Endometriosis is a chronic inflammatory disease defined as the presence of endometrium-like tissue outside the uterus which is responsive to the estrogen levels in blood circulation. Objective: To compare the efficacy of letrozole versus danazol in pain relief in endometriosis. Methods: This randomized controlled trial was conducted at the department of Obstetrics & Gynecology, Ayub Teaching Hospital, Abbottabad, Pakistan from January 2018 to December 2021. Patients diagnosed with endometriosis were enrolled and detailed medical history was taken. Patients were randomly divided into either Letrozole (n=120) or Danazol (n=120) group. Both treatment groups were evaluated after 3 months of treatment and efficacy was compared in terms of pain relief in patients of endometriosis. Results: In a total of 240 patients, the mean age was 28.30±4.76 years. The mean endometrial cyst size was 2.48±1.14 cm. At baseline, mean visual analog scale (VAS) score was recorded as 5.46±1.09 points in letrozole group and 5.28±1.01 points in danazol group (p=0.186). After three months of treatment, the mean VAS score was 2.94±1.96 points in letrozole group and 3.99±1.90 points in danazol group (p=0.002). Relief of symptoms was observed in 114 (47.5%) women and more patients reported relief of symptoms in letrozole group (65 patients) than the danazol group (49 patients) (p=0.039). Conclusion: Letrozole was more effective as compare to danazol in relief of pain in patients with endometriosis
Aim: To evaluate effectiveness of antenatal counselling in increasing the acceptability and insertion of Post Placental Intrauterine Contraceptive Device in postpartum women Study design: Prospective study. Place and duration of study: Department of Obstetrics & Gynaecology, Hayatabad Medical Complex, Peshawar from 1st April 2022 to 30th September 2022. Methodology: Fifty pregnant women were enrolled. The age of the pregnant women was taken within 18-43 years. The couples were counselled for the uptake of PPIUCD through gynaecological professional assistance. The counselling was done at 28 weeks followed by at 36 weeks. The misconceptions and myths were eradicated through the use of one-to-one interview as well as focus group discussions. The fears of the patients and their spouse were addressed through detailed discussion. Results: The mean age was 24.8±4.06 years. There were 70% of the pregnant women who agreed to get PPIUCD inserted, however only 42% actually underwent the procedure. Majority of the cases were within the age group of 18-28 years. The reasons recorded for not getting PPIUCD insertion previously presented data where 23% of the pregnant women had no awareness provided about PPIUCD before while 13% preferred other contraceptive methods. Conclusion: The outcomes of the antenatal counselling are higher uptake of post placental intrauterine contraceptive device with a rate of 42% increase in post-partum women. There is an evident reduction in misconceptions and myths about post-placental intrauterine contraceptive device through antenatal counselling. Key words: Antenatal counselling, Outcome, Intrauterine contraceptive device, Post-partum
Background and Aim: The coronavirus illness (COVID-19) is a public health disaster on a worldwide scale. The present COVID 19 epidemic will cause significant interruption to healthcare systems long after it has passed its peak. Sexual and reproductive health (SRH), including contraception, must be viewed as a critical service. The aim of the present study was to assess the COVID pandemic effect upon utilization of contraceptive services. Methods: This epidemiological study was carried out on 1284 women at risk of unplanned pregnancy whose longitudinal data was collected from June 2021 to 31 November 2021 in Gynae & Obs department of Hayatabad Medical Complex Peshawar and KMU Institute of Medical Sciences, Kohat. Baseline details, association of contraceptive dynamics with COVID-19 experiences, and causes for contraceptive non-use were measured outcomes during COVID pandemic. Our key outcome was the dynamics of contraceptive usage classified into four groups: a) persistent non-use, b) persistent use, c) adoption, and d) cessation. Secondary outcomes were contraceptive uptake, cessation, and switching. Factors such as socioeconomic status, reproductive health, and COVID-19 status have been associated with contraceptive behavior. Sociodemographic details consist of age, education, residency, and parity. Results: Of the total 1284 unplanned pregnancy women, during COVID-19, no changes in contraceptive status was seen in 64.8% women, whereas those who responded were much more inclined to adopt a device 26.2% than to discontinue 9.0%. The majority of women who shifted contraceptives were using more efficient techniques than the one they used before the pandemic. In Pakistan, higher contraceptive protection was connected with economic insecurity due to COVID-19. Among all the cases, non-contraceptive users 9.1% (n=117) had cited COVID-19-related causes for not utilizing contraception. Conclusion: The present study concluded that contraceptive status among the majority of women with unexpected pregnancy during COVID pandemic unaltered their contraception status, and adoption was more acceptable to women than discontinued techniques. COVID-19 was mentioned by a minority of women for not using the vaccine, highlighting the significance of extending safe forms of service delivery amid health crises. Keywords: COVID-19, Pandemic, Contraception services
Background: Maternal near-miss (MNM) and maternal mortality (MM) are indicators for quality of health care system. The objectives of our study were to determine prevalence of MNM and MM and their distribution by gestation and gravidity and their causes in women with live births population of District Peshawar, Pakistan.Material Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar, Pakistan from January 2017 to June 2017. From assumed population of 185,676 pregnant women in District Peshawar, 10% prevalence of MNM, 1.0448% margin of error and 95%CL, sample size was calculated 3,115. All women with live birth were eligible. Presence of MNM and MM, causes of MNM and MM, gestational age and gravidity were six variables. Being nominal, all were analysed by count and ratio or percentage with 80%CI. MNM Ratio was calculated per 1,000 live births and MM Ratio per 100,000 live births.Results: Out of 3,115 women with live births, MNM cases were 494 with MNMR 158.59/1,000 (80%CI 150.19-166.97) and MM cases were 16 with MMR 513.64/100,000 population (95%CI 349.50-677.78). There were 232 MNM cases in ≤28 weeks and 262 in 28 weeks gestational age with similar MNMR between these groups. There were 244 MNM cases in primigravida and 250 in multigravida with similar MNMR between these groups. There were five MM cases in ≤28 weeks and 11 in 28 weeks gestational age with similar MMR between these groups. There were five MM cases in primigravida and 11 in multigravida with similar MMR between these groups as their CIs are overlapping. Haemorrhage was most common cause for MNM in 365 (11.7175%) cases and for MM in 8 (0.2568%) cases.Conclusion: The maternal near-miss ratio (MNMR) and maternal mortality ratio (MMR) are relatively higher in population of District, Peshawar, Pakistan. MNMR and MMR both have similar prevalence in ≤28 weeks and in 28 weeks gestational age groups and also similar in primigravida and in multigravida groups. Haemorrhage (antepartum and postpartum) was most common cause both for maternal near-miss (MNM) and maternal mortality (MM).
OBJECTIVES: To determine patient satisfaction in terms of various services such as ease of getting care, in-patient admission, waiting for check-up, staff interaction, medical care, cost of care, and cleanliness in a Tertiary Care Government Hospital. METHODOLOGY: The study design was cross sectional observational. A total of 200 patients meeting our inclusion criteria were enrolled through convenient sampling techniques in this research study. A well-designed questionnaire was used for data collection of admitted patients. RESULTS: Out of 200 patients, 96 (48%) male and 104 (47%) female patients were interviewed. 72% were satisfied with clinical care services, 14% had mixed views while 14% patients were not satisfied at all. CONCLUSION: Patients in general showed their satisfaction in some of the aspects, however, keeping in view the burden a public sector hospital absorbs on a daily basis, and it was imperative to receive unsatisfactory feedback from patients in most of the aspects. Thus, the results of my study recommend to the health care leaders to take practical steps to bring further improvement by developing a proper mechanism for the uplift of public sector hospitals.
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