ROLE OF PAP SMEAR TEST: FROM SCREENING TO CURE IN TERTIARY CARE HOSPITAL

OBJECTIVE 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

Perinatal Outcome in Premature Rupture of Membranes (PROM) and Pre-Prom (PPROM)

OBJECTIVES This study aimed to evaluate the maternal and fetal outcomes in PROM and PRE-PROM at tertiary care hospitals. METHODOLOGY This Cross-sectional study was carried out in the department of obstetrics and gynaecology at Khyber Teaching Hospital Peshawar after ethical approval of the institutional ethical board. Patients who fulfilled the inclusion criteria were selected. On arrival, detailed history was taken, physical and obstetrical examination and per speculum examination were done, patients were managed conservatively, and steroid cover was given for fetal lung maturity.  RESULTS A total of 150 pregnant women who met the inclusion criteria and were complicated by PROM or PRE-PROM were followed. Out of the total patients, 104 presented with PROM, while 46 presented with PPROM. PROM and PPROM patients were identical regarding placental abruption. 104(69.3%) patients presented with PROM and PPROM 46(30.7%).  Patients who delivered were 72(52%) normal vaginal delivery (NVD), 57(38%) C-Section, 15(10%) NVD with episiotomy. In NVD 54(63%) spontaneous, 18(12%) induced, while in C-Section 6(4%) elective and 51(34%) emergency C-Section. In PROM, 18(12%) were complicated by chorioamnionitis, fetal distress meconium stained liquor 18(12%), whereas 100 were uneventful, while in PPROM, 122(81.3%) had no complications, 10(6.7%) chorioamnionitis and 40.7% of the neonates had NICU admission. The personal effects of NVD on the duration of PROM/ PRE-PROM in days with p-value 0.027. The p-value of Complications of PRE-PROM was 0.037. CONCLUSION PROM and PPROM presented with increased maternal and fetal morbidity, vaginal infection, and urinary tract infection should be promptly screened and treated on time to prevent maternal morbidities and improve fetal outcomes

Frequency of Malpresentation in Patients Presenting with Polyhydramnios during Pregnancy at Tertiary Care Hospital

OBJECTIVES To determine the frequency of malpresentation in pregnant women with polyhydramnios. METHODOLOGY This Cross-Sectional Study was conducted at the Department of Obstetrics and Gynecology of Lady Reading Hospital, Peshawar, from March 2021 to September 2021. A total of 175 pregnant women with polyhydramnios were included in the study. Ultrasound was done to make a diagnosis of malpresentation. RESULTSThe age range of pregnant women in this study was from 18-40 years with a mean age of 31.137±3.67 years, mean gestational age of 34.022±2.78 weeks, mean parity of 2.537±1.69 and mean AFI level was 29.017±2.32 cm. A previous history of malpresentation was seen in 25.7% of patients. Malpresentation was observed in 10.3% of patients. The previous history of malpresentation and polyhydramnios had strong statistical significance with current malpresentation (p<0.01). CONCLUSION With the timely diagnosis of polyhydramnios with documentation on ultrasound by an expert radiologist and clinical examination by a gynaecologist, malpresentation can be reduced significantly by prompt treatment.

Frequency of congenital hypothyroidism in new born admitted with neonatal jaundice at tertiary care hospital peshawar

Neonatal jaundice is a common disorder worldwide affecting 30-70% of newborn infants. Severe neonatal jaundice and its progression to kernicterus is a leading cause of death and disability among newborns in poorly-resourced countries. OBJECTIVES: To determine the frequency of congenital hypothyroidism in new born admitted with neonatal jaundice at tertiary care hospital Peshawar. METHODOLOGY: Settings: removed for blind review Duration: Period of 1 year from January 2020- January 2021. Study Design: Descriptive (cross sectional) study. Results: In our study 489 mothers 386(79%) mothers were in age range 18-30 years while 103(21%) mothers were in age range 31-40 years. 279(57%) babies were male and 210(43%) babies were female. 303(62%) newborns had maternal  gestation age ≤38 weeks and 186(38%) neonates had gestation age >38 weeks. 352(72%) newborns had duration of jaundice ≤14 days and 137(28%) newborns had duration of jaundice >14 days. Birth weight was analyzed as 200(41%) newborns had birth weight ≤2.5 kg and 289(59%) newborns had birth weight >2.5 kg.  15(3%) Mothers had positive history of hypothyroidism  while 474(97%) mothers had negative history of hypothyroidism .  24(5%) mother had positive history of anti-thyroid drug intake while 465(95%) mothers had negative history of anti-thyroid drug intake. 5(1%) newborn had congenital hypothyroidism while 484(99%) newborn didn’t had congenital hypothyroidism. Conclusion: Our study concludes that the frequency of congenital hypothyroidism was 1% in new born admitted with neonatal jaundice at tertiary care hospital Peshawar. Key words: Hypothyroidism, Jaundice, kernicterus, bilirubin, morbidity, anti-thyroid drugs

Comparison of Surgical Outcome of Open versus Laparoscopic Nephrectomy

Introduction: Removal of a kidney is a common surgical procedure for a longtime. The procedure was traditionally done by open surgery. Since the advent of laparoscopic surgery, nephrectomy is being done increasingly laparoscopically. The laparoscopic approach has obvious advantages. Better cosmetics, less operative time, lesser need for blood transfusions, feweranalgesia requirements, early mobility,and oral feed, early return to work,and fewerintraoperative and post-operative major complications all contribute to thesuperiority of laparoscopic nephrectomy. Objective:To compare surgical outcomesof open versus laparoscopic nephrectomy. Materials and Methods:This Retrospectives study was conducted in the Department of Urology, Institute of kidney disease, Hayatabad, Peshawar over a period of 2 years from January 2018to January 2020. Results:Our study included a total of 78 cases, 48.7% males and 51.3% females. The patient means the age of 42.69 years. 39.7% had hypertension and 19.2% had diabetes mellitus. Open nephrectomy was done in 40 patients and laparoscopic nephrectomy in 38 patients. The average operating time for open nephrectomy was 160.5 minutes and 130.9minutes for laparoscopic nephrectomy. The average blood loss during open and laparoscopic nephrectomywas 361.25ml and 59.86ml. Blood transfusion rate in open and laparoscopic nephrectomy was 55% and 10.5% (p=0.001). Overall, the post-operative complication rate was 52.5% and 21.5% for an open and laparoscopic approach. Post-operative pain was noted in 7.9% of patients in laparoscopic and 97.5% for an open approach. Fever was noted postoperatively in 26.3% and 62.5% of patients in laparoscopic and open approaches (p=0.001). The average hospital stay in the laparoscopic approach was 2.8days and 4.5days in the open approach. The mean tumor size was 5.65cm in laparoscopic while 8.1cm in the open approach. Catheter and drain removal was on average 1.18 days and 1.32days post-op day in the laparoscopic group while it was 2.35days and 2.3days post-op day in an open group, respectively. There were no per-op complications in the laparoscopic approach as compared to 2 Cases of minor IVC injury in open. Conclusion:In our study,we conclude that the laparoscopic approach for nephrectomy is far superior as compared tothe open approach and it is recommended that Laparoscopic simple and radical nephrectomy shouldbe considered a gold standard treatment. Keywords:Open nephrectomy, laparoscopic nephrectomy, tumor, HTN, D

Comparison of Surgical Outcome of Open versus Laparoscopic Nephrectomy

Introduction: Removal of a kidney is a common surgical procedure for a longtime. The procedure was traditionally done by open surgery. Since the advent of laparoscopic surgery, nephrectomy is being done increasingly laparoscopically. The laparoscopic approach has obvious advantages. Better cosmetics, less operative time, lesser need for blood transfusions, feweranalgesia requirements, early mobility,and oral feed, early return to work,and fewerintraoperative and post-operative major complications all contribute to thesuperiority of laparoscopic nephrectomy. Objective:To compare surgical outcomesof open versus laparoscopic nephrectomy. Materials and Methods:This Retrospectives study was conducted in the Department of Urology, Institute of kidney disease, Hayatabad, Peshawar over a period of 2 years from January 2018to January 2020. Results:Our study included a total of 78 cases, 48.7% males and 51.3% females. The patient means the age of 42.69 years. 39.7% had hypertension and 19.2% had diabetes mellitus. Open nephrectomy was done in 40 patients and laparoscopic nephrectomy in 38 patients. The average operating time for open nephrectomy was 160.5 minutes and 130.9minutes for laparoscopic nephrectomy. The average blood loss during open and laparoscopic nephrectomywas 361.25ml and 59.86ml. Blood transfusion rate in open and laparoscopic nephrectomy was 55% and 10.5% (p=0.001). Overall, the post-operative complication rate was 52.5% and 21.5% for an open and laparoscopic approach. Post-operative pain was noted in 7.9% of patients in laparoscopic and 97.5% for an open approach. Fever was noted postoperatively in 26.3% and 62.5% of patients in laparoscopic and open approaches (p=0.001). The average hospital stay in the laparoscopic approach was 2.8days and 4.5days in the open approach. The mean tumor size was 5.65cm in laparoscopic while 8.1cm in the open approach. Catheter and drain removal was on average 1.18 days and 1.32days post-op day in the laparoscopic group while it was 2.35days and 2.3days post-op day in an open group, respectively. There were no per-op complications in the laparoscopic approach as compared to 2 Cases of minor IVC injury in open. Conclusion:In our study,we conclude that the laparoscopic approach for nephrectomy is far superior as compared tothe open approach and it is recommended that Laparoscopic simple and radical nephrectomy shouldbe considered a gold standard treatment. Keywords:Open nephrectomy, laparoscopic nephrectomy, tumor, HTN, D

FREQUENCY OF NEONATAL SEPSIS AMONG NEONATES PRESENTING WITH SEIZURES

BACKGROUND:  Neonatal seizures may be the first and sometimes the only clinical symptom of neonatal central nervous system disease. Neonatal seizures may indicate an underlying treatable cause. Therefore, the identification of neonatal seizures is important in the management of high-risk newborns.  OBJECTIVE:  To determine the frequency of neonatal sepsis among neonates presenting with seizures.  Settings: Department of child health, Hayatabad Medical Complex, Peshawar.  Duration: 6 months 13/10/2018 to 13/4/2019.  Study Design: Descriptive (cross sectional) study.  MATERIAL AND METHODS:  In this study a total of 195 patients were observed. All neonates were subjected to detailed clinical examination like general physical, neurological examination and detail systemic examination and complete set of baseline investigations. From all neonates, 5cc of venous blood was obtained under strict aseptic technique and was sent to hospital laboratory for measuring the TLC, Absolute neutrophil count, CRP and platelet count to confirm the presence or absence of neonatal sepsis.   RESULTS:  In this study mean age was 10 days with standard deviation ±8.36. Fifty eight percent neonates were male while 42% neonates were female. More over the 42% neonates had neonatal sepsis while 58% neonates didn’t had neonatal sepsis.  CONCLUSION:  Our study concludes that the frequency of neonatal sepsis was 42% among neonates presenting with seizures.

Cathetar Related Antimicrobial Resistance Pattern in Intensive Care Unit Patients: A Single Centre Study

Background Urinary catheter is the most common cause of urinary tract infection (UTI) which has been associated with three fold increase risk in mortality. A high level of resistance was noted among the admitted patients for cephalosporin. The primary aim of the study is to known the strain of pathogens; its drugs sensitivity and resistance in intensive care unit (ICU) patients which help the physician in proper management and reduces the mortality and morbidity in urinary catheter related complication. Methods            This study was conducted in Intensive care unit patients of Hayatabad medical complex Peshawar Pakistan over a period of 1 year from 1st January to 31st December 2019. Medical charts were reviewed and 100 patients were selected based on inclusion criteria and  their urine culture and sensitivity reports were noted to know about the most common pathogens, its drugs sensitivity and resistance in these patients. Clinical and Laboratory Standards Institute (CLSI) used for uropathogen by culture and Disc diffusion method to determined antimicrobial susceptibility pattern. The data were shifted from excel sheet to SPPS 21 IBMS version. Results    The mean age (standard deviation) of patients was 51.60+26.59 years (Median age 58.50 years). Of the total, 64 were female and the remaining were male patients. It was found that most common pathogens in urine sample was E. coli. Maximum pathogens were sensitive to intra venous meropenem (65%), and fosfomycin (55%). Conclusion It is concluded that resistance patterns of uropathogens changes which results in treatment failure. Further, based on clinical practice, meropenem, fosfomycin, and cefepime had high sensitivity profile against catheter related infection in ICU

Frequency of Congenital Heart Disease in Patients with Down Syndrome

OBJECTIVES Frequency of congenital heart disease in patients with Down syndrome.METHODOLOGY This study was conducted in Hayatabad Medical Complex, Peshawar from 10th May 2021 to 9th November 2021. A total of 377 patients of age 1 to 10 years and both gender were included in the study. Those with already diagnosed cases of congenital heart disease and dysmorphic features other than Down syndrome were excluded from the study. All patients were undergone echocardiography and patient with PDA, VSD, ASD, ASVSD, and TOF were labeled as having congenital heart diseases.RESULTSMean age was 5.96 ±1.954, Males were 176 (46.7%) while females were 201 (53.3%), Mean birth weight was 3.45 ± 0.801 kg, Mean age of the mother was 38.25 ± 6.797 years, Congenital heart diseases were present in 157 (41.6%) of the patient while it was not present in 220 (58.4%) of patients, there was no association between congenital heart disease and age of mother, age of the child, sex of child or weight of the child (P >0.05).CONCLUSIONCongenital heart disease is very common in patients with Down syndrome. It is recommended that at the time of diagnosis of this disease, the patient should be screened for congenital heart disease