role of intravenous iron sucrose complex in treatment of iron deficiency anemia in pregnant women

Objective: To observe the effect of iron sucrose complex [Inj Venofer] in pregnant women; suffering from iron deficiency anemia

Study Design: Interventional retrospective study

Place and duration: The study was conducted at Al Tibri Medical College and Hospital, Isra University Karachi Campus and in Private practice from 1[st] April 2013 till 30[th]September 2013

Methodology: Study was carried out on 50 pregnant patients with gestational age of 28 - 32 weeks having iron deficiency anemia.The calculated total dose of iron sucrose was given to patient in infusion form to replenish the Haemoglobin status and iron stores. Hb Level, Red cell indices [MCV, MCH and MCHC] and Serum Ferritin level were performed before starting the therapy on which it was diagnosed and then 3 weeks after completion of therapy. Side effects of the therapy were also observed

Result: Among 50 women included in the study; no patient had any severe reaction. Mean duration of therapy was 3 + 0.7 weeks. After completion of iron sucrose infusion therapy the Hb% level rose to mean 11.2 gm/dl, mean MCV 86.6fL, mean MCH 31.6 pg/cell, mean MCHC 35.6 gm/dl and the value of mean Serum Ferritin level was 128.2ng/ml. In all enrolled pregnant women the differences in values were significant

Conclusion: The Intravenous Iron sucrose complex shows a rapid rise in the haemoglobin level and iron stores up to satisfactory levels in pregnancy and lactation

health hazards of gutka

Use of gutka is increasing in Pakistan especially in Karachi, Hyderabad and other cities of Sindh province. It has increased incidents of mouth, throat, lungs, esophagus and stomach cancer along with other side effects like subfertility, poor pregnancy outcome and cardiac problems, which are reported in literature. It is mandatory that the awareness should be created among the people against this bad habit and people should be educated to adopt healthy life style

miracle of iodine complex in treatment of cases of polycystic ovarian disease induce by subclinical hypothyroidism

Objectives: To determine the Role of Iodine Complex in treatment of Cystic Ovaries due to subclinical hypothyroidism

Study Design: Pilot clinical study

Place And Duration: From 01-03-2012 to 30-10-2012 at Isra University Karachi Campus

Methodology: A total of 30 patients were included in the study. This study All of them were ensured that they were not taking any medication within the last 6 months. Investigations including complete blood picture, serum fasting insulin levels, Thyroid stimulating hormone [TSH], serum free T4 [FT4], free T3 [FT3], serum FSH, LH, Free testosterone, androstenedione and ultrasound of pelvis were carried out in all patients at the start of study and thereafter after four and eight weeks. Exclusion criteria were frank hypothyroidism, other metabolic and cardiac disease, hepatic and renal dysfunction. Capsule Idomarine [Iodine Polymer] 50mg twice daily were prescribe for 8 weeks

Results: The age of patients ranges between 18-35 years. Out of 30 patients 33.3%[n=10] were unmarried, 23.4%[n=7] were married with history of recurrent miscarriages and 43.3%[n=13] married woman with primary infertility. There was marked improvement in the symptoms with return of regular menstrual cycles in almost all patients. Two [6.6%] patients conceive within a period of 6 months time

Conclusion: The Iodine complex marked by the name of Idomarine capsules are found to be very effective in cases of PCO due to subclinical hypothyroidism

Late gynaecological complications following pomeroy method of mini laparotomy for tubal ligation

To analyze the late complications in patients undergoing tubal ligation by Pomeroy method. Descriptive case series. Family Health Hospital [Family Planning Association of Pakistan] and private clinics at Karachi, from January 2010 to January 2011. This study was done on women who underwent tubal ligation by Pomeroy method. Procedure was done under local anaesthesia. Mid portion of each tube was cut and ligated in the form of loop or knuckle. These patients subsequently came for follow-up for up to 2 years. The women with gynaecological complaints were considered for this study. This study was carried out on 300 women. Main complaints at follow up were heaviness in perineal region, chronic pelvic pain, depression [premenstrual syndrome] and intermenstrual bleeding. Complaints of minor nature were reported and easily managed. The procedure of sterilization was a safe and highly effective

Physicians knowledge regarding dengue haemorrhagic fever

OBJECTIVE: To assess physician's knowledge regarding Dengue Haemorrhagic fever

DESIGN: Descriptive cross sectional study

PLACE AND DURATION OF STUDY: Government and private hospitals and clinics in Karachi from April 2011 to Nov, 2011

METHODOLOGY: An appropriate questionnaire regarding origin, transmission, symptoms, treatment, prevention and vaccination for dengue fever was prepared and was filled by asking questions from two hundred physicians, after conducting approval for this study from the institutional review board of Dow University of Health Sciences, Karachi

RESULTS: The results indicate that 100% of the doctors were aware about Dengue viral infection but lack knowledge about its diagnosis [72%] and management, while 50% of doctors want to isolate the patient

CONCLUSION: The results concluded that more knowledge and training should be provided to doctors regarding dengue fever

Knowledge of doctors working in Karachi about vitamin D deficiency

To assess the knowledge of doctors working in Karachi about Vitamin D deficiency. This descriptive cross-sectional study was carried out at public and private hospitals and clinics in Karachi from January 2010 to March 2010. Four hundred doctors registered with the Pakistan Medical and Dental Council [PMDC] working in Karachi were included in the study. A well structured, pre-tested questionnaire was designed to gather data. Each interview was completed by an investigator. Questions included the sources and metabolism of vitamin D, deficiency of vitamin D, its presentation in clinics and its management. Questionnaires were completed by 400 doctors. The results indicate that doctors are aware of the sources and metabolism of vitamin D but lack information about the duration and factors regarding sunlight exposure. The physicians generally have good information about the signs and symptoms of vitamin D deficiency and the factors causing it, but do not have sound information about deficiency management. The results support the fact that doctors need more knowledge and training about vitamin D deficiency

Comparative nephrotoxic effects of gentamycin and tobramycin

To compare the nephrotoxic effects of two aminoglycosides namely, gentamycin and tobramycin on rabbits. Comparative study. Allama Iqbal Medical College Lahore, from January 2010 to December 2010. The serum levels of creatinine and electrolytes [sodium and potassium] were measured in different groups of rabbits [control group-A, gentamycin group B and tobramycin-group C]. Rabbits in group B and C received laboratory diet and 32 mg/kg/day of gentamycin and tobramycin were given through intramuscular [IM] route twice daily for 7 days. Blood samples were collected on day 1, 10, 16, and 22 of drug administration. Each rabbit of all groups was sacrificed on 22[nd] day of experiment. Kidneys were removed and histological examination of the 4 components of the renal tissue [glomeruli, tubules, blood vessels and interstitial tissue] was carried out. Level of serum creatinine was significantly increased in both experimental groups [B and C] as compared to the control group A. On the other hand, level of serum sodium was insignificantly increased in groups B and C, whereas level of serum potassium was significantly decreased in groups of rabbits receiving gentamycin and tobramycin as compared to control group. There was no significant difference in nephrotoxicity between gentamycin and tobramycin

Outcome of abdominal myomectomy

To find out the results of in abdominal myomectomy in terms of complications and fertility. Study design. Place and Duration of study Jinnah Medical and Dental college and Hospital, Baqai Medical University and other private hospitals where author practiced from January 2003 to January 2009. The study included all women who underwent abdominal myomectomy. Indications for surgery were menorrhagia, abdominal mass, dyspareunia, infertility, repeated abortions and chronic pelvic pain. Patients who had endometriosis, adenomyosis, ovarian cyst and those whose spouse had abnormal semen analysis, patient not desirous for further pregnancies and malignancies were excluded. All patients had routine pelvic ultrasound and hysterosalpingogram before and after surgery. Morbidity such as intra operative blood loss, injury to adjacent viscera, trauma to the tubes, febrile morbidity, wound haematoma, infection, fertility, recurrence of myoma, adhesion formation were noted. All patients were followed at 3, 6 and 12 monthly interval. The analysis was performed by using SPSS version 10. Frequency and percentages were computed for presentation of all categorical variables. A total of 50 abdominal myomectomies were performed during the study period. Mean age of the patients was 36 years with parity of 0 -2. Duration of operation ranged between 60 - 90 minutes. Blood loss varied between 1800ml - 2500ml. Hospital stay was between 5-7 days. Fibroid size ranged between 5 - 7cm. Uterine cavity got opened in 5[10%] cases. In 10[20%] patients myomas had distorted the tubes bilaterally and trauma resulted during surgery. Febrile morbidity was noted in 7[14%] cases, vaginal discharge in 2[4%] and lower abdominal pain in 5[10%]. Uterine cavity of reduced size in 7[14%] patients and bilateral tubal blockage in 10[20%] cases were noted on hysterosalpingogram. At follow up two patients conceived at 12 months and one patient at 24 months. Abdominal myomectomy is a preferred treatment for women who want to become pregnant in future and is associated with fewer complications

study of maternal mortality

To study the maternal mortality and complications of sepsis leading to maternal death in a tertiary care hospital. Descriptive study. Baqai Medical University Hospital Gadap Karachi, from January 2005 to September 2009. This retrospective study was carried out on 30 mothers who died over a period of five years due to various causes. They were referred to Baqai Medical University Hospital from peripheral areas in moribund state. Case summaries of all the maternal deaths were reviewed from death register and studied for the causes of maternal mortality. Patients' age, parity, antenatal booking status and the level of care providers at rural/urban setting along with distance from the hospital, were noted. Causes of maternal mortality were selected for the study. The frequency of maternal mortality was [3/1000] live births. The age range was between 30- 35 years and parity between 4 - 5. All were un booked cases and received no treatment during antenatal period. Out of 30 cases 20 [66.6%] were due to sepsis, 5 [16.6%] due to postpartum haemorrhage [PPH], 3 [10%] due to eclampsia and 2 [6.6%] due to ruptured uterus. Out of 20 cases of sepsis, in 12[60%] it was due to induced abortion followed by 4[20%] due to prolong labour and repeated vaginal examination. The main causes of maternal mortality include sepsis followed by haemorrhage and obstructed labour. All these causes were preventable if proper antenatal care and referral to the hospital were provided

Vaginal hysterectomy is superior than abdominal hysterectomy

To determine the outcome of vaginal hysterectomy versus abdominal hysterectomy in terms of intra operative and post operative complications in women with benign uterine conditions. A comparative study. Baqai Medical University Karachi from November 2006 to February 2008. The study included 50 women who under went vaginal hysterectomy [VH] and 50 women who had abdominal hysterectomy [AH] for benign uterine diseases. Inclusion criteria for vaginal hysterectomy was utero vaginal prolapse [UV prolapse], uterine fibroid less than 12 weeks size and DUB and for abdominal hysterectomy was menorrhagia and pelvic pain, fibroid uterus, adenomyosis of uterus and dysfunctional uterine bleeding. Patients over 60 years of age, cancer of cervix and uterine malignancy were excluded from the study. Detailed history was taken and examination done. Routine investigations including ultrasound were carried out and hysterectomy was performed by clamp-cut and ligate method. The mean age of patients was 52 years and parity between 4-10. The commonest indication for surgery in VH was UV prolapse 30[60%], DUB 15[30%], fibroid less than 12 weeks size 5[10%] while the commonest indication for surgery in AH was fibroid 20[40%], DUB 15[30%], menorrhagia and pelvic pain, 10[20%] and adenomyosis of uterus 5[10%]. Among the intra operative complications there was one case of bladder injury in patient who underwent AH which was repaired. It was a case of previous C section. There were 2[4%] case of excessive haemorrhage [>500ml] one in each TAH and VH respectively. Early post operative complications like febrile morbidity was noted in each group, 10[20%] in AH and 5[10%] in vaginal hysterectomy, urinary tract infection in 4[8%] cases of VH and AH each. Wound infection in 6[12%] of AH and nil in VH. Paralytic Ileus in 4[8%] cases of AH and nil in VH. Vaginal vault haematoma in 2[4%] cases of VH while wound haematoma in 1[2%] case of AH. Late complications like vaginal discharge was noted in 3[6%] of VH while 2[4%] cases of AH. There was 1[2%] case of vault granulation in each AH and VH. Vaginal hysterectomy is easy to perform and is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and post operative morbidity, while abdominal hysterectomy is associated with longer duration of surgery, longer hospital stay, greater blood loss, more intra operative and post operative morbidity

Intrapartum complications of macrosomic fetus

To study the intrapartum complications of macrosomic fetus. Descriptive study. Department of Obstetrics and Gynaecology at Jinnah Medical and Dental College and Hospital Karachi, Pakistan from April 2003 to December 2004. One hundred patients were selected for the study. Age, parity, past obstetric performance and estimated fetal weight by ultrasound were noted. Gestational age at delivery was calculated by date of last menstrual period as well as by early scan if available. Out of 100 patients, 30 cases with intrapartum complications fulfilled the criteria of macrosomia. Among them, 18 had perineal trauma and postpartum haemorrhage, 3 had shoulder dystocia and 9 patients delivered by caesarean section. Macrosomic pregnancy is associated with increased incidence of operative vaginal delivery, postpartum haemorrhage and shoulder dystocia. Prevention requires early detection of risk factor and planning for safe delivery

outcome of subtotal abdominal hysterectomy

To determine the outcome of subtotal abdominal hysterectomy in terms of intraoperative and postoperative complications in women with benign uterine conditions. Descriptive study. The Jinnah Medical and Dental College and Hospital, Karachi from March, 2003 to March, 2004. The study included 50 women, who underwent subtotal abdominal hysterectomy due to technical difficulties during surgery in benign uterine diseases. Inclusion criteria were menorrhagia and pelvic pain, dysfunctional uterine bleeding, repeated pelvic infection refractory to medical treatment, fibroid uterus and ovarian cyst with adenomyosis of uterus. Patients over 60 years of age, uterine prolapse and suspected cancer of cervix were excluded. Detailed history was taken and examination done. Routine investigations including ultrasound were carried out. Subtotal hysterectomy was performed by clamp-cut and ligate method. The mean age of patients undergoing hysterectomy was 44 years and parity between 4 - 10. Most common complaint was excessive menstrual loss. Fibroid was found in 10 [20%] cases, dysfuntional uterine bleeding in 15[30%], pelvic pain and menorrhagia in 5[10%], ovarian cyst with adenomyosis in 13[26%] and repeated pelvic infections refractory to medical treatment in 7[14%].There was no injury to adjacent vicera during the procedure .Early complications like temperature was noted in 5[10%] and late complications like cyclical menstrual bleeding in 1[2%] and vaginal discharge in 2[4%] patients. All cases were followed-up 3 and 6 monthly and urinary, sexual and bowel functions were found to be unaffected during this period. There was no mortality associated with the procedure. The histopathology of specimen revealed fibroid followed by adenomyosis to be the commonest pathology. Subtotal abdominal hysterectomy resulted in less operative time, rapid recovery, fewer short-term complications but infrequently caused cyclical bleeding and vaginal discharge

Diagnosis of bacterial vaginosis by Amsel's criteria

To evaluate Amsel's criteria for the diagnosis of bacterial vaginosis in reproductive age group. Design: Prospective study. Place and Duration of Study: This study was conducted in a private hospital in Jeddah, K.S.A between January, 2001 and January, 2002. Subjects and Patients attending the clinic with complaint of vaginal discharge were selected and screened out for bacterial vaginosis on the basis of Amsel's criteria. Ot of 100 cases 35 [35%] cases were diagnosed as bacterial vaginosis, 25 [25%] were of Candida albicans and 15 [15%] were suffering from trichomoniasis. No pathogen was found in 25 patients. Amsel's criteria is an accurate test for the diagnosis of bacterial vaginosis