Low-dose urinary human chorionic gonadotropin is effective for oocyte maturation in vitro fertilization/ intracytoplasmic sperm injection cycles independent of body mass index

Background: Currently, there is no agreement on the optimal urinary derived human chorionic gonadotropin [u-hCG] dose requirement for initiating final oocyte maturation prior to oocyte collection in in vitro fertilization [IVF], but doses that range from 2500-15000 IU have been used. We intended to determine whether low dose u-hCG was effective for oocyte maturation in IVF/intracytoplasmic sperm injection [ICSI] cycles independent of body mass index [BMI]

Materials and Methods: We retrospectively evaluated a cohort of 295 women who underwent their first IVF/ICSI cycles between January 2003 and December 2010 at the Division of Reproductive Endocrinology and Infertility, Wayne State University, Detroit, MI, USA. Treatment cycles were divided into 3 groups based on BMI [kg/m[2]]: <25 [n=136], 25- <30 [n=84], and >/=30 [n=75] women. Patients received 5000, 10000 or 15000 IU u-hCG for final maturation prior to oocyte collection. The primary outcome was clinical pregnancy rates [CPRs] and secondary outcome was live birth rates [LBRs]

Results: Only maternal age negatively impacted [P<0.001] CPR [odds ratio [OR=0.85, confidence interval [CI: 0.79-0.91]] and LBR [OR=0.84, CI: 0.78-0.90]

Conclusion: Administration of lower dose u-hCG was effective for oocyte maturation in IVF and did not affect the CPRs and LBRs irrespective of BMI. Women's BMI need not be taken into consideration in choosing the appropriate dose of u-hCG for final oocyte maturation prior to oocyte collection in IVF. Only maternal age at the time of IVF negatively influenced CPRs and LBRs in this study

Growth hormone estimation; insulin-like growth factor-1 a possible alternative

Introduction: Despite the use of growth hormone replacement therapy for decades, our ability to make a definitive diagnosis of growth hormone deficiency in children is limited. Growth hormone stimulation tests have been used to discriminate between Growth hormone deficiency and idiopathic short stature. However all these tests lack reproducibility, accuracy, cost affectivity and safety. Insulin like growth factor-1 is an effector hormone and its serum level may be used as simple, easy to perform diagnostic test for growth hormone deficiency

Objective: To determine the efficacy of IGF-1 as a diagnostic tool in children with growth hormone deficiency

Study Design: Prospective cross sectional survey

Place of Study: Departments of Pediatrics and Pathology, Shalamar Medical and Dental College, Lahore

Duration of study: 1st July to 31st December, 2011

Material and Methods: We included 40 children of 3.5 - 17 year age and detailed clinical data was collected. All these children were subjected to stimulation by standardized exercise on treadmill, after taking basal blood samples for GH and IGF-1. Post stimulation growth hormone was recorded to identify growth hormone deficient children

Results: 17 [42.5%] children had post stimulation growth hormone level <10ng/ml while 23 [57.5%] had values >10ng/ml. Post exercise stimulation GH level showed weak correlation with IGF-1 in either of the two study groups. P value was found >0.05 in deficient as well as sufficient groups, depicting non significance of IGF-1 in relation to post stimulation GH level

Conclusions: IGF-1 is not a suitable surrogate diagnostic marker for growth hormone deficiency. Diagnosis should always be based on combination of auxological biochemical, radiological and genetic considerations

One-year audit of breast clinic at abbasi shaheed hospital, Karachi

The British Association of Surgical Oncology [BASO] has set standards for services provision and provides an audit program for the breast clinics. This study is an audit based on retrospective data to examine and report the one-year performance of Breast clinic at Abbasi Shaheed Hospital, Karachi. Between October 2009 and September 2010,615 new and 1158 follow up in a total of 1773 patients visited Breast clinic for their breast symptoms. A specially designed Performa for breast diseases was filled on the first visit of all patients, which included each patient's detailed history, physical examination, investigations and diagnosis. Each Performa was reviewed for audit. The total number of patients visited Breast clinic at Abbasi Shaheed hospital was 1773 including 615 new and 1158 were follow-up cases.Majority of them were between 16 to 50 years of age group. There were 348 [56.58%] patients with breast lump out of which 300 [48.78%] turned out to be benign on further investigation and 48 [07.80%] were malignant. Breast pain was the presenting complaint in 144 [23.41%] patients while 33 [05.36%] patients presented with nipple discharge, 54 [08.78%] with breast abscess, 15 [02.43%] had atrophy breast, 06 [0.97%] had hy-pertrophied breast, 09 [01.46%] were with asymmetry of breast and 06 [0.97%] with eczema of nipples. The audit showed that 03 out of 07 performances based standard, according to British Association of Surgical oncology [BASO] were not met satisfactorily. It is concluded that multidisciplinary breast clinic in public hospital provides better services to the symptomatic breast patients on their first visit

Intestinal tuberculosis - a common cause of intestinal obstruction

To assess the prevalence and presentation of intestinal tuberculosis in cases of mechanical bowel obstruction. Retrospective study from Oct. 1999 to Sept. 2005. Surgical Unit I, Abbasi Shaheed Hospital, Karachi. All patients [> 10 years of age] presenting with mechanical bowel obstruction. The data and files of all the cases of dynamic bowel obstruction was retrieved and analyzed with reference to age, sex, symptomatology and examination findings, investigations, aetiology, surgical procedures performed and outcome. A total of 163 patients were admitted with mechanical bowel obstruction over a period of six years. The ages of the patients varied between 10-74 years, maximum cases being seen between 30-40 years, with a male preponderance [60.1%]. Abdominal pain [40.5%], vomiting [20.2%] and constipation[16. 0%] were the prominent modes of presentation. Intestinal Tuberculosis [70.6%] was the most common cause of intestinal obstruction, followed by irreducible inguinal hernias [17.2%] and malignancies [7.4%]. Less than half [46.0%] the tuberculous patients were already on anti-tuberculous treatment at the time of presentation. About 9% of the tuberculous cases were managed conservatively, while the rest were operated upon; right hemicolectomy being the most frequent [47.6%] procedure performed. Histopathology was positive for tuberculosis in all the cases. Five patients of intestinal Tuberculosis died due to Tuberculous peritonitis. Intestinal Tuberculosis is the leading cause of mechanical bowel obstruction in our part of the world. Many patients of abdominal tuberculosis, managed conservatively on anti-tuberculous treatment, develop signs and symptoms of acute obstruction. Hence early surgical intervention is recommended to improve the morbidity and mortality of such patients