Objective: To compare the clinical performance and side effects of Implant (jadelle) and intrauterine contraceptive device (Cu-T). Study Design: Prospective Analytic study. Setting: Department of Obstetrics & Gynaecology, PNS Shifa Hospital, Bahria University of Health Sciences, Karachi. Period: 1st January 2021 to 31st December 2021. Material & Methods: A total of 162 married females of childbearing age participated in our study, n=81 in each group. Group A consisted of those females who had subdermal implant jadelle inserted and Group B included those ladies who were using intrauterine devices (IUDs) for contraception. Patient with pre-existing medical disrorders and those using levonorgestrel Intrauterine system (Mirena) were excluded. They were interviewed using a structured questionnaire at 6-months post insertion. The outcome were success/ failure rate and side effects. Data was analysed using SPSS 22. Results: A total of 162 women were part of this study. Most, 30(37.03%) were between 26-30 years in age in Group A (Implant) vs. 36 (44.4%) in Group B Intrauterine devices. 56 (61.7%) in Group A vs. 68 (83.9%) in Group B had regular menstruation prior to use of LARC; p-value 0.05 which is statistically significant. 45 (55.5%) in Group A vs. 33 (40.7%) in Group B had at least secondary level of education. Among the two study groups, 12(14.8) of Group A vs. 24 (29.6%) of Group B reported mild increase in menstrual bleeding, p-value 0. 000. Other side effects noticed were headache, nausea, and weight gain. Conclusion: Progesterone only subdermal implant showed same efficacy as Copper T IUD (intrauterine devices) with significantly fewer side effects.
Objective: To evaluate the diagnostic validity of Sonosalphingography as a tubal patency test in infertile women using laparoscopy as gold standard. Methodology: This study was carried out at the Shifa International Hospital Islamabad, and the duration of this study was from January 2021 to June 2021. We used the WHO method for sample size by taking the prevalence of tuboperitoneal factors as 30%, sensitivity 72.9%, specificity 81.22%, margin of error 12%, and 95% confidence interval. It was a cross-sectional study that lasted for 6 months and assessed a total of 178 patients. Additionally, a non-probability, sequential sampling strategy was utilized to acquire the sample. Results: Our patients aged between 18-45 years, out of which 30% of the participants aged 18 to 25 years, 55% were between 26 and 35 years, and 15% were between 36 and 45 years. Standard deviation was 1.26, with a mean age of 27. The data collected from both the diagnostic tests was analyzed, diagnostic accuracy of Sonosalphingography was calculated as a sensitivity of 81%, specificity of 76%, positive predictive value of 90%, negative predictive value of 60%, and diagnostic accuracy of 79%. Conclusion: According to the results of our study, Sonosalphingography is a very helpful supplemental diagnostic tool for evaluating tubal disease in patients with infertility, though direct laparoscopic assessment is the gold standard. Sonosalphingography and laparoscopy can be used to evaluate patients with secondary infertility. This spares the patient from being exposed to radiations and the discomfort of contrast administration in HSG. Keywords: Diagnostic Accuracy, Sonosalphingography, Tubal Patency, Infertility, Laparoscopy
Objective: To study the pattern of clinical presentation in patients with unsafe miscarriages. Study Design: Case series study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2016 to Mar 2017. Methodology: Thirty patients were included in this study after approval of the Ethical Committee. Detailed clinical assessment and clinical presentations of the cases were noted. Methods of miscarriage and associated complications were also noted. All cases were unbooked and referred cases. Results: In this study, 30 patients with unsafe miscarriages were studied. The mean ages of the patients were 27.4±7.1 years. Most of the patients were married (93.3%, n=28,) multigravida (73.3%, n=22,) and in 1st trimester (76%, n=23). The method of the abortions was by instrumentations in 90%, (n=27) cases and vaginal tablets in only 10%(n=03) of the cases. The mean hospital delay was of 8.5±10.1 days. Abdominal pain was the commonest presentation in 90% of the patients (n=27). Acute abdomen with abdominal distension and constipation was seen in 53.3%(n=16) cases. There was a history of vaginal bleeding in 43.3%(n=13) cases, and 6.7% (n=2) of patients presented in shock. Mean vitals on admission were as pulse 108.7±13.4 per minute, temperature 99.4+2°F, respiratory rate 24.3±4 per minute, systolic and diastolic blood pressure were 103.5.5±14 mmHg and 68.6±10.4 mmHg respectively. Conclusion: Illegally induced abortion remains a prominent cause of maternal morbidity in our society. However, high-quality post-abortion care will help a long way in saving many lives.
Madam, As per the World Health Organisation, anaemia is the condition of having an inadequate number of red blood cells or if the concentration of haemoglobin in them is reduced. Haemoglobin is a complex protein component of RBCs that carries oxygen around the body, a deficiency that can lead the person to experience fatigue, dyspnoea, weakness, dizziness etc.1 Such an ailment is bound to make daily life activities difficult and take a toll on one’s mental health. The WHO approximates that anaemia is prevalent in two billion people world-wide. There are many reasons for anaemia, including nutritional deficiencies, menstruation, stomach ulcers, parasitic infections, chronic illnesses and haemoglobinopathies etc. Nutritional deficits are the most common cause of anaemia, among which iron deficiency is namely the guiltiest, accounting for half of the total cases world-wide. It is a global public health travesty, especially for children and pregnant women.1 A vital component in the synthesis of the haemoglobin molecule is iron. Haemoglobin that is iron-deprived produces hypochromic and microcytic red blood cells. Iron is associated with several neurological functions, a deficiency of which leads to poor myelination of the white matter as well as a disturbance in monoamine metabolism. Additionally, fluctuations in the levels of brain iron interfere with the homeostasis of neurotransmitters such as gamma-aminobutyric acid and glutamate. Enzymes for synthesising neurotransmitters like dopamine and serotonin- essential in the modification of mood, anxiety, and other emotional behaviours- require iron as a vital component.2 Abnormalities in the physiology of these neurochemicals due to disruptions in an adequate iron supply will undoubtedly increase the likelihood of associated disorders, including but not limited to depression, anxiety, sleeping issues, developmental and emotional afflictions etc. A research paper comparing the risk of various psychiatric illnesses in patients with iron deficiency anaemia and healthy controls concluded the IDA group at a higher risk for developing anxiety, depression, sleep disruption, and psychotic disorders. Interestingly, it also found t that IDA with iron supplementation reported remarkably lower risks of psychiatric disturbances.3 It is, thus, necessary to monitor iron levels in anaemic individuals and where needed, introduce supplements to reduce the risk of developing and/or progression of psychiatric disorders. Further studies are also required to better expound on the relationship between iron deficiency anaemia and psychiatric illnesses.
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