Sexuality during pregnancy in Pakistani women.

OBJECTIVE: We investigated the patterns of sexual activity during pregnancy and explored all beliefs related to coitus during pregnancy in women with the objective of promoting awareness and assisting health care providers in understanding and dispelling fears/misconceptions prevalent in our culture. METHODS: A cross-sectional, KAP (Knowledge, Attitude, Practice) study was conducted using questionnaires to interview 150 healthy pregnant women attending antenatal clinics at Aga Khan University Hospital (AKUH) and Lady Dufferin Hospital, both located in Karachi, Pakistani. Data was analysed using Epi Info 6 statistical package. RESULTS: The mean frequency of intercourse during pregnancy (1.6 times/week) was less than before pregnancy (3.5 times/week). Husbands were the main initiators of sexual activity (44%) while the wives only rarely did so (0.7%). Some (13.3%) women felt it served to keep husbands around. Coitus during pregnancy was gratifying in 64.7% and painful in 37.3% of respondents. Most (45.4%) believed coitus was harmful for the foetus. Others (28.7%) thought it did not make any difference whereas 4.7% believed that it made a difference if the foetus was female by gender. 22.7% women believed that coitus during pregnancy caused abortions early in pregnancy and 6.7% that it induced pre-term labour. 26% did not know the means by which the harmful effects were produced but still maintained their beliefs. Some (10.7%) thought it could actually help widen the birth canal and facilitate labour. Majority (85.3%) believed that frequency should be lowered during pregnancy, 10% thought that it should be continued as before and 4% that it should be stopped completely. CONCLUSION: This study suggests a mixed attitude towards sexuality in pregnancy with a tilt towards the belief that it is harmful and should therefore be decreased during pregnancy, specially during the last trimester. It is the responsibility of health care providers to dispel fears and clarify any misconceptions regarding such matters.

Clinical scoring system: a valuable tool for decision making in cases of acute appendicitis.

OBJECTIVE: Decision making in cases of acute appendicitis poses a clinical challenge specially in developing countries where advanced radiological investigations do not appear cost effective and so clinical parameters remain the mainstay of diagnosis. The aim of our study was to devise a scoring system from our local database and test its accuracy in the preoperative diagnosis of acute appendicitis. METHODS: Clinical data from 401 patients having undergone appendectomy were collected to identify predictive factors that distinguished those with appendicitis from those who had a negative appendectomy. Ten such factors were identified and using Bayesian probability a weight was assigned to each and the results summated to get an overall score. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was then retrospectively applied to a second population of 99 patients in order to compare suggested actions (derived from the scoring system) to those actually taken by surgeons. The sensitivity, specificity and accuracy for the level of decision was then calculated. RESULTS: Of the 99 patients, the method suggested immediate surgery for 65 patients, 63 of whom had acute appendicitis (3.1% diagnostic error rate). Of the 33 patients in whom the score suggested active observation, 18 had appendicitis. The accuracy of our scoring system was 82%. The method had a sensitivity of 78%, specificity 89% and a positive predictive value of 97%. The negative appendectomy rate determined by our study was 7% and the perforation rate 13%. CONCLUSION: Scoring system developed from a local database can work effectively in routine practice as an adjunct to surgical decision making in questionable cases of appendicitis.

Prognostic indicators of childhood acute viral encephalitis.

OBJECTIVE: To devise a set of clinical signs and laboratory parameters that would help clinicians assess prognosis in patients and plan appropriate management. METHODS: Medical records of 147 paediatric cases (with a discharge diagnosis of acute viral encephalitis) admitted over a ten year period from 1987 to 1997 were reviewed and relevant information collected on a data extraction form. RESULTS: Of 147 patients, 24 (16.3%) died and 48 (32.7%) were left with severe neurological deficits. A GCS (Glasgow Coma Scale) score between 6-10 had an association with poor outcome (OR = 2.62, Chi-square = 5.57, p-value = 0.018) and that a GCS score of > or = 5 was even more strongly suggestive of poor outcome (OR = 5.49, Chi-square = 12.08, p-value = 0.0005). A history of having seizures, for more than 3 days, also showed a strong association with poor outcome (OR = 3.66, Chi-square = 5.46, p-value = 0.019). CONCLUSION: Patients with an increased risk of death and severe disability can be identified using a few guidelines. Of these, a history of seizures of > 3 days and/or impaired consciousness (GCS < or = 10), at the time of presentation to the hospital, constitute high risk. These cases must be identified promptly and aggressive therapy initiated in order to improve long term outcome.