Mean Duration of Active Phase of Labour between Amniotomy [Artificial Rupture of Membranes (AROM)] and Spontaneous Rupture of Membranes (SRM) in Primigravida

Background: Labor is “the presence of uterine contractions of sufficient frequency, duration, and intensity to cause demonstrable effacement and dilation of the cervix” whose evaluation of progress is restricted to episodes of rudimentary examination of cervix while prospectively pointing the onset of labor still remains a challenge. This randomized trial was done to ascertain the short duration of labor in primigravida in active phase labor. Objectives: To compare the mean duration of active phase of labour between amniotomy [artificial rupture of membranes (AROM)] and spontaneous rupture of membranes (SRM) in primigravida. Materials and methods: A total 120 patients who were admitted in Labour room of Department of Obstetrics & Gynaecology, Nishtar Hospital, Multan in this randomized controlled Trial. In group A patients, Amniotomy (also referred to as artificial rupture of membranes [AROM]) was performed by using Kocker’s forceps in a controlled manner under aseptic measures with prophylactic antibiotics cover. Color of liquor was noted. In group B, patients with spontaneous rupture of membranes (SRM) were included. In both groups, labor was followed by keeping record of fetal heart sounds and vaginal examination one hourly to see the progress of labor. Duration of labor was noted in every patient of both groups as per partogram.  All the data was entered and analyzed by using SPSS version 20.0. Results: Our study comprised of a total of 120 primigravida females in active phase of labor. Mean age of our study cases was 25.13 ± 2.61 years ranging 22- 31 years. Mean gestational age of our study cases was 38.41± 1.18 weeks (ranging 37 – 41 weeks). Mean body mass index (BMI) of our study cases was noted to be 23.89 ± 1.66 kg/m2. Mean duration of active phase of labor in our study was noted to be 5.14 ± 0.83 hours. Mean duration of active phase of labor in group A was 4.61 ± 0.59 hours while that of in group B was 5.67 ± 0.70 hours (p= 0. 000). Conclusion: Artificial rupture of membrane is safe, reliable and cost effective modality when employed in primigravida. Our study results indicate that artificial rupture of membrane in active phase of labor in primigravida is associated with significant reduction in duration of labor which reduces fetomaternal morbidity and mortality. Artificial rupture of membrane can be effectively employed to decrease hospital costs which is not only beneficial to the suffering families but also a relief for hospital authorities as well as healthcare professionals. Keywords: Primigravida, Spontaneous rupture, duration of labor, artificial rupture of membranes

EFFECT OF HONEY DRESSING VERSUS POVIDINE PYODINE DRESSING IN POST-CESAREAN INFECTED WOUND HEALING

Background; Wound complications are of the most common morbidities following cesarean section and it affects mother`s quality of life due to stress, anxiety, delay in mother`s ability and health recovery, and also they are associated with additional cost as a result of the increased need for wide spectrum antibiotics and sometimes hospitalization and repeated repair of wound. Objective; To compare the efficacy of honey dressing versus povidine pyodine dressing in post-cesarean infected wound healing. Material and Methods; A total of 62 post-cesarean surgical site wounds that were infected (discharge of pus from wound on examination) of > 7 days were deemed as positive, <15 cm and > 7 days were taken in this randomized controlled trial study. Group A (honey dressing) contains 31 cases in which honey dressing was appled daily and group B (povidine pyodine dressing) containing 31 cases in which povidine pyodine dressing was applied. In both groups, dressing was applied and each patient was followed till 3 weeks for efficacy. Results; Our study comprised of a 62 study cases meeting inclusion and exclusion criteria of our study. Mean age of our study cases was 29.48 ± 3.51 years (with minimum age was 22 years while maximum age was 35 years). Mean duration of wound was 14.06 ± 4.73 (with minimum duration was 8 days while maximum duration was noted to be 24 days). Mean size of wound was noted to be 10.60 ± 2.23 centimeters. BMI was in normal range in 54 (87.1%) of our study cases while obesity was seen in 8 (12.9%) of our study cases. History of diabetes was seen in 17 (27.4%) of our study cases. Efficacy was noted in 24 (38.77%) of our study cases. Both groups were compared in terms of efficacy and efficacy in group A was noted to be 61.3% while in group B only 16.1%. Conclusion; Our study results have indicated that the efficacy of honey dressing is significantly higher compared to povidine pyodine dressing in post-cesarean infected wound healing. Post cesarean surgical site infections have major economic impact and our study results recommend the use of honey dressing as it is safe, reliable, associated with short hospital stay and cost effective for these suffering families. Keywords; Wound Infection, cesarean section, honey dressing

Incomplete miscarriage during the first trimester: a comparison of indoor versus outdoor procedure

Introduction: Miscarriage is defined as the natural death of a fetus inside the uterus. To remove complete conception material after a miscarriage, vacuum aspiration or dilatation & curettage are methods to remove uterine contents. Controversies exist regarding both procedures. So we conducted this study to confirm the more successful method. Objective: To compare the effectiveness of manual vacuum aspiration versus traditional evacuation and curettage (E & C) among females presenting with incomplete miscarriage during the first trimester of pregnancy Materials and Methods: This randomized controlled trial was done at the Department of Obstetrics & Gynecology, Shalamar Hospital, Lahore for 6 months. Then the selected females were divided randomly into 2 equal groups. In group A, females had manual vacuum procedure while in group B, females had evacuation & curettage under general anesthesia. After 12 hours of the procedure, ultrasonography was done to confirm complete evacuation. Results: The mean age of the patients was 29.87 ± 6.71 years, the mean gestational age was 8.06 ± 2.82 weeks. The effectiveness was noted in 248 (91.85%) patients. Statistically, manual vacuum showed significantly more effective as compared to evacuation & curettage procedure in the management of incomplete miscarriage i.e. p-value = 0.008. Conclusion: It has been proved that manual vacuum aspiration is more effective than traditional evacuation & curettage in the management of incomplete miscarriage

Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

Background: Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual’s socioeconomic status. Methods: A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. Results: Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. Conclusions: There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity

Demand Estimation and Forecasting for DALDA Banaspati in Pakistan: An Empirical Analysis from Multan District

The main purpose of our study is to estimate the demand equation. By using this equation, we have to forecast the future demand. To forecast demand, we have collected actual data on demand of Dalda, price of Dalda, price of Hoor and total sales from Jan 2013 – Dec 2014. By using the Multiple Regressions, we have formulated the demand equation from actual data, and then we have forecasted the values by using exponential smoothing technique for all independent variables. Forecasted demand for the Jan of 2015 is 2072.2921, Quantity demanded will increase by 272.2921 (15 percent) for Jan 2015 as compared to the Jan of 2013. We find that price elasticity is -0.825279 it means that demand of Dalda lie in inelastic portion, it means that if price increase or decrease, there is less impact on the quantity demanded. Cross price elasticity of sultan is positive, its value is 0.4964 it shows that it is substitute commodity. Cross price elasticity of Hoor should be positive, but according to our result its value is –2.718552, which means that in this specific area people are using Hoor as a complementary product .Cross price elasticity of total sales is 1.7299. Keywords: Multiple Regression Analysis, Demand Estimation and Forecasting, Elasticities, Price of Dalda, Total Sales

Role of interventional radiology in the management of peripheral vascular malformations: a tertiary care center experience.

Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs. Purpose The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our approach. Materials and methods A retrospective review of all patients with PVMs treated in our interventional radiology department from 2011 to 2017 was carried out. Medical records, imaging, and follow-up notes were reviewed to evaluate the response to treatment and post-procedure complications. Results Thirty-four sessions were performed in 15 patients (eight male, seven female) with PVMs. Low-flow lesions were identified in 10, intermediate flow in one, and high flow in four patients. Sodium tetradecyl sulfate (STS) was used as the sclerotherapeutic agent in 10 (66.67%), glue with lipoidal in three (20.0%), and bleomycin in one patient (6.67%). Coils with PVA and a covered stent were used in one and a combination of coil, PVA, and gel foam was used in one patient. A marked response was seen in 11 and a partial response in four patients. One patient developed foot gangrene. Stent thrombosis was noted in one patient with no clinical consequences. Recurrence was seen in two patients, who were lost to follow up. Conclusion PVMs are complex lesions. Sclerotherapy with or without embolization is a safe and effective treatment modality, with clinical response approaching 100

Prevalence and Associated factors Of Temporomandibular Joint Dysfunction among Young Adults in Karachi

ABSTRACT Objective: The objective of the study was to determine the prevalence and associated factors for temporomandibular joint dysfunction among young adult in Karachi. Material and Methods: A cross-sectional study was carried out in (n=383) subjects with (n=165) males and (n=218) females aged between 18–30 years. The subjects were requested to answer Fonseca’s questionnaires, consisted on ten questions. The collected data sets were analyzed statistically through using the SPSS version 22. Result: A total (n=383) participants, the prevalence of TMD is 66.6%. The participant with TMD (66.6%) show 54.0% mild TMD, 12.0% moderate and 0.5% severe. Women with 61% showing TMD, as compare to men 73.93%. When considering only severe TMD, only women are affected 0.5%. Participant with any level of TMD show marked characteristics: 12.53% considered themselves tense people; 17.5% reported to clench or grind their teeth; 8.88% reported clicking of the temporomandibular joint; 24.28% reported frequent headache. Conclusion: The result of the study concluded that the TMD a high prevalence among young adult in Karachi, among participant with TMD most of the participants had mild TMD which reveals that in young population about half of the participants presented with mild TMD. Key Points: Temporomandibular disorders (TMDs), Mastication, Helkimo's indexes, Fonseca anamnestic Index (FAI

Reepithelialization in noise exposed skin wound

Objective: To observe the effect of noise on reepithelialization in rat skin wound. Methodology: A Quasi experimental study was conducted in Anatomy Department of Al-Nafees Medical College Isra University Islamabad & National Institute of Health (NIH) Islamabad from June 2015 to February 2016. Thirty male sprague Dawley rats were divided into control and experimental groups by convenient sampling. Each main group comprised of 15 rats. An incision of 2 cm was made on dorsal region of all rats. Control sub groups were left to heal with routine background noise exposure, while experimental sub groups underwent a 4 hour/day intermittent noise exposure of 85-95 db, five days a week for two consecutive weeks. Five rats from each group were sacrificed on day 3, 7 and 14. Wounds were excised, fixed and processed for haematoxilin and eosin stain to see the thickness of epithelium in rat skin wounds Results: Process of reepithelialization was not as significant in noise induced group as noticed in control group (routine noise exposed) Conclusion: Noise adversely affects the skin wound healing by interfering with epidermal regeneratio