Background and Aim: Cesarean section rates are rising around the globe and are considered as the major surgical procedure conducted on females. Cesarean-related hemorrhage contributes to increasing mortality rates around the world. Due to the rise in cesarean rate and its associated complications, post-cesarean severe bleeding without proper management is a major concern. Therefore, the present study aimed to assess the intravenous tranexamic acid (TA) and sublingual misoprostol effect on reducing post-cesarean section bleeding. Materials and Methods: This cross-sectional study was conducted on 146 term pregnant women undergoing emergency or elective cesarean section at the Department of Obstetrics and Gynaecology, Qazi Hussain Ahmad Medical Complex, Noshehra during the period from 7th September 2020 to 6th March 2021. All the participants were randomly categorized into two groups. Each group comprised of 73 participants whereas groups I and II received sublingual misoprostol (600 µg) and 500 mg intravenous tranexamic at card clamping respectively. Both groups were administrated for postoperative 48 hours and blood loss was measured. The packed cell volume and postoperative Hb were evaluated and compared with initial values before surgery. The need for blood transfusion, drug side effects, and additional uterotonics was evaluated. SPSS version 20 was used for data analysis. Results: The mean age of groups I and II were 28.32±4.73 and 28.17±4.83 years whereas the overall mean age was 28.25±4.78years. A higher reduction of hemoglobin level was observed in an intravenous tranexamic group compared to the sublingual group (-2.39±0.93 versus -2.09±1.28g/dL) (p=0.001). Moreover, the intravenous tranexamic group had significantly higher blood suction and gauze usage than sublingual misoprostol (256.73± 83.25versus 189.68± 102.4 cubic centimeter (cc) and 4.59±1.43 versus 3.19±1.27) for a significant value of 0.001. The decrease in mean blood pressure during the cesarean section procedure was significant in intravenous tranexamic than sublingual misoprostol (p=0.001). Conclusion: Our study concluded that sublingual misoprostol significantly reduced total bleeding when compared to tranexamic acid. Furthermore, hemodynamic variables were stabilized more in the misoprostol group than in the tranexamic acid group. Keywords: Cesarean Section Bleeding; Intravenous Tranexamic acid; Sublingual misoprostol.
Background: Hypertension is a highly relevant public health challenge. Digital interventions may support in improving adherence to anti-hypertensive medications and alter health behavior. Therefore, this protocol describes a study which aims to assess the effectiveness of mHealth and educational support through peer counseling (Ed-counselling) to control blood pressure in hypertensive patients when compared to standard care.Methods: We chose a double-blinded pragmatic randomized-controlled with factorial design for this investigation. The trial is going to recruit 1440 hypertensive patients with coronary artery disease at the age of 21 to 70 years. All participants will already be on anti-hypertensive medication and own a smartphone. They will be randomized into four groups with each having 360 participants. The rst group will only receive standard care; while the second group, in addition to standard care will receive monthly Ed-counselling (educational booklets with animated infographics and peer counselling); the third group will receive daily written and voice reminders and an education-led video once weekly together with standard care; while the fourth one gets both interventions given to second and third groups respectively. All groups will be followed-up for one year (0, 6, and 12 months). The primary outcome will be the change in systolic blood pressure while secondary outcomes include health-related quality of life and changes in medication adherence.Discussion: Besides adding up to existing evidence in the literature on the subject, our designed modules using mHealth technology can help reducing hypertension-related morbidity and mortality in developing countries.Trial registration: ClinicalTrials.gov (NCT05106790),
Objective: To determine the frequency of disorders leading to sudden cardiac death (SCD). Study Design: Cross-sectional study. Place and duration of study: Pathology Lab in collaboration with the Cardiology Department, AFIC & NIHD, Rawalpindi Pakistan, from Jan 2017 to Dec 2018. Methodology: A total of 305 cases of sudden cardiac death reported within the last 24 hours of a death to AFIC Rawalpindi were included consecutively. Cases with a history of extracardiac diseases leading to sudden death were excluded. Most of the included cases were diagnosed phenotypically based on clinical examination, biochemistry, ECG, echocardiography, angiography, thallium scan, electro-physiological studies, cardiac CT scan, MRI and routine autopsy whenever recommended. Results: Out of 305 cases, 197 (65%) were males and 108 (35%) females. Disorders leading to SCD were found in 178 (58.3%) cases due to ischemic heart disease (IHD), aortic dissection (0.7%), hypertrophic cardiomyopathy (HCM) (0.3%), dilated cardiomyopathy (DCM) (10.5%), congenital heart disease (12.1%) and valvular heart disease (7.9%). While in cardiac channelopathies, catecholaminergic polymorphic ventricular tachycardia (CPVT) in 5 (1.6%) and congenital long QT syndrome (LQTS) in 2 (0.7%) cases. However, 24 (7.9%) cases remained as sudden unexplained deaths (SUD). Conclusion: In our setup, ischemic heart disease and dilated cardiomyopathy were the commonest causes of sudden cardiac death, followed by congenital heart disease and valvular heart diseases.
Objective: To determine the frequency of disorders causing secondary hypertension in patients less than 45 years of age. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pathology and Medicine, Combined Military Hospital (CMH), Risalpur, Pakistan, along with Armed Forces Institute of Pathology (AFIP)and Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan from Apr 2017 to Apr 2019. Methodology: A total of 50 patients, less than 45 years of age, newly diagnosed with hypertension (systolic blood pres-sure>140 mm Hg or diastolic BP>90 mm Hg) and reported to CMH Risalpur for the workup of HTN were included. Analysis of serum cholesterol, triglycerides, urea, creatinine, sodium, potassium, calcium, thyroid stimulating hormone, plasma glucose random, urine analysis and renal ultrasonography were carried out. In addition, serum cortisol, 24 hours urinary free cortisol, dexamethasone suppression test, growth hormone level, insulin-like growth factor-1,24 hours urinary vanillylmandelic acid, serum aldosterone and renin levels, Doppler renal ultrasonography, renal arteriogram, CT abdomen, MRI pituitary and MR/CT angiography were carried out. Results: A total of 50 patients comprised of 82% males and 18% females with a mean age of 36.1±6.2years. Primary hypertension was in observed in 31(62%) cases. Secondary causes of HTN in 19(38%) cases, were obstructive sleep apnea (4, 8%), primary hyperaldosteronism (3,6%), renal parenchymal hypertension (3,6%), renal artery stenosis (1,2%), Cushing's syndrome (2,4%), hyperthyroidism (2,4%), hypothyroidism (2,4%), pheochromocytoma (1,2%) and coarctation of aorta (1,2%) cases. Conclusion: Obstructive sleep apnea primary hyper-aldosteronism and renal parenchymal diseases were the commonest.........
Objective: To compare the outcome of expectant management versus immediate delivery in females with preterm premature rupture of membrane close to term. Study Design: Randomized controlled trial Place and Duration of Study: Department of Obstetrics & Gynaecology Unit III, Fatima Memorial Hospital Lahore from 20th June 2018 to 20th December 2018 Methodology: Three hundred females were included through emergency. They were divided in two groups; females of group A managed conservatively and females of group B were induced for delivery and immediate delivery was conducted. After delivery in both groups, outcome was recorded i.e. neonatal distress, poor Apgar score or NICU admission. Results: The mean age of group A was 27.53±4.99 years and group B was 25.81±4.92 years. The mean gestational age of group A was 33.92±1.41 weeks and group B was 33.88±1.40 weeks. In group A there were 28 (18.7%) women with parity 1, 40(26.7%) with parity 2, 42 (28%) with parity 3 and 40 (26.7%) with parity 4 whereas in group B there were 28(18.7%) women with parity 1, 40 (26.7%) with parity 2, 42 (28%) with parity 3 and 40 (26.7%) with parity 4. In group A there were 54 (36%) women with normal BMI, 44 (29.9%) were overweight and 52 (34.7%) were obese while in group B there were 63 (42%) women with normal BMI, 38 (25.3%) were overweight and 49 (32.7%) were obese. There was no significant (P=0.329) association between neonatal distress and study groups and also no significant (P=0.202) association between poor APGAR score and study groups. Conclusion: Incidence and rate of neonatal distress in complicated pregnancies by PPROM within 34 and 37 weeks of gestation is very low Keywords: Delivery, Preterm, Premature, Rupture of membrane, Term, Outcome, Expectant, Management
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