Background: Laparoscopic hysterectomy literature showed varied results regarding outcome of laparoscopic hysterectomy. Moreover, there is no local evidence which could help us to determine the outcome of laparoscopic hysterectomy in females having uterine pathology. Methods: This descriptive case series was conducted in the Department of Obstetrics & Gynecology, Imran Idrees Teaching Hospital Sialkot for a period of 11 months from 1-1-2022 to 30-11-2022. Total 175 patients fulfilling selection criteria were enrolled in the study from emergency. Then all females underwent laparoscopic hysterectomy under general anesthesia. During surgery, operative time was noted. During surgery, bladder injury was noted if occurred (as per operational definition). Patients were shifted in post-surgical wards and were discharged from there after recovery. Results: In this study the main outcome variables were operative time, hospital stay and bladder damage. Mean operative time and hospital stay for patients who underwent laparoscopic hysterectomy was 170.93±49.18 minutes and 2.63±0.60 days. None of the patients had bladder damage. Practical implication: Laparoscopic hysterectomy is a safe, effective, and reproducible technique that can be adopted after completing a period of training required to standardize the technique. It has been associated with lesser blood loss, shorter stay in hospital, quick return to normal activity, and fewer surgical site infections when compared with abdominal hysterectomy. This approach must be established in our real, day-to-day clinical practice. Conclusion: Laparoscopic hysterectomy is an effective procedure for benign uterine pathology in terms of minimal complication rate (bladder injury), shorter hospital stay and an average mean operative time. Hence showing very promising results and a better outcome for the patients Keywords: Laparoscopic Hysterectomy, Benign Uterine Pathology, Operative time, Hospital Stay
Background: Electrolytes disturbances observed in hypoxic ischemic encephalopathy can further complicate the already asphyxiated babies Serum sodium is one of the most important electrolytes associated with neuronal activity, routinely serum sodium is added after 24 hour of life in maintenance fluid of neonates but we will monitor the changes in our suspected cases earlier so that early intervention should be done to reduce the perinatal mortality and its fatal outcomes. Aim: To determine the association of hyponatremia with hypoxic ischemic encephalopathy in term infants during first 24 hours of life. Methods: Case control study was carried out at Department of Pediatrics, Aziz Bhatti Shaheed Teaching Hospital Gujrat from12th Feb 2018 to 12th Feb 2019. 134 cases and 134 controls were included in the study. Full term babies (>37 weeks) of either gender was included for both cases and controls. Cases were hypoxic ischemic encephalopathy infants who has history of delayed cry at birth of >5 minutes, respiratory distress and moaning. Hyponatremia was labelled if serum sodium levels are below 130 mmol/lit. Matched controls i.e. healthy neonates from same setting were selected for the study. The serum sodium levels were compared between cases and controls. Results: Serum sodium was unequally distributed among cases & controls (Median±IQR 136±5, 139±8, P value using Mann Whitney U test= 0.01). Hyponatremia was also unequally distributed among cases & controls (3.4% vs 0.4%, P value using Fischer exact test = 0.01). Logistic regression analysis using STEP wise analysis proved that the association found regarding hyponatremia/ serum sodium with hypoxic ischemic encephalopathy is not significant after adjusting for weight and gender of the infant. The distribution of birth weight and gender among cases and controls was similar (P value > 0.05). Conclusion: It is concluded that hyponatremia is not associated with hypoxic ischemic encephalopathy in term infants during first 24 hours of life. Keywords: Hypoxic ischemic encephalopathy, Hyponatremia, Serum sodium, Perinatal asphyxia
Background: Assessment has been shown in studies to have a significant impact on the learning process. There has been a lot of interest in making assessment an important element of the learning process for students. Senior medical students may be able to assist teachers with peer evaluations. There is little evidence to support the idea that peer examiners should be officially trained before taking on the job. Aim: To find the difference in teaching faculty scores of untrained and trained peer examiners in Obstetrics & Gynecology OSCE. Study design: Cross-sectional (analytical) study Place and duration: The study was conducted at Sialkot Medical College Sialkot” affiliated with Imran Idrees Teaching Hospital in Obstetrics /Gynecology department over the period of 6 months from January 2022 to June 2022 Methodology: One hundred and five medical student of 4th year were enrolled for practice of OSCE examination. Forty final year medical students took part in the assessment program as peer examiners. One group of examiners were given 2-hour training session describing about the assigned OSCE stations, marking method, evaluation, and feedback methods. Other group was given only checklist to read with no prior training. Using the checklist and a global rating, senior faculty and peer student examiners (both trained and untrained groups) simultaneously assessed students in basic Obstetrics /Gynecology clinical skills at 4 OSCE stations. Every station ran for five minutes (3 minutes of evaluation while 2 minutes of feedback). A comparison between the check list and global rating scores of trained and untrained peer student examiners was made. SPSS version 21 was used to calculate intra-rater reliability was assessed to build the consensus of faculty examiners with the trained and untrained peer examiners according to checklist scores and global rating. Results: Student examiners found sitting at OSCE stations as a useful learning experience. Observing different performances at OSCE stations was so absorbing and it gave them awareness about examination procedure. Practical implication. Peer assessors in a formative OSCE could be successfully implemented in the curriculum of a large medical school with more than 100 students annually. They can be trained to conduct undergraduate assessments of their junior peers and can prove to be very reliable and effective assessors. Conclusion: Peer markers who underwent the formal training session showed the capacity to assess fourth-year students with suitable consistency and devotion. Hence training helped to improve peer marker consensus with faculty. Keywords: Peer examiners, OSCE, trained peer examiner, untrained peer examiner.
Objective: To find the frequency of common clinical features of Idiopathic Thrombocytopenic Purpura (ITP) in childrenand to see whether bone marrow aspiration needed in every child with typical presentation of ITP. Design: Cross-sectional study. Setting:Hematology/Oncology Department, the Children Hospital & the Institute of Child Health Lahore Pakistan. Duration: April 2008 to March2009 (One year). Material and Methods: A total of 30 children presenting with bleeding through any orifice with diagnostic evidence ofITP were evaluated by a cross sectional study. Common clinical features were recorded along with the related hematological parameters.After taking detailed history and thorough examination, relevant investigations like peripheral smear, bleeding time and coagulation screenwere carried out in all cases. Bone marrow examination was done only in selected cases. The cases were then managed according tostandardized management criteria. Results: Male: Female ratio was 3:2, age ranging from 18 months to 14 years (mean±SD of 5.2±years) with median age of 5.2 years. 26.6% (n=08) patients were having preceded history of upper respiratory tract infection. Thepositive clinical findings were bruises in 30% (n=09) cases; petechiae in 23.3% (n=07) cases; epistaxis in 23.3% (n=07) cases; gumbleeding in 13.3%(n=04) cases and hematuria only in 10% (n=03) cases. Anemia (<9gm%) was noted in 40% (n=12) patients. Onperipheral smear examination this was microctic hypochromic in nature. Bleeding time was prolonged in all patients in line withdocumented thrombocytopenia i.e platelet count < 150,000. PT/APTT was normal in all 30 patients. Conclusions: Bruises, Petechiaeand epistaxis are the commonest clinical findings of ITP. Bone marrow aspiration revealed inconclusive results in such cases.
Background: Intrauterine growth restriction refers to a fetus with a fetal weight in the 10th percentile on ultrasonography who has not reached its biologically set growth potential due to a pathologic condition. Aim: To determine the association of adverse outcome with abnormal umbilical artery waveform groups in intrauterine growth restricted pregnancies. Methods: This Cohort Study was conducted from February 2019 to 12 February 2020 at Gynae & Obs Department, Imran Idrees Teaching Hospital Sialkot, Sialkot Medical College, Sialkot 120 pregnant females, attending Department of Gynae & Obs were recruited into the study after 28 weeks of gestation. The women were divided into two groups depending on their Doppler findings. One group (exposed) comprised of women with intrauterine growth restriction, with absent or reversed diastolic flow in the umbilical artery. The control (unexposed) group included women with small-for-date fetuses, with normal umbilical artery Doppler flow. Results: The mean age of females was 27.40 ± 4.77 years. The mean gestational age was 30.69 ± 2.19 weeks. The mean birth weight of neonates was 2.37 ± 0.90 kg. The mean AGPAR score of neonates was 6.60 ± 1.70. It was observed that there was significant association between groups and low birth weight with p-value = 0.002. Admissions to NICU were significantly lower in normal Doppler wave form group having p-value = 0.001. Conclusion: The percentage of NICU admission was 46.7% and the percentage of low birth weight was 46.7% in intrauterine growth restriction. The mean birth weight was significantly lower in exposed group and the mean APGAR score was also significantly lower in exposed group. Keywords: Apgar score, neonatal intensive care unit, Intrauterine Growth Restriction, Doppler ultrasound,
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