Critical appraisal of endometriosis management for pain and subfertility

Objective: To critically appraise current best available management of pain and subfertility ascribable to endometriosis.Methods: Medline and specialist computer databases were searched along with reference lists of known reviews and primary articles to identify cited articles not captured by electronic searches. We included all studies pertaining to treatment of pain and subfertility ascribable to endometriosis.Discussion: Medical and surgical management options for pain and subfertility are presented as Evidence-based inquiries for critically appraised topics. Each problem is presented as an answerable question followed by assessment of literature search for level of evidence. This is followed by critical appraisal of results. In the end, take-home answer to individual problem is presented in view of best available evidence.Conclusion: Evidence-based management of endometriosis provides realistic therapeutic goals and expectations for the clinicians and women experiencing pain and subfertility due to this disease. It also promotes efficient and effective use of medical and surgical options when required

The effect of grandmultiparity on pregnancy related complications: The Aga Khan University experience

Background: Grandmultiparity has been associated with complications for both mother and the fetus.Objective: To evaluate if grandmultiparity is a risk factor in the presence of adequate antenatal care.Setting: A tertiary care teaching hospital.Methods: It was a retrospective study conducted in the department of Obstetrics & Gynecology at The Aga Khan University Hospital in Karachi. During this period 9253 women were delivered, out of these 143 booked grandmultiparas (GMP) served as cases. The outcome of these women was compared with 430 non-grandmultiparas (NGMP). Logistic regression model was used to adjust for potential confounders.Results: Grandmultiparas had almost three times increased risk of having postpartum hemorrhage compared to NGMP group. Similarly, there were significantly low five-minute apgars in the GMPs compared to the NGMP group. Although the neonatal intensive care admissions were three times more in the GMPs but this did not reach statistical significance due to small number of cases in both groups.Conclusion: Our study indicates that grandmultiparity is a risk factor for pregnancy in this part of the world, even in the presence of reasonable antenatal care. This may be explained on the basis of the increased age of these women. Finally, we also recommend that an age-matched study needs to be undertaken in order to determine if age is an important determinant for risk factors in grandmultiparas

Gestational diabetes in a developing country, experience of screening at the Aga Khan University Medical Centre, Karachi

In order to determine the prevalence of glucose intolerance in pregnancy, 1267 consecutive women attending the antenatal clinic of the Aga Khan University Medical Centre were subjected to a 75 g glucose challenge followed 2 hr later by plasma glucose determination irrespective of gestation on the first antenatal visit. The test was repeated at 28-32 weeks of gestation if the patients had an abnormal initial screen at less than 28 weeks gestation and a normal glucose tolerance test on diagnostic follow-up and for those who had a risk factor for gestational diabetes and a normal initial screen at less than 28 weeks gestation. The glucose challenge test was abnormal (2 hr plasma glucose greater than 140 mg%) in 8.6% of the screened population. Follow-up oral glucose tolerance test on these patients revealed a prevalence of 3.2% of gestational diabetes and 1.9% of impaired glucose tolerance test based on the modified O\u27Sullivan criteria. Improvement in cost effectiveness of screening programmes was adjudged possible by avoiding glucose tolerance tests in patients with 2 hr plasma glucose value of greater than 170 mg% after a 75 g oral glucose challenge for screening

Malicious User Attack in Cognitive Radio Networks

Signal detection in cognitive radio network (CRN) is influenced by several factors. One of them is malicious user that emulate primary user (PU) signal. Emulation of PU signal causes detection error. This paper investigates the impact of malicious user attack to PU signal detection. A number of malicious users are randomly deployed around secondary user (SU) at a certain distance. They attempt to attack primary signal detection that is transmitted from 100 km to SU receiver. Then, the received signal power at secondary receiver and the performance of probability of false alarm and probability of miss detection under two hypothesis of Neyman Pearson criterion are studied. The derived results show that a number of malicious users has a significant impact to the performance of received power at SU and detection error rate

Platelets and leucocyte counts in pregnancy

A study involving the obstetric clinic population of 3 major teaching hospitals of Karachi has been conducted to define changes in leucocyte and platelet counts as pregnancy progresses. 573 “normal” pregnant women - 183 in the first trimester, 195 in the second trimester and 194 in the third trimester were included in this analysis. We have found leucocytosis to be a feature of normal pregnancy; the change is subsequent to a progressive increase in granulocytes. Platelet counts were found to decrease slightly as pregnancy progresse

Effectiveness of percutaneous nephrostomy in reversing obstructive renal failure

A retrospective analysis of 34 patients of obstructive renal failure, initially managed by percutaneous nephrostomy was performed. Pre procedure blood biochemical profile was compared with upto one week follow-up of blood chemistry. There was a decline of 71.1% and 56.08% (P-values 0.0001 and 0.0028) in the mean values of serum creatinine and blood urea nitrogen respectively at 7 days after the procedure. Improvement in blood biochemical profile was solely dependent on performance of percutaneous nephrostomy

PRIMARY MALIGNANT MELANOMA UTERINE CERVIX

A 40-year-old premenopausal female presented with foul-smelling per vaginal discharge for 3 months. Diagnostic work revealed a locally advanced primary malignant melanoma of uterine cervix. The patient declined pelvic surgery and was treated with Dacarbazine. Malignant melanoma is a rare tumour of skin and has been ranked in the top ve cancers of Australia and Sweden. It is a tumour of melanocytes which forms melanin pigment in the skin. In men, the most common site is trunk while in females common site is limbs. However, melanoma can arise from mucosal surfaces where the melanocytes are present. Most common mucosal sites are head and neck followed by female genital tract. Key words: Cervix, dacarbazine, malignant melanoma

Bacteriuria and pregnancy outcome: A prospective hospital-based study in Pakistani women

The prevalence of bacteriuria in Pakistani women and its association with complications of pregnancy was studied. Out of 1579 women, 77 had bacteriuria (4.8%). There was no association of age, gravidity, parity, haemoglobin, pre-eclampsia, mode of delivery, gestational age at delivery, preterm delivery and low birth-weight with presence of bacteriuria. With detection and treatment the pregnancy outcome of women with bacteriuria in pregnancy was the same as that of those without

Genetically engineered minipigs model the major clinical features of human neurofibromatosis type 1.

Neurofibromatosis Type 1 (NF1) is a genetic disease caused by mutations in Neurofibromin 1 (NF1). NF1 patients present with a variety of clinical manifestations and are predisposed to cancer development. Many NF1 animal models have been developed, yet none display the spectrum of disease seen in patients and the translational impact of these models has been limited. We describe a minipig model that exhibits clinical hallmarks of NF1, including café au lait macules, neurofibromas, and optic pathway glioma. Spontaneous loss of heterozygosity is observed in this model, a phenomenon also described in NF1 patients. Oral administration of a mitogen-activated protein kinase/extracellular signal-regulated kinase inhibitor suppresses Ras signaling. To our knowledge, this model provides an unprecedented opportunity to study the complex biology and natural history of NF1 and could prove indispensable for development of imaging methods, biomarkers, and evaluation of safety and efficacy of NF1-targeted therapies