Postpartum haemorrhage; a preventable complication of Labour

To determine the frequency, risk factors and existing practice for the management of massive primary postpartum hemorrhage [PPH]. Retrospective cross-sectional study. Department of Obstetrics and Gynaecology at Kuwait Teaching Hospital, Peshawar. this study was performed from June 2008 to June 2010. Women who developed massive primary PPH after admission or were admitted with it, were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum hemorrhage, supportive medical and surgical intervention. Data was entered in the pre-structured proforma. Estimates of blood loss were made on history, visual parameters and patient's condition. All the data was analyzed by using statistical computer soft ware SPSS 6. During the study period total number of obstetrical admissions were 2944. Forty nine out of 2769 [1.76%] deliveries, developed massive primary PPH. The highest frequency of massive primary PPH was observed in grand multiparous patients. Uterine atony was the most common cause of the complication. Birth attendants other than doctor and delivery outside the study unit were significantly associated with the adverse outcome in these patients. Seventy five percent patients,[36/49] who had massive PPH, delivered vaginally. High dependency unit [HDU] was required in 12% [6/49] of women. Only one caesarian hysterectomy was done. There was one maternal mortality. Blood transfusions were required in 82% [40/49] of the patients. Postpartum hemorrhage can be a preventable condition if early identification and timely management of this complication and its risk factors is observed. Uterine atony is the leading cause of immediate PPH. The main risk factors for PPH due to uterine atony are high parity, a large fetus, multiple fetuses, hydramnios, or past history of PPH. Determining the frequency, risk factors and management of primary postpartum hemorrhage will help design stepwise protocols for prevention and management of primary PPH in our setup

Diabetic foot risk classification in a tertiary care teaching hospital of Peshawar

To find out diabetic foot risk classification in patients admitted with diabetes mellitus at a tertiary care teaching hospital. The hospital record of one hundred and twenty seven patients of diabetes mellitus, admitted to the medicine department, Khyber teaching hospital Peshawar from 1st October 2005 to 31st March 2006 were evaluated against the Royal College of Physicians, London; Clinical Guidelines for Type 2 diabetes: prevention and management of foot problems. Both male and female indoor patients above 15 years of age were included in the study. An audit of 127 diabetes mellitus patient revealed that 25 [19.68%] patients were having low current risk, 21 [16.53%] were classified as having risk foot, 6 [4.72%] were categorized as high risk patients, 16 [12.59%] were admitted with ulcerated foot and 5 [3.39%] were having diabetic foot emergency according to Royal College of Physicians, London; Clinical Guidelines for Type 2 diabetes: prevention and management of foot problems. The main reason for poor diabetic foot outcomes in the tertiary care teaching hospital is the absence of classification of majority of diabetic patients into different risk groups for the appropriate treatment. This lack of risk classification results in ensuing gaps in the management and an overall increase in morbidity

Principal causes of coma in medical units of a tertiary care hospital of Peshawar

To determine the principal causes of coma in patients admitted to the medical units of a tertiary care hospital of Peshawar. This cross sectional study was conducted at department of Medicine, Khyber Teaching Hospital Peshawar, from July 2006 to August 2007. All patients were randomly selected. Relevant information was recorded on a questionnaire prepared in accordance with the objectives of the study. A total of 124 patients with coma, 96[77.41%] males and 28[22.58%] females were included in the study. The age range of patients was from 12 years to 72 year with mean age of 50.5 years. The principal causes of coma were: cerebrovascular accident [CVA] 73.38% [n=91], epilepsy in 10.48% [n=13], head injury 5.64% [n=11], hepatic coma 2.41% [n=3], central nervous system [CNS] infections 2.41% [n=3], metabolic acidosis, drug abuse [1.61%] [n=2] each and cerebral malaria, hypoglycemia and uremia 0.8% [n=1] each. Risk factors for stroke recorded were hypertension in 46.2% [n=42/91], diabetes in 15.4% [n=14/91], ischemic heart disease 12.1% [n=11/91], smoking 5.5% [n=5/91], hyperlipedemia 3.3% [n=3/91] and atrial fibrillation 1.1% [n=1/91]. Scoring on Glasgow coma scale showed that 74.2% [n=92] patients scored 3-8, 25.8% [n=32] scored9-12 and none of the patients scored 13-15. In our setup CVA is the most common cause of coma followed by epilepsy, and head injury Other minor causes recorded were metabolic acidosis, drug abuse, central nervous system infections, cerebral malaria, hypoglycemia and uremia

clinical and etiological profile of urinary tract infection

To study clinical profile of urinary tract infection [UTI] and to document the common microorganisms causing UTI in admitted patients and to test their sensitivity pattern. We did a hospital based descriptive study in the department of Medicine Khyber Teaching Hospital, Peshawar from December, 2005 to July, 2006. The data of total 50 patients above 13 years of age with signs and symptoms suggestive of UTI was collected on a structured proforma. The clinical presentation, the common causative organisms and their sensitivity pattern was documented. The results were compared with other national and international studies. In this study 47/50 [94%] cases were culture positive with a colony count >105/ml. Overall male to female ratio was 1:2 table. 1. Among the culture positive cases, the commonest pathogens found were E. coli in 25 cases [53.1%] followed by citrobacter in 8 cases [17.02%]. The commonest organisms E.coli and citrobacter showed maximum sensitivity to Amikacin, ofloxacin, ciprofloxacin and ceftriaxones, in decreasing order of frequency. The most common symptom found in all age groups was fever while the commonest sign was anaemia. UTI should be considered in any patient with fever without focus beyond three days. E Coli is the commonest organisms and amikacin is the drug of choice

Upper gastrointestinal endoscopic assessment of patients presenting with dyspepsia

To evaluate common causes of dyspepsia and to correlate endoscopic findings with histological examination of biopsy specimens. Material and This observational descriptive study was conducted at department of medicine Khyber Teaching hospital Peshawar, from 1st June 2006 to 31st December 2006. Detailed history, thorough physical examination and relevant investigations were done in each patient. All patients underwent upper gastrointestinal [GI] endoscopy. Biopsies were taken in every patient from oesophagus, stomach and duodenum. Histological examination was done from single pathologist. The endoscopic findings of 50 patients with dyspepsia were studied. Out of 50 patients, 35[70%] were males while 15[30%] were females. Eighty two percent [41/50] were in the age group of 30-50 years. The most common presentations were epigastric pain in 45 [90%] cases, heartburn in 36 [72%] and flatulence in 35 [70%] cases. The endoscopic findings were normal in 25 [50%] patients. The abnormal findings included esophagitis in 6 [12%] patients, gastric ulcer in 5 [10%] patients, duodenal ulcer in 4 [8%] patients, gastritis in 4 [8%] patients and duodenitis in 2 [4%] patients; while esophagogastritis, gastroduodenitis, esophagogastroduodenitis and carcinoma stomach were present in 1 [2%] patient each. All the endoscopically abnormal as well as normal findings were confirmed by histopathology. The endoscopic findings were normal in majority of patients with dyspepsia. The common abnormal endoscopic findings included esophagitis, gastric ulcer, duodenal ulcer and gastritis. The endoscopic findings were, matching with histological diagnosis

Risk factors and complications of hepatitis "C" in Peshawar. [A hospital based study]

To determine the risk factors and complications of hepatitis C in a tertiary care hospital in Peshawar. Prospective observational study. Medicine department, Khyber Teaching Hospital Peshawar. From April 2004 to June 2005. A total of 252 HCV positive patients were selected, 165 were males and 87 were females. Relevant information was obtained from the patients with the help of a predesignd questionnaire prepared in accordance with the objectives of the study. The age range of patients was from 11 years to 84 years with mean age of47.5 years. Out of total sampling 137[54.36%] patients had positive family history of hepatitis C virus [HCV]. Risk factors distribution was: intravenous drug users 73, HCV positive sexual partners 58 [23.01%], blood or blood product transfusion 34[13.49%] and occupational acquired HCV 18[7.14%]. Unknown source of HCV transmission was recorded in 69[27.38%]. Clinical presentation of HCV positive patient was: Chronic persistent hepatitis 87[34.52%], liver cirrhosis 41[16.26%], hepatocellular carcinoma 2[0.79%] and fulminant hepatitis 2[0.79%]. One hundred and twenty patients [47.61%] were asymptomatic or subclinical symptomatic. Intravenous drug abuse and HCV positive sexual partners [wife or husband] were found as major risk factors of HCV transmission and chronic persistent hepatitis and liver cirrhosis were recorded as major clinical presentations of HCV in our patients

frequency and age presentation of G6PD deficiency in 200 patients of hemolytic anaemia

To determine the frequency of G6PD deficiency in the etiology of anaemia and jaundice and to determine the most common age of presentation with anaemia and jaundice due to G6PD deficiency in adults. We did a hospital based study in the department of Medicine Khyber Teaching Hospital Peshawar from June 2003 to December 2003. The data of adult patients with signs and symptoms of anaemia and jaundice was collected on structured proforma. The clinical presentation and laboratory investigation results were documented. Out of 200 patients studied, 24 [12%] patients were found to be deficient in G6PD enzyme. The male to female ratio was 21:3 [87.5% and 12.5%] respectively. The age of appearance of jaundice in adults varied [most common age from 13 to 17 years]. The most common signs and symptoms were jaundice, anaemia and haemoglobinuria. All G6PD deficient patients except one recovered spontaneously when the offending precipltating factor were stopped or treated. One [0.5%] died because of rapid fall of haemoglobin and delayed recognition of the condition and subsequent blood transfusion. G6PD deficiency is not an uncommon cause of jaundice and anaemia in our patients. The jaundice due to G6PD mainly affects the adults in 2nd or 3rd decade. Therefore all the children and adults with jaundice and anaemia should be screened for G6PD status