Evaluation of reasons of failure of trial of labor for better prognosis of VBAC

The present study was conducted to determine the reasons of failure of VBAC after previous one caesarean section. Descriptive type of study. This study was carried out in the department of obstetrics and gynecology Ayub Teaching Hospital Abbott Abad from 21 October, 2007 to 20 April 2008. The study population included 201 cases that were declared eligible for TOL having only one previous CS for non recurrent cause, a low transverse uterine scar, and adequate pelvis. All the findings were noted and recorded on predesigned proformas. Data was analyzed on SPSS version 10.Discriptive statistics were used to calculate Mean and standard Deviation for age, frequencies for abnormal lie, fetal distress, failure to progress, placeta previa, and other maternal or fetal causes of failed trial. Chi square test was used to test for significant difference of frequencies between groups; the student T test was used for significant Result A total of 201 patients with previous one caesarean section were admitted. VBAC was successful in 60 patients, the rest i.e. 77 patients were given trial of labor but failed. Among them 20[26%] failure was due to scar tenderness in the prospective pregnancy, 15[19.5%] patients had emergency lower segment CS for failure to progress, 8[10.4%] patients had another CS for fetal distress, 6[7.8%] had CS for impending rupture, 1[1.3%] had failed trial of labor due to rupture of uterus and 4[5.2%] had scar dehiscence. Results show that trial of labor in patients with previous one caesarean section due to non-recurrent causes is safe and has a success rate of 43.7%, which brings a hope to check the existing rate of CS

delima of wisdom tooth

Estimation of age from 17years to 23 is being in practice on the basis of eruption of 3[rd] molar tooth. However it is important to know whether this method is and will still be applicable in the present decade or in coming decades. This study was conducted at Frontier Medical College, Abbottabad from May 2007 to April 2009. A cross sectional study is carried out in 400 students of FMC Abbottabad between 18 to 23 yrs of age to evaluate the status of eruption of 3rd molar tooth of both males and females. All informations were gathered on a performa especially designed for this purpose. Record of 400 students was collected.6 performas were bias and rejected. Out of 394, 196 were males and 198 were females. All 4 erupted 3[rd] molar were seen in 90 [22.84%] students,3 erupted 3[rd] molar in 67 [17%], 2 erupted 3[rd] molar in 63 [15.98], 83[21.06] showed eruption of only one 3[rd] molar and last but not the least 91[23%] didn't show eruption of 3[rd] molar at all. Result regarding 3[rd] molar tooth eruption shows that human beings of these decades are passing through evolutionary process of contracted jaw and resultant impaction of most of 3[rd] molars at the sight of eruption is the usual outcome. So we can predict that a time will come in coming few decades when forensic experts have to resort to some other factors to determine the age onwards from 17yrs rather than 3rd molar tooth eruption and development

role of medical man in cases of burns

Injuries caused by burns are a common occurrence in our country. Burn always evoke source of interest for forensic curiosity. The victim of burns needs a detailed scrutiny to evaluate the intentional status whether suicidal, homicidal or accidental to provide justice and to satisfy the weeping souls. A retrospective study. This study was conducted in the patients of burn at AMC from March 2005- May 2008. All of the patients were included irrespective of sex and age. Record of burn patient was taken on performas in which their age, sex, type of burn, percentage of burn, causative agent and reason of burning were noted. Total 53 patients were included in the study. Among them 47 sustained accidental, 5 patients homicidal and 1 suicidal burns. Out of 47 accidental cases 7 patients died, 4 out of 5 homicidal cases died and only one suicidal case revived. The patients who are registered as accidental or suicidal burns are not always so. A probe into the history of patients can bring out the key to truth. Moreover timely assessment of critical clinical conditions of patient is necessary to avail them their rights of justices

Morbidity and mortality of firearm injury in Peshawar region

Firearm injuries cause significant morbidity and mortality among its victims. The present study, carried out at a major tertiary care hospital of Peshawar, Pakistan was aimed at highlighting the extent and severity of firearm-related morbidity and resultant mortality despite expert medical care. All victims of firearm injury brought to the Lady Reading Hospital Peshawar Emergency Department and thereafter admitted to hospital wards during the period mid-2006 to mid-2007 were included in the study prospectively regardless of age, gender or socio-economic status. Data relevant to the background of firearm use, type of firearm used, types and extents of injuries, clinical condition of the patients and final outcome were collected on performas and entered into SPSS 15.0 for analysis. Seventy-four cases of firearm injury were recorded during the study period, with a predominant male to female ratio [9.6:1]. Most victims [79.7%] were in the age group of 15-35 years. Although there were more cases from Peshawar [28.4%], there was no major referral pattern noted. High velocity weapons were used in 95.9% of cases and homicide was the main motive for injury [60.8%]. Injuries were sustained most frequently in the abdomen and pelvis [44.6%] and 67.6% of victims sustained internal injuries. There were only 5 [6.8%] deaths from firearm injuries. It is concluded, the young males of the population must be targeted for lifestyle adjustments such as training to refrain from anger or disputes [usually over petty things] and to prevent the easy access of firearms as a weapon to settle disputes

Morphological changes in human placenta of wet snuff users

Wet snuff is commonly used by both males and females in different parts of Pakistan. Apart from other ingredients, tobacco is the major component of snuff. Adverse effects of smoking on morphology of human placenta have been shown by some previous studies. But snuff is not considered as dangerous as smoking during pregnancy. This study was designed to see the effects of snuff on morphology of human placenta. In present study total 80 human placentae, 40 from normal and 40 from snuff users were used. This study was carried out in the Department of Anatomy Basic Medical Sciences Institution [BSMI] Karachi. Duration of study was six months. Samples were obtained from Gynaecology and Obstetric unit-I JPMC. Placentae washed well with running tap water to remove blood clots. Umbilical cord and other membranes were removed and placenta gently squeezed to expel the foetal blood. Gross features like weight, diameters, central thickness and attachment of umbilical cord were noted in normal and snuff users' placentae. Then placentae were preserved in 10% formalin for at least five days before the sectioning for micromorphology. Placentae divided in two groups-A and B. 4 micro m thick sections of the tissue were taken on rotary microtome and stained with H and E, Mallorys trichrome and methanamine silver for different histological observations. Mircromorpholgical changes have been observed in placentae of snuff users leading to loss of functional components of placentae. This loss of functional component may have deleterious effects on outcome of pregnancy. No significant gross morphological changes were found in snuff user placentae. Wet snuff effect the micro-morphology of placenta leading to loss of functional component and in turn effects the exchange of materials between mother and foetus which may leads to intrauterine growth retardation. Loss of trophoblasts may lead to hormonal imbalance necessary for normal pregnancy and this imbalance can cause premature labour. Nocotine can cross the placental barrier[2], which may produce foetal tachycardia

Occupational stress and its effect on job performance a case study of medical house officers of district Abbottabad

Doctors especially house officers are under a great deal of stress related to a variety of occupational stressors. Occupational stressors contribute to organizational inefficiency, high staff turnover, absenteeism due to sickness, decreased quality, and quantity of practice, increased costs of health care, and decreased job satisfaction. One of the organizational outcomes that affected by occupational stress is job performance. The purpose of the present study was to investigate the effect of job stress on job performance. The universe of the study is District Abbottabad and the complete population of house officers was targeted which were present at that time were 55. The data obtained through questionnaire was analyzed using the statistical methods including descriptive statistics, Spearman's correlation and multiple regressions. The analysis showed strong support for the hypothesis that there is an inverse relationship between job stress and job performance indicating that there is high job stress in the house officers, resulting in low job performance. Correct stress management should start from improved health and good intrapersonal relationships. The prevention and management of workplace stress requires organizational level interventions, because it is the organization that creates the stress. Success in managing and preventing stress will depend on the culture in the organization. A culture of openness and understanding, rather than of criticism, is essential. Those house officers who had high level of job stress had low job performance. All the factors affected male house officers more than the female house officers

Penile fracture: experience at Ayub teaching hospital

Penile fracture is a relatively rare traumatic rupture of the tunica albuginea of one or both corpora cavernosa of an erect penis. It is a real urological emergency which needs early assessment and surgical management. Twelve [12] cases of penile fracture were reviewed from July, 1997 to July, 2007 in the Department of Urology, Ayub Teaching Hospital Abbottabad. All cases presented with classical history of penile fracture and the diagnosis was made on the basis of history and clinical examination only. All the patients underwent immediate surgical repair with well preserved potency and excellent overall results. Penile fracture has typical signs. Standard treatment consists of immediate surgical repair of penile fracture with a low incidence of late complications. Post op complications including urethral strictures and erectile dysfunction should be ruled out by regular follow-up

Incidence of road traffic accidents in Hazara division

Road traffic accidents are also one of the commonest causes of mortality and morbidity in both developed as well as in under developed countries. This study was designed to see the "Incidence of Road Traffic Accidents in Hazara Division ". Method: Three years [1998 to 2000] road traffic accidental data of five districts of Hazara Division [Haripur, Abbottabad,Mansehra, Batagram and Kohistan] was collected from S.S.P. office, Abbottabad. The incidence of road traffic accidents was greater in three districts [Haripur, Abbottabad and Mansehra] as compared to two districts [Batagram and Kohistan]. Conclusion The rate of road traffic accidents was proportional to traffic load on the roads along with other causative factors

Epidemiology of suicide in Faisalabad

Suicide is one of the ten leading causes of death in the world, accounting for more than 400,000 deaths annually. The incidence and pattern of suicide vary from country to country. Cultural, religious and social values play some role in this regard. Very few studies about the epidemiology of suicide have been conducted in Pakistan. We conducted this study on the patterns of suicide in autopsies conducted at Faisalabad from 1998 to 2001, to know the incidence of suicide, which subgroups of the population were most vulnerable to such deaths and the methods being used. Materials and The study includes 95 cases of suicidal deaths of both sexes belonging to different age groups autopsied at the Department of Forensic Medicine, Punjab Medical College, Faisalabad. Cases were selected on the basis of information from the scene of crime, police inquest, autopsy findings and interview with the acquaintances of the victim. Findings were tabulated and analyzed. The study revealed that suicide rate was 1.12/100,000, with male preponderance. The peak incidence was in 20'29 years in males and 10'19 years in females. Hanging was the most common method. A seasonal surge in spring was noted. Suicide in Faisalabad is much lower compared to western countries. Suicides occur at a younger age in Faisalabad compared to western countries