Journal of Rawalpindi Medical College
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Connecting The Dots: The Impact Of Subclinical Hypothyroidism On Female Subfertility And Obesity
Full text linkObjective: To find the frequency of subclinical hypothyroidism in females with subfertility
Methods: This was a descriptive cross-sectional study Department of Obstetrics and Gynecology, CMH Hospital Kharan, for 6 months (1st Jan 2023 to 30th June 2023).
A total of 159 females meeting inclusion criteria were included after taking informed consent. Females were enquired about infertility status and their thyroid status was measured in terms of thyroid stimulating hormone (TSH) and free thyroxine (FT4). Mean and Standard Deviation were used for quantitative variables whereas frequency and percentages were used for categorical variables.
Results: The mean age of females in this study was 27.86±7.58 years. The mean weight, height and BMI were 72.87 ± 13.31 kg, 1.64 ± 0.06 m, and 27.23 ± 4.90 respectively.
Fifty-three (33.33%) females were obese and 106(66.67%) females were non-obese. The mean level of TSH was found to be 2.51 ± 2.29 mIU/mL with huge variation as the minimum TSH level was 0.1 and the maximum was 7.90 mIU/mL. The mean FT4 was 1.29±0.4 ng/dl with a minimum and maximum FT4 level of 0.70 and 1.90 ng/dl respectively. There were 43 (27%) females with subclinical hypothyroidism whereas, 116 (73%) did not have subclinical hypothyroidism. There was an association between subclinical hypothyroidism and obesity, p-value < 0.05.
Conclusion: This study concludes that the prevalence of subclinical hypothyroidism was found to be greater in infertile women and hence routine screening of subclinical hypothyroidism among females with subfertility should be practiced. We also found an association of SCH with obesity in these females.
REFERENCES:
Abangah G, Rashidian T, Nasirkandy MP, Azami M. A meta-analysis of the prevalence and etiology of infertility in Iran. International Journal of Fertility & Sterility. 2023;17(3):160-73.
Carrell DT, Peterson CM. Reproductive endocrinology and infertility. Springer Sci+ Busin Med. 2010;345.
Bala R, Singh V, Rajender S, Singh K. Environment, lifestyle, and female infertility. Reproductive sciences. 2021;28:617-38.
World Health Organization. Infertility prevalence estimates: 1990–2021. 2023 [Online available from]: https://www.who.int/publications/i/item/978920068315. Retrieved from 18th Sep 2023
Shafierizi S, Basirat Z, Nasiri-Amiri F, Kheirkhah F, Chehrazi M, Pasha H, et al. The prevalence of adjustment disorder and predisposing factors in infertile women. BMC psychology. 2023;11(1):142.
Maaherra Armstrong P, Augustin H, Bärebring L, Osmancevic A, Bullarbo M, Thurin-Kjellberg A, et al. Prevalence of Vitamin D Insufficiency and Its Determinants among Women Undergoing In Vitro Fertilization Treatment for Infertility in Sweden. Nutrients. 2023;15(12):2820.
Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. International journal of applied and basic medical research. 2012;2(1):17-9.
Priya DM, Akhtar N, Ahmad J. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Indian journal of endocrinology and metabolism. 2015;19(4):504-6.
Cooper DS. Subclinical hypothyroidism. New England Journal of Medicine. 2001;345(4):260-5.
Biradar SM, Poornima R, Sonagra AD, Jayaprakash Murthy D. Thyroid dysfunction in infertile women. Int J Pharm Bio Sci. 2012;2:53-8.
Mahadik K, Choudhary P, Roy P. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC pregnancy and childbirth. 2020;20(1):1-7.
Ratnaparkhe V, Shah H, Upadhyay K. Link between infertility, overweight and subclinical hypothyroidism. Int J Health Sci Res. 2020;10(2):10-7.
Sadbhawna D, Sonia S, Nitin G. Prevalence of subclinical hypothyroidism among females with menstrual disorders. International Journal of Health Sciences & Research. 2019;9(8):110-5.
Ali T, Bahadur A, Bashir B, Hassan T, Ishaq B, Qasim M. Prevalence of Hypothyroidism in Pregnancies and its Obstetric Outcomes. Pakistan Journal of Medical & Health Sciences. 2022;16(03):1184-6.
Onwubuariri M, Bassey G, Kasso T, Nyengidiki T. A-Case Control Analysis of Thyroid Disorders in Infertile Women at the University of Port Harcourt Teaching Hospital, Nigeria. Asian Journal of Pregnancy and Childbirth. 2020;3(1):1-9.
Mohadure DS, Fating L. Case Report on Hypothyroidism in Infertile Woman with IVF Conception. Journal of Pharmaceutical Research International. 2021;33(35B):148-51.
Jagun OE, Andu BA, Olawale OO. Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria. Afr Health Sci. 2022;22(2):444-50.
So S, Tawara F. Risk factors of subclinical hypothyroidism and the potential contribution to miscarriage: A review. Reproductive medicine and biology. 2020;19(3):232-42.
Kant R, Barnwal S, Yadav P, Tendulkar P, Bairwa M. Subclinical hypothyroidism in community perspective: Treat or not to treat? J Prevent Med Holistic Health 2023; 7(1): 19-22
Kaur G, Kaur S, Mahajan M, Kaur A. To Study Prevalence of Infertility in Patients of Hypothyroidism. Indian Journal of Clinical Biochemistry. 2022;30(S1):S63-S.
Amer MH, Thuwain MM, AL-Snafi A. Investigation of thyroids dysfunction among infertile women in Nasiriyah city. Int J Curr Pharm Res. 2020;12(5):31-4.
Dhillon-Smith RK, Tobias A, Smith PP, Middleton LJ, Sunner KK, Baker K, et al. The prevalence of thyroid dysfunction and autoimmunity in women with history of miscarriage or subfertility. The Journal of Clinical Endocrinology & Metabolism. 2020;105(8):2667-77.
Bendary AA, El Hodiby ME. Study of thyroid immunological and functional disorders in women with unexplained infertility 2022; 2(63): 1-6
Wali AA-E-D, Abdelfattah W, Abd-El-Fatah SM. Prevalence of thyroid dysfunction and thyroid autoimmunity in infertile women. Evidence Based Women's Health Journal. 2020;10(4):308-15.
Jagun OE, Andu BA, Olawale OO. Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria. African Health Sciences. 2022;22(2):444-50.
Zhang Y, Wu W, Liu Y, Wang X, Guan Y, Jia L. Analysis of basal serum TSH, FT3, and FT4 levels based on age, sampling time in women with infertility. BMC Women's Health. 2021;21(1):317.
Zhang B, Wang J, Shen S, Liu J, Sun J, Gu T, et al. Subclinical hypothyroidism is not a risk factor for polycystic ovary syndrome in obese women of reproductive age. Gynecol Endocrinol. 2018;34(10):875-9.
Ratnaparkhe V, Shah H, Upadhyay K. Link between infertility, overweight and subclinical hypothyroidism. Int J Health Sci Res. 2020;10(2):10-7.
Frequency And Type Of Refractive Errors Among The Teenage Groups Presenting In Eye OPD In Shaikh Zayed Hospital Lahore
Full text linkObjective: To determine the frequency and type of refractive errors in the teenage groups reporting in ophthalmology department of Shaikh Zayed Hospital Lahore, Pakistan.
Methods: This descriptive study was conducted in the Shaikh Zayed Hospital, Lahore, Pakistan from 14-9-2023 to 14-02-24. Total 501 subjects of both genders with refractive errors were included in the study after fulfilling the inclusion criteria. . Participants were in the age group 11-19 years. Visual acuity was checked with Snellen chart. Subjective and objective refraction was performed. All participants underwent complete ophthalmic examination to rule out any ocular abnormality.
Results: In the study 287 (57.3 %) participants were females and 214 (42.7%) were males. Median age of the participants was 16 years. Myopia was most prevalent refractive error with total of 339 (67.7%) followed by astigmatism having total 148 (29.5%). while hyperopia was seen in 14 (2.8%) participant of the study population. There were no gender related differences in distribution of refractive errors. Fewer cased were seen in age group 11 and 12 years. Almost 86% of the subject achieved visual acuity of 6/6 in both eyes after correction.
Conclusion: myopia is a most prevalent form of ametropia in teenage groups. There is a need of creating awareness regarding its risk factors and life style modifications which can help in reducing burden of visual impairmen
Effects Of Metformin And Myo-Inositol In Combination Versus Metformin As Monotherapy On The Metabolic Profile Of Polycystic Ovarian Syndrome Patients With Infertility
Full text linkObjective: To compare the effects of myo-inositol combined with metformin vs. metformin used alone on the metabolic profile of patients with polycystic ovarian syndrome with infertility.
Methods: A randomised controlled trial that was double-blinded was conducted from September 2022 to February 2023. One hundred fourteen PCOS females with infertility were randomly assigned to 57 people made up Group A, which received oral Metformin in a dose of 500 mg 3 times per day together with oral Myo-inositol 4 g once per day; 57 people made up Group B, which received oral Metformin in a dose of 500 mg 3 times per day only. Following the start of medication, all hormonal and metabolic profile parameters were assessed at baseline, one, three and, six months later. Our main goal was to improve polycystic ovarian syndrome patients' metabolic profiles regarding mean change in serum Triglycerides, serum HDL and mean HOMA-IR index throughout one, three and six months. Comparable demographic, hormonal, and biochemical baseline characteristics were present in both groups.
Results: In comparison to Group B, Group A's mean serum triglycerides improved (p=0.16) although not significant, significant improvement in mean serum HDL in Group A as compared to Group B (p=0.00), additionally a significant improvement in the mean HOMA-IR index in Group A when compared to Group B was observed.
Conclusion: Compared to Metformin administered as a monotherapy, it seems promising to treat PCOS and insulin resistance using a combination of metformin and myo-inositol
Intra Cervical Foley’s Versus Combination Of Intra Cervical Foley’s And Extra Amniotic Saline Infusion As Cervical Ripening Agent For Induction Of Labor
Full text linkObjective: To compare IntraCervical Foleys (ICF) and intracervical Foleys along with Extra Amniotic Saline Infusion (EASI) as a cervical ripening agent for Induction Of Labour(IOL).
Methods: It was carried out at the Department of Obstetrics and Gynecology Holy Family Hospital, Rawalpindi. In this comparative study, we included 100 patients with singleton cephalic presentation, intact membranes and a BISHOP score ≤ 6. These were further subdivided into two groups, Group A (ICF) and Group B (ICF with EASI),50 in each group.
In Group A, Foley’s catheter was placed cervically while in Group B extraamniotic saline infusion was also administered in the urine drainage port at midnight. PGE2/ Augmentation with syntocinon was considered according to the bishop score at 6 am. Improvement in BISHOP score, induction to delivery interval, and feto-maternal outcomes were noted in both groups.
Results: Data analysis showed that the mean improvement in the BISHOP score of the patients in Group A was 3.78 ± 1.75 while that of Group B was 3.56 ± 1.79(pvalue = 0.508). The induction to delivery interval in group A patients was 14.6 ± 4.75 hours while that of group B was 13.22 ± 4.54 hours (p =0.103). Only 14/100 patients had failed IOL and underwent C- C-sections and 8/100 neonates had NICU admissions and were discharged later on.
Conclusion: Both Intra Cervical Foley’s and a Combination Of Intra Cervical Foley’s And Extra Amniotic Saline Infusion are equally effective as cervical ripening agents for induction Of labour with high chances of successful vaginal delivery and good feto-maternal outcome.
Keywords: Induction of labour, Intracervical folleys, Extra-amniotic saline infusion, BISHOP score
Comparison Of Frontalis Sling With Or Without Tarsal Fixation Sutures For Severe Ptosis With Poor Levator Function
Full text linkObjective: To compare the outcomes of frontalis sling with tarsal fixation or without tarsal fixation suture in patients of severe ptosis with poor levator function.
Methods: This QUASI-experimental study was conducted at the College of Ophthalmology & Allied Vision Sciences/King Edward Medical Study after obtaining ethical approval vide no 2162/22. Ten Patients above 10 years of age and having levator muscle function of less than 4mm were selected by probability consecutive sampling. Those patients who were diagnosed with Blepharophimosis, Marcus Gun phenomenon, CN III palsy and other lid or facial deformities were excluded. Patients were equally divided into two groups A and B. Group A patients underwent fascia lata sling with tarsal fixation while Group B patients underwent simple fascia lata sling without tarsal fixation. Postoperatively (1 week) surgical success including marginal reflex distance (MRD) and complications including slippage of the sling, exposure keratopathy, recurrence and lid margin deformity were evaluated. Paired t-test and Independent sample t-test were applied to check for statistical significance.
Results: Eight out of ten patients had bilateral ptosis with poor levator muscle function while the other two patients had unilateral ptosis. Changes in the marginal reflex distance and palpebral fissure height after surgery were statistically significant. Both marginal reflex distance and palpebral fissure height were statistically better in group A as compared to group B (0.001 & 0.003) respectively.
Conclusion: Cosmetic results are better when a fascia lata sling is done with tarsal fixation sutures.
Keywords: Ptosis, Fascia lata, Patient
Association Of Conjunctival Vitreous Reflux With Intraocular Pressure Spikes After Intravitreal Bevacizumab Injection
Full text linkObjective: To evaluate the effect of conjunctival vitreous reflux on intraocular pressure immediately after intravitreal bevacizumab injection.
Methods: A prospective interventional study was done at Benazir Bhutto Hospital, for 6 months from 13-01-2021 to 12-07-2021.Patients were selected through a non-probability consecutive sampling technique. A total of 88 eyes undergoing intravitreal bevacizumab were included in the study. IOP was checked before injection, immediately after injection, at 30 minutes and 60 minutes. The presence or absence of conjunctival reflux was noted. Data was analyzed to see the association of post-injection IOP and conjunctival reflux.
Results: Those having conjunctival reflux positive had mean Intraocular pressure before intravitreal injection 13.14+2.569, the p-value was 0.0001. Immediately after injection at 0 minutes it was 27.95+3.988, and the p value was 0.0001. At 30 minutes, it was reduced to 21.58+2.814, the p-value was 0.0001, and at 60 minutes, the mean intraocular pressure was 17.26+1.853, and the p-value was 0.001. Those having conjunctival reflux negative had mean Intraocular pressure before intravitreal injection 13.44+2.981, p-value 0.0001. Immediately after injection at 0 minutes it was 33.69+5.608, and the p-value was 0.0001. At 30 minutes, it was reduced to 24.51+5.337, the p-value was 0.0001, and at 60 minutes, the mean intraocular pressure was 18.98+2.973, and the p-value was 0.001.
Conclusion: Patients with vitreous reflux positive had less IOP elevation as compared to those with vitreous reflux negative.
Keywords: Intravitreal bevacizumab injection, Intraocular pressure, conjunctival reflux
IgG4-Related Orbital Disease: An Analysis of Patient Profiles, Clinical Presentation, And Histopathological Features
Full text linkObjective: To study various presentations of patients with a histopathologically confirmed diagnosis of IgG4 disease.
Methods: This study is a retrospective review of medical records from the IgG4-RD registry at the Al-Shifa Trust Eye Hospital. Nine patients with orbital manifestations were identified. All had histopathologically confirmed diagnoses of IgG4-RD. Data obtained from the medical records included patient demographic information (name, age, gender), brief patient history, clinical presentation, histopathology reports, and diagnoses.
Results: Most patients presented with proptosis and swelling in various parts of the orbital area. Some patients also presented with pain and diplopia. The most common orbital structures involved were the lacrimal gland and the extraocular muscles, with some patients also having soft tissue involvement. 4(44%) patients had bilateral orbital involvement, while the remaining 5(55%) had unilateral disease.
Conclusion: Ophthalmic involvement is a feature of IgG4-RD and has significant implications regarding the diagnosis, prognosis, and treatment of patients with IgG4 disease
Comparative Analysis In The Treatment Of Myocardial Infarcted Patients In The Tertiary Care Hospital Of Peshawar Against American Heart Association (ASA) Treatment Guidelines
Full text linkAbstract
Objective: To analyze pharmacotherapy provided in the hospital for MI indications and outcomes and to assess the protocols that are practiced for MI patients against the AHA and NICE guidelines.
Methods: This study was conducted from 23rd July 2022 to 13th December 2022 in Cardiology ward of Lady Reading Hospital (LRH), Peshawar, Khyber Pakhtunkhwa, Pakistan. Patients of Myocardial Infarction (n = 240) admitted to hospital during the said period were included in this work.
Results: The results showed that around 77% (185) of male patients suffered from MI as compared to 23% (55) of female patients. In our study only 68% of the patients were kept on aspirin and clopidogrel simultaneously, rest were either only administered aspirin or clopidogrel. The p-value for anti-coagulant and beta-blocker usage was found to be significant as it came out to be less than 0.001 whereas the use of ACE inhibitors was around 0.67, which stated that it was the least important.
Conclusion: MI is as emergency that needs the patients follow up and monitoring and their treatment is administered to the latest and most advanced guidelines whether they are AHA or NICE guidelines. For this a thorough study was conducted on admitted patients in cardiac ward with MI and the drugs data was tabulated. Then studied the different internationally accepted guidelines that are followed by the most advanced hospital in the world ranging from Europe to America.
The data collected showed that the tertiary care hospital of Peshawar do not follow the latest new guidelines. The practicing doctors administered the drugs that were correct almost half decade ago but now new guidelines have overtaken them which leads to improved patients morbidity and decreased mortality
Varied Presentations Of Patients With Systemic Lupus Erythematosus – What Makes Pakistani Lupus Patients Different
Full text linkObjective: This study was conducted to characterize the clinical presentation, results of serological and immunological tests and sociodemographic factors in the Pakistani Lupus population.
Methods: This prospective, cross-sectional study was undertaken at the Clinic for Arthritis and Rheumatic Diseases, Rawalpindi Teaching Hospital, Rawalpindi, Pakistan between January 2020 and June 2023, involving adult patients with SLE (classified based on 1997 revised ACR criteria). Demographic data, clinical and laboratory features, auto-antibody profile, disease duration, treatment history and organ damage (calculated by SLICC/ACR-DI) were recorded for all patients. Descriptive statistics and logistic regression analysis were performed for statistical assessment.
Results: A total of 98 patients (94.9% females and 5.1% males) were enrolled in the study. The mean age of patients was 30.93±11.09 years while the mean duration of illness was 3.27±3.01years. The most commonly observed clinical manifestations were neuropsychiatric systemic lupus erythematosus in 84% of patients and mucocutaneous involvement (photosensitivity, mucosal ulcers, facial rash, alopecia and discoid lupus in 63.92%, 56.70%, 48.45%, 37.11% and 13.40% patients respectively). They were followed by serositis, arthralgias and renal involvement in 60.42%, 33.67% and 25% of patients respectively. Anti-nuclear antibody by indirect immunofluorescence was positive in all while anti-dsDNA was positive in 50% of patients.
Conclusions: Fatigue was the most commonly recorded symptom while Neuropsychiatric SLE was the most commonly observed systemic manifestation in the Pakistani population followed by mucocutaneous involvement, serositis, arthralgias and renal involvement. Reasons for serious manifestations at initial presentation include deficiency of healthcare professionals trained in the field of Rheumatology and lack of awareness among patients.
Keywords: Clinical profile, Systemic Lupus Erythematosus, Clinical and laboratory features, Organ damage, Pakista
An Update on National Consensus Practice Guidelines for the Treatment of Hepatitis C & Literature Review in Epidemiology of Hepatitis C in Pakistan - 2022
Full text linkHepatitis C is a global health problem affecting around 58 million people worldwide and killing almost 0.29 million in on one year [1]. The world has united to fight against this lethal disease in 2016 with a moto to eliminate hepatitis by 2030. To achieve this goal WHO’s World Health Assembly has set some targets and individual countries have developed their own strategies to achieve those targets [2]. Pakistan has the 2nd highest prevalence of hepatitis C in the world with 5.8% viremia positive patients [3]. Pakistan is amongst the few countries that have been assisted by the Center for Disease Control and Prevention(CDC) to prevent and control Hepatitis[4].
With the availability of Direct Acting Antivirals(DAAs), the whole paradigm of treatment of hepatitis C has changed not only globally but also in Pakistan. However, the patients in Pakistan are unable to gain access to the latest DAAs at the pace, as they are available globally. International guidelines are being updated on regular basis as per global evidence, recommending such combinations which are not readily available to many parts of the world. Hence there is a dire need to develop national guidelines, keeping in consideration the efficacy of the drugs as well as their availability, in the broader canvas of achieving the targets of eliminating Hepatitis set by WHO.
In this context, our consensus guidelines are an effort to fill the gap created because of upgraded scientific evidence and possible combinations available in our part of the world. Furthermore, quite some good research and evidence has also been shared in the literature from Pakistan during last five years (2016-2021). Hence a literature review has also been carried out to update our own epidemiologic data, risk factors and treatment responses to Hepatitis C in Pakistan