Abdominal Hysterectomy for Benign Gynecological Diseases

OBJECTIVES This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear

PROCESS OPTIMIZATION FOR AMYLOGLUCOSIDASE BY A MUTANT STRAIN OF ASPERGILLUS NIGER IN STIRRED FERMENTER

Abstract The present study was designed to optimize the process parameters for the production of amyloglucosidase bya mutant strain of Aspergillus niger in stirred fermenter by. For this purpose, various cultural conditions like rate of fermentation, process pH, rate of agitation and size of inoculum was investigated. The maximum production (25.15 U/mL/min) of amyloglucosidase was achieved at the agitation speed of 200rpm. The production of amyloglucosidase was found to be maximum (25.08 U/mL/min) at pH 5 of the medium. The optimum productivity (25.15 U/mL/min) of the enzyme was achieved with 4% inoculum after 48 h of incubation. The process temperature was optimized at 30 o C throughout the study

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Caesarean Section Rate and Frequencies of Indications Using Robson–Ten Classifications

OBJECTIVES: To determine the caesarean section rate (CSR) and frequency of different indications of caesarean section (CS) in a tertiary care hospital. METHODOLOGY: A retrospective study done in the Department of Obstetrics and Gynecology Hayatabad Medical Complex Hospital Peshawar, a tertiary care hospital, from a period of 1st January 2019 till 31st December 2019. The required data was collected from the patient’s hospital records (clinical charts) with the consent of the hospital ethical committee. RESULTS: The total number of deliveries over the study period was 5611. Out of these 1258 patients were delivered through caesarean section (CS), giving a CSR of 22%. The main contributing groups in our study were Robson Groups R5 (multiparous with prior CS, singleton, cephalic and >37 weeks), R1 (nulliparous, cephalic, singleton >37 weeks in spontaneous labor or CS) and R6 (all nulliparous breeches) with percentages of 21.1%, 17.5% and 12.9% respectively. CONCLUSION: Our study showed Robson Groups 5, 2 and 6 as the major contributors, focusing on these groups could have an impact on decreasing the cesarean section rate in future. Limiting the primary cesarean section rate can affect the overall cesarean section rate (CSR)

Benefits of Near-Peer Tutoring in Small Group Discussions: A Pilot Study

Background: A year senior medical students can prove to be a useful teaching resource with added benefits for the tutors. The objective of this study was to explore the perceptions of near-peer tutors after facilitating small group discussions while delivering an integrated curriculum in preclinical years. Material and Methods: This qualitative exploratory pilot study was conducted in Rawal Institute of Health Sciences Islamabad, Pakistan from July 2017 to November 2017. Students of First year MBBS class (n=100), were divided into six small groups. Seven Second year MBBS students who had secured more than 60% marks throughout year one assessments and in Professional examination were selected as Near-Peer tutors after informed verbal consent. In the first discussion, three groups were taught by three tutors and three by junior faculty. In the second discussion, the groups were swapped and exposed to the same strategy as above, with new learning objectives, but the remaining three tutors now took batches. One tutor acted as a substitute. Qualitative data was collected after interviewing the tutors individually and responses were audio recorded. The collected data, both notes and audio recordings of the interviews, was transcribed into text to generate codes, theme and sub themes. Results: Transcription of data revealed that the tutors enjoyed teaching and were of the opinion that Near-Peer tutoring is more effective in small groups, for both tutors and the learners. The tutors felt a boost in self-confidence and improvement in communication skills, after facilitating a small group. Tutoring also helped in developing their higher order cognitive thinking, learning skills and time management. Conclusions: Near-Peer tutoring helped the tutors develop learning and communications skills while facilitating small group sessions, thus helping them in their future medical roles. Key words: Integrated curriculum, Near-Peer tutoring, Peer Assisted Learning, Small group discussions

FORMULATION AND IN VITRO EVALUATION OF FLOATING TABLETS OF PSYLLIUM HUSK & TRAGACANTH USING SITAGLIPTIN PHOSPHATE AS A MODEL DRUG

Abstract A novel floating controlled release drug delivery system of Sitagliptin phosphate was formulated in an effort to increase the gastric retention time of the dosage form and thereby increased drug bioavailability. The tablets were prepared by wet granulation method using Psyllium Husk and tragacanth gum as a release retarding polymers and sodium bicarbonate as a gas generating agent. All the designed nine batches of floating tablets were evaluated for physical characteristics viz. weight variation, thickness, content uniformity, hardness, floating capacity, swelling studies. All formulations had floating lag time of less than 1 min and constantly floated for 12 h except F1, F4 and F7 (that dissolved completely in 8 h or less than 8 h). In vitro drug release studies were carried out for 8 h and release mechanism was further evaluated by linear regression analysis, F9 composed of 30% Psyllium Husk, 10% tragacanth gum and 18% sodium bicarbonate sustained the drug release for longer period. The formulations followed first order kinetics, Higuchi drug release kinetics with diffusion as the dominant mechanism of drug release and the release exponent ranged (0.452-0.635) indicating that the drug release from all formulations was by non-Fickian diffusion mechanism. The prepared floating tablets of STP (F9) might be a promising drug delivery system with sustained release action and improved bioavailability