in pregnancies associated with placenta praevia

To evaluate the frequency of placenta praevia, risk factors, and complications, both maternal and fetal associated with placenta praevia. Cross-sectional and analytical study. Study was conducted in Department of Obstetrics and Gynaecology, Unit-1, Ghulam Muhammad Maher Medical College Hospital Sukkur from April 2010 to March 2012. In this study 75 cases of pregnancy beyond 24 weeks of gestation complicated by placenta praevia were included. Total number of deliveries was 5041 and patients presented with placenta praevia were 75. Patients with placenta praevia were 75 giving an incidence of 1.5%. Among 75 cases 67 cases were non-booked, 71 cases came in emergency, out of which 8 were referred cases. The gestational age at the time of admission was < 37 weeks in 57% of cases. The maximum number of patients 28 [37%] were between 30-40 years and above, while 44 [58.7%] women were multiparous, 41 [54.7%] cases had at least one or more gynaecol / obstet procedure before the presnt pregnancy. Incidence of placenta praevia was significantly high in patients with previous caesarean section [6%] than overall incidence of%. Regarding complication 7%] cases ended up in caesarean hysterectomy due to postpartum haemorrhage and morbid adherent placenta. Intra operative haemorrhage was found in 11 [14.7%] cases and 2-4 units of bloodlransfusion were required in 52 [69%] of cases. Pre-maturity was found commonest cause of perinatal mortality about 87%. The improvement in social, nutritional and educational status of women, provision of antenatal care and ultrasonography can help in diagnosing and in decreasing the complication rate. One should anticipate placenta praevia in all patients with previous caesarean section and ultrasound scan should be used for its diagnosis specially for placental localization in patients with history of previous caesarean section

Manual vacum aspiration: a safe alternative for surgical management of early pregnancy loss

To assess the efficacy of MVA in the management of first trimester early fetal demise and first and mid-trimester incomplete miscarriages. Prospective observational study. This study was conducted at the Department of Obstetrics and Gynaecology, Ghulam Muhammad Mahar Teaching Hospital Khairpur from 1[st] January to 31[st] December 2012. A total of 145 cases with early pregnancy loss at < 12 weeks gestation, with a ultrasound diagnosis of an embryonic pregnancy, incomplete, missed and molar pregnancy were included in the study. Primary outcome measures were to assess the efficacy of the procedure and secondary outcome measures included safety of the procedure and rate of complications. A total of 145 women were included in the study. Efficacy of the procedure was 90.3%. Incomplete uterine evacuation was seen in 14 [9.6%] patients while severe hemorrhage was seen in 1 [0.6%] and infection in 6[4.1%] of study population. MVA is an effective alternative to conventional suction curettage, in terms of reduced cost, need for general anesthesia and it is also useful in low resource setting with scarcity of electricity and to avoid prolonged hospital stay

Comparison of efficacy of cervical foleys catheter and prostaglandin E2 for induction of Labour

Labor and subsequent termination of pregnancy in presence of unfavorable cervix requires cervical ripening in order to reduce complication and to diminish the rate caesarean sections as well as the duration of labor. There are a number of agents used for cervical ripening. Two commonly used agents are transcervical Foleys catheter and prostaglandin E2 vaginal pessary. To determine and compare the effects of inflated transcervical Foleys catheter and prostaglandin E2 vaginal tablet on pre-induction ripening of cervix. A prospective quasi-experimental study. This study was conducted at the Department of Obstetrics and Gynaecology, Ghulam Muhammad Mahar Medical College Hospital Sukkur from 1[st] July 2011 to 30[th] June 2012. A total 100 women were selected through non-probability sampling with a gestational age between 28-41 weeks and unfavorable cervix, requiring induction of labor were allocated in two groups. All women were received an intracervical Foleys catheter or prostaglandin E2 tablets. The outcome variables including the change in cervical Bishop Score, beginning of uterine contractions and complications during and after labor were assessed. Student's t test and chi-square were used for the analysis of data. There were no differences in mean Bishop Score changes between the Foleys catheter and prostaglandin group. Bishop Score after ripening were 6.6 +/- 61 and 6.7 +/- 0.86 for Foleys catheter and prostaglandin E2 group [P=0.64]. The prostaglandin group showed a statistically shorter induction to delivery time 15.0 +/- 7.7 compared with Foleys catheter 20.81 +/- 5.8 and [P=<0.01]. Both group showed there was no significant difference in occurrence of labor. Vaginal delivery occurred in 74% in Foleys group while 78% in prostaglandin group. There were needed more oxytocin for labor augmentation in Foleys group as compared to prostaglandin group. Foleys catheter was found effective as prostaglandin E2 for induction of labor additional benefits like cheaper, readily available, no need of extensive monitoring and lower chance of tachycystole and other systemic side effects