Comparison of sampling adequacy between OPD based pipelle biopsy and in- patient conventional D&C, presented with abnormal uterine bleeding

Objective: To determine agreement on adequacy of sample by pipelle biopsy and conventional dilatation and curettage in patients with abnormal uterine bleeding. Study design: Cross sectional studySetting and Duration of Study: Department of Obstetrics and Gyneacology, Islamic International Medical College Trust, Railway Hospital Rawalpindi. Study was carried out over a period of six months (11-07-2012 to 14-01-2013). Patients and Methods: 84 patients presented with abnormal uterine bleeding age 45 years and older, attended Gynecology department of Railway Hospital Rawalpindi. Who qualified the inclusion criteria were enrolled in this study by non-probability consecutive sampling technique. The diagnostic intervention for endometrial sampling was by pipelle device and by conventional D&C. Both procedures were performed in the OT at the same time.First the pipelle sample was taken and was labeled as “A” then conventional D&C was performed and was labeled as “B”. Both samples were sent to the pathologist, who was blinded as to the method of sample collection for histopathology assessment. Adequacy of the sample was assessed as per operational definition. A data base was made in SPSS version 17. Kappa statistics was applied to assess the agreement. Results: Out of 84 patients, 80 (98.8%) of the patients had adequate sample with Pipelle Biopsy as compared to conventional curettage and dilatation (D & C). We therefore recommend the use of pipelle biopsy as a first line tool for endometrial assessment for our setups instead of D&C. Conclusion: Our study concluded that the Pipelle biopsy is a useful and convenient method to the patients and physicians as ompared to D&C performed in the operating theatre. It is useful in obese and high-risk patients with minimum chances of perforation of uterus due to its soft flexible tip

MHD Unsteady Flow and Heat Transfer of Micropolar Fluid through Porous Channel with Expanding or Contracting Walls

The unsteady laminar incompressible flow and heat transfer characteristics of an electrically conducting micropolar fluid in a porous channel with expanding or contracting walls is investigated. The relevant partial differential equations have been reduced to ordinary ones. The reduced system of ordinary differential equations (ODEs) has been solved numerically by lower-upper (LU) triangular factorization or Gaussian elimination and successive over relaxation (SOR) method. The effects of some physical parameters such as magnetic parameter, micropolar parameters, wall expansion ratio, permeability Reynolds number and Prandtl number on the velocity, microrotation, temperature and the shear and couple stresses are discussed

Comparative study to evaluate the prevalence of deranged lipid profile and oral glucose tolerance test in polycystic ovarian syndrome patients with normal females: a prospective observational study

Background: PCOS is a complex endocrine disorder characterized by menstrual dysfunction, anovulation, infertility and hyper androgenic symptoms with dyslipidaemia, cardiovascular diseases, and impaired glucose tolerance and type II diabetes mellitus. Multiple risk factors are involved in the pathogenesis of PCOS.Methods: A comparative evaluation of deranged lipid profile and OGTT in PCOS patients with normal females was done in patients with age group of 15 to 30 years. The Rotterdam criteria for PCOS was used for selection of the participants prospectively and a detailed history regarding period of amenorrhea, menstrual cycles, obstetric history, any past history of medical disorder were taken followed by general physical, systemic and obstetric examination. All the patients underwent Ultrasound examination, OGTT and lipid profile, prolactin, 17-OH progesterone and testosterone level.Results: A significant association of PCOS with deranged lipid profile and blood glucose tolerance and obesity was observed. Patients with PCOS had higher prevalence of oligomenorrhoea, infertility, hirsutism and acne. Furthermore, a statistically significant trend was seen where signs and symptoms like infertility, hirsutism and acne, deranged OGTT and dyslipidaemia were more frequently associated with increased BMI, sedentary life style intake of high calorie diets.Conclusions: An association between obesity, sedentary lifestyle, and dietary factors with PCOS was observed which can be modified to improve the health condition of the women with PCOS

Comparative study to evaluate the effect of colloid coloading versus crystalloid coloading for prevention of spinal anaesthesia induced hypotension and effect on fetal Apgar score in patients undergoing elective lower segment caesarean section: a prospective observational study

Background: Spinal anesthesia for LSCS has a high incidence of maternal hypotension which can be severe and disastrous for the fetus and the mother. Coloading in these patients is a physiologically more appropriate method for preventing spinal anesthesia induced hypotension.Methods: 100 ASA I patients for elective LSCS were randomly divided into two equal groups to either receive 1000ml colloid (6% Hetastarch) or 1000ml crystalloids (Ringer lactate) as coload. NIBP, heart rate SPO2 and incidence of nausea and vomiting and use of ephedrine to treat any hypotension was recorded. Fetal outcome was measured using APGAR score at 0, 1 and 5 minutes.Results: The incidence of hypotension was lesser with colloid coload group (41.7%) as compared to the crystalloid coload group (58.3%) but the difference between the two groups was statistically insignificant. Similarly, no statistically significant difference was noted in the incidence of nausea and vomiting and Fetal APGAR score between the two groups.Conclusions: Both Colloid and Crystalloid coloading is effective in decreasing the incidence of spinal anesthesia induced hypotension during LSCS with lesser incidence of hypotension and nausea vomiting with colloid coloading

Psychotherapy as a treatment modality for psychiatric disorders: Perceptions of general public of Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Psychiatric disorders affect about 450 million individuals worldwide. A number of treatment modalities such as psychotropic medications, psychotherapy and electroconvulsive therapy can be used to treat these disorders. Attitudes of general public play a pivotal role in effective utilization of mental health services. We explored the perceptions of general public of Karachi, Pakistan regarding psychotherapy.</p> <p>Methods</p> <p>A cross-sectional study was conducted in Karachi, Pakistan during July-August, 2008. A three-step sampling strategy and a structured questionnaire were employed to survey knowledge and perceptions of adult general public about psychotherapy. Descriptive statistics were used for baseline characteristics. Logistic regression models were used to investigate any significant associations between baseline characteristics of the participants and their perceptions.</p> <p>Results</p> <p>The study sample comprised of 985 individuals (536 males; 531 financially independent) with an average age of 36.7 years (SD 13.54 years) and 12.5 years (SD 3.09 years) of education were included. Majority (59.4%; n = 585) claimed to be aware of psychotherapy as a treatment option for psychiatric disorders but 47.5% of these (n = 278/585) failed to identify its correct definition. Concerns voiced by the participants about psychotherapy included stigma (48.7%) and breech in confidentiality (39.5%); 60.7% opined it cost effective and 86.5% favored its use as an adjuvant modality. A preference for psychotherapy as the treatment strategy for psychiatric disorders was demonstrated by 46.6% (n = 459/985). Younger, more educated, financially independent and female participants were more likely to prefer psychotherapy as were those who deemed it cost effective.</p> <p>Conclusion</p> <p>Positive attitudes regarding the acceptability, clinical utility and cost-effectiveness of psychotherapy were observed in a sample representative of general public of Karachi, Pakistan. These findings highlight its potential utility for devising pragmatic mental health strategies in the face of limited resources.</p

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation