RESUMO
To compare clinical efficacy and side effects of oral misoprotol with vaginal misoprostol for termination of second trimester pregnancy. Interventional Quasi experimental. Gynae Unit III, Liaquat University Hospital, Hyderabad. 1st March 2006 to 31st August 2006. Sixty patients were selected with thirty in each group i.e thirty for oral route [group A] and thirty for vaginal route[group B]. The patients included in this study were those having singleton pregnancy with gestational age between 12 to 26 weeks requiring termination of pregnancy. A dose of 100ug to 200ug was used with maximum of 1200ug in each group of patients. The subjects of either group were similar with respect to mean age, height, weight, parity, gestational age and pre induction Bishop Score. The success rate in group A was 94.4% as compared to group B was 86.8%. intra uterine death was the commonest indication in both groups found in 46.7% women of vaginal misoprostol group and 50% women of oral misoprostol group. Surgical evacuation was needed in 36.7% women of oral misoprostol group and 16.7% women of vaginal misoprostol group. The present study shows misoprostol to be effective for mid trimester abortions, both orally and vaginally, the later route is preferable because it requires lesser doses and produces a shorter induction-abortion interval. However safety data are needed to guide the route choice and well designed studies are necessary
RESUMO
To determine the frequency of hepatorenal syndrome in patients with chronic liver disease and ascites. A cross-sectional study. From July 2001 to March 2002 at Civil Hospital, Karachi. The study included 240 patients who were admitted in the Medical Wards of Civil Hospital, Karachi, during the study period. The subjects were diagnosed as having chronic liver disease and all of them had ascites. All the patients with renal dysfunction were identified and were worked up for hepatorenal syndrome and other causes of renal dysfunction. Of two hundred and forty [240] patients enrolled in the study, 148 were male [61.7%] and 92 were female [38.3%]. Seventy-six [76] patients [31.6%] were found to have renal impairment as diagnosed by serum creatinine level of 1.5 mEq/L or greater. Six [6] patients showed improvement in their serum creatinine level [below 1.5 mg/dL] after receiving 1.5 liter of normal saline infusion and diuretic withdrawal. Eleven [11] patients were diagnosed to have primary renal disease based on urine analysis, urinary protein excretion and ultrasound examination. Six [6] patients were diagnosed to have renal dysfunction secondary to analgesic nephropathy and in seventeen [17] patients renal dysfunction was secondary to spontaneous bacterial peritonitis. The remaining 36 [47.4%] patients with renal dysfunction were diagnosed as suffering from hepatorenal syndrome based on the diagnostic criteria. This represents the frequency of 15% among patients with chronic liver disease and ascites. Hepatorenal syndrome is common complication in patients with cirrhosis and ascites. It was the most common cause of renal impairment in this series followed by other causes like spontaneous bacterial peritonitis, primary renal disease, analgesic nephropathy and hypovolemia