Journal of Bahria University Medical and Dental College
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An Audit Of Maternal Mortality At Jinnah Postgraduate Medical Centre Karachi
Get PDFObjective: To evaluate the maternal deaths andits causes in a tertiary care hospital.
Materials and Methods: This is an observational analytic study of one year from January 2012 - December 2012, carried out at the department of Obstetrics and Gynaecology Unit 1, Jinnah Post Graduate Medical Centre Karachi.A prospective analysis of one year data comprised of total obstetric admissions, total no of deliveries, live birthsand number of maternal deaths was done.
Results: During the period of one year the total number of deaths certified in the department was 55. During the same year the total number of obstetric admissions and total number of deliveries were 7784 and 6980 respectively. Fifty three(96.4%) maternal deaths were amongst non booked patients.Direct causes were responsible for 70.9% of deaths. Hemorrhage was the direct leading cause and was responsible for 22 (40.2%), deaths. Eclampsia was responsible for 9 (16.4%) deaths. It was the leading cause among all women having their first baby. Ruptured uterus was seen in 3 (5.4%) Patients Three (5.4%) patients died as a result of complications of unsafe abortion. Anemia was the leading indirect cause of death responsible for 14.5% of cases followed by hepatic failure in 6 (10.9%) cases. Two patients died as a result of cardiac disease.
Conclusion: Maternal mortality still remains very high in the tertiary care centers, mainly due to high percentage of referred cases from the periphery brought in moribund condition
Placental gross morphology in gestational diabetes mellitus
No full textObjective: To examine the placental gross morphological features in patients having gestational diabetes mellitus. Materials and Methods: One hundred patients were enrolled following written informed consent. At term the placentae were collected, preserved in formalin. Examination was done for size, shape, consistency, color, membrane completeness, detailed cord examination and for any gross pathology on cut section. The mean was taken out for numerical parameters and percentages were calculated for categorical data using SPSS version16. Results: Mean placental size was 15.98±2.75 cm and 13.58±2.54 cm. The mean placental width was 2.4±0.67 cm, mean weight of placentae was 630±137.4gm. Out of 100, 73 placentae were disc shaped,66 were soft, 85 had complete membrane covering ,59 were pale in color, 66 had central cord insertion and 30 had blue discoloration of the cord.23 had brown lesions, 29 had white lesions and 17 had both types of lesions whereas remaining 35 had no gross lesion. Conclusion :Examination of the placental gross morphology in patients having gestational diabetes mellitus revealed features which necessitates that placenta should be examined in the labor rooms after delivery in GDM patients as it provides important information regarding prenatal life of the new born
Grooming Future Doctors With Research Based Medical Curriculum
Get PDFContent of the medical curriculum is the hottest issuewhich is confronted by most of the educationist, both indeveloped and developing countries. Traditional medicalcurricula were designed in such a vogue that studentshould take benefit of the knowledge of the earlierphysicians and then apply the same to treat his patientwhile stressing on memorization of the differentialdiagnosis, as suggested by the senior physician, basedon their experience. This approach focused on trainingthe future doctors to apply the already searched knowledgein the field without thinking critically about the otherunknown factors influencing the outcome of the treatmentand based on long didactic lectures
Fissure Sealants - Role in Dental Public Health in Context to Pakistan
Get PDFLiterature reports that first molars are the first to be lost due to dental caries in children globally. They also experience greater decay in pits and fissures which are relatively inaccessible to regular oral hygiene aids. Many preventive strategies have been instituted for reducing dental caries in general among children. Pits and fissures caries are difficult to counter by fluoridation alone. The role of pits and fissures sealants in dental public health programs have become significantespecially in children. Such programs have been targeted towards private practice globally in the past. In a country with deprived economic conditions, health care system and low literacy rate the success of such a program is unlikely. This articlehighlights the significance of caries prevention in general and the role of fissure sealants in dental public health programs in particular. Limitations of such programs and possible solutions to have a greater impact on prevention through sealants in a cost effective manner in context to local circumstances are also mentioned
Guide Line for Item Writing by National Board of Medical Education Problem-Based Learning and use of Case Clusters
No full textAn increasing number of medical schools have adopted problem-based learning (PBL) as aninstructional strategy for portions of the basic science curriculum. Although each school’sapproach to PBL is somewhat unique, all involve the use of written patient cases (problems) inbasic science instruction. Problems are designed to stimulate learning of material from traditionalbasic science disciplines (e.g, anatomy, physiology, biochemistry) from a clinical perspective,and application of basic science principles to clinical situations is stressed. Material is typicallycovered through independent study and discussed in small groups with a faculty tutor
Physical Examination Of Arteriovenous Fistula: A Basic Approach In AV Fistula Stenosis Detection
Get PDFObjectives: To determine the accuracy and equivalence of physical examination, MDCTA and Doppler ultrasound in detection of arteriovenous fistula (AVF) stenosis.
Materials and Methods: We conducted a pilot study in hemodialysis department of PNS Shifa withprospective diagnostic cohort design on 15 patients, referred for evaluation of arteriovenous fistuladysfunction. Physical examination of arteriovenous fistula was done followed by Doppler ultrasound and MDCTangiography.The results of each patient was recorded and sealed. Data analyzed byCohen's Kappa, which determined the level of agreement between the diagnosis made by Physical examination, MDCTangiography and Doppler ultrasound .
Results: There was significant agreement in AVF stenosis detection made by physical examination and MDCTangiography (K: 0.865 for inflow stenosis and K: 0.602 for outflow stenosis).Whereas moderate level of agreement was observed between physical examination and Doppler ultrasound (K: 0.471 for inflow stenosis, K: 0.444 for outflow stenosis). Fair agreement existed between MDCTA and Doppler ultrasound in outflow stenosis detection.
Conclusion: Physical examination is accurate and equivalent in AVF stenosis detection when compared with MDCTangiography and superior in stenosis detection when compared with Doppler ultrasound in our hospital. Doppler Ultrasound is inferior to MDCTA in diagnosis of outflow stenosi
Grip Strength Test A Simple Functional Adjunct Tool for Rheumatoid Arthriris
No full textObjective: To evaluate the usefulness of Grip Strength Test as an adjunctive tool for patients having rheumatoidarthritis.Materials And Methods: A twenty four (24)-week, single-blind, interventional, prospective study was carriedout from October, 2009 to March, 2011 in 126 patients of either sex, between 19-64 years of age. They werediagnosed to have rheumatoid arthritis according to the American College of Rheumatology Criteria. They weregiven tablet Methotrexate, 10 mg (4 tablets of 2.5 mg, orally) weekly for six months. Grip strength wasmeasured by pneumatic method. Patients were made to compress a locked, aneuroid, sphygmomanometer cuff,inflated to 20 mm of Hg, in their palms. The level of pressure reached was recorded as a measure of gripstrength.Results: All patients had morning stiffness, symmetric arthritis, soft tissue swelling and arthritis of hand joints.Baseline values of Hb, TLC, ESR, PC, CRP, serum creatinine and SGPT were 10.76 +1.12g/dl, 8572.06+1445.08 per cubic mm, 81.03 +17.98 per cubic mm, 290,277.78 + 68,813 per cubic mm, 2.33 + 0.69microgram/dl, 0.95+ 0.16 mg/dl, and 31.67 + 7.37 IU/L respectively. Grip Strength increased from a baseline of71.10 mm of Hg to 154.04 mm of Hg in the right hand and from 70.58 mm of Hg to 151.53 mm of Hg in the lefthand, both values being significant statistically [p< 0.001].Conclusion: Grip strength test is a useful, simple, effective, functional, adjunct tool for assessing patients’sresponse to therapy in rheumatoid arthritis
Ageing ovaries and endometrium in PCOS
No full textObjective: to measure the outcome of age on ovarian and uterine morphology in women with primary infertility due to polycystic ovarian syndrome (PCOS) Materials and Methods: It was an observational cross sectional study. Two hundred primary infertile women with PCOs were subdivided into age groups (years) 20-30 (group I) and 31- 40 (group II). The ovarian volume (OV), follicles count (FC) and size (FS), uterine area (UA) and endometrial thickness (Endo) were determined by trans- abdominal (TAS) and trans -vaginal scan (TVS) using the ultrasound machine. Unpaired t-test was applied to evaluate the result Results: Comparison between group I and group II was made to evaluate the outcome. A significant raise was noted in the uterine morphology of group II. The UA was 89.99±5.83 v/s 119.0±23.33 (0.001) and endometrial thickness was 0.48±0.11 v/s 0.59±0.13 (0.001). A significant decline was noted in the ovarian morphology of group II; the OV (TAS) was 15.36± 2.56 v/s 10.57±12 (0.001) and TVS showed 15.74±2.23 v/s 10.37±1.08 (0.001). The FC was 14.05±1.56 v/s 12.47±0.89 (0.022) and FS was 9.45±7.98 v/s 4.33±5.88 (0.00). Conclusion: The OV, FC and FS (ovarian morphology) variables decreases in the elder infertile group with PCOs but the uterine morphology variables showed an increase in area with thickening of endometrium in the elder group
Placental Morphology And Feto-Maternal Outcomes In Gestational Diabetes
Get PDFObjective: To observe the placental morphology and feto- maternal outcomes in patients having gestational diabetes mellitus. Materials and Methods: In this descriptive pilot study placentae were collected from 20 patients having gestational diabetes. They received oral and or parenteral drugs along with diet control and exercise during pregnancy. After verbal informed patients, placentae were collected within 30-40 minutes of delivery and preserved in formalin. Gross examination was done including weight, size consistency of placental tissue, attachment, size and color of the cord, membranes complete or incomplete, retro-placental hemorrhages and any other gross abnormality in the placental tissue. Weight and health of the baby and mode of delivery were observed as determinants of fetal and maternal outcome.
Results: Mean placental size was 18.3±3.22 cm and 14.2±2.14 cm in two dimensions with mean placental width of 2.4±0.94 cm. Mean placental weight was 680± 122.9 grams, mean cord length was 19.55±7.22 cm and mean cord width 1.17±0.51cm. Out of 20 placentae, 13 placentae were disc shaped, 19 placentae were soft in consistency, 8 were blue in color, 7 had central insertion of umbilical cord, 14 had complete membranes and 16 had other gross pathologies such as hemorrhages, fibrinoid necrosis etc. Weight of the baby was 3.4±0.38 kg. There was 1 intrauterine death and out of 20 patients 13 had cesarean deliveries.
Conclusion: Gross morphology of placenta exhibited deformities with adverse fetal and maternal outcomes in patients with gestational diabetes mellitus
Key words: Gestational Diabetes Mellitus, Placenta, Placental morphology, Fetal outcome, Maternal outcom
Dens Invaginatus Literature Review
Get PDFDens invaginatus is a developmental malformation of the tooth germ which originates as a result of the infolding of the enamel organ. It has been expressed as a ‘tooth within a tooth’ or ‘dens in dent’ or as an invagination of an enamel-lined tract extending into the root at a various depth, with or without involvement of the dental pulp. Search engines as Pak-Medinet, Pub Med, Medline and Google scholar were used to search literature about this abnormality. Dens invaginatus has complicated root canal morphology and the etiology of this developmental abnormality is still ambiguous. Possible causes include trauma, infection, development retardation of specific cells, interruption in factors regulating the development of enamel organ, and associations to genetic factors. Clinical features, radiological findings (periapical, occlusal radiograph, 3-dimensional imaging system CBCT) and surgical operating microscope help the clinician in classifying the morphology of the dens so that correct treatment planning and management alternative can be chosen. The treatments choices consist of; preventive sealing, restoration of the invagination, endodontic management, apical curettage and surgical endodontic, planned replantation and removal of tooth