Paget's disease in an Asian woman.

Extramammary Paget's disease is a rare disease, which mainly occurs in postmenopausal women. The case of Paget's disease of vulva, in a 40 year old Asian woman, who presented with a history of intense itching in vulva for 1 year is being reported. After being medically treated, she was diagnosed on Vulval biopsy. Local excision of the vulval lesion was performed, and histopathology revealed Paget's disease, extending close to the surgical margins. Therefore, a re-excision was performed and patient remained disease free at six months follow up.

Knowledge, attitudes and practices (KAP) regarding sexuality, sexual behaviors and contraceptives among college/university students in Karachi, Pakistan.

OBJECTIVE: To assess the knowledge, attitudes and practices regarding sexuality, high risk sexual behaviors and methods of contraception, among college/university students of Karachi, Pakistan. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Higher Education Commission-recognized government and private colleges/universities in Karachi from 2005-2006. METHODOLOGY: Two colleges/universities were randomly selected from each category i.e. government medical, government non-medical and private medical and non-medical colleges/universities. Three stage cluster sampling was employed to draw a representative sample of students. A self administered questionnaire was used to elicit information on knowledge, attitudes and practices regarding high risk sexual behaviors, methods of contraception and sources to obtain information about sexual issues. RESULTS: A total of 957 students were interviewed. They comprised 542 (56.6%) males and 415 (43.4%) females with mean age of 21 ± 1.8 years. Bivariate analysis showed that students enrolled in medical colleges/universities were less likely to watch adult films (O.R. 0.7, CI; 0.5-0.9) to acquire sex related knowledge and go out on dates (O.R. 0.6, CI; 0.4- 0.8). Similarly, medical students were less likely to consider contraception as being against Islamic teachings (O.R. 0.7, CI; 0.5-0.9). CONCLUSION: The curricula of non-medical studies at undergraduate level should include education regarding sexual health and contraception.

Knowledge, attitude and practice of parous women regarding contraception.

OBJECTIVE: To determine the frequency of knowledge, attitude and practice regarding contraception of parous women. STUDY DESIGN: A cross- sectional survey. PLACE AND DURATION OF STUDY: The Out-patient Department of Obstetrics and Gynaecology, Sir Syed Hospital, Karachi, from October 2008 to March 2009. METHODOLOGY: A self-maintained structured questionnaire was used to interview 100 parous women, who had practiced contraception. This questionnaire covered socio-demographic characteristics of women as well as knowledge of different contraceptive methods. Attitude towards contraception, religious beliefs, myths and misconceptions were also assessed. It also covered decision-making and involvement of other family members in the choice of contraceptive methods. Results of knowledge, attitude and practice were presented in terms of frequencies and percentages. Exclusion criteria were primigravida, nullipara and sub-fertile women and those who had never used any contraceptive method. RESULTS: Majority of women were Muslim (88%) and educated housewives (78%) while 55% belonged to lower middle class. Majority of the women (70%) received information from a health professional. Male condom was used by 57%; 43% used injectables, 33% used oral contraceptive pills, 28% practiced withdrawal and 30% used intrauterine contraceptive device. Majority of the women (78%) were self-motivated and 67% considered family planning as their own responsibility. Majority (65%) believed that contraception is not permitted in religion and 57% of women discontinued contraception because of side effects. CONCLUSION: This study highlights good knowledge and positive attitude of women regarding contraception.

Perinatal outcome in high risk pregnancies.

OBJECTIVE: To determine the perinatal outcome of high risk pregnancies, in terms of perinatal mortality, Apgar score, birth weight and neonatal complications in first week after birth. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Obstetric Department of Sir Syed Trust Hospital, Karachi, from January to December 2007. METHODOLOGY: All antenatal patients attending the Outpatient Department were interviewed, after informed consent. Those who fulfilled the required criteria were grouped in 2 categories; high risk (group A cases) and low risk (group B control) pregnancies according to the risk factors identified in the history. All singleton pregnancies from 28th weeks of gestation till delivery were included in the study. All pregnant women, who had multiple pregnancies or congenital malformations were excluded. Patients were followed till delivery and neonatal outcome was assessed in both the groups. Outcome measures were recorded. RESULTS: There were a total of 282 patients studied. The number of patients in group A were 162 and in group B, 120. Anaemia 98 (60.49%), pregnancy induced hypertension 24 (14.8%) and preterm labour 26 (16%) were identified as the major risk factors in group A. There were 12 (7.40%) stillbirths and 5 (3.08%) early neonatal deaths in group A, while there was 1 (0.84%) stillbirth and no neonatal death in group B (p=0.004, RR=1.72). There were 58 (35.80%) neonates with low birth weight in group A, while the same were only 4 (3.33%) in group B, which was statistically significant (p=0.001, RR=1.98). Poor Apgar score of < or = 7 at 1 minute was observed in 6 (4%) and at 5 min was observed in 5 (3.33%), while none of the neonates in group B was born with Apgar score of less < or = 7 at 1 or 5 minute (p=0.036, RR=1.83; p=0.068, tR=1.82 respectively). Meconium aspiration syndrome was observed in 7 (4.3%) cases in group A, and 2 (1.66%) in group B, which was statistically insignificant. Complication rate among the neonates was statistically not significant between the two groups. CONCLUSION: Perinatal mortality was twice as high in high risk group compared to low risk group. However, the complications in the neonates were statistically insignificant between the two groups.

Effect of domestic violence on pregnancy outcome.

OBJECTIVE: To determine the causes and type of domestic violence endured by pregnant women and their effect on pregnancy, in terms of maternal and neonatal outcome. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: The study was conducted in Sir Syed Trust Hospital, Karachi, from March 2007 to February 2008. METHODOLOGY: All the antenatal patients were screened for domestic violence, using a self-made questionnaire and abuse assessment screen. All the pregnant patients, who had language barrier or those who declined to be interviewed were excluded. All the pregnant patients with positive response, according to the abuse assessment screen were included in the group A, while every 4th patient with negative response was taken as control. SPSS 10 was used for statistical analysis. Logistic regression analysis was performed to determine the effect of domestic violence on delivery outcome. Relative risk was also calculated. Statistical significance was taken at p (2) 0.05. RESULTS: Four hundred and ten (n=410) antenatal patients were interviewed. The factors associated with domestic violence included addiction in 32 (39%), allegedly aggressive nature of husband in 21 (25.6%) and unemployment of husband in 6 (7.31%) cases (p=0.001). Fifty two per cent women had been victims to more than one form of violence. Antenatal complications were not observed in a statistically significant number in either group. Depression was identified in 25.60% of group A and in 3.65% of group B (p=0.001; RR=2.01; 95%CI=1.58-2.56). CONCLUSION: Various factors leading to domestic violence were identified among the husbands of women subjected to violence during pregnancy. The differences between the two groups, with regard to neonatal outcome (except depression), did not reach statistical significance. However, depression was significantly higher in the women enduring violence.

Management and obstetric outcome of ovarian hyperstimulation syndrome.

OBJECTIVE: To describe the management and obstetric outcome, in terms of take home baby rate, of Ovarian Hyperstimulation Syndrome (OHSS). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Baqai University Hospital, Nazimabad and Baqai Institute of Reproduction and Developmental Sciences, from January 1998 to December 2002. PATIENTS AND METHODS: All patients undergoing in vitro fertilization and intracytoplasmic sperm injection from 5th January 1998 till 12th December 2002 were selected for the study. The infertile couple were interviewed, after informed consent, examined and investigated. Ovulation induction agents were prescribed to the female, if all the investigations were normal. In vitro fertilization was reserved for blocked fallopian tubes, endometriosis and abnormal semen parameters. Intracytoplasmic sperm injection was indicated for cases with few normal sperms. All the patients, who had developed mild ovarian hyperstimulation syndrome were excluded from the study. The patients who had developed moderate and severe ovarian hyperstimulation syndrome were included in the study. RESULTS: Out of 30 patients who developed OHSS, 23 had moderate OHSS, 7 patients had developed severe OHSS. Polycystic ovaries were present in 21 cases. Clinical pregnancy rate in the study was 40% and the take-home baby rate was 21.7%. Patients with polycystic ovarian disease were identified as the main reason for subfertility and were identified as the main reason for adverse foetal outcome. CONCLUSION: A remarkable pregnancy rate was achieved, but the take-home baby rate was comparatively low. But even then, the results were comparable in terms of take-home baby rate to the results reported in international literature.