Knowledge, skill and attitude of community midwives regarding intrauterine devices for family planning in Lahore

Objective: Study was designed to assess the knowledge, skill and attitude of community midwives before and after three days training workshop on the subject insertion of intrauterine device, as a tool for family planning

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at Community Medicine, Sharif Medical and Dental College, Jati Umra, Lahore and Department of Public Health, The University of Lahore from January 2015 to June 2015

Materials and Methods: An intervention study was conducted by collecting data from designing structured questionnaire which was answered by the midwives taking part in the training to evaluate their basic knowledge, skill and attitude towards use of intrauterine devices. This study was based on three phases. 1] assessment 2] intervention 3] evaluation. Thirty community midwives in the community based maternity homes of Lahore was selected as subjects. Data through a pretested questionnaire was collected and analyzed by statistical package for social sciences [SPSS]

Results: 50-70% of community midwives had the basic knowledge of IUD, insertion skill and its benefits, before going through the training. After the training, knowledge of IUD, its insertion skill and advice to women increased up to 85-100% among the participants. Results clearly show that the knowledge of the community midwives regarding use of IUDs use as a family planning tool was minimal and increased after getting the training

Conclusion: Study finding suggested that training is essential for the community midwives for improving their knowledge, technical skill for insertion of IUD, and aptitude for counseling to the families upon follow up visits

Frequency of thrombocytopenia in Plasmodium vivax Malaria

Background: Plasmodium vivax is the most widely distributed human malarial parasite. Mild thrombocytopenia is a common feature of acute malaria caused by P. vivax regardless of the severity of infection which may progress to severe thrombocytopenia. The aim of our study was to find the frequency of thrombocytopenia in Plasmodium vivax

Materials and Methods: This descriptive cross sectional study was carried out at Peadiatrics unit, Shaikh Zayed Hospital, Lahore from July, 2013 to November, 2014 comprising of 56 children of both gender age 14 years and below who presented with fever of more than 101o F and Plasmodium vivax rings, trophozoites or schizonts on peripheral blood smear [thick and thin smear]. Full blood counts and platelet counts were done along with other routine as well specific investigations where required. The data was entered in standardized proforma and analyzed on SPSS 17

Results: There were 40 [71.43%] males and 16 [28.57%] females with the mean ages of 6.3 +/- 4.4 and 9.4 +/- 3.3 of males and females respectively with an overall mean age of 7.6 +/- 4.2. The frequency of thrombocytopenia was noted in 46 patients [82.14%]. Mild thrombocytopenia was in 15 patients [26.79%] with mean of 119,000.89 +/- 8,000.76SD, moderate in 23 [41.07%] with mean of 89,210.56 +/- 5637.23 and severe thrombocytopenia was in 8 patients [14.29%] with mean of 29,678.98 +/- 2389.54

Conclusion: Thrombocytopenia is common in P. vivax malaria in our set up and all patients with such malaria must be screened for thrombocytopenia

Frequency and etiology of urinary tract infections in neonatal late onset sepsis

Objective: To determine the frequency and etiology of urinary tract infections in neonatal late onset sepsis

Study Design: Cross-sectional study

Place and Duration of Study: The study was carried out in neonatal unit, Shaikh Zayed Hospital, Lahore for six months period from January to June, 2014

Methodology: 175 neonates admitted in Neonatal Unit, Shaikh Zayad Hospital, Lahore through emergency, obstetric unit or outpatient department with late onset sepsis were included. Cases were selected by non-probability sampling technique

Results: Culture proven urinary tract infection [UTI] was present in 21.6% of late onset sepsis. The most common causative organism was Eschericha coli [84.21%] followed by Klebsiella [13.6%]. No male, female predisposition was found in this study

Conclusion: All neonates with late onset sepsis should be investigated for urinary tract infection and most common causative organism is Escherichia coli

influence of the mode of anesthesia on the neonatal well being after the caesarian delivery

To evaluate the influence of the mode of anesthesia on the neonatal outcome after the caesarian delivery. All the patients who were going to have a caesarian section were enrolled to the trial and their demographic data along with the Apgar Score and need for the NICU [Neonatal intensive care unit] admission, was entered in a specially designed proforma. After the data collection [from 1[st March 2010 to 28[th] February 2011] the data was entered in SPSS version 19 and was analyzed statistically. There were 1308 caesarian deliveries out of which 59.6% [n=779] were delivered electively while 40.4% [n=529] had an emergency delivery. The rate of general anesthesia versus spinal anesthesia was the same i.e. 59.2% [n=199] and 59.7% [n=580] respectively in elective delivery group and 40.8% [n=137] and 40.3% [n=392] respectively in emergency delivery group and this difference was found statistically insignificant. The Apgar Score of the neonates delivered to patients having general anesthesia was significantly poor as compared to the spinal anesthesia group and the rate of NICU admission is also high in general anesthesia group i.e. 10% [n=34] as compared to 5.8% [n=56]; this difference was also statistically significant [p=0.018]. Spinal anesthesia is associated with better neonatal outcome as compared to general anesthesia in both emergency and elective C/Section group.

comparison of intravaginal misoprostol with prostaglandin E2 [dinoprostone] for induction of Labour at term

To compare the efficacy of Misoprostol and Dinoprostone used as labour inducing agents. The first 100 patients admitted in the labour ward of Shalamar Hospital Lahore for induction of labour between March 2003 and February 2004 and fulfilling the inclusion criteria were randomly allocated to the two drug trial groups and followed till outcome of the delivery. Parameters included induction to delivery interval, need for augmentation of labour, C-section rate, safety of drugs to mother and the neonate and the cost benefit rates. One case got dropped out on her personal choice and left the hospital. The remaining 99 were followed up. Among the vaginally induced Misoprostol group 56% women delivered vaginally within 12 hours, while in vaginally administered Dinoprostone group only 26% delivered within 12 hours. This difference was found statistically significant [p<0.05]. The rate of C-Section in the two groups was not found statistically different [p>0.05]. The most common side effect with Misoprostol was nausea while the patients in the other group experienced vomiting. Vaginally prescribed Misoprostol reduced the induction to delivery interval but did not effect the rate of C-Section. No increase in maternal or neonatal complications was observed. It was highly cost effective

Long term outcome of patients with endometriosis on medical treatment

To evaluate long term outcome of patients with endometriosis on medical treatment [OCP's, progestin, clomiphene citrate according to need of patients], in terms of symptomatic relief, successful conception, recurrence and treatment failure. This quasi experimental study was conducted in Shalamar Hospital Lahore. All patients who had confirmed diagnosis of endometriosis by laparoscopy or by laparotomy were included in the study after informed consent. Type of medical management was decided according to the need of the patients. The patients who did not want to conceive were given medical treatment in the form of combined oral contraceptive pills or progesterone. Patients who wanted to conceive, were given clomiphene citrate. Patients were followed up for 1 to 9 years. Study outcome was expressed in terms of symptomatic relief, pregnancy, recurrence and treatment failure. Data was analyzed using SPSS version 16. Initially, there were 94 patients who had confirmed endometriosis and were included in the study. Out of these,18 patients lost follow up, and were excluded from study. The mean age of these patients was 25 +/- 4.73 years and 50 percent presented with pelvic pain and 36% with infertility. They were followed for 1-9 years. The mean duration of follow up was 4.37 +/- 2.29 years. 61.8% cases became symptom free, 15.8% conceived successfully, whereas 9.2% had persistence of pain. 11.8% had recurrence rate over 12-14 months after discontinuation of medical treatment. Long term follow up of patients with endometriosis showed that medical treatment of endometriosis with COCPs, progestogens, and clomiphene citrate has promising results with less then 20% cases requiring other modes of treatment

effect of anaesthesia modus on amount of blood loss in cesarean sections

A cesarean section is the delivery of a baby through a incision in the mother's abdomen and the uterus. It is the most common major surgery that women undergo. In the UK about 1:4 pregnant women give birth by c/section every year. To compare the effect of spinal and general anaesthesia on the amount of blood loss during cesarean section. It is a cross - sectional study to be carried out at Shalamar Hospital. It was conducted in one year's time i.e. from 1st March 2010 to 28th February 2011. All the patients with low risk of bleeding were enrolled to the trial. The choice of anaesthesia was the patient's choice after counselling by the anaesthesiologist. The total number of patients enrolled to the trial were 1308 out of which 972 patients received spinal anaesthesia and 336 patients were given general anaesthesia. The Demographic data along with preoperative haemoglobin and haematocrite was recorded on the proforma designed for the purpose. The demographic data including age and gravidity was not statistically different in both the groups similarly the preoperative haemoglobin and haematocrite was also insignificantly different in both the groups. The mean amount of blood loss is 357 ml in the spinal group and 501 ml in the patients who received general anaesthesia, this difference is statistically significant. The postoperative haemoglobin and haematocrite is also significantly reduced in the patients who received general anaesthesia. The rate of transfusion is 14.6% [n = 49] in general anaesthesia group and 3.2% [n = 31] in the spinal anaesthesia group and this difference is also statistically significant. The study proves that spinal anaesthesia is a better choice of anesthesia as it reduces the amount of blood loss and requirement of the post-operative blood transfusion

Appropriate gestational age for elective C-section

Timing of elective caesarean delivery is a relevant public health issue. Neonatal outcome is associated with the duration of gestation at the time of delivery. Rate of C-section is increasing worldwide even in USA it increased from 20.7% in 1996 to 31.1% in 2006. The objective to determine the appropriate age of gestation for elective C-Section in order to have good neonatal outcome and decrease perinatal morbidity. It is a cross sectional study that is retrospective. It will be carried out in the Department of Obstetrics and Gynaecology, Shalamar Hospital, Lahore from March 2011 to Nov. 2011. One hundred consecutive subjects who had elective C-Sections during the study period were included in the study. Gestation of pregnancy was correlated with the outcome of babies. The newborns were assessed by 5 minutes apgar score and by admission in neonatal unit. In a total of 100 patients 9 had C-Section at 39 completed weeks and 47 had C-sections at 38 completed weeks and 44 had C-Sections at 37 completed weeks of gestation. Most of the babies who had respiratory problems and shifted to nursery were those who were delivered at 37 weeks gestation. Timing of elective Caesarean delivery at term has a relationship and influence on neonatal outcome. The perinatal morbidity can be reduced by decreasing elective caesareans before 39 completed weeks of gestation

Yield of suprapubic aspirate versus bag collection in diagnosis of UTI in children 0 to 6 months of age

Objective: To evaluate the accuracy of urine sample collection methods among children suspected of having urinary tract infection

Subjects and Methods: Urine samples were collected in infants 0-3 months of age presenting with features of sepsis. Two methods of collection were used, one was bag attached to perineal skin and the other was suprapubic aspirate. Within 30 minutes of collection, all specimens were sent to the laboratory, refrigerated and processed according to standard hospital microbiological procedures. Urine samples were analyzed using routine culture technique

Setting: This cross sectional study was conducted at Shaikh Zayed hospital Lahore. The duration of study was six months. A total of 100 cases fulfilling the inclusion criteria were included in this study. Results were analyzed according to SPSS 16

Results: Out of 100 patients [n=100] 17 had positive bag culture, only 4 out of 17 had culture positive by SPA, so there were 13 false positives while using bag collection method

Conclusion: Suprapubic aspiration showed the positive yield in 4 SPA which does not indicate contamination and sterile urine bag showed the highest contamination rate among the two methods of urine sample collection. So urine bag leads to unnecessary treatment burden on the child and family. There fore we cannot rely on bag samples for diagnosis of urinary tract infections specially the bag collection method because the specificity of bag collection method is very low

Frequency of gastroesophageal reflux disease in children with chronic cough

Objective: To identify the frequency of gastroesophageal reflux disease in children with chronic cough aged 2 months to 2 years

Methods: This cross sectional survey was conducted in 75 children between 2 months to 2 years in the department of pediatrics, Shaikh Zayed Hospital, Lahore. Children having chronic cough of > 4 weeks duration included in study and were admitted in ward and barium swallow was done in the Radiology Department

Results: Total 75 of chronic cough were included in this study, out of these 75 patients GERD was diagnosed in 29 [39%] on barium study. Out of these 29 patients, 20[27%] were in the age group of 2-9 months, 9[12%] were between 10-17 months. No patients of age group 18-24 months were diagnosed as GERD on barium study. In this 29 patients, 18[24%] patients were male and 11[15%] were female

Conclusion: Gastro esophageal reflux disease is one of the most common reasons for chronic cough seeking consultation of pediatricians. Early diagnosis and management of GERD can lead to decrease morbidity in children

Role of C-reactive protein in the diagnosis of sepsis in early infancy

Objecctives: To assess the role of serial C-reactive protein in the diagnosis of sepsis during the early period of infancy [<90 days]

Materials and Methods: This cross sectional study was conducted in the pediatrics Department of Shaikh Zayed Hospital [SZH], Lahore. The duration of study was 6 months from 1[st] July to 31[st] December 2010. Total 150 cases fulfilling the inclusion criteria were enrolled randomly in the study. Babies were divided in two groups: Group 1 -Healthy babies. Group II- Babies with sign and symptoms of sepsis. The first C-reactive protein and blood cultures were sent in all cases at the time of admission. Antibiotics were started in the suspected cases of sepsis. After 48 hours of admission, second sample of C-reactive protein was again sent in all cases

Results: The study was carried out in babies <90 days admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 [45.33%] culture proven cases of sepsis and 82 [54.67%] cases were culture negative. Escherichia coli was the most common organism isolated followed by Staphylococcus aureus. Males [63%] were predominant as compared to females [37%]. 80% were term babies while 20% were preterm. 75% babies were born by lower segment caesarian section, 15% were delivered at home while 10% were born at the private clinics. Early onset sepsis was seen in 39.33% of cases while late onset sepsis was seen in 60.67% cases. Mechanical ventilation was done in 10 babies [6.6%]. 97.4% babies survived and 2.6% babies expired. The sensitivity, specificity, PPV, NPV of C-reactive protein was 91.18%, 53.66%, 62% and 88% respectively at the time of admission. The CRP level was statistically different between the two group [p<0.001], at the time of admission and at 48 hours after admission

Conclusion: Babies during the early infancy period are susceptible of developing sepsis that may lead to potential consequences if not treated in proper time. Also babies may be over-treated and may have prolonged stay in the hospital if not properly investigated, which may itself be a burden to the family members and have a financial instability also. So keeping in mind all these factors, were performed a serial CRP test at admission and after 48 hours for treatment monitoring and observing the response. Sensitivity of C-reactive protein and negative predictive value was high in this study at the time of admission. So, serial monitoring of C-reactive protein is recommended for the monitoring treatment response

Prevalence of polycystic ovaries among patients with hirsutism and menstrual abnormalities

Polycystic ovaries are considered to be the most frequent cause of hirsutism with its prevalence of 10% of woman of reproductive age group. Polycystic ovarian syndrome [PCOS] reflects multiple potential etiologies and variable clinical presentations. To investigate the prevalence of polycystic ovaries among patients with hirsutism and menstrual abnormalities [oligo- or oligohypomenorrhea] and to correlate presence of hirsutism with BMI, polycystic ovaries, ovarian volume and biochemical markers. All patients who presented with oligo- or oligohypomenorrhea or hirsutism either in outpatient clinic of Obstetrics and Gynecology, Shalamar Hospital or a private laser clinic were enrolled in study. Patients who had hirsutism with normal menstrual cycle were excluded from study. Enrolled patients were categorized into two groups on basis of hirsutism, group 1: oligomenorrhea/oligohypomenorrhea with hirsutism and group 2: oligomenorrhea/oligohypomenorrhea without hirsutism. A detailed clinical history, clinical examination, hormonal profile and abdominopelvic ultrasound were done in all patients. SPSS- version 16 was used for statistical analysis. Out of 90 patients who enrolled in the study, 10 did not report back, so were excluded from study. Out of 80 patients with menstrual problem, 55 [68.7%] had hirsutism [group 1] and 25 [31.3%] had no hirsutism [group 2]. Prevalence of polycystic ovaries was 815% among patients with hirsutism and oligo/oligohypomenorrhea [group 1] as compared to 44% in patients with oligo/oligohypomenorrhea without hirsutism [group 2]. Ovarian volume >10ml and BMI were not statistically significant among both groups. Regarding hormonal profile, serum LH/FSH ratio and testosterone levels were significant among patients with hirsutism as compared to without hirsutism. Prevalence of polycystic ovaries by morphology, FSH/LH ratio and serum testosterone are significantly present among patients with oligo/oligohypomenorrhea and hirsutism as compared to those with oligo/oligohypomennorhea without hirsutism. However Ovarian volume and BMI are not statistically significant among both groups

Congenital adrenal hyperplasia with polycystic ovarian disease: a rare cause of hirsutism

Hirsutism may be defined as presence of terminal hairs in women with a male-like pattern of distribution. Hirsutism is related to serum androgen and cutaneous sensitivity to other hormones. The most prevalent causes of hirsutism are polycystic ovary syndrome and isolated hirsutism. Nonclassical congenital adrenal hyperplasia [21-hydroxylase deficiency] and drug induced type are less frequent rather rare causes. Diagnostic evaluations should address identifying etiology and its associated co-morbidities to properly manage the patients. We present a case of 22-year-old unmarried female who presented with hirsutism and on detailed evaluation she was diagnosed as a case of nonclassical adrenal hyperplasia and polycystic ovaries. Along with laser hair removal,proper treatment of underlying etiology led to reversal of her symptoms

Rupture of membranes in second trimester of pregnancy

The management of rupture of membranes at a nearly viability stage is still controversial. A case of a primigravida, who had rupture of membranes at 23 weeks of gestation, is reported. On conservative management, her pregnancy continued to 30 weeks and she delivered a normal fetus, who showed no abnormality till one year of follow-up

Trial of labour after caesarean section

Fifty six women, aged 20 to 34 years, who had previous cesarean births, were given a trial of labour. The labour was induced in 14.3% women while 65.7% women proceeded to spontaneous labour. The rate of vaginal delivery was 67.9%. Delivery was achieved through cesarean section in 75% of inductions and 25% of spontaneous labours. The overall cesarean rate was 32.1%. The most common indications for repeat caesarean was failure to progress [44.4%], foetal distress [27.7%] and failed induction [16.7%]. There was no maternal or foetal mortality and the trial of labour was associated with minimal maternal or foetal morbidity. The number of vaginal births prior to first caesarean section did not seem to influence the outcome. The success rate in the present study [67.9%] compares favourably with reports from other countries