Discrimination Indices for Diagnosis of Beta(β) Thalassemia Trait

Background: To determine the reliability ofhematological indices and derived formulas indiagnosing beta thalassemia trait.Methods: In this observational cohort study,patients diagnosed as beta thalassaemia minor wereincluded. All hematological indices wererecorded.Haemoglobin electrophoresis wasperformed using capillarys 2 flex piercing system.An HbA2 value > 3.5% was considered as a cut-offpoint for beta-thalassemia trait. Fourteenhaematological indices were then applied accordingto the formulae and cut off values. Percentage ofpositive cases accurately identified along with themean, median and mode were calculated for eachdiscrimination index.Results: The study cohort constituted of total 493patients, out of which 246 (49.9%) were male and 247(50.1%) were females. The mean age of all thepatients was 20.34 +12.835, with range of 6-50 years.The mean haemoglobin level of all patients was10.82+1.64 and ranged between 4.60 and 16.30. A redblood cell count more than 4.9 X 10 12/l and a MCHless that 25 pg were the most consistent findings.Srivastava index was more near to predicting betathalassaemia minor .Conclusion: Red cell indices and discriminationfactors have a potential utility in screening for βthalassaemia trait , keeping in view their sensitivityand specificit

Role of Prenatal Diagnosis in Thalassaemia Prevention

To determine the role of chorionic villi examination in the prenatal diagnosis of ß- thalassaemiaMethods: In this descriptive study couples requesting prenatal diagnosis (PND) for ß- thalassaemia were registered for chorionic villous sampling after 10 weeks of gestation. After appropriate counseling placental sample was taken under local analgesics with suction cannula by trans-abdominal approach. The sampling system was then withdrawn under negative pressure .Placental villi were proceeded for further DNA analysis. Each PND was carried out by including the parents DNA, fetal DNA for the mutation, as well as the normal gene, appropriate negative and positive controls and reagent blanks.Results: Six hundred and twenty females underwent chorionic villi sampling. Most patients (82.25%) , who requested for PND, already had an affected child. Consanguineous marriages were present in 83.20% ..The average reporting time for identification of the mutation was 7 to 10 days. Thalassaemia major was found in 25.48%. In the case of ß- thalassaemia major, majority (98.73) opted for termination of pregnancy. Spontaneous abortion, after the procedure was found in one case .Two cases turned out false negative. The commonest mutations were Fr8-9 (40.85% ) and IVS 1-5(25.70%) .Conclusion: Pre natal diagnosis for ß- thalassaemia by chorionic villi examination is a safe and cost effective procedure

Effect of Cyclodextrin Derivatization on Solubility and Efficacy of Drugs

Cyclodextrins (CDs) possess cyclic structure having (α-1,4)-linked glucopyranose units making them less vulnerable to enzymatic degradation as than the linear dextrins. Commonly used natural CDs are α-CD, β-CD, and ɣ-CD with truncated cone-like appearance having lipophilic central cavity and hydrophilic exterior surface. The problem of low aqueous solubility of natural CDs can be addressed by reacting them with various reagents to produce water-soluble derivatives. CD derivatives can be categorized in many ways depending upon their substituents, biological activity, polarity, and size. The derivatization of natural CDs produces noncrystalline and amorphous forms with higher water solubility that are physically and microbiologically stable for prolonged time period. Variety of methods can be used to determine average degree of substitution for a modified CD. Dissociation by dilution is considered as major release mechanism of drugs from complex. It is essential to optimize the amount of CDs for a given preparation because they can either retard or promote drug delivery through biological membrane

Comparison of efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia

INTRODUCTION: Eclampsia contributes to maternal mortality in developing, underdeveloped world. Various drugs have been tried to treat eclampsia. Magnesium sulphate has become the drug of choice due to various advantages and is associated with adverse outcome for both mother and fetus if not used correctly. OBJECTIVE: To compare the efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia STUDY SETTING: The study was conducted at Gynecology and Obstetrics Department unit II, Holy Family Hospital, Rawalpindi, from June 20, 2020 to December 20, 2020. Study design was Randomized Controlled Trial. SUBJECTS & METHODS: Patients were randomly distributed into two groups, group-A (IM Group) and group-B (IV Group). Group-A patients received a loading dose of 4 gm IV MgSO4 over 5-10 minutes+10 gm MgSO4 deep intra-muscular injection (5 gm in each buttock) and a maintenance dose of 5 gm MgSO4 deep intramuscular injection in alternate buttock every 4 hourly. Group-B patients received MgSO4 4 gm slow IV over 5-10 minutes as loading dose and 1 gm MgSO4 per hour as continuous intravenous maintenance infusion. Clinical response to therapy for both drugs was calculated in terms of efficacy and safety. All the data were entered & analyzed by using SPSS v25.0. Both the groups were compared in terms of efficacy and safety by using Chi-Square test. A p-value less than 0.05  was taken as significant. RESULTS: A total of 160 patients with eclampsia were enrolled for this study. Patients were divided into two groups i.e. Group-A (IM MgSO4) and Group-B (IV MgSO4). In group-A, there were 45(56.3%) in 18-30 years age group and 35(43.8%) in 31-40 years age group, while in group-B, there were 48(60.0%) in 18-30 years age group and 32(40.0%) in 31-40 years age group. In IM MgSO4 group, prevention from recurrence of seizure was noted in 74(92.5%) and 78(97.5%) in IV MgSO4 group, which is statistically insignificant with a p-value of 0.147. CONCLUSION: Both IM and IV regimen are equally effective in controlling the recurrence of convulsions. IM Magnesium Sulphate is associated with a higher incidence of toxicity as evidenced by significantly higher incidence of loss of knee jerk reflex. Both IM and IV regimen are equally effective but IM Magnesium Sulphate is associated with a higher incidence of toxicity. KEY WORDS: Eclampsia, Intramuscular MgSO4, Intravenous MgSO4

Role of Modified Biophysical Profile in Prediction of Fetal Asphyxia

Objective    To determine the diagnostic accuracy of Modified Biophysical Profile (MBPP) in determining fetal asphyxia in high risk pregnancies keeping actual birth asphyxia on Apgar Score as gold standard.       Patients and Methods After written informed consent from patients, 235 patients with high risk pregnancies admitted to obstetric ward unit 2 Holy Family Hospital were enrolled in study. BPP was done by modified method in high risk patient at > 36 week gestation. Amniotic fluid index was calculated by measuring 4 quadrant vertical pockets and if sum of 4 pockets was< 5 it was considered as abnormal. Total score in MBPP is 4.Out of which 2 score for CTG and 2 score of AFI. These patients were followed till delivery and newborn will be assessed at the time of delivery for fetal asphyxia. Fetal asphyxia was assessed on the basis of Apgar score at 5 min after birth. All patients delivering beyond 7 days of MBPP was excluded from the study. Results Mean age (years) in our study was 27.11+1.47 whereas mean parity was 2+1.06 with ranges from nulliparous to para four. The sensitivity, specificity, positive predicative value and negative predicative value of Modified Biophysical Profile (MBPP) in determining fetal asphyxia in high risk pregnancies keeping actual birth asphyxia on Apgar score as gold standard was 95.02%, 71.43%, 98.13% and 47.62% respectively. Conclusion MBPP was found to have high sensitivity and positive predictive value in predicting fetal asphyxia as assessed by Apgar score at birth. Key words:             Modified Biophysical profile, Perinatal outcome, High risk pregnancies, Non stress tes

Frequency of pregnancy induced hypertension and its association with elevated serum beta human chorionic gonadotropin levels during mid trimester of pregnancy

Objective: To determine the frequency of PIH amongst elevated beta-hCG levels and non-elevated beta-hCG in the mid-trimester of pregnancy. Materials and Methods: It was Descriptive case series conducted for six months (02-12-2019 to 02-06-2020) in OPD of Gynae Unit-II, Holy Family Hospital, Rawalpindi. A total of one hundred and twenty-two (n=122) normotensive pregnant females at 13-20 weeks gestational age and 18-35 years of maternal age were selected in this study after informed consent from every patient. The frequency of PIH in patients with elevated serum beta-hCG was measured. Data were analyzed using SPSS version 20. Effect modifiers were controlled by stratification. A p-value of ≤ 0.05 was considered significant. Results: Mean beta-hCG levels in the total study population were found to be 7305.09±3900.64 IU/mL. Median b-hCG levels in our study population were noted as 6936.15 IU/mL. Pregnancy-induced hypertension was found positive in 16 (13.1%) patients. Raised beta-hCG levels were present in 10 (8.2%) patients. The frequency of PIH in raised beta-HCG levels was found in 7/10 (70%) of patients. We found a statistically significant (p-value ≤ 0.05) difference in the frequency of PIH among patients with elevated and not-elevated beta-hCG levels. Conclusion: It is evident from my study that patients with raised levels of serum β-hCG during mid-trimester pregnancy are at increased risk to develop hypertensive disorders of pregnancy. We further elaborated that there is a statistically significant difference in various effect modifiers such as maternal age, gestational age, residential status, and BMI  for developing  PIH among patients with elevated and non-elevated beta-hCG levels

Emerging Trends in Peripartum Hysterectomy; A High Alert in Obstetrics

Introduction: The high incidence of lower segment caesarean section (LSCS) leading to morbidly adherent placenta and making it a leading cause of peripartum hysterectomy.Objective: Peripartum hysterectomy is one of the major obstetrical procedures that need to be performed electively/emergency in patients having morbidly adherent placenta (MAP) for the sake of the patient’s life. Need to conduct this study arises because we want to highlight the increasing rate of peripartum hysterectomy secondary to MAP, the emerging trend of increased LSCS in our socio-demographic strata, and its effects on maternal morbidity and mortality.Materials and Methods: This was a retrospective study which was carried out in the Department of Obstetrics and Gynaecology Unit II, Holy Family Hospital, Rawalpindi. All patients who underwent peripartum hysterectomy were included in the study. Data was collected from record files and labor room registers in accordance with ethical guidelines.Results: Out of 11,440 deliveries in one year, 60 patients underwent peripartum hysterectomy with an incidence of 5.2 per 1000 deliveries. The majority of patients (87%) fell in the age group of 25-33 years. 4(6.6%) patients undergone peripartum hysterectomy for postpartum hemorrhage (PPH) due to uterine atony, 3(5%) due to the ruptured uterus, and 53(88%) due to MAP. All patients who had undergone a peripartum hysterectomy due to MAP were previously scarred for LSCS (100%). 5% with previous 1 LSCS, 31% with previous 2 LSCS, 44% with previous 3 LSCS and 18% with previous 4 LSCS.Conclusion: The high incidence of peripartum hysterectomies in young patients secondary to MAP highlights the need for critical review and audit of indications of primary LSCS and repeat LSCS. It also highlights the need for expertise at the time of surgery to decrease the rate of maternal morbidity and mortality