To compare the frequency of PPH in patients given tranexamic acid versus control group in third stage of Labour

Obstetrical haemorrhage is the leading cause of maternal mortality, most commonly occurring in post partum period. Each year worldwide 530,000 die from causes related to pregnancy and childbirth. Post partum haemorrhage is a common and occasionally life threatening complication of labour and is mostly due to uterine atony, which is a failure of uterus to properly contract after the child is born. Consequently, bleeding from the blood vessels in the uterus is not controlled

Objectives: To compare the frequency of post partum haemorrhage in patients given tranexamic acid with active management of third stage of labour versus the control group given active management of third stage of labour alone

Methodology: A randomized controlled trial study carried out in the Department of Obstetrics and Gynaecology Unit-II, Sir Ganga Ram Hospital, Lahore. Total 420 patients were selected, 120 cases who received active management of third stage of labour with 1 gram injection of tranexamic acid and 120 controls who received active management alone

Results: Patients were divided in two groups with 210 patients in each group. As compared to active management of third stage of labour alone addition of tranexamic acid was associated with a significant reduction in frequency of post partum haemorrhage [PPH] and amount of blood loss. Frequency of PPH was 7.1% in control group and 2.4% in tranexamic acid group

Conclusion: It is concluded that adding tranexmic acid to the active management of third stage of labour is an efficient and safe method of reducing post partum haemorrhage

Age related white matter lesions on magnetic resonance imaging

To find out the frequency of cerebral white matter lesions [WML] in elderly individuals with no neurological symptoms. This descriptive study was carried out at Radiology Department, Military Hospital, Rawalpindi; January to December 2003. One hundred asymptomatic patients of either gender, aged 50 years and more without a known systemic disease were selected and divided into two groups of age 50-65 years and more than 65 years and MRI brain was performed. WML when found were classified as subcortical and periventricular hyperintensities and rated for both hemispheres simultaneously along with regional distribution of the WML. Frequency of each type of WML was assessed in the sample Relationship with age and gender of patients was also sought. Subcortical WML were present in 54% [n=54] of subjects. Periventricular WML were found in 19% [n=19] of study population. Both subcortical and periventricular WML were more frequently observed in more than 65 years age group. However findings were not statistically significant [-values = 0.8333 and 0.3646 respectively]. Periventricular white matter lesions were observed more commonly in males with statistically significant distribution [p-value = 0.0018]. Subcortical WML were also more frequently observed in males. However the distribution was statistically insignificant [p-value = 0.1566]. Distribution of subcortical WML was most frequent in frontal lobes [62.9%] followed by parieto-occipital regions [33.3%]. WML are a frequent finding on MRI brain of asymptomatic elderly individuals of either gender with periventricular WML having a statistically significant preponderance in males

Role of carotid doppler in coronary artery disease

To find out the Intima media thickness [IMT] of carotid artery disease in coronary artery disease and to identify hemodynamically significant stenosis [i.e.>70%] in patients undergoing coronary artery bypass surgery. A descriptive study. The study was conduct at AFIC and MH Rawalpindi from 2003 to 2004. One hundred patients of triple, double and single vessel coronary artery disease were studied. There were 85 male and 15 female patients, ranging from 35 to 77 years. The patients were studied by Toshiba Ultrasound Machine equipped with high frequency linear transducers. In 10 patients having more that 70% ICA stenosis, conventional angiography was done. Intima-media thickness of common carotid artery was increased in 92 patients with mean value of 1.1 mm. Plaques were seen in 92 patients with commonest location at carotid bifurcation with extension into the origin of ICA. 15 patients has >70%, 10 patients > 50% stenosis and 67 patients in the range of 1-50% stenosis. 6 patients showed normal intima-media thickness with no evidence of plaque. In two patients ultrasound could not locate bifurcation of CCA. Doppler ultrasound showed 98% sensitivity in diagnosis of > 70% stenosis. Doppler ultrasound is a non-invasive imaging modality of choice in evaluation of extra-cranial carotid artery disease

Endoscopic retrograde cholangiopancreatographic evaluation of patients with obstructive jaundice

To evaluate the role of endoscopic retrograde cholangiopancreatography [ERCP] in patients with obstructive jaundice. Design: A retrospective, observational study. Place and Duration of Study: The study was carried out at Valley Clinic, Rawalpindi, from January 1999 to January 2002. Subjects and Two-hundred and twenty-six patients, who underwent ERCP for evaluation of obstructive jaundice were included. ERCP in each case was performed with standard technique and the findings were recorded. Therapeutic procedures like sphincterotomy, Dormia extraction for stone, and stent placements were performed whenever indicated. Of the 226 patients, 117 [51.8%] were males, and 109 [48.2%] females, their mean age being 51.8 ' 16.6 years. Common bile and pancreatic ducts were visualized in 81.8% and 68.1% patients respectively. Growth/masses and stones were commonest causes of obstructive jaundice. Choledocholithias was common in males, while biliary channel related growth/masses were common in females [p-value = 0.03]. Common bile duct stone clearance rate was 88%, stenting was highly successful in patients with growth and strictures. ERCP related complications were noted in 11 [4.8%] patients. ERCP is an important diagnostic and therapeutic modality for evaluation of patients with obstructive jaundice. Growth/masses and stones are common causes of obstructive jaundice which can be diagnosed and treated with ERCP