A comparative trial of copper T 380 and Cu 375 IUCD.

BACKGROUND: The IUCD, primarily in the form of copper IUD is used by more than 150 million women around the world, making it the most widely used reversible method of contraception. The objective of this study is to do double blind clinical trial to compare the side effects of Copper-T and Cu 375 IUCD in women using contraceptive method and had used no contraception before. METHOD: A total of 80 women of reproductive age group who are sexually active and who wanted to practice some contraceptive method were included in the study. After filling Performa speculum examination was also done and all the contra indications for the fitting of IUCD were ruled out. RESULTS: In this comparative study the effectiveness and side effects of two copper releasing IUCDs, Copper-T and Cu 375 IUCD was observed. Pelvic inflammatory disease occurred more often with Cu 375 IUCD than other group. Dysmenorrhoea was also experienced more with Cu 375 IUCD user than Copper-T. Menorrhagia rate was also high in Cu 375 IUCD users. The only case of uterine perforation was in the user of Copper-T. CONCLUSION: It is concluded from this study that Copper-T is a highly effective method of contraception than Cu 375 IUCD with good patient acceptance and lesser side effects.

Response to standard interferon A2b and ribavirin combination therapy in chronic hepatitis C treatment naive patients.

BACKGROUND: Treatment of Chronic Hepatitis C is now well established with conventional interferon or pegylated interferon in combination with ribavirin. Peginterferon Alfa and Ribavirin for 6 to 12 months is currently approved initial therapy, which is expensive. Response of our patients to standard Interferon-alpha-2b and ribavirin for 24 weeks have been studied. The objective of this study was to asses Sustained Viral Response (SVR) with standard Interferon A2b and Ribavirin combination treatment in chronic Hepatitis C patients. METHODS: This quasi-experimental study was conducted at Combined Military Hospital, Quetta from Jan 2006 to Jun 2007. One hundred and three patients, with 20-60 years of age suffering from chronic Hepatitis C were selected on the basis of raised ALT, positive anti-HCV antibodies, evidence of viraemia by quantitative PCR for HCV RNA and liver biopsy. All patients were started on same brand of Interferon alpha-2b, 3 MIU subcutaneously, thrice weekly and oral Ribavirin (1,000-1,200 mg/day) for 24 weeks. End treatment response (ETR) after completion of treatment and SVR six months after ETR were recorded. RESULTS: The 103 patients, 85 males and 18 females with mean age of 21-48 years completed the treatment for 24 weeks. Mean ALT was 96.17 (SD +/- 49.98). End treatment response (ETR) was 89.3% (p = 0.032). Sustained Viral Response after 6 months of treatment was 86.4% (p = 0.034). CONCLUSION: Standard Interferon and Ribavirin had excellent SVR. It is effective as well as economical treatment in Chronic Hepatitis C patients.

Maternal and neonatal complications in term breech delivered vaginally.

OBJECTIVE: To evaluate the maternal and neonatal complications in terms of genital tract trauma to mother, perinatal mortality, Apgar score at 5 minutes and neonatal trauma in all singleton term breech cases delivered vaginally. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Bolan Medical Complex Hospital, Quetta, from May 2005 to March 2006. METHODOLOGY: A 100 consecutive patients with singleton breech presentation, whether booked or unbooked, were admitted and delivered vaginally in hospital during the study period. They were studied for maternal and neonatal complications. Maternal complication included any genital tract trauma during delivery while neonatal complications were perinatal mortality, low Apgar score (less than eight at 5 minutes) and birth trauma. RESULTS: There were a total 3977 deliveries during this study period, 145 breech presentation (incidence 3.6%). Out of those, 100 were included in the study. All were unbooked cases, 87% were multigravida while 13% were primigravida. An Apgar score of eight was recorded in 87% babies while 10% had an Apgar score of less than eight after 5 minutes. There were 3 still births and one neonatal death. Aggregated perinatal mortality rate was 40/1000 live births. Only one baby had birth trauma (Erb's paralysis) during vaginal breech delivery. Ninety seven (97%) mothers had no complications while only 3 (3%) had complications. Out of these, one had cervical tear and 2 had vaginal tears. CONCLUSION: Offering a trial of vaginal breech delivery to strictly selected and well-counselled patients remains an appropriate option without compromising perinatal and maternal outcome. It also decreases the rate of operative delivery for this malpresentation.

Smear-negative pulmonary tuberculosis and lymphocyte subsets.

OBJECTIVE: To correlate and quantitate lymphocyte subsets with clinically diagnosed smear-negative pulmonary tuberculosis and severity of disease. DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Military Hospital and Armed Forces Institute of Pathology Rawalpindi. 1999-2000. SUBJECTS AND METHODS: Freshly diagnosed, well-characterized smear-negative patients (n=15) of pulmonary tuberculosis were selected. Non-induced three-consecutive negative smears of sputum with simultaneous culture for AFB for 6-8 weeks, positive Mauntoux test (Z10 mm), blood complete picture with ESR and chest x-rays were done. Selected panel of monoclonal antibodies against specific CD markers were used. Statistical analysis done by student t-test or Mann-Whitney rank-sum test with the help of Sigma State software. RESULTS: Hemoglobin and total lymphocyte counts were significantly reduced whereas total leukocyte counts with absolute neutrophil counts were increased. Fraction of CD4+ and CD8+ T lymphocytes with HLA-DR expression was reduced while no significant change in rest of the TB and NK lymphocytes. CONCLUSION: Low hemoglobin level, high neutrophil count and low total lymphocytes suggest possible direct relationship with extent of disease. The number of activated CD4+, CD8+, ab and gd TCR T cells have tendency to increase during Mycobacterium infection. This seems to have a potential of being a good, non-invasive prognostic indicator for patients with pulmonary tuberculosis.