Prevalence of coeliac disease among adult patients with autoimmune hypothyroidism in Jordan

The prevalence of coeliac disease among patients with autoimmune hypothyroidism has not been studied before in Jordan and other Arab countries. A cross-sectional record-based review was made of all adult autoimmune hypothyroidism patients who attended a referral centre in Jordan, during an 8-month period. Coeliac disease in these patients was diagnosed by the attending physician based on positive serological tests for anti-endomysial antibodies IgA and IgG followed by duodenal biopsy to confirm the diagnosis of coeliac disease. Of 914 patients recruited, 117 [12.8%] were seropositive for coeliac disease. Of 87 seropositive patients who underwent duodenal biopsy, 39 had positive histological findings of coeliac disease [44.8%]. Extrapolating from these findings the overall rate of coeliac disease among autoimmune hypothyroidism patients was estimated to be 5.7%. In multivariate logistic regression coeliac disease was significantly associated with older age [> 40 years], presence of other autoimmune diseases, vitamin B12 deficiency and anaemia

Clinical audit of hysterectomies

This descriptive study was carried out at Gynae unit II Sir Ganga Ram Hospital, Lahore from lst January 2004 to 3151 December 2004. All patients who underwent hysterectomy due to various gynaecological reasons were evaluated; objective was to determine frequency of different types of hysterectomies, indications and correlation with age and parity. During the study period 78 hysterectomies were performed out of which 77%. Were abdominal. Vaginal route was opted in 23% of cases and all patients were having uterovaginal prolapse of various degrees. Fibroid uterus was the commonest indication of abdominal hysterectomies [55%] followed by dysfunctional uterine bleeding [25%]. Majority of cases of fibroid were in low parity group and prolapse was observed in women of high parity. About 70% of hysterectomies were performed in patients above 40 years of age and about 67% were para three and above. Overall there was positive trend of hysterectomies with increasing age and parity. Medical management of many conditions can be a good alternative provided there is earlier consultation from trained professionals about gynaecological problems, ultimately decreasing the rate of hysterectomies

Obstetric out come of cases referred to a tertiary care hospital after trial of labour

Childbirth is a natural process but with its' inherent risk of complications. Skilled birth attendant can provide timely emergency obstetrics services. Objective of this study was to analyze fetomaternal outcome of cases referred to our hospital after trial of labour and to identify factors, which could prevent adverse obstetric outcome. This study was conducted at Obstetrics and Gynae Unit II Sir Ganga Ram hospital, Lahore. One hundred patients who were admitted through emergency after trial of labour by TBA, LHV or doctors at home or private clinics were analyzed for fetomaternal outcome. Out of hundred patients in study group 49 were Primigravida while 10 were grandmulti. About 90% of patients never had any antenatal checkup. Maximum patients [94%] were under care of TBA and LHV. 54 patients had already prolong labour out of which 38 cases were of obstructed labour. Five patients had ruptured uterus. 49 patients were delivered by caesarean section while 29 had forceps delivery. Laparotomy was carried out in four patients due to ruptured uterus out of which two had hysterectomy. There was one maternal death due to ruptured uterus. Post partum hemorrhage occurred in ten patients, while 12 had puerperal pyrexia. Regarding perinatal outcome there were 23 stillbirths, while 45 had Apgar score below 5 at five minutes. Ten babies died in first 12 hours. This study concludes that complications of labour if not timely diagnosed and rectified results in adverse fetomaternal outcome. Provision of skilled birth attendant at doorstep will be an ideal solution

Prevalence of abnormal cervical cytology and its relation with age and parity

This screening study was carried out in Gynae Unit II, Sir Ganga Ram Hospital, Lahore. The aim of study was to find out prevalence of abnormal pap smears and its correlation to age and parity so that we can formulate a policy to screen at risk population with Utilization of minimum resources in our setup. Role of Pap smear in detection of cervical pre-malignant and malignant lesions can not be over emphasized. The Cervical smears of 310 women have been evaluated. The frequency of mild to severe cervical intraepithelial neoplasia was found to be 8% while smear positive for malignant cells was in 0.9% of cases. This study reveals 41-60 years of age and Para three and above a high risk group for Cervical Intraepithelial Neoplasia [CIN] and cytology positive for malignant cells. In view of the expenditure involved and technical constraints in mass screening, an approach of selective screening of high risk population could be an effective strategy for control of carcinoma of cervix in developing countries like ours

Role of prenatal sonography in the managment of encephalocele

We present the findings in a series of 13 fetuses diagnosed as having encephalocele. 92% encephaloceles were located in the occipital region and 8% at the frontal region. The prognosis of the encephalocele was poor. Only 3[23%] of the 13 with follow up were borne alive at full term. One died in postpartum period. Out of the other two one died after surgery while one is surviving normal. One fetus was diagnosed as Meckle-Gruber syndrome. Associated cranial and extracranial abnormalities observed in various number of fetuses included Ventriculomegaly [43%], microcephaly [31%], unilateral microphthalmia [8%], Clept lip [16%]. Accurate prenatal diagnosis of encephalocele plays a major role in the management of the pregnancy, depending upon the type and extend of encephalocele, especially with associated anomalies and in care of the fetus and in counseling the parents prenataly for pediatric neurological problem