Valsalva ratio: a measure of stress in first year medical students.

Background: The Valsalva manoeuvre is commonly used as a method of assessing normal or disordered Autonomic control of Blood pressure and Heart Rate. Continuous changes in sympathetic and parasympathetic neural inputs exhibits alteration in Heart Rate and blood pressure which causes oscillation of R-R interval. Acute and short term stress leads to rapid changes throughout the body. Almost all body system gear up to meet the perceived dangers (stress).When healthy subjects are acutely stressed Heart rate increases and R-R interval on ECG decreases transiently. The purpose of the study is to see the changes in VMM in prestress and stress conditions. Methods: 56 non-smoking apparently healthy first year medical students (26 males and 26 females) were selected for the present study. Data collected two month prior to the examination as prestress values and during examination as during stress values. Data analyzed using Wilxcon Rank signed 2 tailed test and the sub groups data analyzed paired t test. Results: 11.54% males and 19.23% females had mild stress in prestress condition. During stress 46.15% males and 19.23% females had mild stress while 34.62% males and 57% of females had severe stress. The female had more stress as compared to males both in prestress and during stress conditions. Conclusion: We conclude that VR is affected by the academic stress in the first year medical students and that among them females are more affected which may be due to the new environment and new protocol of the education system.

Chronic idiopathic urticaria and helicobacter pylori infection: effect of eradication therapy on the relief of symptoms

OBJECTIVE: To find out the correlation between Chronic Idiopathic Urticaria and H.pylori infection and to observe the effect of Eradication therapy

STUDY DESIGN: Observational study

MATERIALS AND METHODS: 20 patients giving history of Chronic Idiopathic Urticaria were enrolled in the study. Serological testing for the presence of H. pylori infection done and were given eradication therapy [Capsule Esomeprazole 40 mg o.d, Tablet Metronidazole 400 mg t.d.s and Tablet Clarithromycin 500 mg b.i.d] for a period of 2 weeks. Clinical assessment was done at day 0, 30, 60, 90 and 120 by a scoring system [symptom evaluation scale], H.pylori status was reassessed at day 60 to confirm eradication effectiveness or to see any relapse of symptoms

SETTING: The study was conducted by the Department of Pharmacology and Therapeutics, BMSI, JPMC with the collaboration of Department of Dermatology JPMC Karachi from May 2008 to August 2008

RESULTS: Among 20 patients, 19 were positive for H.pylori infection and were given eradication therapy. Eradication therapy was successful in 18 patients one patient could not complete the study and there was relapse in one patient The mean SES scores decreased from 3.73 +/- 0.45 on day 0 to 2.52 +/- 0.51 on day 30, 1.52 +/-0.51 on day 60, 1.15 +/- 0.51 on days 90 and 0.47 +/- 0.77 on day 120. A percentage change of 59.13% was observed with a p value of <0.002

CONCLUSION: There is a possible role of H.pylori infection in pathogenesis of chronic idiopathic Urticaria

Preterm Delivery: Role of Zinc.

Background: Preterm delivery is a very challenging obstetric complication in Bangladesh. Reduced serum zinc (Zn) concentration of the pregnant mother may have some role in causing preterm delivery. Objectives: To measure serum zinc level in preterm delivery mother and their respective neonates to observe their status. Methods: This cross sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Mitford Hospital, Dhaka, during the period of 1st January to 31st December 2009. A total 136 subjects were included in this study, of whom 27 were full term delivery mother with their respective neonates (group B), treated as control group and another 27 were preterm delivery mothers with their respective neonates (group C), treated as study group. Age ranged of preterm and full term mother were from 20-40 years. Again, 28 non pregnant women with age range from 20-30 years were taken as reference value (groupa A). Statistical analysis was done by using appropriate method as applicable. Results: Mean serum zinc level was significantly (p<0.001) lower in preterm mother in comparison to that of full term mother and also in preterm neonates than that of full term neonates. Serum total protein and albumin were significantly (p<0.001) lower in preterm mother than those of full term mother and also in preterm neonates than those of their respective mothers and full term neonates. Again, maternal serum zinc level showed positive correlation with birth weight of neonates and also with zinc concentration of neonatal blood. Conclusions: The present study revealed a lower level of serum zinc in pre-term delivery mother and their neonates. These hypozincemia may be responsible for low birth weight of the fetus.

Audit of leiomyoma uterus at Khyber Teaching Hospital Peshawar

Fibroid is the commonest tumor of the reproductive tract and frequently encountered problem in gynecological practice. This study was carried out to observe the frequency of fibroids in relation to age, parity and clinical manifestations along with a critical review of its management. This study was carried out over a period of one year from 1st January to 31st December 2000 in Gynae "A" unit of Khyber teaching hospital, Peshawar. All patients presenting with fibroid uterus were included in the study. Data collection included age, parity, menstrual pattern, presenting symptoms, medical and surgical treatment history. Diagnostic criteria were clinical and ultrasonography. Evaluation of medical treatment and surgery were carried out. Management outcome of minimal invasive surgery was also observed. Results and Total 146 cases were observed. Greater frequency was found in late reproductive and perimenopausal years [65.7%]. There were 34.2% cases in reproductive age group. Majority was multiparous [72%] and 28% were nulliparous. Infertility was noticed in 16%. Myomas were mostly symptomatic [70%]. Menstrual symptoms were commonest [81.5%], pain was second common symptom [27.3%]. About 24% presented with abdominal mass and hyaline degeneration were in 50% of cases. Leiomyomas were multiple in 63.1% and commonest variety was interstitial [60.4%]. Familial factor noticed in 5.4%, clinical diagnosis was made in 582% of cases, while ultrasound was used in 40.4% of patients, conservative treatment was given in 37.6% including medical therapy [8.2%], Surgery was performed in [62.3%]. Myomectomy [10.2%] and hysterectomy was carried out in 52.05%. Minimal invasive surgery was not possible in our set up

Analysis Maternal mortality in a tertiary care hospital to determine causes and preventable factors

All pregnant women are at risk of obstetrical complications and most of these occur during labor and delivery that lead to maternal death. In our setup maternal mortality is seriously under estimated. Safe motherhood as a priority for action can not be identified with out properly assessing maternal mortality. The objectives of this study were to determine causes and preventable factors responsible for maternal mortality. This study was conducted in Gynaecology 'C' unit of Ayub Teaching Hospital, Abbottabad, from January 2000 to December 2001. Patients were admitted through emergency obstetrics care unit and Gynaecology out patient department. Patients' demographic record including age, parity, education, socio-economic status along with antenatal care record, level of care and distance from hospital were noted. Causative factors leading to maternal death and contribution factors evaluated. All this information was collected from patients records. Twenty-six maternal deaths were recorded during study period. The major causative factors were haemorrhage 9 [34.6%], eclampsia 8 [30%], sepsis 5 [19.2%], anaesthetic complications 3 [11.5%] and hepatic encephalopathy 1 [3.8%]. Maternal mortality ratio was 12.7/1000 live births [26/2040]. The age range was between 18'42 years. There were 16 [61.5%] patients in >30 years age group. Most of them [69%] were grand multiparas [Parity >5]. Education, antenatal booking and socio-economic status were poor. The distance from hospital was between 10 and 100 KM. The level of care available at nearest health facility was estimated, 40% were attended by traditional birth attendants, 33% by lady health visitors, 10% by doctors and to 17% no level of care was available. Obstetrical haemorrhage and hypertensive disorders are still major causes of maternal deaths. Most maternal deaths are preventable. The provision of skilled care and timely management of complications can lower maternal mortality in our setup

Minilaparotomy and ovarian diathermy drilling for clomiphene resistant poly cystic ovarian disease

This study was carried out to determine the effectiveness and safety of minilaparotomy and ovarian drilling for sub fertile women with clomiphene resistant polycystic ovarian syndrome. During a 2 year period [August 2000 to August 2002] 16 patients with polycystic ovarian disease were managed by minilaparotomy and ovarian drilling by diathermy. All the patients underwent full infertility workup and then treated with cyclical clomiphene citrate for 6 months. Six patients [37.5%] presented in age group 15'25 years. Eight patients [50.0%] were in age group 26'35 years. Only 2 [12.5%] patients presented in age group 36'44 years. Eleven [68.75%] patients had primary infertility. Five [31.25%] patients presented with secondary infertility. After treatment and 6 months follow up, ovulation occurred in 14 [87.5%] patients. Eleven [68.75%] women conceived pregnancy. Ovarian drilling is a powerful tool in the treatment of polycystic ovarian disease

Uterine rupture: a review of 34 cases at Ayub teaching hospital Abbottabad

Uterine rupture is a deadly obstetrical emergency endangering the life of both mother and fetus. This descriptive study was conducted to determine the frequency of ruptured uterus at Ayub Teaching Hospital Abbottabad and to elicit possible causes/reasons of ruptured uterus. The study was conducted at the department of Obstetrics and Gynaecology, Ayub Teaching Hospital, Abbottabad, Pakistan over a period of one year from July 1st, 2001 to June 30th, 2002. All cases of uterine rupture presenting during the study period were recorded and managed in the department using a protocol prepared for the purpose of this study. Data was recorded on pre-designed Proforma. There were 34 cases of ruptured uterus out of a total of 3435 deliveries [including 1128 Caesarian sections] over a one-year time period [incidence of 1/100 deliveries] with 31 intra-partum deaths. The most common age group was from 31'35 years [16/34, 47%], followed by the 26'30 years age group [13/34, 38.2%]. A majority [29/34, 85.3%] were cases of unscarred uterus presenting with rupture; the most common cause of rupture in all cases was inappropriate injections of Oxytocin [11/34, 32.35%], followed by obstructed labour [9/34, 26.5%]. All were anemic and most of them were in shock. The leading cause of ruptured uterus was found to be mismanagement by traditional birth attendants. We can reduce maternal mortality due to rupture uterus by giving proper training to traditional birth attendants and by mass education through electronic media