Etio-pathological profile of abnormal uterine bleeding in Abbottabad

Objective: To determine the etiology and clinical profile of patients with abnormal uterine bleeding

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Shahina Jamil Teaching Hospital, Abbottabad from September 2014 to February 2016

Materials and Methods: Patients who were not pregnant, among the age of 20-60 years and had history of abnormal menstruation were included. Exclusion criteria included patients who were pregnant, less than 20 years or greater than 60 years, or suffering from cancer. Epidemiological data was noted and detailed history was taken especially about menses, vaginal discharge, use of drugs, hormonal treatment including oral contraceptive pills and any method of contraception used. Physical, ultrasonographic examination and histopathological examination of endometrium was performed in all patients

Results: There were 200 patients enrolled in this study. Their mean age was 38 +/- 5 years. Majority of them were between the age of 31-40 years, [82 patients] and 41-50 years, [66 patients].About 150 patients had menstrual irregularities. Eighty of these patients had menorrhagia while seventy had polymenorrhagia. Fifty patients had history of vaginal bleeding. Contraceptive measures were used by 38 patients. Out of which, OCPs were the preferred mode of contraception used. Twenty two patients had infertility with 16 had primary while 6 had secondary infertility. Sixty two patients had abnormal ultrasound examination. The chief ultrasonographic abnormality was that of uterine fibroid, ovarian cyst and ovarian cancer. On endometrial examination, 168 patients had normal physiological changes. The predominant change in this group was that of proliferative and secretory changes. Twenty patients had abnormal physiological endometrial changes. The chief abnormalities found were that of Pill endometrium, [12 patients] and irregular shedding, [4 patients]. Preneoplastic and inflammatory changes were observed in six patients in each group

Conclusion: AUB is one of the commonest gynecological disorders. The underlying cause can be determined by meticulous work-up in these patients which can help in deciding optimal treatment option for AUB patients. This, in turn, will not only improve health and well-being of these patients but as well as improve their quality of life. Endometrial sampling plays an important role in the diagnostic work-up of AUB. Therefore, it should be offered to all such patients as part of their evaluation

Urinary tract infections; etiological profile and antimicrobial susceptibility patterns of uropathogens

Background: Urinary tract infections [UTIs] constitute important bacterial disease which contributes to significant morbidity world-wide. Empirical treatment in patients suffering from UTI depends upon the local knowledge of common microorganisms responsible for UTI in that geographical area as well as their antimicrobial susceptibility patterns

Objectives: To determine the frequency and antimicrobial susceptibility of uropathogens which are responsible for urinary tract infections. Study Design: Experimental study. Setting: Department of Pathology, Frontier Medical and Dental College and Mohi Ud Din Islamic Medical College. Period: January 2015 to June 2015

Material and methods: Total of 113 patients were included in the study. Urine samples were cultured on MacConkey's agar and Cysteine Lactose Electrolyte Deficient [CLED] agar. Micro-organisms were identified using standard tests and antimicrobial susceptibility was checked using modified Kirby Bauer method following Clinical and Laboratory Standards Institute [CLSI] guidelines

Results: The average age of patients was 32.19 +/- 16.47 years. Gram negative organisms accounted for majority of cases, about 89 [78.76%] cases. Escherichia coli was the most common micro-organism which was found in 50 [44.24%] cases followed by Staphylococcus aureus in 24 [21.24%], Enterobacter spp. in 19 [16.81%], Klebsiella spp. in 11 [9.73%] and Proteus spp. in 9 [7.96%] cases. E. coli was sensitive to imipenem and ciprofloxacin and was resistant to amoxicillin/clavulanic acid and gentamicin

Conclusion: Gram negative organisms are largely responsible for UTIs and E. coli being the most common etiological agent. E. coli is sensitive to commonly prescribed drugs for UTI like ciprofloxacin

Quality assurance in medical education in Pakistan medical education

Objective: To assess the level of quality assurance in medical education in Pakistan

Study Design: Observational / Descriptive study

Place and Duration of Study: The study was carried out at Frontier Medical College, Abbottabad, from January 2016 to March, 2016

Materials and Methods: No significant research was carried out on this subject earlier in Pakistan. Therefore, an internet search was carried out. Published research [in Pakistan and sub-continent] and documents pertaining to policy were analyzed

Results: Total no of medical schools had risen to 132 in Pakistan, while the no of medical institutes was 314 in India. There are 52 medical and dental colleges in public sector throughout Pakistan while 82 medical and dental colleges in private sector. This shows that the no of medical institutes is considerably high in private sector than in public sector. In public sector, Punjab had the largest no of medical institutes with 22 [18 medical colleges and 4 dental colleges], Sindh has 13 [9+4], Khyber Pakhtunkha [K.P.K] has 10 [8+2], Baluchistan has 2 [1+1] and Azad Jammu and Kashmir [AJK] has 3 [3+0]. In private sector, Punjab had the largest no of medical institutes with 40 [28 medical colleges and 12 dental colleges], Sindh has 26 [14+12], Khyber Pakhtunkha [K.P.K] has 14 [9+5], Baluchistan has 1 [1+0] and Azad Jammu and Kashmir [AJK] has 1 [1+0]. The no of students admitted to medical programs in Pakistan and India in 2014 was 11250 and 35783 respectively

The maximum no of students, about 6250, were in Punjab, followed by 2850 students in Sindh, 1550 in K.P.K, 400 in AJK and 200 in Baluchistan

Conclusion: Quality assurance plays a pivotal role in medical health education. There is a need to establish stringent policy guidelines for accreditation standards

This will help improve level of medical education in Pakistan. It will also ensure that medical graduates will receive good education and public will get highest standards of healthcare services from well-educated doctors

Hepatitis B and C virus infections; in haemodialysis patients in Abbottabad, Pakistan

Patients with end stage renal disease require haemodialysis as a part of their treatment. The incidence of hepatitis B and C virus infection is quite high in patients undergoing maintenance haemodialysis than in general population. This risk is specifically associated with use of blood and its products as well as repeated intravascular access in these patients

Objectives: To determine the seropositivity of hepatitis B and C virus infection in patients receiving haemodialysis

Design: Descriptive cross sectional study

Setting: Nephrology Department, Ayub Teaching Hospital, Abbottabad, Pakistan

Period: From October 2014 to April 2015

Methods: Five hundred patients were included in the study based on inclusion and exclusion criteria. Demographic data was recorded and detailed history was taken from each patient specifically about the no of blood transfusions received, the frequency of dialysis and the dialysis done in other centers. All patients were checked for the presence of hepatitis B surface antigen [HbsAg] and antibodies to HCV using third generation enzyme linked immunoassay [ELISA]

Results: Mean age of study sample was 46 +/- 5 years with 60.8% males. Incidence of hepatitis positive cases was 164 [32.8%], out of which 66 [13.2%] patients were HBV positive and 98 [19.08%] patients were HCV positive. The hepatitis B and C infections were more common in males than females. Seropositivity of HBV and HCV was higher [HBV 18.1% and HCV 22.2%] among haemodialysis patients who have received more than three blood transfusions. The frequency of HBV and HCV infections increases significantly with the increase in frequency of dialysis, with 49 [17.11%] patients were HBV positive and 70 [24.5%] patients were HCV positive cases, who have received haemodialysis for more than five times. There were 48 [15.7%] HBV positive cases as well as 68 [22.3%] HCV positive cases in patients who have received their treatment from a single center

Conclusion: Hepatitis B and C infection is quite common in patients undergoing haemodialysis. The risk of these infections can be reduced by following infection control guidelines, proper training of the staff and strict screening of blood and blood products specifically for hepatitis C virus

Bacteriological profile and antibiotic susceptibility of blood isolates in blood stream infections

The current study was aim to analyse Bacteriological Profile and Antibiotic Susceptibility of Blood Isolates in Blood Stream Infections. Experimental study. This study was conducted at Department of Pathology, Frontier Medical and Dental College, Abbottabad from January 2010 to August 2011. 1056 blood samples were collected aseptically. The positive blood isolates were identified by standard biochemical tests and their antimicrobial resistance patterns were checked using modified Kirby-Bauer method. Blood cultures were positive in 152 [14.39%] cases. Gram negative isolates were predominant with 104 [68.42%] cases, consisting, in decreasing frequency, of Salmonella typhimurium [39, 37.5%], Pseudomonas aeruginosa [23, 22.1%], Escherichia coli [18, 17.3%] and Klebsiella pneumoniae [14, 13.4%]. Staphylococcus aureus accounted for 30 [19.7%] cases followed by coagulase negative Staphylococcus aureus [CONS] in 11 [7.23%] cases among gram positive isolates. Gram positive bacteria were highly resistant to amoxicillin while they were sensitive to cefuroxime and aztreonam. Among gram negative organisms, Escherichia coli and Klebsiella pneumoniae were sensitive to ofloxacin while Pseudomonas aeruginosa to cefpirome and ceftazidime. Our study provides important information about the bacteriological profile and antibiotic resistance pattern of blood isolates in blood stream infections. It will help clinicians to choose an empirical antibiotic therapy to treat such infections

Smoking behavior among medical and dental students in Abbottabad, Pakistan

Objective: To assess the prevalence of smoking among young medical and dental students and explore the smoking habits and associated variables

Study Design: Cross-sectional observational study

Place and Duration of Study: The study was conducted in Frontier Medical and Dental College, Abbottabad, Pakistan during June-July, 2015

Materials and Methods: This was a cross-sectional observational study where anonymous, self-administered questionnaire was used to collect data like socio-demographic data and details about various aspects of smoking from 146 studysubjects

Results: The rate of smoking was found to be 23.28%, with male preponderance. The mean age of initiation of smoking was 18.79 +/- 1.68 years. The most common reason for starting smoking was company and peer pressure followed by stress or tension. The mean number of cigarettes smoked per day was 13.39 +/- 6.52. The commonly used product was cigarette [89.28%] among males and waterpipe[shisha], [83.33%], among females. Majority of study subjects, 63.70%, and 73.53% of smokers were aware of harmful effects of smoking. The most commonly known harmful effects included; lung cancer, carcinoma of oral cavity, respiratory and cardiovascular diseases

Conclusion: Smoking is common among medical graduates. Tobacco control measures should be introduced to reduce smoking as well as it should be made part of curricula taught at medical and dental colleges to increase awareness among students

Typhoid fever with jaundice; a clinical study in Abbottabad

Typhoid fever is a systemic infection which is caused by Samonella enterica serotype typhi. It is a multi-system disorder involving many organs including liver. Liver involvement could be in the form of jaundice, rise in liver enzymes or hepatomegaly. It can present as acute hepatitis in rare cases, called typhoid hepatitis. This study was carried out to study the association of typhoid fever in patients with jaundice. To determine the frequency of typhoid fever among patients presenting with jaundice. Descriptive cross sectional study. At Gastroenterology Unit, Ayub Teaching Hospital, Abbottabad. March 2011 to December 2011. Total 115 patients were included in the study based on inclusion and exclusion criteria. Typhidot IgM test was performed to confirm the diagnosis of typhoid fever. The mean age of patients was 28.5 +/- 10.14 years, with 54.8% male gender predominating the overall sample. The male to female ratio was 1.2:1. Typhoid fever was found in 22 [19.1%] out of 115 patients with jaundice and there were 68.2% were males and 31.8% were females. Typhoid fever is not rare to present as jaundice in our part of the world where typhoid fever is endemic. Therefore, all those patients who have fever, jaundice, abnormal liver function tests or hepatomegaly must be screened for typhoid fever especially in areas where typhoid fever is endemic

Pattern of hematological disorders in Abbottabad

To study the pattern of distribution of different hematological disorders in Abbottabad based on bone marrow examination results. Retrospective study. This study was conducted at the Aksa Laboratory, Abbottabad from January 2011 to December 2013. 143 patients, who presented to Aksa laboratory for bone marrow aspiration, were selected. Complete details of history, examination, blood tests were recorded. Bone marrow aspiration was performed using aseptic technique and bone marrow aspirate samples were prepared. Bone marrow aspirate results of 143 patients were studied. There were 104 cases [72.72%] of non-malignant hematological disorders while 39 [27.27%] of hematological malignancies. Among non-malignant hematological disorders, megaloblastic anemia was the most common disease affecting 31 patients [29.80%], followed by iron deficiency anemia in 20 patients [19.23%]. There were 39 cases [27.27%] of hematological malignancies. Out of these, 23 cases [58.97%] were of acute leukemia followed in descending order by 5 cases [12.82%] of multiple myeloma and 4 cases [10.25%] of chronic myeloid leukemia. Megaloblastic anemia was the most common disease followed by iron deficiency anemia among non-malignant hematological disorders. Acute leukemias were most common among malignant hematological disorders. Bone marrow aspiration was very useful in making a correct diagnosis and determining the cause of disease