Volume 3 Issue-2 Apr-June,14

The Myers-Briggs Type Indicator (MBTI) is a personality assessment test that measures the psychological preferences of different people and helps them identify their strengths and limitations, interests and satisfaction to make right choices. The history of MBTI is unique and interesting, it was inspired by the work of Carl Gastav Jung, a Swiss psychiatrist who proposed psychological types theories which described how people are innately different both in terms of how they perceive and take in information and how they make decisions. The MBTI instrument was initially designed by Katharine Cook Briggs and her daughter Isabel Briggs Mayers after their research on their work on different personality types theories…

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Background:

Many conditions related to appendix present as appendicitis. These conditions can range from fecolith obstruction to tumors .Carcinoid tumors are most common tumors to present in appendix. Most of the carcinoid tumors in appendix present as appendicitis. Majority of the cases are diagnosed after histopathological examination, with 90% of the tumors measuring smaller than 1 cm with excellent prognosis after appendectomies. Tumors with the size of 2cm are treated with right hemicolectomy.

Objective:

To determine the frequency of carcinoid tumors in appendectomies using histopathological data.

Methods:

This was a retrospective study conducted at Ziauddin University Hospital, Nazimabad for a time period of 7 years from March 2005 to December 2012. 2,157 appendectomies were analyzed, out of which 13 appendectomy specimens were diagnosed as carcinoid tumors. Incidental and negative appendectomies were excluded from this study.

Results:

0.60% of the appendectomy specimens were diagnosed as carcinoid tumors (n=13), male to female ratio was (5.5:1), 77% (n=10) of the tumors were up to 1 cm in size and 23% (n=3) of the tumors were of 1.5 cm in size. Majority of the tumors (n=9) had well differentiated cell types. 77% of the tumors were localized to the tip of the appendix, 15% of the tumors spread locally to the distal half of the appendix and 8% spread to the mesentery.

Conclusion:

Carcinoid tumors of the appendix, mostly present as appendicitis in early stage. While 90% of the cases show excellent prognosis with appendectomy, 10% of the cases might need further management.

Key Words:

Carcinoid Tumors, Appendix, Appendicitis, Appendectomy, Right Hemicolectomy.

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Background:

The presence of around 12 or more follicles in one or both ovaries with diameter ranging from 2-9mm is known as polycystic ovaries (PCO). This condition is associated with hyperandrogenemia and is one of the most common causes of infertility. Due to increase in use of ultrasonography as a diagnostic tool, more cases of PCOs are being timely reported. This has also lead to diagnosis of PCO in younger age group.

Objective:

To measure the effect of age on ovarian and uterine morphology in infertile women with polycystic ovaries (PCO).

Methods:

The cross sectional study was conducted in Karsaz Hospital, Karachi from January 2010 to March 2011. One hundred 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 ultrasonography. Unpaired t-test was applied to analyze the result.

Results:

The ovarian morphology showed a significant decrease in group II; the OV transabdominally was 14.26± 2.42 vs 10.56±1.0 (0.00) and transvaginally 14.93±2.55 vs 11.75±1.06 (0.00). The FC was 14.00±1.60 vs 12.3±0.78 (0.023) and FS was 8.23±8.9vs 3.29±6.9 (0.00). The uterine morphology however showed a significant increase in group II. The UA was 87.79±5.83 vs 118.71±22.83 (0.00) and endo was 0.46±0.10 vs 0.57±0.12 (0.00).

Conclusion:

Ovarian morphology variables include OV, FC and FS decrease in the older infertile group of women with PCOs but the uterine morphology variables showed an increase in area with thickening of endometrium in the older group. The association of endometrium and PCOs has not been reported in this part of the world and the study is an attempt to fill this gap and prevent misdiagnosis of endometrial cancer.

Key Words:

Polycystic Ovaries, Infertile, Ovarian Volume, Follicle Count, Follicle Size, Uterine Area, Endometrial Thickness.

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Background:

Osteporosis is increasingly observed as a major public health concern as it leads to poor quality of life, pain and often disability for those effected. Especially in the developing countries, its prevalence in alarming in the face of poor awareness and management.

Objective:

To assess the risk factors for osteoporosis in females coming to a tertiary care hospital of Karachi.

Methods:

This was hospital based case control study conducted in a private tertiary healthcare facility of Karachi. It was carried out in 2012. 57 cases and 60 controls were selected through WHO Sample size calculator. Matching among cases and controls was based on gender, socioeconomic status and age group. Data was collected through questionnaire based personal interviews. Data entry and analysis was done using Epi Info. Association between categorical variables was found using chi square. Odds ratio was calculated for finding association between different risk factors and osteoporosis. The study was cleared through the Ethical review board.

Results:

One hundred and seventeen cases and controls were taken in this study with the age range of 45+ years (mean age 56.8 ± 11.8). Statistically significant difference was found in under 50 age group where cases were only n=8 (14%) as compared to controls n=25(42%). Parsi ethnicity showed strong association with osteoporosis (OR 2.23). Strong association was observed between smoking and osteoporosis with an Odds Ratio of 4.0. Strong association was observed with Rheumatoid arthritis (OR 2.8, CI at 95% 1.2-6.3) and Calcium deficiency (OR 2.2, CI at 95% 1.1-4.7).

Conclusion:

The study revealed specific to Parsi ethnicity, family history, smoking, rheumatoid arthritis and Vitamin D deficiency were found to be potent risk factors. Therefore as reaffirmed from our study also, risk factors except from the non modifiable ones should be tackled well in advance through health education and interventions.

Key Words:

Osteoporosis, Rheumatoid Arthritis, Bone Density

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Background:

Caesarean section rate as a mode of delivery has been increasing in the recent years despite the three fold increased risk of mortality compared to vaginal deliveries. This study is conducted to determine the mode of deliveries and their maternal and fetal outcome.

Objective:

To determine the maternal and perinatal outcome in women having a VBAC (Vaginal Birth after Cesarean Section) and to assess the safety of VBAC.

Methods:

A total of 206 pregnant females fulfilling the inclusion criteria were selected via consecutive sampling. Patients with previous 1 LSCS were observed for outcome. This study was conducted at Department of Obstetrics and Gynecology, Ziauddin Hospital, Kemari Campus, Karachi employing case series over a period of one year.

Results:

Of the 206 patients 72.8% delivered vaginally. Of these 60% of the patients with VBAC had no maternal or perinatal complication while 27.8% has failed trial of labor and had emergency caesarean section due to different reasons .Approximately 13.6% of patients had impending uterine rupture while undergoing VBAC trial needing emergency LSCS with 1% complicated by scar rupture, 4% developed scar tenderness leading to emergency LSCS, 1% resulted in vaginal hematoma and 1% with cervical tear.The perinatal outcome in VBAC was a NICU admission of 6.9%; Meconium stain liquor: 6.8%; Fetal distress 1.9% and no perinatal death.

Conclusion:

is safe & good modality to reduce caesarean section rate and should be offered and conducted under close monitoring and is successful with few maternal and perinatal complications.

Key Words:

Caesarean Section, Fetal Outcome, VBAC.

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Background:

Thyroid gland volume (TGV) is highly variable as it is greatly influenced by age, gender, anthropometric measurements and geographical location. It has become essential for every population to determine reference range of their normal thyroid gland volume (TGV) in healthy individuals. This in turn will help the population in grading of goiter and will guide in large scale iodine monitoring programs.

Objective:

To determine TGV in a subset of Karachi population and to determine its association with age and gender.

Methods:

A cross-sectional study employing 421 volunteers aged 21 years and above went through the ultrasound (US) examination of their thyroid gland (TG) after being confirmed euthyroid by their serum thyroid stimulating hormones (TSH) evaluation.

Results:

TGV in the study was found to be 6.26 ± 2.89 ml. Males had significantly higher TGV 6.78 ± 2.88 ml as compared to females 5.7 ± 2.79 ml (P=0.00). Volume of right lobe was significantly greater than that of left lobe (P=0.00) in both the genders. TGV increased significantly with age till 60 years (P<0.05) and after the age of 60 years it decreased (P=0.035)..

Conclusion:

Mean volume of thyroid gland in this studied population is not only smaller than that of the Western countries but is also much smaller than the neighboring country Iran. The study has also proved that there was a significant decrease in mean thyroid gland volume after the age of 60 years. Prolonged and severe iodine deficient status of Pakistan till recent past could be an answer for small thyroid gland volume in the studied population. Similar studies in future will give more accurate facts and figures regarding mean thyroid gland volume in this population if Pakistan retains itself as an iodine sufficient State.

Key Words:

Thyroid Gland, Ultrasonography, Reference value, Goiter, Thyroid Hormones, Iodine.

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Background:

The role of vitamin D, a steroid hormone that exerts most of its biological activities by binding to the vitamin D receptor, in health and disease is far from understood and the literature is full of contradictory findings. Still, evidence that vitamin D is capable of modulating several features of cancer exist.

Objective:

To correlate changes in breast tissue with low serum levels of Vitamin D(Vit D) in females during their reproductive years.

Methods:

This study was conducted in the department of Anatomy, Ziauddin Medical College, Karachi and data collected from the department of surgery, Patel Hospital, Karachi in patients undergoing biopsy of the breast lump, between February 2012 and February 2013. 90 patients with diagnosis of breast lump, between 25-40 years of age, with parity varying from 1-5 were divided into 2 groups, those with serum Vit D levels in the normal Range(group A) and those having marked deficiency of serum Vit D levels(group B). Detailed histological study of the biopsy specimen was conducted in all the patients.

Results:

Patients who had a marked deficiency of serum vitamin D levels, had more proliferation of stromal connective tissue in group B whereas in group A patients, minimal proliferation of connective tissue was observed in H and E stained slides under the light microscope.

Conclusion:

It seems clear that Breast Cancer prevention includes maintaining adequate Vitamin D levels by using oral vitamin D supplementation and with prudent exposure to sunlight.

Key Words:

Breast Lump, Vitamin D, H and E Stain, Serum 25(OH) D, VDR, MAARS Protein.

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Background:

Diarrhea is cited as one of the main causes of death for infants and children, especially in squatter settlements, owing to poor sanitary conditions. Treatment and prevention of diarrhea can be managed at home by primary caregivers. It is therefore important for mothers and primary care givers to be aware of strategies for management and treatment of diarrhea.

Objective:

To assess the awareness of mothers regarding home management of childhood diarrhea in a squatter settlement of Karachi.

Methods:

A cross sectional study was conducted from 2012 to 2013 among mothers from Gulshan-eSikanderabad of Karachi who had at least one child under age of 5years. In total 110 mothers were interviewed. Non probability convenience sampling technique was used. Data was collected by structured questionnaire filled via personal interview. Informed consent was obtained before collection of data. Data Analysis was done by using SPSS version 20.

Results:

Out of total 110, 93 (84.5%) mothers said that their children had an episode of childhood diarrhea during last 3 months. For the management of diarrhea 91 (82.7%) mothers took their children to PHC centre and 99 (89.9%) mothers were aware about ORS. Almost two third of them aware about the ingredients of homemade ORS but their knowledge about correct amount was poor. Dirty water and food was identified as the important causes of diarrhea by 106 (96%) and 76 (69%) mothers respectively. According to 101 (91.8%) mothers hand washing would be an effective measure to prevent diarrhea.

Conclusion:

Despite the high rate of diarrhea in this community, knowledge of mothers regarding home management of diarrhea was found satisfactory. Adopting the preventive measures and intensifying the mothers education is the dire need to reduce the high rate of diarrhea in this community.

Key Words:

Childhood Diarrhea, Home Management, Awareness and Practices of Mothers, Squatter Settlement.

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Introduction:

Hands-on postgraduate training on techniques are the foundation of professional development in research. The medical professionals generally show resistance towards learning laboratory techniques especially related to molecular biology. A hands-on workshop was designed for post graduate candidates, to overcome their inhibitions and develop proficiency at research based molecular techniques.

Key Words:

Postgraduate Training, Biomedical Research, Medical Education.

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Abstract:

According to regulatory guidelines, Fresh Frozen Plasma expires within 24 hours of thawing. Therefore, if transfusions are delayed or cancelled, FFPs are often wasted. The coagulation factor activity of thawed plasma was extensively researched and it was determined that most of the factor activity maintained its efficacy for four days after thawing making it usable with equivalent clinical results. Although derived from FFP, the composition of this product differs slightly and so, the AABB introduced this product as a separate entity called Thawed Plasma. In the US, many blood banks have been using Thawed Plasma interchangeably with FFPs. This not only increases the inventory of plasma products but also eliminates thawing time, providing faster patient care. There are still some concerns regarding transfusing neonates and liver failure patients, but for the majority of surgical patients or those with elevated INRs, Thawed Plasma is an acceptable alternate to FFP. This manuscript reviews attributes and benefits of thawed plasma and its approval by various recognized authorities.

Key Words:

Fresh Frozen Plasma, Warfarin Effect, Extended Life Plasma.

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Abstract:

Uterine leiomyoma’s are noncancerous growths of the uterus1 and represent the most common benign tumors of the female reproductive tract. Fibroids affect 20-50% of women of reproductive age, while its presence in the adolescent population has not been well documented. The etiology of uterine fibroids is unclear; however, their growth is regulated by ovarian steroids, and growth factors. Multiple uterine leiomyoma’s represents a great challenge for diagnosis and therapy. Several new therapies show promise, but are still at the experimental stage.2 This report illustrates the case of a 22 year old woman presenting to the gynecology department with an 8-month history of progressively increasing abdominal size associated with pain. There was no history of nausea, vomiting, weight loss, loss of appetite or menstrual irregularities. Physical examination and ultrasound pelvis suggested multiple enlarged uterine fibroids. A myomectomy was performed and multiple fibroids were resected weighing 4.5kg. The patient’s postoperative evolution was uneventful and she was discharged from the hospital on the fourth postoperative day.

Key Words:

Multiple Uterine Leiomyoma’s, Myomectomy, Ovarian Steroids.

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