To study the role of metformin on outcomes of pregnancy in patients with polycystic ovarian syndrome

Objectives: To evaluate the effects of Metformin on outcomes of pregnancy in patients of polycystic ovarian syndrome who conceived on Metformin and then continued it till they delivered, compared to patients where use of metformin was stopped on conception

Study design: This open label randomized study was conducted from October 2010 to October 2012 at the outpatients department of Maroof International Hospital, Islamabad

Place and duration: 46 patients with polycystic ovarian syndrome who conceived on Metformin [both with and without the help of ovulation inducing agents] were included in the study. Out of these 23 patients discontinued the use [of Metformin] and remaining 23 never stopped using Metformin throughout pregnancy, both these groups were compared to each other in their outcomes

Methodology: Forty six patients having polycystic ovarian syndrome and infertility were treated with Metformin1gm/day with or without other ovulation induction agents [Clomiphene and injections of Human Menopausal Gonadotropins]. Twenty three patients were continued with Metformin 1gm/day throughout pregnancy [group A], and in the second group consisting of twenty three patients [group B] Metformin was discontinued after they conceived. The were first trimester abortions, preterm delivery, Live birth rate, Birth weight, gestational diabetes and fetal anamolies

Results: The incidence of first trimester abortions in group B patients of polycystic ovarian syndrome was 34.7% as compared to group A where the incidence was 4.3% [where Metformin was continued throughout pregnancy].The incidence of gestational diabetes was 8.6% in group A [when Metformin was continued] and 26 % in group B [when Metformin was not continued]. There were no fetal anomalies in the women receiving Metfromin during pregnancy

Conclusion: Metformin reduces the incidence of first trimester abortions gestational diabetes and impaired glucose tolerance, when the drug was continued throughout pregnancy in subjects with polycystic ovarian syndrome. In addition no adverse effects on the mother or fetus were seen

Occupational noise induced heraing loss

Objective: To investigate hearing threshold of industrial workers and correlate between noise exposed and unexposed groups

Study design: An observational cross sectional study

Place and duration of study: Study was conducted at medical testing and research organization located at Islamabad from January 2010 to May 2010

Methodology: 50 industrial workers [Gp A] exposed to constant high level noise were integrated in study and compared with matched control group [Gp B]. Pure tone audiometry [subjective test] was carried out to measure the hearing threshold at various frequencies

Results: Hearing loss was more prevalent in group A. A characteristic dip of hearing threshold was noted at 4000 Hz in Gp A

Conclusion: Industrial workers are at higher risk of developing Sensor-neural hearing loss [SNHL] as compared to general population. These individuals can easily be picked in early stages by audiometry and appropriate protective measures advised to prevent or interrupt the silent progress of disease

Assessing the role of disodium pamidronate in the management of rheumatoid arthritis

OBJECTIVE: To assess the role of Disodium pamidronate [ 3-amino-1-hydroxypropylidine-1,1-bisphosphonate] in the management of Rheumatoid Arthritis

STUDY DESIGN: A prospective, open, randomized, observational, dose response comparasion [30 mg vs 15 mg of Disodium Pamidronate] study done in the medical department of Cantonment General Hospital Rawalpindi over a three month period

PATIENTS AND METHODS: 16 patients of both genders with rheumatoid arthritis were divided into two groups of 8 each. [Designated A and B.].All patients had established Rhuematoid Arthritis according to 1987 American Rheumatology association revised criteria for the diagnosis of Rheumatoid Arthritis. Each group was randomly allocated to receive a single infusion of Disodium Pamidronate of either 15 [group A] or 30 mg [group B] . A number of parameters of disease activity were recorded [Grip strength [dominant hand; mean of three readings],Ritchie articular index, and early morning stiffness among others]. All patients were admitted and directly observed initially

RESULTS: Group A: Was given 15 mg Pamidronate infusion.Two [2] patients [25 %] showed improvement in clinical parameters and biochemical parameters. 6 patients showed biochemical improvement alone

Group B: Was given 30mg Pamidronate infusion. Five [5] patients [70%] showed rapid clinical and biochemical improvement which was relatively sustained for 1-3 months. All the 8 patients showed biochemical improvement. A transient flu like illness observed in one patient only however he was a responder

CONCLUSIONS: 30mg of single Disodium Pamidronate infusion in an efficacious and rapidly acting management strategy in the therapy of active rheumatoid arthritis. The response is dose related

survey of health problems and total disease burden in a group of senior managerial officers in an autonomous organization

OBJECTIVE: To evaluate the spectrum of common health problems in a group of male senior managerial officers in an autonomous organization in Pakistan and to analyze the results obtained for any expected or unexpected patterns of total disease burden

STUDY DESIGN: A Cross-sectional study

PLACE AND DURATION: Out patients of PTCL [Pakistan Telecommunication Company limited] health centers over a six months period from Jan 2004 to June 2004

METHODOLOGY: Fifty senior managerial officers of BPS [Basic Pay Scale] 18 to 21 were selected for the purpose of this study. The survey was done over a six month period on outpatient basis [Jan 2004 to June 2004].The subjects ranged from 45y to 59y [mean age 53y]. All the subjects were assessed first with a detailed history and physical examination followed by a health questionnaire [to be filled by the subjects]

Subjects were then tested for Complete blood count, fasting serum lipids , Renal function tests, liver function tests, chest X-ray, ECG, abdominal and pelvic ultrasound and a second layer of tests as guided by physical examination , answers to the questionnaire and the first battery of tests

RESULTS: Eosinophilia and raised triglycerides were both seen in 30% [n=15] of the subjects each. Other derangements of lipid were also seen in 10% [n=5] percent of patients. Osteoarthritis of the knee [clinically suspected and radiological confirmed] was seen in 12% [n=6] of the subjects. Prostatic symptoms, Diabetes, Systemic Hypertension and renal stones were seen in 8 % [ n=4] of the patients. Raised serum uric acid and other problems were seen less frequently. Lipid derangements and Eosinophilia were seen as the most frequent abnormal finding and osteoarthritis leads as most frequent health problem

CONCLUSION: There are very few officers in this group without any health problems or deranged lab indices. However significant serious disease burden [especially cardiovascular disease] was not a very a prominent feature in this group