Prevalence of PCOS with Associated Symptoms and Complications at Tertiary Care Hospital of Karachi

Aim:The aim of this study is to determine the prevalence of PCOS among different gynecological disorders at tertiary care hospital of Karachi and to assess the most frequent presenting complaint with associated complications among them. Study Design:Single-centered cross-sectional study.Place and Duration of Study:Gynecological clinic of Karachi at a Tertiary care Hospital during 3rd December 2018 to 29th March 2019.Methodology:Total 335 premenopausal women approached the clinic with different gynecological disorders during the period of four months and 305 patients agreed to participate. The patients were enrolled via convenient sampling technique. After taking the informed consent they were evaluated through clinical interviews, questionnaire, and anthropometric measurements. The diagnosis of PCOS was made by using Rotterdam criteria 2003. Menstrual irregularities were assessed via history. Clinical hyperandrogenism was evaluated by using modified Ferriman–Gallwey scale and Acne Global Grading System. Obesity was calculated through BMI. The Hamilton scale was used to appraise associated psychological disturbances.Results:PCOS was the most prevalent gynecological disorder (55.41%) among women of the premenopausal age. Overall, the most frequent presenting complaint was infertility but age related variations in symptoms showed that young adolescent and adulthood had more menstruation irregularities while, in late adolescent the chief complaint was infertility. Moreover, these patients were either overweight 32% or obese 46.2%. Other associated problems such as anxiety and migraine were more frequent in young adults and juveniles respectively.Conclusion:PCOS is the most common gynecological problemin our region. These women usually presents with altered complains that influence their physiological and psychological health which in turn effects the quality of life

Effects of diet and metformin on placental morphology in gestational diabetes mellitus

Objective: To evaluate the effects of diet control and Metformin on placental morphology in gestational diabetes mellitus [GDM]

Methods: After written informed consent 62 GDMs were enrolled. According to WHO criteria, 30 cases of GDMs with blood sugar level <130 mg/dl, were assigned Group B [2000-2500Kcal/day and 30 minute walk thrice weekly were kept on diet control and 32 cases of GDM with blood sugar level >130 mg/dl, assigned Group C were kept on diet with tablet Metformin, [500mg TDS] Finally 25 normal pregnant females were kept in Group A as control. After delivery placentae were preserved and evaluated for morphology

Results: Heavy placentae with abundant villous immaturity, chorangiosis and syncytial knots in group B and fibrinoid necrosis and calcification in group C were seen. In group B versus A placental and cord width while in Group C versus A only cord width in gross morphology showed significant results. In group B versus A villous immaturity, chorangiosis, infarction and syncytial knots in light microscopy were present; similarly in B versus C placental width, chorangiosis and syncytial knots showed significant results, while in C versus A results were non-significant

Conclusion: Metformin produced beneficial effects on placental morphology being comparable to normal control in contrast to diet group

Effects of insulin on placental, fetal and maternal outcomes in gestational diabetes mellitus

To observe the effects of exogenous insulin on placental, fetal and maternal outcomes in Gestational Diabetes Mellitus [GDM]. After screening and diagnoses [WHO criteria] 30 GDM patients[Group A] were kept on diet control and 39 GDM [Group B] who did not achieve glycemic targets were added subcutaneous insulin. Term placental weight, size, shape, consistency, fibrinoid necrosis, hemorrhages, cord color, length of the cord, completeness of membranes, weight and condition of baby and mode of delivery were assessed in 25 patients in each group. Placental weight, cord width and baby weight were found to be more in Group B, than Group A and were statistically significant with p value 0.005, 0.02 and 0.003 respectively. Ten patients in group A and 17 patients in group B had cesarean deliveries. Exogenous insulin produces significant effects on the placental, fetal and maternal outcomes in patients with GDM

Antiproliferative and hepatoprotective activity of metabolites from Corynebacterium xerosis against Ehrlich Ascites Carcinoma cells

<p><b>OBJECTIVE</b>To find out the effective anticancer drugs from bacterial products, petroleum ether extract of Corynebacterium xerosis.</p><p><b>METHODS</b>Antiproliferative activity of the metabolite has been measured by monitoring the parameters like tumor weight measurement, tumor cell growth inhibition in mice and survival time of tumor bearing mice, etc. Hepatoprotective effect of the metabolites was determined by observing biochemical, hematological parameters.</p><p><b>RESULTS</b>It has been found that the petroleum ether extract bacterial metabolite significantly decrease cell growth (78.58%; P<0.01), tumor weight (36.04 %; P<0.01) and increase the life span of tumor bearing mice (69.23%; P<0.01) at dose 100 mg/kg (i.p.) in comparison to those of untreated Ehrlich ascites carcinoma (EAC) bearing mice. The metabolite also alters the depleted hematological parameters like red blood cell, white blood cell, hemoglobin (Hb%), etc. towards normal in tumor bearing mice. Metabolite show no adverse effect on liver functions regarding blood glucose, serum alkaline phosphatases, glutamic pyruvic transaminase, glutamic oxaloacetic transaminase activity and serum billirubin, etc. in normal mice. Histopathological observation of these mice organ does not show any toxic effect on cellular structure. But in the case of EAC bearing untreated mice these hematological and biochemical parameters deteriorate extremely with time whereas petroleum ether extract bacterial metabolite receiving EAC bearing mice nullified the toxicity induced by EAC cells.</p><p><b>CONCLUSION</b>Study results reveal that metabolite possesses significant antiproliferative and hepatoprotective effect against EAC cells.</p>

study of effect of type of anesthesia on post operative cesarean section pain in Tawam hospital, Al ain, United Arab Emirates

To evaluate the effect of type of anesthesia for cesarean section on postoperative cesarean section pain in Tawam Hospital. A retrospective study of 100 consecutive women undergoing cesarean section in Tawam hospital, Al Ain ,UAE from 1[st] January 2008 till 30[th] April 2008. A purpose built performa was used to collect the data including, type of cesarean section, types of anesthesia, intra operative additional analgesia and analgesia used at end of surgery.

Regional anesthesia which included spinal and epidural was given in 59 cases while 41 cases had general anesthesia. Analgesia requirement was reduced after regional anesthesia. 52% had a pain score of zero and only 2% had a pain score of six to ten. With general anesthesia 15% had a pain score of zero, 13% had a pain score from 1-5 and 9% had pain score from 6-10. Regional anesthesia was associated with less post operative pain in cesarean section. A clinical practice guideline is issued for detailed counseling of patients during their antenatal visits for regional anesthesia for cesarean section

Epidemiology, risk factors and sites of ectopic pregnancy in madina maternity and children hospital, Kingdom of Saudi Arabia

The objective of the study was to study the epidemiology, risk factors and sites of ectopic pregnancy in the Saudi women and correlate the data to international incidences. The retrospective descriptive study was conducted from May 2002 till April 2004 at Madina maternity and children hospital, Saudi Arabia. Seventy patients diagnosed as ectopic pregnancy, which constituted 2.32/1000 of 30,066 deliveries conducted during this period were included. Patients were divided into 6 categories based on age ranging from 15-40 years [5 groups] and more than 40 years [group 6]. Data were collected on predesigned proforma, including the relationship of ectopic pregnancy to age, parity, associated risk factors and the sites of ectopic pregnancy. The data were analyzed on SPSS version 14. Majority of the cases were between 20 to 34 years of age i.e., 60%. The parity was studied from nulliparous to Para 8 and mean parity was 4. Risk factors were classified into 3 categories: surgical, clinical and contraceptive. Most of the cases had two or more factors. The surgical factors were present in 41 cases; clinical factors were present in 44 cases while contraceptive use was present in 11 cases. The sites of ectopic having nearly an equal incidence in the right and left fallopian tubes were 61 [91%] cases. There were 3 ovarian, 2 Broad ligament and 1 abdominal secondary ectopic pregnancy. The frequency of ectopic pregnancy was nearly 0.23% in our study. Association with risk factors and demographic features is consonance with international literature

Hepatoprotective effect of acetone semicarbazone on Ehrlich ascites carcinoma induced carcinogenesis in experimental mice

<p><b>OBJECTIVE</b>To determine the hepatoprotective effect of acetone semicarbazone (ASC) in vivo in normal and Ehrlich ascites carcinoma (EAC) bearing male Swiss albino mice.</p><p><b>METHODS</b>Drug-induced changes in biochemical and behavioral parameters at dose of 2.0 mg/kg body weight for 14 d and nullifying the toxicity induced by EAC cells were studied. The histopathology studies of the protective effects of ASC on vital organs were also assessed.</p><p><b>RESULTS</b>The administration of ASC made insignificant changes in body weight and behavioral (salivation, diarrhea, muscular numbness) changes during treatment period due to minor toxicity were minimized after the treatment in normal mice. The biochemical parameters, including serum glutamate pyruvate transaminase, glutamate oxaloactate transaminase, alkaline phosphatase, serum glucose, cholesterol, urea, triglyceride and billirubin changed modestly in normal mice receiving ASC. Though the treatment continued, these values gradually decreased to normal level after the treatment. In EAC bearing mice, the toxic effects due to EAC cells in all cases were nullified by treatment with the ASC. Significant abnormalities were not detected in histology of the various organs of the normal mice treated with ASC.</p><p><b>CONCLUSIONS</b>ASC can, therefore, be considered safe in formulating novel anticancer drug, as it exhibits strong protective effect against EAC cell bearing mice.</p>

Anti-inflammatory and antioxidant activities of ethanolic extract of aerial parts of Vernonia patula (Dryand.) Merr

Objective:To investigate the inflammatory and antioxidant activities of ethanolic extract of aerial part of Vernonia patula (Dryand.) Merr (EAV). Methods:The anti-inflammatory activity of EAV was studied using carrageenan and histamine-induced rat paw edema test at different doses (100, 200 and 400 mg/kg body weight). DPPH free radical scavenging, nitric oxide scavenging, reducing power and Fe2+ion chelating ability were used for determining antioxidant activities. Results: The EAV, at the dose of 400 mg/kg, showed a significant anti-inflammatory activity (P Conclusions: Therefore, the obtained results suggest the acute anti-inflammatory and antioxidant activities of the EAV and thus provide the scientific basis for the traditional uses of this plant part as a remedy for inflammations.

Metformin prevents macrosomia and neonatal morbidity in gestational diabetes

To assess the clinical efficacy of Metformin in the prevention of fetal macrosomia and neonatal morbidity in gestational diabetes pregnancies compared with insulin treatment. In this interventional study, randomized clinical trial a total of 150 patients with gestational diabetes between 20-35 weeks of gestation were selected for pharmacological treatment using metformin or insulin during the study period form 20-Dec-2008 till 20-Dec-2010 from Antenatal OPD after screaning with 75 grams OGTT. The primary outcomes were fetal macrosomia and neonatal morbidity. Patients on metformin and insulin were matched in age, parity, BMI and gestational age at study entry. Mean birth weight did not differ in both groups but fetal macrosomia was less in metformin group than in insulin group 18.67% V/S 10.65% P < 0.05. Neonatal morbidity and NICU admissions were less in metformin group. Metformin is a safe and effective alternative to insulin in gestational diabetes. Metformin treatment resulted in less fetal macrosomia and fewer NICU admissions and neonatal morbidity with advantages of cheap oral therapy in our resource poor setting

Audit of post caesarean section fain management in tawam hospital, Al Ain, United Arab Emirates

To evaluate the consistency in management of postoperative caesarean section pain in Tawam Hospital according to evidence based practice and to introduce change in practice and to bring uniformity in practice for post cesarean section pain relief. A retrospective audit of hundred consecutive women undergoing cesarean section in Tawam hospital, Al Ain, UAE from l[st] January 2008 till 30[th] April 2008. A purpose-designed performa was used to collect the data including the Body mass index BMI, Type of cesarean section, Duration of cesarean section, types of anesthesia, First pain scoring [day 0] and type, dosage and route of pain relief used and finally post medication pain score of patient. Tawam Hospital is a 500 bedded hospital with a delivery rate of 4000 per year and cesarean section rate of 15%. Patients who had a BMI >30kg/m[2] were 42%. Emergency caesareans were done in 60% of the patients. Most of the caesareans were completed within 1.5 hrs. Regional anesthesia was given in 59% of the cases. Analgesia requirement was reduced after regional anesthesia. Only 30% of the patients had pain scoring within the 1[st] hour of cesarean section. Patients received variable pain relief medications without correlation to the pain score. Post analgesia pain score was done in 62% of the patients only. There is no uniform or evidence based practice for post operative analgesia in cesarean section in our Institution therefore a Clinical practice guideline is issued to achieve evidence based practice and to reaudit to review change in practice.

Effects of poverty on pregnant women

To estimate the effects of low maternal education, malnutrition, anemia, pre-eclampsia, gestational diabetes, depression, domestic violence on pregnancy outcome. Hospital based cross sectional study done in obstetrics and gynecology department of a tertiary care teaching hospital from November 2010 to April 2011. Five hundred married women between 15-45 years of age attending the obstetric clinic for any problem or were admitted in the obstetrics ward were interviewed and data entered in a questionnaire. Apart from basic demographic information, their educational level, nutritional status, anemia, history of eclampsia, diabetes, depression and domestic violence were recorded. Socioeconomic groupings was done on the basis of monthly income i.e. monthly income less than Rs. 6000 [lower], 6000-12000 [middle] and more than Rs. 12000 [upper]. For the ease of analysis, the study population was divided into three socioeconomic groups. Majority [62.4%] were in the lower socioeconomic bracket while 34.6% were in the middle and only 3% were in the upper strata. In the lower socioeconomic group 62% women were uneducated, only 25.3% women had regular antenatal care, and only 80% could afford balanced diet once in two weeks. Almost 50% were anemic, 13.1% were under weight, 12.1% had low birth weight babies and 3.2% had still births. Violence was reported by 17%. In the high socioeconomic group only 13% women were uneducated and all parameters were 50% better than those in the lower socioeconomic group with 53.3% women having regular antenatal care, 40% taking balanced diet once in two weeks, 6.7% being under weight and 6.7% having low birth weight babies. The frequency of anemia was slightly less [40%] when compare d with the lower socioeconomic group. Violence was reported by 7%. Mode of delivery was a cesarean section in 26.4% with 13.4% ending up in wound infection. Poverty is a key hindrance to women's wellbeing especially during pregnancy resulting in malnutrition, anemia, low birth babies or fetal loss

Heart rate variability - a review

Heart rate variability [HRV] is a measure of the balance between sympathetic mediators of heart rate that is the effect of epinephrine and norepinephrine released from sympathetic nerve fibres acting on the sino-atrial and atrio-ventricular nodes which increase the rate of cardiac contraction and facilitate conduction at the atrio-ventricular node and parasympathetic mediators of heart rate that is the influence of acetylcholine released by the parasympathetic nerve fibres acting on the sino-atrial and atrio-ventricular nodes leading to a decrease in the heart rate and a slowing of conduction at the atrio-ventricular node. Sympathetic mediators appear to exert their influence over longer time periods and are reflected in the low frequency power[LFP] of the HRV spectrum [between 0.04Hz and 0.15 Hz].Vagal mediators exert their influence more quickly on the heart and principally affect the high frequency power [HFP] of the HRV spectrum [between 0.15Hz and 0.4 Hz]. Thus at any point in time the LFP:HFP ratio is a proxy for the sympatho- vagal balance. Thus HRV is a valuable tool to investigate the sympathetic and parasympathetic function of the autonomic nervous system. Study of HRV enhance our understanding of physiological phenomenon, the actions of medications and disease mechanisms but large scale prospective studies are needed to determine the sensitivity, specificity and predictive values of heart rate variability regarding death or morbidity in cardiac and non-cardiac patients

Metformin therapy prevents early pregnancy loss in polycystic ovarian syndrome

The study was done to compare the early pregnancy loss rate in women with polycystic ovarian syndrome who received or did not receive metformin in pregnancy. A case control interventional study carried out at Civil Hospital Karachi, Hamdard University Hospital and Private Gynaecology clinics from January 2005 to July 2008. Eighty two non diabetic patients with polycystic ovarian syndrome who became pregnant were included in the study. A questionnaire was filled for all patients that included information on basic demography and mean age, parity, weight. Fasting blood sugar and serum insulin levels were done for all these women. Only patients with raised insulin levels [more than 10 mu/l] were included in the study and all were offered to use oral metformin throughout pregnancy as 500mg three times a day with folic acid supplements 5mg once daily. Those who agreed to take the drug throughout pregnancy and to comply with the therapy were taken as cases, while those who did not agree to take the medicine acted as controls. Patients with other causes of recurrent pregnancy loss were excluded from the study. All pregnancies were followed using serial ultrasound examination to see any pregnancy loss in the two groups. Eighty two cases of polycystic ovaries with pregnancy were seen during the study period. All cases had raised serum insulin levels. Fifty patients agreed to take metformin through out pregnancy while, 32 cases did not agree to take metformin during pregnancy and thus acted as controls. The two groups did not differ in mean age, parity, weight and mean fasting blood sugar levels. Fasting insulin levels were high in metformin group [18.40 mu/l] than in controls [12.53 mu/l]. Missed abortion rate was significantly lower [12%] in metformin group than in controls [28%] [p<0.028]. No congenital anomalies were found in both the groups on ultrasound at 16-19 weeks. Metformin treatment during pregnancy significantly reduced the rate of early pregnancy loss in women with polycystic ovarian syndrome. Metformin should be given during pregnancy in cases having polycystic ovarian syndrome with high insulin levels

Chemoprophylaxis in caesarean section

To determine the usefulness of two different regimens of antibiotics on post caesarean infectious morbidities. A comparative study drug trial. Department of Obstetrics and Gynaecology Lyari General Hospital and private hospitals of Karachi, from January 2009 to June 2009. Patients who underwent caesarean section were recruited. The patient were divided into two groups of 74 each. Group A received triple antibiotic therapy including injection cephradine, aminoglycoside and metronidazole for first 48 hours. Followed by oral therapy for 5 days. Group B received injection ceftriaxone and metronidazole for first 48 hours followed by oral therapy for 5 days. In both groups therapy was started before skin incision. Those who had established infection prior to surgery or who received antibiotics in last 24 hours or allergic to any of the infection prior to surgery or who received antibiotics in last 24 hours or allergic to any of the antibiotics used, were excluded. Patients were assessed post operatively for infectious complications including febrile illness, dysuria, offensive lochia and abdominal wound infection. No significant difference was found between the two groups. Complications found were febrile morbidity [23.0% Vs 18.7%], urinary tract infection [13.3% Vs 16.0%] wound infection [14.7% Vs 10.7%] and lochia [6.7% Vs 8.0%] respectively in Group A and Group B. There was a significant difference in terms of cost effectiveness of 3[rd] generation cephalosporin that was more. Both first and third generation cephalosporins are equally effective in caesarean section as prophylaxis

Effect of metformin on ovulation in PCOS

To evaluate the effect of metformin on ovulation in patients having Polycystic Ovarian Syndrome [PCOS]. This clinical trial was carried out in a private infertility clinic of Karachi on fifty infertile PCOS females with individual study period of 3 months. A total of 57 infertile PCOS females with ages between 20-40 years were enrolled after a written consent. Only 50 subjects completed the study. Metformin HC1 thrice daily was given to fifty infertile PCOS females with ages between 20-40 years for three months. Plasma progesterone level was done at day-0 and day-90, besides fasting serum glucose, insulin, follicle stimulating hormone, luteinizing hormone, prolactin and testosterone at day- 0 as per requirement for the diagnosis of PCOS. 33 [66%] patients developed regular cycles and 11 [22%] patients showed improvement in their cycles at day-90. Serum progesterone level showed an increase from a mean +/- SD of 1.3 +/- 0.3 to 9.5 +/- 5.1 at day-0 to day-90. On statistical evaluation it was found to be significant with P-value of 0.001. Metformin promotes ovulation in PCOS patients

Management and maternal outcome in morbidly adherent placenta

To describe the management and maternal outcome in diagnosed cases of morbidly adherent placenta. Descriptive case series. Hamdard University Hospital and Two private hospitals, from May 2005 to June 2009. All diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay were recorded. Thirty cases of morbidly adherent placenta diagnosed on doppler ultrasound scan were identified. Scheduled caesarean hysterectomy without attempting placenta removal, was done. Sub total hysterectomy was performed in 26 cases and total hysterectomy in remaining 4 cases. Two patients sustained urinary bladder injury and two went into DIC. One needed ventilatory support. No patient died in this series. Significantly reduced maternal morbidity was observed. In diagnosed cases of morbidly adherent placenta, antenatal diagnosis and avoidance of placental separation and caesarean hysterectomy results in better maternal outcome

Antimicrobial Activity of Some Schiff Bases Derived from Benzoin, Salicylaldehyde, Aminophenol and 2,4 Dinitrophenyl Hydrazine

The antibacterial and antifungal activities of three schiff bases were evaluated against some pathogenic bacteria and fungi. Parallel experiments were also carried out with standard drugs (Kanamycin for bacteria and Nystatin for fungi). Two compounds [N-(1-phenyl-2-hydroxy-2phenylethylidine)-2',4' dinitrophenyl hydrazine, abbreviated as PDH and N-(2-hydroxy benzylidine)-2'-hydroxy imine, abbreviated as HHP] showed significant antimicrobial activities. The rest one [N-(1-phenyl 2-hydroxy-2 phenyl ethylidine) 2'-hydroxy phenyl imine, abbreviated as PHP] showed moderate activity. All these three compounds were found to possess pronounced cytotoxic effect. These compounds can be considered as potent antimicrobial agents.

Biological Screening of a Novel Nickel (II) Tyrosine Complex

A newly synthesized Nickel (II) tyrosine complex was screened as potential antimicrobial agent against a number of medically important bacteria (Bacillus subtilis, Streptococcus beta-haemolytica, Escherichia coli, Shigella dysenterae) and fungi (Aspergillus fumigatus, Candida albicans, Aspergillus niger, Aspergillus flavus, Penicillium sp.) strains. were used for antifungal activity. The antimicrobial activity was evaluated using the Agar Disc method. Moreover, the minimum inhibitory concentration of the complexes was determined against the same pathogenic bacteria and the values were found between 4~64 microg ml(-1). Brine shrimp bioassay was carried out for cytotoxicity measurements of the complexes. The LC50 values were calculated after probit transformation of the resulting mortality data and found to be 6 microg ml(-1).

Management of pregnancy with ovarian tumour

To study the maternal and fetal outcome of pregnancies complicated by ovarian tumours.Descriptive study. Gynaecology and Obstetrics Unit I, Dow University of Health Sciences and Civil Hospital Karachi, from January 2003 to December 2004. All patients who attended the antenatal clinic and Emergency Department of Civil Hospital Karachi, Gynaecology and Obstetrics Unit I, from January 2003 to December 2004, were included in the study, if pregnancy was complicated by a coexistent ovarian tumour of > 5cm. Fetal outcome after conservative or surgical management was noted. Thirty Six patients were enrolled in the study. Twenty-seven had surgical interventions and nine were managed conservatively. All patients with conservative management were asymptomatic. Obstetric outcome revealed only one preterm. delivery after conservative management but surgical intervention resulted in five abortions, three pretermand 19 term deliveries. Fetal outcome revealed comparable results in both the groups. There was only one preterm fetus in conservative group while surgically managed group produced three preterm fetuses. No still birth was noted in either group, however intra-uterine growth retardation [IUGR]found in three of the surgically managed group and one of conservative group. Surgical intervention is a reasonable approach to deal with cases of ovarian tumours with pregnancy, but conservative management also has comparable obstetric outcome if safe selection criteriafor mothers is defined

Use of recombinant factor VII for massive posrtpartum haemhorrage: Case serie and review of literature

Recombinant activated factor VII is indicated mainly for the treatment of patients with haemophilia inhibitors. It has also been found successful in the treatment of platelet disorder Glanzmann's thrombasthenia. Recently, its use in trauma patients and in patients with intracereberal haemorrhage has become well established. We present three cases of massive post partum haemorrhage treated with rFVIIa, following caesarean section. The response of these three patients is discussed along with review of literature