Journal of Gandhara Medical and Dental Science
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Efficacy of Tranexamic Acid in Reducing the Blood Loss During Cesarean Section in Primigravida Patients with Breech Presentation
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The objective of the study was to evaluate the efficacy of tranexamic acid in decreasing blood loss at the caesarian section (CS).
METHODOLOGY:
A descriptive case series study was conducted in the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, Pakistan. Data were collected from September 24, 2018, to March 24, 2019. A total of 114 term women (18-35 years age) with singleton term breech cases were analyzed for a period of six months
RESULTS:
In this study the mean age was 30 years with SD±2.341 and the mean period of gestation was 38 weeks with SD±4.76. Moreover, tranexamic acid was effective in 91% of patients and was not effective in 9% of patients.
CONCLUSION:
Our study concludes that the efficacy of tranexamic acid was 91% in reducing the blood loss during CS in primigravida patients with breech presentation
Comparison of Outcomes of Topical Anesthesia with Peribulbar Anesthesia in Vitrectomy for Unresolving Vitreous Hemorrhage
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To compare the Surgeon's ease level and duration of surgery in topical anesthesia with peribulbar anesthesia for vitrectomy without sedation in patients with unresolving vitreous hemorrhage of duration greater than 3 months.
METHODOLOGY:
A randomized controlled trial was carried out at the Department of Ophthalmology, Lahore General Hospital, Postgraduate Medical Institute, Lahore from October 2017 to September 2018. A total of 110 patients were equally divided (n=55) in group A (topical anesthesia) and group B (peribulbar anesthesia) by lottery method. In group A, 0.5% proparacaine hydrochloride eye drops were instilled into the conjunctival sac every 3 minutes preoperatively 5 times before surgery. For group B patients, 5cc injection consisting of 2.5ml of 0.5% bupivacaine and 2.5ml of 1% lidocaine was injected thirty minutes before surgery. Surgical time was noted from first incision to enter the eye for vitrectomy till application of last closing suture. Surgeon ease was recorded with a 4 Grade scale. All data was recorded, entered, and analyzed by SPSS version 25.0. Continuous variables were presented as mean, standard deviation and independent t-test was applied.
RESULTS:
The mean age of the patient was 43.83±9.76 years. Male cases were 78 (70.9%) and female cases were 32 (29.1%). Mean duration of surgery was 30.32±7.07 minutes and the surgeon’s ease was 2.30±0.98. There was a significant difference (P<0.05) with respect to mean duration of surgery and surgeon’s ease level in patients who were given topical anesthesia (28.12±6.57 minutes and 3.11±0.90) versus peribulbar anesthesia (32.52±6.92 minutes and 2.67±0.90).
CONCLUSION:
Topical anesthesia without sedation is better than peribulbar anesthesia for vitrectomy without sedation in patients with unresolving vitreous hemorrhage of duration greater than 3 months
Universal Health Coverage; A Way Forward
Get PDFUniversal health coverage means every person has access to quality health care without suffering financial hardships. The basis of universal health coverage lies in the primary health care concept, which was envisioned way back in 1978, as mentioned in Alma Ata Declaration1. The "World Health Report" published by the World Health Organization (WHO) in 2008 structures primary health care reforms in four groups. One of the crucial reforms was universal coverage reform to improve health equity2. WHO and UNICEF in 2018 documented how primary health care will be in the 21st century? The approach was towards universal health coverage and sustainable development goals. Sustainable development goals were to be achieved by 2030, and they were a continuation of millennium development goals 2000–20153. The resolution on Transforming our world: the 2030 Agenda for Sustainable Development adopted the target of universal health coverage by 2030, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all4. Currently, many developing nations do not have access to health services. About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. To make health for all, we need individuals and communities to have high-quality health services to take care of their families health. Skilled health workers providing quality, people-centred care and policy-makers should be committed to investing in universal health coverage. Universal health coverage should be based on intense, people-centred primary health care. Good health systems are rooted in the communities they serve. They focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life5. Pakistan, the developing country, is struggling to provide good quality health services, mostly availed from the out-of-pocket expenditure.
Both private and public sector hospitals were trying to deliver health services, but poor people failed to have access to many services due to poverty. To overcome this obstacle and address indicator 3.8 of SDGs, the current government developed a five-year program to improve the targeted population's health by increasing their access to quality health services. The initiative will also reduce poverty, as the government will cover most of their health budget through the "Sehat Sahulat Program". The program was part of the National vision to ensure Universal Health Coverage (UHC) for all Pakistani families. No one is denied quality healthcare services only because of financial constraints. Initially, it was piloted in selected four districts of Khyber Pakhtunkhwa, which was later extended to all over the province. Currently, 7.2 million families are getting free in-patient health care services, and the program's annual cost is 18 billion. It was a bold initiative of the current government, which helped improve access to UHC, thus addressing one of the sustainable development goals6,7.  
Frequency of Complications Following Cataract Surgery in Diabetic Patients at Tertiary Care Hospital
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To determine the frequency of complications following cataract surgery in diabetic patients admitted in the ophthalmology unit.
METHODOLOGY:
A prospective descriptive interventional case series study was conducted after approval of the ethical committee, from June 2017-June 2020 at the Ophthalmology department MTI-MMC. A total of 129 patients from either gender were enrolled in study. All the study patients went through detailed history and complete ocular examination. After necessary investigations, surgical procedure was carried out. Results were analyzed through the SPSS-24 version.
RESULTS:
Out of the total 129 eyes of the diabetic patients, fifty-nine (45.7%) were males and seventy (54.3%) were females with a ratio of 1:1.2. Uveitis leads the chart in complications found in twenty (15.50%) eyes while PODR being the least common found in only ten (7.75%) eyes. Worse visual acuity was observed in fourteen (10.85%) eyes. Striate keratopathy and posterior capsule opacification were found in sixteen (12.40%) and fifteen (11.62%) eyes respectively. Among the patients, 15.7% were having more than one complication during follow-up visits and eighty-eight (68.2%) eyes were found to have none complication. The age group 51-60 years observed frequent complications as compared to other groups. Similarly female gender (38.57%) has frequent complications as compared to males (2.7%).
CONCLUSION:
The study concludes Uveitis as the most common complication observed in 15.50% 0f the eyes while worse visual acuity (10.85%) and progression of diabetic retinopathy (7.75%) being the least common. Striate keratopathy was found in 12.40% while posterior capsule opacification in 11.62% of the eyes
Diversity of Mosquitoes Collected from the Southern Areas of Khyber Pakhtunkhwa Pakistan
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The objective of the study was to assess the diversity of mosquitoes in various towns of the southern belt of KPK.
METHODOLOGY:
This was a descriptive study that was conducted in numerous towns of Western belt of Khyber Pakhtunkhwa. The study areas were Darra Adam Khel, District Kohat, District Karak, District Banu, District D.I. Khan and newly merged districts Mir Ali and Miranshah. From each study site, the samples were collected randomly. The sample collection was done through survey and area visits whereas; the identification process was done in a parasitology laboratory of Hayatabad-Peshawar. Sampling was done from June 2016 to May 2017.
RESULTS:
A total of 2150 adult mosquitoes were gathered and collected from 42 different locations of the southern belt of KPK and were identified. Based on their identification, 5 genera of the mosquitoes were recognized which were Culex, Anopheles, Psorophora, Aedes and Uranotenia. Culex was found to be most dominant in all the visited areas with a percentage of 12.65 in Miranshah followed by 11.81 in Mirali, 7.16 in Karak, 6.88 in Darra Adam Khel, 6.69 in D.I.Khan, 6.41 in Kohat and 5.11 in Bannu respectively. The results of our findings also revealed the presence of Culex genera in all the habitats and remained the dominant genera among the others followed by Anopheles and Psorophora. Aedes was found in the habitat of plants and grasses etc. whereas Uranotenia was found in marsh/swampy areas as well as in plants/grasses habitat only.
CONCLUSION:
The outcomes reveal that a climate shifting and extensive urbanization process is enforcing the diversity of mosquitos’ fauna in the southern belt of KPK
Frequency to Non-Compliance to Oral Iron Therapy in Pregnancy and Common Factors Leading to it
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The objective of this study was to determine frequency of non-compliance to oral iron therapy in pregnancy and common factors leading to it.
METHODOLOGY:
It was a cross-sectional study done in the Department of Obstetrics and Gynecology of Lady Willington Hospital Lahore, Pakistan. The duration of this study was six months i.e., 3rd October 2019 to 2nd March 2020. All antenatal patients between ages of 18 to 45 years presented in the obstetrics outdoors or admitted in the ward were included in this study. A total of 245 patients were included in this study by consecutive non-probability sampling. Patients with gynecological problems, patients dependent on others for their medication cost, patients with psychiatric illness or physical disability were excluded. Post stratification Chi-square test was applied keeping P-value ≤0.05 as significant
RESULTS:
Among 245 patients, mean age was 27±2.16 years. Iron supplement used by 245 patients was analyzed as 159 (65%) patients had used the iron supplement while 86 (35%) patients didn’t use iron supplements (P-value 0.001). Iron supplement used by 245 patients was analyzed and only 93 (38%) patients had used the iron supplement while 152 (62%) patients didn’t use iron supplements.
CONCLUSION:
The coverage of antenatal iron and folic acid supplements is very low in the surveyed districts of Pakistan due to lack of parental education and older aged women belonging to poor households
Frequency of Genital Tuberculosis in Patients Undergoing Diagnostic Laparoscopy for Infertility
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To determine the frequency of genital tuberculosis in patients undergoing diagnostic laparoscopy for infertility.
METHODOLOGY:
It is a descriptive (cross-sectional) prospective study. The study was performed within the duration of six months i.e., February 12th, 2020 to August 12th, 2020 at the Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar. A total of 196 patients were observed by using 47.1% proportion of genital tuberculosis in infertility, 95% confidence interval with margin of error 7%, using software of WHO for sample size calculation. Further, sample collection was performed using non-probability (consecutive) sampling techniques.
RESULTS:
The mean age of the patients in our study was 30 years (SD+3.92). Fifty seven percent of cases were having primary infertility and 43% of patients were having secondary infertility. The incidence of genital tuberculosis undergoing infertility was 45%.
CONCLUSION:
Our study concludes that the incidence of genital TB in infertility in our setup was 45%
Comparison of Constrained Induced Movement Therapy and Bimanual Training on Functional Outcome of Hemiplegic Cerebral Palsy
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The aim of this study was to compare the effects of constrained induced movement therapy (CIMT) and BimanualIntensive Training (BIT) on functional outcomes of hemiplegic cerebral palsy children.
METHODOLOGY
Cerebral palsy children with age groups of 5 to 12 years were included with a total sample size of 38. Simplerandom sampling was done, and data was collected from Islamabad. Two groups were formed and named groupA: constrained induced movement therapy with 19% and group B: bimanual training with 19% respectively. Thefunctional outcome for the CIMPT and for the BIT group was assessed on the pretest and post-test scoreevaluation of QUEST and JTHF tests.
RESULTS
Statistically significant (p <0.05) improvement was found in The Quality of Upper Extremity Skills Test (QUEST)and Jebsen-Taylor Test of Hand Function (JTHF) in the between -group analysis. For within the group analysisthe p-value <0.05 suggests that there was a significant diffe rence in within-group analysis too. The values forgrasp and dissociated movements suggest that QUEST post-test values are impactful in the CMIT group whereasin the BIT group simultaneous and spontaneous movement was increased but JTHF post -test values were moresignificant in CMIT.
CONCLUSION
BIT is more beneficial for both hand’s simultaneous and spontaneous movement, whereas CMIT is morebeneficial for grip and overcoming the “learned-nonuse” phenomena in cerebral palsy children
Source of Bleeding and Per-Operative Findings in Extradural Hematoma (Edh): A Three-Year Experience in Lady Reading Hospital Peshawar
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The purpose of this study was to analyze the main source of bleeding and operative findings in an extradural hematoma (EDH).
METHODOLOGY:
This study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar. The sample size of the study was analyzed through WHO sample size calculator and 300 diagnosed patients were recruited by purposive sampling technique. Ethical approval was taken from the College of Physicians and Surgeons Pakistan (CPSP) and the hospital’s ethical committee. By using the SPSS version 23.0, all the collected data were analyzed.
RESULTS:
The mean age of enrolled patients was 27.96±12.71 years. There were 65.7% male and 34.3% female. The most common age group was 21–30 years followed by 31 to 40 years and 11 to 20 years with the most common source of bleeding was middle meningeal artery, 39.7% of patients fall in the temporal parietal category.
CONCLUSION:
Middle meningeal artery is the most common source of bleeding in EDH. Therefore, proper management of this vessel is significant to avoid the chances of re-bleed and re-do surgeries.
A Rare Case of Pneumoperitoneum due to Perforation at Tip of Appendix
Get PDFPneumoperitoneum caused by a perforated appendix is extremely rare. We encountered a case of a 24 years old male presented in the emergency department of EAST surgical ward of MAYO Hospital Lahore with a history of epigastric pain for 10 days, which later became generalized. Chest X-ray showed free air under the right hemidiaphragm. On the basis of clinical examination and radiological correlations diagnosis of duodenal ulcer perforation was made. On exploration of abdomen through midline incision it was found to be a perforated appendix at its tip. The body and base of the appendix was normal. No per operative and postoperative complications were encountered and the patient discharged on the second postoperative day. Biopsy of appendix showed acute inflammation of appendix