Comparison of Hydralazine and Labetalol tolower severe hypertension in pregnancy

Objective: To compare the intravenous Labetalol versus intravenous hydralazine in patients having severe Pregnancy induced hypertension [PIH] and pre eclampsia [PE] in pregnancy

Methods: Seventy eight women admitted in the Department of Gynecology and Obstetrics, Civil Hospital Karachi, having severe PIH/PE and fulfilling the inclusion criteria were included in the study. Random selection of patients was performed using sealed opaqe envelop for administration of either intravenous noted [IV] Labetalol or Hydrallazine. The mean fall in the MAP in each group was noted. This data was compared by applying SPSS version 13. The study was conducted from November 2012 to April 2013

Results: The mean [+/-SD] age of the labetalol group was 27.46 [+/-5.28] years while that in the hydralazine group was 26.28 [+/-5.17] years. The mean fall in MAP observed in the labetalol group was 29.10 +/- 7.21 mmHg and that in the hydralazine group was 25.05 +/- 10.15 mmHg which was statistically significant with the p value being 0.046

Conclusion: Intra Venous labetalol lowered MAP more than hydralazine, when administered to pregnant females with severe Pregnancy induced hypertension [PIH] and pre eclampsia [PE] in pregnancy

Frequency of pre-menstrual syndrome and menstrual irregularities in adolescents of different socioeconomic groups

Objective: To assess association between menstrual irregularities and socioeconomic status in adolescent girls

Study Design: Cross sectional study

Place and Duration of study: This study was conducted at different schools and colleges of Karachi from December, 20[th] 2010 to 15[th] January 2011

Materials and Methods: The study included 650 girls from schools and colleges of Karachi district representing different socio economic groups. A questionnaire was constructed comprising of biodata, menstrual cycle pattern and details of dysmenorrhea and premenstrual syndrome [PMS]. Girls between 15-19 years were selected randomly from schools and colleges representing low, middle and high income group. They were requested to fill questionnaire. Information thus obtained was analysed on spss version 11

Results: A total of 611 questionnaires were analyzed. 33.2% of adolescent girls belonged to low income group, 30.3% were from middle and 36.5% from high income group. Mean age of girls was 16.7 years. Menstrual cycle pattern was regular in 75.28% girls. No difference was found in cycle pattern between different socioeconomic groups. 83.79% girls complained of dysmenorrhea and 34.76% of them were from low income group, 29.49% from middle and 35.75% from high income group. Treatment of dysmenorrhea was required in 14.56% girls, including 41.57% from low, 24.71% middle and 33.8% from high income group. PMS was noted 71.68% girls. 36.1% girls reporting PMS were from low and 32.2% and 31.7% from middle and high income group respectively

Conclusion: Menstrual cycles are regular in majority of teen age girls. Dysmenorrhea and PMS are prevalent menstrual disorders in young adolescents. Incidence of PMS is significantly higher in low socio-economic group

Sacrohysteropexy performed as uterus conserving surgery for pelvic organ prolapse: Review of case files

Objective: To assess the outcome and safety of sacrohysteropexy as uterus conserving surgery for pelvic organ prolapse in young women and to assess patients' satisfaction with the procedure

Methods:This is a case series of patients operated at Sind Government Lyari General Hospital and Civil Hospital Karachi, between January, 2007 to October, 2015. Data of the patients who had sacrohysteropexy were reviewed. Complications during surgery and post-operative period including haemorrhage, visceral injury, paralytic ileus and peritonitis were studied. Success of procedure, need of blood transfusion, hospital stay and condition on discharge and six weeks follow-up were noted. Data were analyzed using SPSS version 16. Mean +/- SD was calculated for numerical, while frequencies were computed for categorical variables

Results:Data of 60 patients were reviewed. Early post-operative success was 100%. Duration of surgery was less than two hours in 57 [95%] patients. Blood loss was negligible in majority of cases. Out of all 60 cases, 52 [86.7%] did not suffer any complication. One patient had ureteric injury, while one patient sustained bowel injury. Two patients had paralytic ileus. Four patients suffered from abdominal wound infection. All patients were managed satisfactorily. Mean duration of stay in hospital was four days. Upon follow up 96.7% patients were satisfied with results of operative procedure. Sixteen [26.7%] patients complained of backache on follow-up visit

Conclusion:This review concludes that sacrohysteropexy was successful in all cases in early post-operative period. It is a safe procedure and should be considered as an option for the treatment of pelvic organ prolapse in young women, in whom uterine conservation is required

Frequency and risk factors of low birth weight in term pregnancy

Objective: To determine frequency of Low Birth Weight [LBW] at term and to determine frequency of various associated risk factors

Methods: This cross-sectional study was conducted in Department of Obstetrics and Gynaecology Layari General Hospital and Dow University of Health Sciences Karachi between January 2007 to July 2008. Women with singleton pregnancy of 37 and above completed weeks were identified. Those women who gave birth to babies with less than 2500gm were recruited in the study. In all those patients who gave birth to LBW babies risk factors were assessed. The variables including age, parity, booking status, maternal weight and height, socioeconomic condition, smoking, fetal gender and birth weight were noted on a questionare. The data was analyzed on SPSS Version 15. Frequency of LBW and its associated risk factors were determined

Results: During study period 10.6% patients delivered LBW babies. Antenatal care was not received in 67% patients. Parity was less than three in 87%. In 26% of patients maternal weight was less than 50 kg and in 37% patients with LBW, maternal height was less than five feet. Majority of patients were anaemic [72%] including 20% with haemoglobin< 7 grams

Conclusion: LBW is associated with a group of factors which may be regarded as high risk factors. These include low socio economic status, anaemia, primiparity, short maternal height and less than average weight

Job satisfaction; among doctors working in public and private tertiary care hospitals of Lahore

Background: Doctor's profession has been among one of the most attractive profession in Pakistan Society, but doctors are getting increasingly dissatisfied with their jobs in our region as unfortunately job satisfaction has still not received the proper consideration from policy makers

Objectives: To determine the level of satisfaction with various job characteristics and compare the characteristics of doctors with level of job satisfaction among doctors working in public and private sector teaching hospitals

Study Design: Cross sectional study

Period: July 2014 to August 2014

Setting: Public sector [Jinnah Hospital Lahore] and a private sector [Fatima Memorial Hospital] Lahore

Methods: A total of 308 medical officers, 154 from each hospital were included through simple random sampling. They were interviewed regarding their socio demographic and work related characteristics and satisfaction level regarding various job characteristics, using a structured, pretested questionnaire. The job satisfaction was rated on the basis of a three point liker scale with scores ranging from 1 - 33 and scores >/= 25 were considered as satisfied. All the data was entered and analyzed using SPSS version 17.0

Results: Among the total study respondents, majority 212 [68.8%] doctor were dissatisfied with their jobs while high level of satisfaction was seen only regarding timeliness of pay 92.9% and job safety 98%.On comparing characteristics of doctors with job satisfaction, it was seen that age, gender, marital status, number of family members, total family income, work experience and nature of job was not significantly related with satisfaction while doctors working in private hospital were more satisfied with their job as compared to doctors working in government hospital and this result was statistically significant [P = 0.000]

Conclusion: Satisfaction level of doctors especially working in public hospitals was low as compared to doctors working in private sector. There is need to address the reasons of dis-satisfaction and formulate strategies to eliminate these issues

Effect of green tea polyphenols and HbA1c in type 2 diabetic patients

In many previous studies, green tea has been shown to prevent and treat type 2 diabetes 16-18. Some controversial results have also been noticed in few studies. Primary objective of the present study was to determine the effect of green tea polyphenols on glycaemic control among the patient with type 2 diabetes. Conflicting data exists according to previous studies about green tea that it might have a positive effect on the glycaemic control in patients with diabetes mellitus type 2. The aim of the present study was to give evidence whether a crude extract of green tea improves glycated haemoglobin A1C [HbA1C] and fasting plasma glucose in patients with type 2 diabetes. Study was prospective, interventional and randomized. This study was conducted at the Department of IMBB [Molecular Biology], University of Lahore from April 2007 to June 2007. A total of 60 patients, 20 with diagnosed diabetes mellitus type 2 taking oral anti-diabetics and 20 diabetic individuals who were not taking any hypoglycemic drug, of either sex were randomly assigned to take green tea extract twice a day, at the dose of 15 gram, for 3 months. A group of 20 healthy subjects was also enrolled in the study. A very significant difference between the pre- and post-intervention fasting plasma glucose level was observed in both the groups of diabetic patients while no significant difference was seen regarding HbA1C level. Significant changes were not observed in either of the parameters in healthy individuals, as was expected throughout the study. No adverse effects were observed in any of the three groups. The green tea extract seems to have a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients with poor glycaemic control

Polycystic ovarian syndrome; Determination of alterations in glucose level and lipid profile

The objective of the present study was to determine the changes in the glucose level and lipid profile in patients with polycystic ovarian syndrome [PCOS]. Descriptive study. This study was conducted at lnstitute of Molecular Biology and Biotechnology, The University of Lahore from June 2009 to June 2010. Total 50 patients with PCOS were included and 50 age-matched control subjects were also selected for comparison. Their glucose levels and lipid profile were assessed using commercial kits. The data thus obtained was subjected to statistical analysis. Results: Significant differences [P<0.05] in fasting blood glucose level and individual parameters of lipid profile were observed in women with PCOS. A higher prevalence of hypertriglyceridemia, hypercholesterolemia, higher LDL, lower HDL and higher fasting blood glucose levels was explored in PCOS women than controls. Abnormal glucose level and lipid profile in PCOS women showed that these women are at an increased risk of developing diabetes and subsequently cardiovascular diseases.

Leukemia; alteration in serum electrolyte [NA[+], K[+], MG[+2], CL[-] and PO[4][-3]] levels

The present work was undertaken to analyze qualitatively the serum electrolyte [K[+], Na[+], Mg[2+], PO4[-3] and Cl[-]] levels by photometric analysis in cancer patients as compared to non-cancer individuals. An understanding of the mechanisms involved in disease pathogenesis is paramount for prevention and treatment in cancer patients. Total 120 blood samples were collected for analysis randomly which were divided into two groups as A [leukemia patients] and B [normal individuals] having 60 in each. Both of these groups were further sub-divided [20 each] into three age groups [20-35, 36-50 and 51-70] A1, B1, A2, B2, A3, B3 respectively. A significant [p<0.05] increase in serum K[+] level [hyperkalemia] was observed in cancer patients as compared to normal individuals having a non significant [P>0.05] interaction with the age limits. However a significant decrease [P<0.05] in the levels of Mg[2+], PO4[-3] and Cl[-] [hypomagnesia, h pophosphatemia and hypochloridemia respectively] was recorded in group B as compared to group A having independency of age limits. Low serum Na[+] [hyponatremia] was observed in Group B3 as compared to Group A3 [51-70] except the age limits [20-35 and 36- 50] which showed a non significant interaction with this decreased level of sodium. The data was statistically analyzed by ANOVA and a highly significant [P< 0.05] difference was obtained between both of the groups

Raised serum cholesterol; evaluation of hypocholesterolemic effect of green tea [Camillia sinensis]

Hypercholestrolemia has a strong association with Atherosclerosis and coronary artery disease [CAD]. It is a major worldwide health problem and the incidence is rising in Pakistan. Hypocholesterolemic effect of green tea [GT] has been proven in various research studies in the world. Present study aims to evaluate this effect in Pakistani population in the context of specific dietary and social habits prevailing here. The university of Lahore. Sixty subjects were included in the study comprising of thirty healthy subjects and thirty hypercholesterolemic individuals who were not taking any medication to control their serum cholesterol. They were all given GT in a dose of 3 gm twice daily for sixty days. Serum cholesterol levels were estimated at day 1 and then every 2nd week till the 60th day. Significant lowering of serum cholesterol was observed [p<0.001] in hypercholesterolemic individuals after 60 days. There were no side effects reported of GT intake. Our results suggest that GT can safely reduce the raised serum cholesterol level in Pakistani population

Effects of poverty on pregnant women

To estimate the effects of low maternal education, malnutrition, anemia, pre-eclampsia, gestational diabetes, depression, domestic violence on pregnancy outcome. Hospital based cross sectional study done in obstetrics and gynecology department of a tertiary care teaching hospital from November 2010 to April 2011. Five hundred married women between 15-45 years of age attending the obstetric clinic for any problem or were admitted in the obstetrics ward were interviewed and data entered in a questionnaire. Apart from basic demographic information, their educational level, nutritional status, anemia, history of eclampsia, diabetes, depression and domestic violence were recorded. Socioeconomic groupings was done on the basis of monthly income i.e. monthly income less than Rs. 6000 [lower], 6000-12000 [middle] and more than Rs. 12000 [upper]. For the ease of analysis, the study population was divided into three socioeconomic groups. Majority [62.4%] were in the lower socioeconomic bracket while 34.6% were in the middle and only 3% were in the upper strata. In the lower socioeconomic group 62% women were uneducated, only 25.3% women had regular antenatal care, and only 80% could afford balanced diet once in two weeks. Almost 50% were anemic, 13.1% were under weight, 12.1% had low birth weight babies and 3.2% had still births. Violence was reported by 17%. In the high socioeconomic group only 13% women were uneducated and all parameters were 50% better than those in the lower socioeconomic group with 53.3% women having regular antenatal care, 40% taking balanced diet once in two weeks, 6.7% being under weight and 6.7% having low birth weight babies. The frequency of anemia was slightly less [40%] when compare d with the lower socioeconomic group. Violence was reported by 7%. Mode of delivery was a cesarean section in 26.4% with 13.4% ending up in wound infection. Poverty is a key hindrance to women's wellbeing especially during pregnancy resulting in malnutrition, anemia, low birth babies or fetal loss

Osteopenia in the younger females

To find out the frequency of osteopenia in young females and compare the bone mineral density [BMD] in females of different age groups. Cross-sectional study. This study was conducted by the Department of Obstetrics and Gynaecology, Unit V, Lyari General Hospital during Dow University of Health Sciences Health Expo at Expo Centre, Karachi, held on October 12, 2009. All females visiting our stall were offered BMD testing, irrespective of age group and parity. Pregnant ladies were excluded. Age, marital status, parity and occupation were noted. BMD was tested using calcaneal quantitative ultrasound [BMD Sahara Hologic G 4262]. WHO criteria were used for defining BMD. Data was entered and analyzed using SPSS version 15. Chi square test was used to compare various groups. Results were considered significant if p value was <0.05. A total of 170 women were included in the study, with mean age of 37.89 +/- 12.6 years. BMD was found decreased in 64% of women of /= 45 years. Osteoporosis was more frequent in women with parity >/= 4. Non-working women were found to have lower BMD as compared to working women and students. Majority of young female population had osteopenia. Steps should be taken to address this problem at an earlier age so as to prevent its complications later in life

Efficacy of fine needle aspiration cytology in the diagnosis of breast lumps

To determine the sensitivity and specificity of fine needle aspiration cytology [FNAC], by comparing the results with excision biopsy. This observational and comparative study was conducted in Surgical B Ward of Khyber teaching hospital Peshawar, Pakistan from August 2002 to May 2003. A total of 50 women, who had a clinically palpable breast lump were subjected to concurrent FNAC and excision biopsy. Out of 12 malignant lesions on excision biopsy, FNAC correctly diagnosed 9, and 2 were diagnosed suspicious, and the remaining one was misdiagnosed as non malignant. So false negative being 1/12 [8.3%]. Of 38 benign cases on excision biopsy, FNAC diagnosed correctly duct ectasia 3, tuberculosis 2, and galactocele 1, while out of 22 fibroadenoma, FNAC diagnosed 20, and 2 were diagnosed as unsatisfactory. Ten cases diagnosed as fibrocystic disease on excision biopsy, FNAC picked only 6 cases correctly. The one case diagnosed on FNAC as fibrocystic disease, turned out to be malignant on histology. The remaining 4 cases of fibrocystic disease diagnosed on histopathology were either reported as unsatisfactory [3 cases] or suspicious [1 case] on FNAC. The sensitivity and specificity of FNAC was 91.66% and 96.96% respectively. Breast cytology was an effective and rapid method of diagnosis of breast diseases. It helps in deciding which patient needs early open biopsy. A negative cytology does not exclude the possibility of malignancy, as there was a false negative rate of 8.3%

Tolerability of hysteroscopy under local anaesthesia

To assess the tolerability of hysteroscopy amongst patients, when performed under local anesthesia. Quasi experimental study from January to December 2006. Dept. of Gynae. and Obstetrics, Sindh Govt. Lyari General Hospital and AI-Hafeez Medical Centre, Karachi. Patients attending the Outpatient Clinics with bleeding per vagina were randomly selected. After the clinical work-up and taking consent, all patients were given injection diclofenac sodium half an hour prior to the procedure. After preparing and positioning the patient, 10cc of injection Bupivacaine was given for para cervical block at 3 and 9 o'clock positions. The uterine cavity was distended with normal saline. Hysteroscopy was performed and the findings noted. Pain scoring was done by visual analogue scale. The condition of the patient was monitored during and after the procedure; they were kept under observation for four hours. Tolerability of the procedure was assessed by pain scoring and the presence of complications, and the results analyzed. During the study period 113 patients underwent hysteroscopy for abnormal uterine bleeding. The procedure was performed successfully in 98.2% patients without any complications, while 1.8% patients experienced transient vasovagal attack. The procedure was painless in 52.2% patients; 40.7% patients had mild pain [score < 3] and were reassured, whereas 7.1% patients had moderate pain [score 3-5]. Only 3.5% cases required analgesia for pain control. All patients remained haemodynamically stable during and after the procedure. Hysteroscopy is very well tolerated under local anaesthesia by our local population

Human chorionic gonadotropin [hCG]: a treatment of oligospermia

The most commonly accepted definition of the term infertility is the lack of pregnancy [regardless of cause] after one year of unprotected intercourse. Infertility affects approximately 15% of couples of reproductive age. Its prevalence has been stable during the past 50 years, although a shift in etiology and in the age of the patient has occurred. In Pakistan there are roughly 10-15% newly married couples who require some kind of medical help before they can become parents. Even if the wife is fertile and the husband is normal, there is roughly 1 in 3 chances the wife will conceive. A total of 17 patients were diagnosed for Oligospermia and were placed in one group. 5000 IU of hCG were administered intramuscularly once a week for four month. Every month serum testosterone and semen count was analyzed. Progressive increase of semen count was observed in four month. hCG though, never produced in male but has significant effect on spermatogenesis via LH receptor. Initial value of 25 million/ml roused to 69 million/ml in just four month. Use of hCG in male infertility is though common world wide but it has not gained its popularity in Pakistan. General awareness of its usage especially among physicians treating infertility is required

Estimation of lactic acid tq assess proper exercise protocols for patients undergoing cardiac rehabilitation therapies

Exercise regiments either for healthy life style or for Rehabilitation therapies, cause stresses resulting in physical and metabolic alterations. It is noted that if some of the extremes of exercise were continued for even prolonged periods, it might easily be fatal. In this regard, three metabolic systems are exceedingly significant in understanding the limits of physical activities, viz, the aerobic system, the phosphagen system and glycogen-lactic acid system. During anaerobic metabolism of glucose, and to acquire ATPs for muscular activities, pyruvate is converted into lactic acid, which diffuses out of the muscle cells into interstitial fluids and blood. A high level of lactic acid in blood is hazardous for acid-base balance of the body. Reconstitution of lactic acid, commonly known as removal of lactic acid from the system, is necessary to avoid metabolic acidosis state. This is especially important because lactic acid cause extreme fatigue. Reconstitution of lactic acid takes place mostly through lactic acid-oxygen debt system. Therefore, to monitor proper exercise protocols, lactic acid levels were analyzed in patients undergoing rehabilitation therapies, especially with cardiac and pulmonary abnormalities, such as COPD, CABG etc. Both male and females patients were selected and grouped according to their clinical conditions, age, exercise regiments and duration of rehab. Their blood samples were collected, pre and post-exercise, processed and analyzed according to prescribed methods Control subjects were also passed through same exercise pattern and their blood samples were also analyzed. The results suggest significant importance of this protocol in cardiac and pulmonary rehabilitation and discussed in light of the observations and outcomes

Mentally - ill patients charged with homicide

To describe the clinical, social and demographic features of mentally ill patients charged with homicide. Design: Retrospective study. Place and Duration of Study: The study was based on the review of case notes of the patients who were charged with homicide and referred to the mental hospital, Peshawar, between 1988 and 1998 for psychiatric evaluation. Patients and The case notes of all the patients referred for psychiatric assessment between 1988 and 1998 were retrieved. Fifty cases with complete essential information were selected for the study. The details of patients' demographic, clinical characteristics, diagnosis, events leading to the homicide, opinion of the medical board, details of the victim and possible provoking factors were recorded on a performa designed for this purpose. Out of 50 patients referred for psychiatric assessment with homicide, majority [49] were males, while only one was female. The mean age of the sample was 32.4 years and 30 patients [60%] were educated. Schizophrenia was the most frequent diagnosis [72%]. Duration of illness in 96% of the patients was more than one year. Only 12 patients had received some form of treatment before the index crime. Thirty-eight [76%] patients were involved in single murder, while 12 patients were involved in multiple homicides. Majority of the victims [39 out of 64] were close relatives of the patients. Young male patients are mostly referred for psychiatric assessment after homicide. Close relatives are major victims. Lack of adequate psychiatric treatment is one of the contributing factors. Lack of adequate forensic psychiatric services are also highlighted by this study

Characteristics of heroin addicts in government mental hospital, Peshawar

One hundred consecutive admissions for heroin addiction to Government Mental Hospital Peshawar, between June 1989 and December 1989, were studied. Patients were offered a ten day detoxification period. Data were collected by semi-structured interviews. All patients were male, from lower social class, who inhaled the drug. The majority [72%] were unemployed and perceived their families as supportive [62%]. Most patients [7.4%] had previously abused cannabis and had been involved in drug related offences [60%]. The average length of stay in Hospital was 7.7 days