Intracervical PGE2 gel for cervical ripening and induction of Labour

The objectives of the study were to evaluate the efficacy of interacervical gel as a cervical ripening agent in the unfavourable cervix. The changes in the Bishops score, onset of labour and its progress were secondary outcome measures. Fifty patients were enrolled in this prospective study conducted in Gynae "A" unit of Khyber Teaching Hospital, Peshawar from January to December 2004. Patients with singleton living fetus, cephalic presentation, gestational age of >36 weeks completed were included. Half milligram [0.5mg] of prostaglandin E2 gel intracervical was used for intracervical application. The application was repeated after 6-12 hours if the Bishop score remained unfavourable i-e < 5. The indications were postdates pregnancy [50%], PIH [18%], Diabetes Mellitus [18%] and Rh isoimmnization [6%]. The success rate in terms of vaginal delivery was 82%. The lower segment caesarean section rate was 18%. The commonest indication for caesarean section was failure to progress. The complications side effects were minimal and the neonatal outcome was good. This study showed that intracervical application of prostaglandin E2 gel is effective, safe acceptable method for ripening of cervix in women with unfavourable cervix

Epidemiological study of HIV/AIDS in women of NWFP

To determine the epidemiological characteristics of HIV/AIDS positive women of NWFP. Descriptive observational study from January to December 2004. Dept. of Gynaecology, Poly clinic Hospital ESSI, Kohat Road, Peshawar. All female patients diagnosed as having HIV/AIDS by ELISA were included in the study. Data of the patients was collected from the tertiary hospitals of Peshawar [LRH, KTH and HMC] and from, different areas of NWFP through a performed questionnaire and field visits. A total number of 74 patients were diagnosed as having HIV/ AIDS in NWFP. Out of these 28 [38%] were female patients, most of them belonging to Peshawar district and Kurram Agency, with 29% reported cases each. The major route of transmission in women was from life partner [50%] and blood transfusion [18%]. Majority of women were illiterate house wives, belonging to the lower socioeconomic group [71%]. HIV/AIDS in Pakistan is at a dangerous cross road, particularly in the NWFP. Unsafe sexual practices, absence of regular and universal methods for blood screening, mother to child transmission, and use of contaminated syringes and surgical equipments are mainly responsible for the spread of the disease. Socioeconomics status and education play an important role in the prevention of HIV/AIDS. Government, media and NGO's need to work together on HIV/AIDS control, prevention and awareness program

Doppler detected opening size and flow chart as predictors of early failure of arteriovenous fistula in hemodialysis patients

To determine whether Flow rate and the Size of the opening can predict early failure of arteriovenous fistulae in haemodialysis patients on Doppler ultrasonography. Prospective, quasi experimental study from March 2004 to January 2006. This study was conducted in Surgical "c" ward of the Khyber Teaching Hospital, Preshawar. A total of 92 patients with ESRD [End Stage Renal Disease] who were selected for haemodialysis. All the patients were subjected to Doppler study during the first week of AVF [arteriovenous fistula] construction, and the stomal size and blood flow rate detected. Both these parameters were used as predictors of AVF failure on follow-up visits during the next six months. Out of 92 patients, 13 [14.1%] had an initial stomal opening ranging from 2.3-3.5 mm and 44 [47.8%] from 3.5-5mm, while in 35 [385] patients the opening was > 5 mm. Twenty two [23.9%] patients had an initial flow rate of <400ml/min, 52 [56.5%] 400-700 ml/min and in 18 [19.5%] patients the flow rate was >700 ml/min. During the six months follow-up visits there were 14 [15.3%] AVF failures; all these patients had an initial flow rate of less than 400 ml/min, with a stomal opening of <3 mm in size. Initial stomal opening size and flow rate can be used as good predictors of early Arterio-venous failure in haemodialysis patients on Doppler ultrasonography