Prevalence of Anxiety and Depression Among Women With Polycystic Ovarian Syndrome: A Cross-Sectional Study From a Tertiary Care Hospital of Islamabad, Pakistan.

Background Depression and anxiety are common psychological conditions associated with polycystic ovarian syndrome (PCOS). It is important to understand the role of various demographic and socio-economic factors that contribute to the development of these psychological conditions. Objectives The aims of this study were to determine the prevalence of anxiety and depression in women with PCOS and to find the association of various demographic and socio-economic factors with anxiety and depression. Methods This was a single-center cross-sectional study conducted at a tertiary care hospital in Islamabad, Pakistan, from May 2021 to August 2022. All female patients, aged 18 to 40 years and diagnosed with PCOS, who presented to the department of Gynecology during the study period were eligible to be enrolled in the study. The Hospital Anxiety and Depression scale (HADS) was used to determine the level of anxiety and depression in the participants. HADS comprises 14 items scored on a Likert scale ranging from 0 to 3. Seven items correspond to depression and anxiety each. The scores range from 0 to 21 for both domains. A score of 7 or less was considered normal, 8-10 as borderline, and 11 or above as abnormal for both anxiety and depression. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). Results A total of 74 patients with PCOS were included in the study. The mean age of all the participants was 26.8 ± 5.2 and the mean body mass index (BMI) was 28.7 ± 5.4. The presence of PCOS-related symptoms was observed in all 74 cases. Menstrual cycle abnormalities were the most common symptom, which was present in 57 (77.0%) cases, followed by weight gain, which was present in 50 (67.6%) cases, and hirsutism, which was present in 41 (55.4%) cases. Diabetes mellitus and hypertension were present only in three (4.1%) and two (2.7%) cases, respectively, and positive family history of depression and/or anxiety was reported by 20 (27%) cases. The mean HAD score was 7 ± 3.8 for depression and 8 ± 3.7 for anxiety. Depression was diagnosed in 13 (17.6%) cases, and anxiety was diagnosed in 15 (20.3%) cases. Depression was found to be significantly associated with BMI (p = 0.015), level of education (p = 0.033), and monthly household income (p = 0.004). Anxiety was found to be associated with employment status (p = 0.009) and current pregnancy (p = 0.007). Rest of the factors such as age, marital status, ethnicity, menstrual irregularities, comorbidities such as diabetes mellitus and hypertension, and a family history of PCOS, anxiety, or depression did not show statistically significant association with either anxiety or depression (p < 0.05). Conclusion Anxiety and depression are common in patients with PCOS. These psychological conditions are associated with various demographic and socio-economic factors such as BMI, level of education, monthly household income, employment status, and pregnancy. It is recommended to involve a multidisciplinary team while managing patients with PCOS to timely identify and treat these psychological conditions in these patients.

Enhancing Empathy in Medical Students by Focused Learner Centered Activities.

OBJECTIVES: To determine the change in empathy levels of medical students during their progress in professional years internship, and to examine change in empathy after targeted empathy enhancing activities during the course of medical school. STUDY DESIGN: Longitudinal Study. PLACE AND DURATION OF STUDY: Shifa College of Medicine/ Shifa Tameer-e-Millat University, Islamabad, from January 2015 to December 2019. METHODOLOGY: Student version of Jefferson Scale of Physician Empathy was administered sequentially from 2015 to 2019 which evaluated the change in empathy of medical students in a class of 2019. Targeted empathy-enhancing activities included patient-centered module in year-three and stress management workshops in the final year of medical school. RESULTS: Empathy scores rose from the first year of study (4.27 ±0.38) to the third year (4.52 ±0.70). It fell over the next two years of study (4.25 ±0.62 & 4.21 ±0.40) before rising again during the internship (4.39 ±0.43) with focused empathy-enhancing activities. CONCLUSION: Patient-centered module which focused on activities that help develop empathy may have been a factor in the increase of empathy scores in the third year and internship. Placing recurring formal activities throughout all clinical years may help in enhancing empathy in medical students. KEY WORDS: Medical student empathy, Empathy enhancing targeted activities, JSPE.

Exploring Coping Strategies For Stress Management Among Undergraduate Medical Students.

BACKGROUND: College is the time where most mental health disorders are triggered. Due to an extremely strenuous curriculum, medical students are prone to develop high levels of stress. Teaching students stress management skills can be crucial for their mental and physical well being. Objectives of the study were to measure perceived stress level among undergraduate medical students of Year 5 using PSS Scale, and to explore if students find stress management activities helpful in reducing stress. METHODS: It was a quasi experimental study.5th year medical students were asked to take part in a full day workshop regarding stress management. During the day they were introduced to different stress management activities. Stress levels were measured using PSS before the workshop and 1 month after the workshop. RESULTS: On the PSS 1, 17.9% participants scored in the low stress category, 61.1% participants scored in the moderate stress category and 21.1% scored in the high stress category. On the PSS 2, 11.6% participants scored in the low Stress category, 76.8% participants scored in the moderate stress category and 11.6% scored in the high stress category. Pre and post intervention PSS stress results were statistically significant, p< 0.05. CONCLUSIONS: Majority of the final year students had moderate stress. Training undergraduate medical students in integrated stress relieving activities can help lower their perceived stress.

Maternal depression and its correlates: A longitudinal study.

OBJECTIVE: To estimate the burden of antenatal and postpartum depression, and to explore possible predictors of perinatal depression. METHODS: The longitudinal study was conducted at the Department of Obstetrics and Gynaecology, Shifa International Hospital and its Community Healthcare centre in Islamabad, Pakistan, from October 2018 to May 2019, and comprised women in their third trimester of pregnancy. Socioeconomic and obstetrical history was recorded on a proforma, and the Edinburgh Postnatal Depression Scale was used for screening of depression. Data was analysed using SPSS version 23. RESULTS: Of the 200 women, 71(35.5%) were primigravida and 129(64.5%) were multigravida. The overall mean age was 27.1±5.08 years. Further, 64(32%) women belonged to the low-income group, 99(49.5%) middle-income and 37(18.5%) to upper-income group. Women in postnatal period had higher depression scores than women in antenatal period (p<0.05). Antenatal depression increased the risk of postpartum depression (p<0.05). In women having unplanned pregnancies, or being multigravida, or belonging to middle and lower socioeconomic classes, the chances of perinatal depression were higher (p<0.05). CONCLUSIONS: Antenatal depression was strongly associated with postpartum depression, indicating that the former was a significant predictor of the latter. Social class and parity were also found to be directly linked with perinatal depression.

Impact Of Covid-19 On Post Natal Mental Health.

BACKGROUND: In January, 2020 COVID-19 infection was declared a public health emergency characterized as pandemic by the World Health Organization (WHO). In March 2020, special guidelines were issued to address mental and psychological aspects of the disease survivors and community at large. This study was conducted with the aim to evaluate the psychological impact of COVID-19 on mothers in the postpartum period. METHODS: It was cross-sectional study of six months duration on COVID-19 positive deliveries and Covid negative mothers. A total of 84 women (42 Covid Positive and 42 Covid negative) were included through non-probability quota with consecutive sampling technique. Mothers with pre-existing mental health issues, those who had been on medication for any psychological issues or those who suffered from obstetrical and neonatal complications or required transfer to High Dependency Unit (HDU) were excluded from the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen the women for postpartum depression. Independent sample t test was used for continuous variables and Fisher exact test was used for qualitative variables. RESULTS: Mean EPDS score was 9.48±6.33 in COVID-19 positive group. The sub-scale analysis showed mean scores 1.6±1.76 and 4.86±2.94 for Anhedonia and Anxiety with statistically significant difference. CONCLUSIONS: Women experiencing COVID-19 infection during pregnancy were found to have greater anxiety and nervousness in post-natal period compared to their COVID-19 negative counterparts.

Differences in Empathy Levels of Medical Students Based on Gender, Year of Medical School and Career Choice.

OBJECTIVE: To measure mean empathy scores of Pakistani medical students and to explore any association of empathy scores with gender, medical school year and future career choice. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Shifa College of Medicine, Shifa Tameer-e-Millat University, during the academic year 2015-2016. METHODOLOGY: The student version of Jefferson Scale of Physician Empathy (JSPE) was distributed to the students electronically via the student portal. Response that were completed in full were included in the study. Descriptive statistics was used to analyse student demographic data. The student score on the JSPE was reported as the mean (out of 7) of each item. Independent samples t-test was employed to check the significant differences between genders. Empathy score with advancing year of study was investigated using ANOVA. ANOVA with post-hoc Tukey's test was used to study the relationship between career choice and empathy score. RESULTS: The response rate was 70.94%. The mean score was 4.51 ±0.69. Females obtained greater, but statistically insignificant (p=0.08) empathy score (4.58) as compared to the male students (4.45). No statistically significant difference was seen between scores on the survey across the five academic years (F=0.88, p=0.47). Students who selected medicine and allied as career choice showed a significantly higher empathy score than those who opted for surgery. The internal consistency reliability (Cronbach's alpha) was 0.78. CONCLUSION: There were low levels of empathy in Pakistani medical students. Students with interest in medicine and allied showed higher empathy scores compared to surgical or technical specialties. No association of empathy scores with gender and medical school year was observed.

Treatment for Symptomatic Bacterial Vaginosis: ARandomized Controlled Trial.

OBJECTIVE: To compare the efficacy of multiple doses of vaginal clindamycin with a single oral dose of secnidazole for the treatment of bacterial vaginosis. STUDY DESIGN: Double-blinded randomized controlled trial. PLACE AND DURATION OF STUDY: Shifa Foundation Community Health Center, from March 2012 till February 2015. METHODOLOGY: After obtaining written informed consent, a pelvic examination was performed for the confirmation of symptoms of milky white vaginal discharge on speculum examination, positive Amine test and presence of clue cells on microscopy. Pregnant women, known diabetes or any immunocompromised condition, were excluded. Blinding of the patient, doctor, and the pharmacist was done. Study cohort was then divided into two groups, Group Areceived medicine pack Awhich contained active clindamycin and placebo oral preparation, whereas group B was given pack B which contained active 2-gm secnidazole with placebo vaginal cream. Primary outcome and therapeutic success were defined by correction of two out of three (normal Nugent score, negative Amine test, and no milky white discharge) on day 15. RESULTS: At 15th day of treatment, 96.6% participants in vaginal clindamycin group (Group A), recovered from the bacterial vaginosis; whereas, (group B) 23% patients were cured in oral secnidazole group. CONCLUSION: Multiple doses of vaginal clindamycin are superior to single dose of oral secnidazole for the treatment of bacterial vaginosis.

A Quantitative Study of Empathy in Pakistani Medical Students: A Multicentered Approach.

OBJECTIVE: To examine the empathy level of undergraduate medical students in Pakistan. Three hypotheses are developed based on the literature review. (1) Female medical students have a higher level of empathy than do male students. (2) Empathy scores vary during the medical school years in Pakistani students. (3) Medical students interested in people-oriented specialties would score higher than the students interested in technology-oriented specialties. METHODS: This is a quantitative inquiry approach using a cross-sectional design of 1453 students from 8 Pakistani medical schools, both private and state. The sample consists of 41.1% (n = 597) male students and 58.9% (n = 856) female students. Empirical data are collected using the Jefferson Scale of Physician Empathy (JSPE), a well-validated self-administered questionnaire. RESULTS: The mean empathy score among students is 4.77 with a standard deviation of 0.72. The results show that there is no statistically significant association between the empathy scores and gender, t(1342.36) = -0.053, P = .95). There is a statistically significant difference between the empathy scores and the years of medical school, F(14, 1448) = 4.95, P = .01. Concerning the specialty interests, there is no statistically significant difference between the empathy score and specialty interests. CONCLUSION: The findings of this study showed that in Western countries, medical students performed better than Pakistani medical students on the empathy scale. This finding has important implications for Pakistani medical educators to improve the interpersonal skills of medical students in the context of patient care. Inconsistent with our expectations and experiences, our findings do not support that female medical students scored better than their male counterparts on the empathy scale. Because of the nature of a cross-sectional study, it is impossible to argue the decline of empathy during medical school training.

Complete Hydatidiform Mole Coexisting with Three Viable Fetuses in a Quadruplet Pregnancy.

We hereby report a case of quadruplet pregnancy with delivery of 3 viable infants and a complete mole. This was an induced conception with clomiphene citrate. At 22 weeks, cystic structures were noticed in one of the placentae and a suspicion of co-existant molar pregnancy was made. The case discussed with oncologist and pregnancy was continued with close monitoring of &beta;-hCG and Ultrasound. Her &beta;-hCG at 23 weeks was 748 mIU/ml, which continued to rise until the 29th week of gestation to a level of 305881.68 mIU/ml and declined gradually thereafter. Similarly, hydropic change in placenta also continued to increase progressively. She was given steroid cover at 32 weeks and delivery was aimed at 34 weeks of gestation. The patient went into preterm labour at 33 weeks and 3 female infants delivered by lower segment cesarean section (LSCS) followed by removal of 3 placentae along with copious molar tissue at the end. The newborns were kept in the nursery, non-requiring assisted ventilation and discharged in satisfactory condition. The histopathologyand immunohistochemistry confirmed the diagnosis of a quadruplet pregnancy comprising of one complete mole with 3 normal placentae.

Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy: a randomized controlled trial.

OBJECTIVE: To compare the efficacy and safety profile of total dose infusion of low molecular weight iron dextran with divided doses of intravenous iron sucrose for the treatment of iron deficiency anemia during pregnancy. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, over a period of two years from January 2008 to December 2009. METHODOLOGY: Pregnant women at gestational age more than 12 weeks with the confirmed diagnosis of Iron Deficiency Anemia (IDA) were divided into two groups. In the group-A, intravenous iron sucrose was given in divided doses while in the group-B, total daily intake of Low Molecular Weight (LMW) of iron dextran was given. Post-infusion Hemoglobin (Hb) was checked at 4 weeks and at the time of delivery for both groups. Paired sample t-test is applied and comparison (in terms of rise in hemoglobin from pre to post) of both groups was not found to be significant. RESULTS: In the group-A (iron sucrose group), mean pre-infusion Hb levels was 9.09 ± 0.83 gm/dl. Mean increase in Hemoglobin (Hb) was 10.75 ± 1.097 gm/dl after 4 weeks of infusion and 11.06 ± 0.866 gm/dl at delivery (p < 0.001). In group-B (iron dextran group) pre-infusion haemoglobin was 8.735 ± 0.956 gm/dl and the mean increase in hemoglobin was 10.613 ± 1.22 gm/dl at 4-week while mean increase of 10.859 ± 1.11 gm/dl at the time of delivery (p < 0.001). CONCLUSION: Both LMW iron dextran, as well as iron sucrose are equally effective in treatment of IDA during pregnancy, however, LMW iron dextran has the advantage of single visit treatment.

Uterine fibroid embolisation: initial experience in our local population.

OBJECTIVE: To evaluate the results of uterine fibroid embolisation as a treatment option for symptomatic uterine fibroids in the local population. METHODS: The retrospective study was done at the Department of Diagnostic and Interventional Radiology, Shifa International Hospital, Islamabad, and comprised records of 12 patients with symptomatic uterine fibroids who had undergone uterine fibroid embolisation with the use of polyvinyl alcohol between May 2008 and July 2012. All of these patients had been assessed by a gynaecologist. Pre-embolisation workup was done by pelvic Magnetic Resonance Imaging. A detailed questionnaire was prepared to assess clinical improvement and interval change in fibroid size on follow-up imaging. RESULTS: A technically successful embolisation was done in all patients. All patients experienced immediate postprocedure pain, but responded to conservative treatment. Clinical follow-up showed a significant reduction in symptoms within six months of the procedure, with 88% improvement in menorrhagia and 100% improvement in pain. Follow-up imaging showed reduction in fibroid sizes ranging from 17-63%. Two patients developed infection, which is a known complication of this procedure. CONCLUSION: Uterine fibroid embolisation is a well-recognised treatment option for symptomatic uterine fibroids. Ascertaining its long-term results in our local population will, however, require additional studies with larger patient populations.

Efficacy of levonorgestrel intrauterine system (LNG-IUS) for abnormal uterine bleeding and contraception.

OBJECTIVE: To find out clinical response, side effects and patients' acceptability of levonorgestrel-releasing intrauterine system (LNG-IUS). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Gynaecology Department of Shifa International Hospital, Islamabad, from June 2005 to May 2008. METHODOLOGY: Adult women were enrolled in the study. In group-A, 57 married women were enrolled presented with abnormal uterine bleeding while in group-B, 16 married women attended for contraception. All women in group-A had thyroid stimulating hormone, pelvic ultrasound and outpatient endometrial biopsy. Detailed counselling was done before insertion. Outcome variables were improvement in bleeding pattern, safety profile, spontaneous expulsion rate and continuation at the end of one year. RESULTS: In group-A (abnormal bleeding) menstrual cycle became normal in 40.4% women in the first 3 months. At the end of one year, 50.9% women experienced normal cycle, 8.8% were oligomenorrhic and 12.3% were amenorrhic. In group-B (contraceptive group) all women started with normal cycles. At the end of 3 months 42% complained of vaginal spotting which reduced to 10% at the end of one year. Menstrual pattern at the end of one year showed normal cycles in 52%, oligomenorrhea in 19% and amenorrhea in 10% women. Vaginal spotting was experienced by 42% women at 3 months as main complaint which reduced to 10% at the end of one year, however, 7% women requested for removal of device at one year. CONCLUSION: LNG-IUS is an effective and acceptable treatment for abnormal uterine bleeding as well as for contraception. Vaginal spotting was the most frequent side effect experienced by both groups.

Health related quality of life in pregnant women: a comparison between urban and rural populations.

OBJECTIVE: To study mental and physical health of pregnant women and compare the differences between those residing in urban and rural settings. METHODS: A Cross-Sectional Survey was conducted on pregnant women (n=179) in urban and rural areas of Islamabad in January 2009. SF-12, a validated instrument for mental and physical health assessment was used and translated into Urdu. Responses were decoded as per SF-12 analysis protocol. Independent sample t-test was done to compare the quantitative variables. The level of statistical significance was p<0.05. The survey was filled either by the participant or the research team and was anonymous. All the researchers were trained in the interview technique in order to make sure that each question carried the same meaning during the actual survey. This was done to standardize the survey methodology. RESULTS: A total of 179 survey forms were collected, 83 and 96 from both rural and urban areas respectively. Role Limitations because of Physical Problems (p=0.020), General Health Perceptions (p=0.001) and Role Limitations because of Emotional Problems (p=0.023) had statistically significantly lower scores in rural women as compared to urban women. CONCLUSION: Self-perceived mental and physical health was better in urban pregnant women than in rural women.

Low haemoglobin levels, its determinants and associated features among pregnant women in Islamabad and surrounding region.

OBJECTIVE: To estimate the haemoglobin levels in pregnant women and to determine the socio-demographic factors associated with anaemia in pregnancy. PATIENTS AND METHODS: In this cross-sectional survey, a total of 200 patients visiting prenatal clinic of Shifa International Hospital/Shifa Foundation Community Health Centres, Islamabad over the period of six months, both booked and non-booked were included. A detailed questionnaire was filled and complete blood count, peripheral smear and absolute values were performed in all cases. Haemoglobin levels (Hb) of women below 10.5g/dl were considered to be low (anaemia) and were further subjected to urine/stool routine examination. Cases of thalasaemia trait were excluded from the study. All the data was entered in SPSS v 10.0. Descriptive analysis was done obtaining frequencies for socio-demographic factors. Mean haemoglobin levels along with standard deviation and confidence interval were reported. Frequency of helminthic infestation of suspected cases was also reported. Analysis included any significant differences in mean haemoglobin levels of booked versus non-booked cases. RESULTS: Mean haemoglobin of our study population was 11.0 +/- 1.64 g/dl. Frequency of decreased haemoglobin was found to be in 42.5%. Mean haemoglobin of patients having income less than Rs5000 was 10.5 +/- 1.24 g/dl and those with income more than Rs5000/month had a mean Haemoglobin of 11.5 +/- 1.44g/dl. Mean haemoglobin of patients with history with or without pica eating was 10.1 +/- 1.31g/dl and 11.9 +/- 1.56g/dl respectively. CONCLUSION: Low haemoglobin was commonly seen in our population among pregnant women irrespective of their socioeconomic status. The severity of anaemia was significantly associated with lower socioeconomic status and odd eating habits.

Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy.

OBJECTIVE: To determine the efficacy and safety of Total Dose Infusion (TDI) of low molecular weight iron dextran for the treatment of iron deficiency anemia compared to oral iron replacement during pregnancy through improvement in hemoglobin (Hb) after intervention. STUDY DESIGN: Non-randomized control trial. PLACE AND DURATION OF STUDY: Section of Gynaecology and Obstetrics, Shifa International Hospital and Shifa Community Health Centre, Islamabad during January 2005 to January 2006. PATIENTS AND METHODS: A group of 100 pregnant women with gestational age greater than 12 weeks with confirmed diagnosis of iron deficiency anemia attending the antenatal clinics were enrolled in this study. Total dose iron infusion of low molecular iron dextran was given to these patients after calculating iron deficit, in a monitored in-patient setting. Control comprised of a second group of 50 pregnant females matched for age, parity and baseline hemoglobin, tolerant to oral iron supplementation (ferrous sulphate 200 mg three times a day) attending the antenatal clinics during the same period. Post-treatment hemoglobin levels of study group as well as the oral control group were determined between 3 to 4 weeks. RESULTS: In the intervention group, mean pre-infusion hemoglobin level was 8.57 +/- 0.9 gm/dl (range 5-10.5 gm/dl) and mean post-infusion Hb was 11.0 +/- 1.1 (range 8.4-14.3 gm/dl). In control group, mean pre-oral intake Hb level was 9.5 +/- 0.9 gm/dl (range 7-10.5 gm/dl) and mean post-oral intake Hb was 10.2 +/- 1.2 gm/dl (range 6.4-12.8 gm/dl). Mean increase of Hb in intervention group was 2.43 gm/dl (95% CI 2.4 - 3.8) and for controls it was 0.7 gm/dl (95% CI 0.6-2.3). Flushing and palpitations were observed in 4% of interventional group patients and none in the control group. No significant adverse reactions were observed in either group. CONCLUSION: We conclude that the total parenteral iron replacement with low molecular weight iron dextran is an effective and safe method for the treatment of iron deficiency anemia in a selected group of pregnant women.

Clinical diagnosis of polycystic ovarian syndrome and response to metformin therapy.

OBJECTIVE: To determine the accuracy of diagnosing polycystic ovarian syndrome (PCOS) predominantly on clinical features and the response to metformin therapy. STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: Shifa College of medicine and Shifa International Hospital, Islamabad from January 2003 to July 2006. PATIENTS AND METHODS: Women fulfilling the inclusion criteria (oligo/hypomenorrhea, infertility, weight gain, hyperandrogenism) were enrolled. Ultrasound pelvis was obtained in all women. Presence of eight or more multiple follicles in both or one ovary without presence of mature follicle was the cutoff number for positive ultrasound. Thyroid stimulating hormone levels were performed in all patients, and patients with abnormal levels were excluded from the study. Metformin was adjusted to 500 mg thrice daily. Six months later patients were again evaluated for response to metformin therapy and those who failed to conceive were given clomiphene citrate along with metformin. Fertility was re-evaluated at the end of one year. RESULTS: At the start of the study, 81% women had menstrual irregularity and 84% had infertility. Hirsutism was seen in 72% while history of weight gain was present in 62% of patients. Ultrasound evidence of polycystic ovaries was seen in 93% of women. After 6 months of metformin therapy, 80% patients had achieved correction in their menstrual irregularity. After 6 months on metformin alone, 51% patients conceived while an additional 20% conceived on both metformin and clomiphene citrate during next 6 months. Overall fertility rate was 71% at the end of one year. There was statistically significant change in pre-treatment and posttreatment BMI. CONCLUSION: Combination of three or more of the clinical features (irregular cycles, history of weight gain, infertility and hirsutism) provide an appropriate basis for the diagnosis of PCOS. Metformin alone was an effective treatment for PCOS in this series.

Frequency and antimicrobial susceptibility of aerobic bacterial vaginal isolates.

OBJECTIVE: To determine the frequency and antimicrobial susceptibility of aerobic bacterial isolates from high vaginal swab cultures. DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, from January 2003 to February 2004. PATIENTS AND METHODS: The subjects included 136 symptomatic women attending Obstetrics and Gynecology Out-Patient Department. A proforma was filled to document the demographic details, presenting complaint and examination findings. High vaginal swabs were taken for gram staining, culture and antimicrobial sensitivity testing using standard microbiologic techniques. RESULTS: Normal flora was isolated in 30% of the cases, followed by Candida spp. (21.3%), Enterococcus spp. (14.7%), E.coli (10.2%), Beta hemolytic Streptococcus spp. (7.3%), Staphylococcus spp. (4.4%), Enterobacter spp. (4.4%), while Streptococcus pyogenes, Staphylococcus epidermidis and Klebsiella spp. were isolated 1.5% each. Enterococcus, Staphylococcus and Streptococcus were mostly sensitive to penicillin and amoxicillin while E.coli and Klebsiella were sensitive to (piperacillin-Tazobactum, Imipenem and vancomycin. Enterococci species showed significant resistance to aminoglycoside antibiotics (68.8% to 81.3%) resistance to vancomycin was 5%. CONCLUSION: Thirty percent of symptomatic patients had normal flora on culture. Candida spp was the most frequent pathogen isolated. Co-amoxiclav should be used as empiric therapy until culture-sensitivity report is available.

Frequency of hepatitis C in pregnancy and pregnancy outcome.

OBJECTIVE: To determine the frequency of HCV infections in pregnant women, to find out the risk factors for HCV infection in pregnant women and to compare pregnancy outcome of the sero-positive women with sero-negative women. DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, from June 2001 to May 2002. PATIENTS AND METHODS: Study was conducted on 947 booked pregnant women who were screened for HCV antibodies during antenatal consultation and were admitted for delivery in labour room. At the time of admission in labour ward, medical records of all patients were reviewed for anti HCV antibody testing and the presence of risk factors for HCV infection. Previous vaginal deliveries with episiotomy, previous surgeries, blood transfusions, and D&C for abortion or dysfunctional uterine bleeding were taken as independent variables. The obstetric outcome variables studied were: completed weeks of gestation by mother, birth weight and apgar score of newborns. The risk factors under study and the outcome variables were compared among HCV positive and negative women through a case-control study and measures of association calculated. RESULTS: The proportion of HCV sero-positivity among pregnant woman in our study was 3.27%. Among all the risk factors under study, previous surgery was found to have a significant association with HCV positive status of women (p=0.001). Other variables did not have significant association with HCV positive status in our study. There was no statistical difference in the mean birth weight of newborns (p= 0.94), mean Apgar score of newborns (p= 0.73) and mean gestational period among HCV positive cases and controls (p= 0.47). CONCLUSION: Prevalence of hepatitis C in pregnant women was 3.27%. Past history of surgical procedures was the most important factor for transmission of hepatitis C virus infection. No adverse effect on pregnancy outcome was observed in terms of gestational age, Apgar score and baby weight when compared with the controls.

Neoadjuvant chemotherapy in stage IV ovarian malignancy.

A 57 years old woman was diagnosed to have stage IV ovarian malignancy on the basis of ascitic fluid cytology, tumor marker and imaging. Neoadjuvant chemotherapy was administered before surgery. Four months after surgery no evidence of malignancy was found on laparotomy and histopathology. She is under surveillance for any signs of recurrence.