Outpatient endometrial biopsy with Pipelle vs diagnostic dilatation and curettage.

BACKGROUND: Pipelle is a silastic curette which does not require a tenaculum or straightening of the cervical fundus axis because of its flexibility and does not require general anaesthesia, whereas Dilatation and curettage (D&C) requires hospitalization and general anaesthesia along with the problem of postoperative pain. The objective of the study was to assess the effectiveness of Pipelle sampling in terms of adequate specimen collection and patients' knowledge and perception about Pipelle and compare it D&C. METHODS: In this randomized control trial, 203 women presenting with abnormal uterine bleeding were enrolled. The patients were randomly assigned to one of the two procedures. In group A 102 patients were subjected to Pipelle endometrial sampling and in group B 101 patients were enrolled for D&C. Frequencies of adequacy of histopathology reports and cost effectiveness of both groups were compared. Patient's knowledge, perception, pain and acceptability of the procedure of both groups were also assessed and compared. RESULTS: The mean age of the patients was 46.3 ± 4.45 years. Tissue obtained for histopathology was 100% adequate when the procedure was D&C while it was 98% in Pipelle group. In group-A 92% patients experienced no discomfort, with only 2% experiencing severe pain and 6% mild pain. On the other hand in group-B, 45% patients experienced moderate and 5% experienced severe pain up to 9 on visual analogue scale (VAS) postoperatively arid requiring post-operative analgesia. The acceptability for the Pipelle suction curette was 98% and for the D&C group was 34%. Regarding previous knowledge of procedure none of patients (100%) knew about Pipelle procedure but 98% patients were aware of D&C procedure. Pipelle was eight times more cost effective as compared to D&C. CONCLUSIONS: The results of obtained by endometrial sample by Pipelle and D&C are compareable. Pipelle significantly produced less pain than D&C.

Impact of essential surgical skills with an emphasis on emergency maternal, neonatal and child health training on the practice of doctors: a cluster randomised controlled trial in Pakistan.

INTRODUCTION: Majority of studies on evaluation of emergency management courses have focused on outcomes such as knowledge and skills demonstrated in non-clinical or traditional testing manner. Such surrogate outcomes may not necessarily reflect vital changes in practice. The aim of this study was to determine if and to what extent, specific training in the management of life threatening emergencies resulted in an increased in compliance with established care guidelines of doctors working in the emergency departments of public sector hospitals in Pakistan. METHODS: A cluster randomised controlled trial was conducted in three districts hospitals in three cities (Khairpur, Vehari and Peshawar) of Pakistan. Thirty-six doctors, 18 in intervention (trained in ESS-EMNCH training) and 18 in control (untrained), were enrolled and 248 life threatening emergency events, 124 in each group, were observed for the correct use of the Airway, Breathing, Circulation (ABC) structured approach. The outcome measure was structured approach defined a priori. Data was analysed by using STATA software. RESULTS: At individual level, 79 (63.7%) life threatening episodes were managed according to the structured approach in the intervention group and 46 (37.1%) were managed according to the structured approach in controls (OR 2.98, 95%CI 1.78-4.99, p-value=0.0001). At cluster level, the mean percentage (95% CI) of the structured approach used by doctors in the intervention group [62.9% (50.4-75.3%)], was significantly higher than those in the control group, [36.3% (26.3-46.4)] (p-value=0.001). CONCLUSIONS: 5-day training of ESS-EMNCH significantly increased the compliance with established care guidelines of doctors during their management of life threatening emergency episodes in the public sector hospitals in Pakistan.

Role of metformin in correcting hyperinsulinemia, menstrual irregularity and anovulation in polycystic ovary syndrome.

BACKGROUND: Previous studies suggest that metformin by reducing hyperinsulinemia is clinically useful in the treatment of polycystic ovary syndrome (PCOS). Our Objective was to observe the role of metformin in correcting oligomenorrhea/amenorrhea and anovulation within six month in hyperinsulinemic women with PCOS. Another aim was to assess the decrease in hyperinsulinemia and body weight by metformin in our population. METHODS: This study was carried out at the Department of Obstetrics and Gynaecology, Islamic International Medical Complex (IIMC) Islamabad, from October 2001 to March 2003. Fifty women fulfilling the clinical and biochemical criteria for PCOS and hyperinsulinemia were enrolled. Metformin was started at an oral dose of 500mg/day and maintained at 1500mg for 6 months. Besides ultrasonography and body weight. serum FSH, LH, fasting insulin, fasting blood sugar and creatinine levels were performed. After six months menstrual cyclicity, fasting insulin levels, day 21 serum progesterone and body weights were assessed. RESULTS: After six months of Metformin therapy, menstrual regularity was achieved in 19 out of 22 women (86%). Out of these 11 women (50%) were ovulating at six months. On Metformin, the median fasting serum insulin decreased from 23.6 micro U/ml to 20.2 micro U/ml (P<0.05). There was no significant weight reduction (p=0.096) with Metformin in six months. Data was analyzed using SPSS by paired t-test.