Prof. Ghazala Mahmud - Academia.edu (original) (raw)
Papers by Prof. Ghazala Mahmud
Pakistan Armed Forces medical journal, Jun 28, 2024
Cervical cancer remains one of the leading causes of cancer-related deaths among women. Worldwide... more Cervical cancer remains one of the leading causes of cancer-related deaths among women. Worldwide about 500,000 new cases are reported every year. Of these, 300,000 end up in mortality. Almost 80% of these cases occur in low-resource countries. 1 Cervical cancer has been found to be the most prevalent malignant neoplasm among women in developing countries. 2 In Pakistan researched evidence puts 3.6% of total female cancers to be of cervical origin, affecting women mainly in fifth and sixth decades of life. 3 Incidence and mortality related to cervical cancer are both declining in developed countries because of effective screening programmes through Papanicolaou (Pap) smear. 4,5 The test is successful in detection of precancerous lesion as well as early stage of cervical cancer and is widely used in developed countries. 6,7 The pap smear screening is not replicable in developing countries because of its cost, scarcity of trained cytopathologist and multistage nature of the procedure. These potential difficulties in cytology-based programme have prompted the investigations of alternative low-cost screening technology such as visual inspection with acetic acid (VIA). The result of VIA is immediately available and does not require lab support. Numerous studies have been conducted on its accuracy and its ability to detect precancerous cervical lesions when compared with Pap smear. The outcome evaluation of these studies indicate that sensitivity of VIA ranges from 66% to 96%, and specificity between 64% and 98%. 6-10 Authors comparing cytology with VIA have concluded that overall usefulness of VIA compares favourably with Pap test. Majority of these are conducted in primary healthcare facility and thus are not applicable to tertiary care hospitals. 11 VIA was introduced in the Maternal and Child Health Centre (MCHC) at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, in 2006 as a cervical screening tool. However, the test is being used in conjunction with Pap smear and has not yet been able to replace the Pap test due to lack of controlled trials. This study was conducted to determine the potential of VIA to supplement or replace Pap smear at our tertiary care hospital where all modalities, including Pap smear and colposcopy, are available and yet majority of patients are lost to followup
Update Dental College Journal, Sep 27, 2018
Purpose:The Pediatric Outpatient department (POPD) of a dental hospital deals with children with ... more Purpose:The Pediatric Outpatient department (POPD) of a dental hospital deals with children with different tooth related complaints. Dental treatment of a child patient requires three way interactions between the child, the parent and the dental surgeon. Though health of the patient remains the top priority for caregivers, satisfaction with the delivery system is vital for long lasting doctor-patient relationship. Thepurpose of the study was to evaluate the performance of Pediatric OPD by the accompanying parents of children receiving treatment at the OPD of a private dental college hospital. Methods: A cross sectional study was carried out at the POPD of Sapporo Dental College Hospital, Uttara Model Town of Dhaka city during May-July 2017. Sampling was done by simple random sampling method .Data were collected from the parents of 122 children aged between 1-12 years by using a self-administrated questionnaire. Results: Majority of the participating parents were residents of Uttara Model Town or areas in the vicinity and were employed, educated and are middle are middle socioeconomic class. More than sixty percent (62.3 %) of the respondents were parents of children between 4-7 years of age. More than 90% of the patients had waiting time at the department between 0-30 minutes. Treatment cost was described as 'low or 'reasonable' by 87% of the parents. Only 8.2% mentioned 'unsatisfactory' regarding the cleanliness of Pediatric OPD. More than 95% of the respondents expressed 'Satisfactory' and 'good' level of satisfaction with general performance of OPD and the treatment provided by the dental team.Conclusion: Parents expressed general satisfaction with the
BJOG: An International Journal of Obstetrics & Gynaecology, 2006
Objective The aim of this study was to assess long‐term effects for women following the use of m... more Objective The aim of this study was to assess long‐term effects for women following the use of magnesium sulphate for pre‐eclampsia.Design Assessment at 2–3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998–2001, ISRCTN 86938761), which compared magnesium sulphate with placebo for pre‐eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the follow‐up centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow‐up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially relat...
Journal of SAFOG with DVD, 2009
Objective To determine the efficacy and safety of oral misoprostol with intravenous oxytocin and ... more Objective To determine the efficacy and safety of oral misoprostol with intravenous oxytocin and syntometrine in the active management of third stage of labor. Methodology 325 women were randomly allocated by convenient sampling to receive either 10 IU of intravenous oxytocin or 10 IU of oxytocin with 0.2 mg of Methergine (syntometrine) or 400 mcg of oral misoprostol at the delivery of anterior shoulder. Main outcome measures were estimation of blood loss > 500 ml, drop in hemoglobin/hematocrit levels and adverse effects of drugs. Results Estimated blood loss was significantly higher in group misoprostol group (p = 0.016) but comparable to oxytocin group (p = 0.40). Drop in hemoglobin level was comparable in all the three groups (p = 0.106). Drop in hematocrit value was significant for misoprostol and syntometrine (p = 0.022) but comparable to oxytocin. Nausea and vomiting was common in oxytocin and syntometrine group whereas fever and shivering was the leading adverse effect in ...
PubMed, Apr 1, 2002
Objective: To test the hypothesis that women with multiple gestations are at increased risk of ad... more Objective: To test the hypothesis that women with multiple gestations are at increased risk of adverse maternal and perinatal outcomes when compared with singletons. Design: From January 1999 to December 2000, all multiple pregnancies delivering > 28 weeks gestation in the labour ward of Mother and Child Health (MCH) Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, were taken as cases. Singleton pregnancy > or = 28 weeks gestation period delivered immediately after each case was chosen as control. Prenatal complications, gestation at delivery, mode of delivery, birth weight and perinatal morbidity and mortality of the two groups were compared. Results: There were 6831 deliveries including 120 twins and 2 triplets. The data of the two triplets are presented separately and further comparison is between 120 twins and singleton controls. Pretem labour was the commonest prenatal complication in twin pregnancies (21 vs 62) followed by anaemia (11 Vs 39). The mean gestational age of singletons was 38.3 weeks compared to 35.9 weeks for twins. The mean birth weight of singletons was 2.9 kg vs 2.1 kg for twins. Six (4.9%) singletons and 46 (19.2%) twins had caesarean section. Thirty one (13%) of the twins and I (1.6%) singleton had vaginal breech delivery. Five (4%) singleton infants and 40 (17%) twins required admission. Ten singletons and 26 twins died perinatally resulting in a PNMR/1000 births of 82 and 108 respectively. Conclusion: Women with multiple gestations are at a higher risk of antepartum and intrapartum complications and their infants require special care. There is need to identify these cases early in order to provide good prenatal care and deliver them in hospitals with facilities for neonatal and maternal intensive care.
Rawal Medical Journal, 2021
Journal of Bahria University Medical and Dental College, 2017
Objective: To determine the responsiveness of Pelvic Floor Distress Inventory (PFDI) and Pelvic F... more Objective: To determine the responsiveness of Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women with pelvic organ prolapse, undergoing vaginal reconstructive surgery versus women with no surgery. Methodology: This study was a cross sectional comparative study carried out in the department of Obstetrics and Gynecology, Pakistan Air Force Hospital, Mianwali in a period from January 2011 to December 2015. Prolapsed women with stage II or more and with willingness for surgery were included in the surgery group. Those willing for conservative management (pelvic floor exercises) were included in the non-surgical group. All patients in both groups completed the PFDI and PFIQ at baseline and 6 month follow-up. Results: Mean (±SD) age, weight, and parity of the patients were 51.42 (±9.07) years, 58.60 (±6.8) kg and 4.00 (±2.14) respectively. More than half of the patients (61%) belonged to low socio economic status, followed by middle class 34% and ...
Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients thr... more Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients through multidisciplinary meetings (MDM) at MCH centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Material and Methods: MDM is a regularly scheduled meeting of core and limited team members for the purpose of prospective treatment and care planning of newly diagnosed cancer patients. It was started in 2009 in order to improve the management of the cancer patients according to the international recommendations. In a total of 1 year study period 24 meetings were held. The major audit tool was the documentation of the meeting and its outcomes, patient communication and record of the Nuclear Oncology and Radiotherapy Institute of Islamabad (NORI). A postgraduate student was deputed for documentation. Results: The study identified that MDM helped in achieving many of the best practices of international recommendations which include team approach to treatment planning as well as t...
Abstract: Enlargement of clitoris is often a prominent manifestation of disorders of sexual devel... more Abstract: Enlargement of clitoris is often a prominent manifestation of disorders of sexual development. Removal of the clitoris has been accepted as the standard procedure for severe clitoromegaly in infants and young children but clitoroplasty especially in adults is rarely done. This case report is about a 39-year-old woman with symptomatic clitoromegaly since childhood. We performed a clitoral reduction procedure for her in which the corpora cavernosa is partially removed while neurovascular supply and glans clitoris is preserved. The procedure is aimed at achieving a normal clitoral morphology without compromising sexual function.
JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2014
To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intr... more To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intravenous syntocinon and 0.25 mg intramuscular ergometrine in the prevention of atonic uterine haemorrhage during caesarean section. The quasi-experimental study was conducted at the Maternal and Child Health Centre, Unit I, Pakistan Institute of Medical Sciences, Islamabad, from November 1, 2010 to February 28, 2011. All women undergoing caesarean section were included in the study. Patients were given intravenous 10 units syntocinon alone intraoperatively from November 1 to December 31,2010, while 0.25 mg ergometrine intramuscular was added to 10 units intravenous syntocinon from January 1 to February 28, 2011. Frequency of postpartum haemorrhage, adverse effects of drugs and maternal morbidity and mortality were assessed by using chi square test. P < 0.05 was taken as statistically significant. Of the total number of 701 subjects, 378 (54%) women were given 10 units syntocinon and 32...
Journal of Ayub Medical College
HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease w... more HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease with immense social, psychological, economic and public health consequences. Since we are living in a global village where human interactions has become fast and frequent, diseases like HIV are no more alien to us. HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. Objectives of this study were to determine the prevalence of HIV in pregnant women identified with a high risk factor/behaviour at a tertiary care hospital. It is a Descriptive study. All pregnant women attending antenatal booking clinic were assessed via a pre-designed 'Risk assessment questionnaire'. Women identified with a risk factor were offered HIV Rapid screening test (Capillus HIV1/2). Positive (reactive) results on screening test were confirmed with ELISA. During the study period (March 2007-May 2008), out of 5263 antenatal bookings 785 (14%) women were identified w...
Journal of the College of Physicians and Surgeons, 2005
Advanced abdominal pregnancy is a complex condition demanding challenging management. High index ... more Advanced abdominal pregnancy is a complex condition demanding challenging management. High index of suspicion may reduce the diagnostic error. Management varies from patient to patient. Expectant management is a feasible option in a well-equipped tertiary care hospital in case of alive viable fetuses. This evidence-based report describes the author's experience of managing a series of advanced abdominal pregnancies at 24 weeks or more of gestation.
JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2011
To compare the efficacy, safety and cost-effectiveness of Manual vacuum aspiration (MVA) with Ele... more To compare the efficacy, safety and cost-effectiveness of Manual vacuum aspiration (MVA) with Electrical vacuum aspiration (EVA) in the management of first trimester pregnancy loss. A single-centre randomized controlled trial (RCT) was conducted at Maternal and Child Health Centre (MCHC), Unit-I, Pakistan Institute of Medical Sciences (PIMS), Islamabad from April 2007-Dec 2008. A total of 176 cases with early pregnancy loss at < 12 weeks gestation, with a diagnosis of anembryonic pregnancy, incomplete, missed or septic induced abortion and molar pregnancy were randomly allocated to either MVA or EVA in the operation theatre. A total of 176 women were included out of which 70 underwent EVA and 106 had MVA. Baseline characteristics were similar in the two groups except significantly higher gestational age and gestational sac diameter in MVA group. Majority of EVA were performed under general anaesthesia (95.7%) while majority of MVA were performed under paracervical block (60.3%). ...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
Advanced abdominal pregnancy is a complex condition demanding challenging management. High index ... more Advanced abdominal pregnancy is a complex condition demanding challenging management. High index of suspicion may reduce the diagnostic error. Management varies from patient to patient. Expectant management is a feasible option in a well-equipped tertiary care hospital in case of alive viable fetuses. This evidence-based report describes the author's experience of managing a series of advanced abdominal pregnancies at 24 weeks or more of gestation.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
OBJECTIVE To determine an association between reduced prenatal visit frequencies and pregnancy ou... more OBJECTIVE To determine an association between reduced prenatal visit frequencies and pregnancy outcome in women, found to be at low-risk of obstetric complications at initial prenatal visit. DESIGN Prospective cohort study. PLACE AND DURATION OF STUDY Mother and Child Health Center, Pakistan Institute of Medical Sciences, Islamabad. from January to December 2002. PATIENTS AND METHODS The hospital case records of 1290 women, who were found to be at low risk of obstetric complications at their first prenatal visit. Prenatal visits were categorized into '<3', '3-6' and 'z 7 visits groups'. 'z7 visits were taken as controls. The main outcome measures were peripartum maternal complications, obstetric interventions and perinatal outcome. RESULTS The median number of prenatal visits was four, (range 1-14; lower quartile 2, upper quartile 6). Women with less than 3 prenatal visits had significantly higher risk of antepartum complications, low birth weight neon...
Pakistan Armed Forces Medical Journal, 2016
Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients thr... more Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients through multidisciplinary meetings (MDM) at MCH centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Study Design: A pre and post intervention comparative study. Place and Duration of Study: The study was conducted at MCH centre, PIMS and Nuclear Oncology and Radiotherapy Institute, Islamabad from 1st April 2009 to 31st Mar 2010. Material and Methods: MDM is a regularly scheduled meeting of core and limited team members for the purpose of prospective treatment and care planning of newly diagnosed cancer patients. It was started in 2009 in order to improve the management of the cancer patients according to the international recommendations. In a total of 1 year study period 24 meetings were held. The major audit tool was the documentation of the meeting and its outcomes, patient communication and record of the Nuclear Oncology and Radiotherapy Institute of Islamabad (NORI). A po...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2014
OBJECTIVE To compare the efficacy and safety of Manual Vacuum Aspiration (MVA) performed as outpa... more OBJECTIVE To compare the efficacy and safety of Manual Vacuum Aspiration (MVA) performed as outpatient versus inpatient procedure in terms of success rate, blood loss, hospital stay and procedure related complications. STUDY DESIGN A quasi-experimental study. PLACE AND DURATION OF STUDY Maternal and Child Health Centre (MCHC), Unit-I, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from December 2009 to December 2010. METHODOLOGY Cases with early pregnancy failure (incomplete, missed and an embryonic) at gestational age less than 12 weeks were allocated to MVA as outpatient or elective procedure performed in the operation theatre. Studied variables were noted as above. RESULTS A total of 177 women were eligible for study, out of whom 78 underwent MVA as outpatient procedure and 99 as indoor procedure. The baseline characteristics were comparable in both groups except significantly high multipara in the indoor group. Complete evacuation was achieved in 96.1% in outpatient v...
JPMA. The Journal of the Pakistan Medical Association, 2014
OBJECTIVE To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 ... more OBJECTIVE To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intravenous syntocinon and 0.25 mg intramuscular ergometrine in the prevention of atonic uterine haemorrhage during caesarean section. METHOD The quasi-experimental study was conducted at the Maternal and Child Health Centre, Unit I, Pakistan Institute of Medical Sciences, Islamabad, from November 1, 2010 to February 28, 2011. All women undergoing caesarean section were included in the study. Patients were given intravenous 10 units syntocinon alone intraoperatively from November 1 to December 31,2010, while 0.25 mg ergometrine intramuscular was added to 10 units intravenous syntocinon from January 1 to February 28, 2011. Frequency of postpartum haemorrhage, adverse effects of drugs and maternal morbidity and mortality were assessed by using chi square test. P < 0.05 was taken as statistically significant. RESULTS Of the total number of 701 subjects, 378 (54%) women were given 1...
Pakistan Armed Forces medical journal, Jun 28, 2024
Cervical cancer remains one of the leading causes of cancer-related deaths among women. Worldwide... more Cervical cancer remains one of the leading causes of cancer-related deaths among women. Worldwide about 500,000 new cases are reported every year. Of these, 300,000 end up in mortality. Almost 80% of these cases occur in low-resource countries. 1 Cervical cancer has been found to be the most prevalent malignant neoplasm among women in developing countries. 2 In Pakistan researched evidence puts 3.6% of total female cancers to be of cervical origin, affecting women mainly in fifth and sixth decades of life. 3 Incidence and mortality related to cervical cancer are both declining in developed countries because of effective screening programmes through Papanicolaou (Pap) smear. 4,5 The test is successful in detection of precancerous lesion as well as early stage of cervical cancer and is widely used in developed countries. 6,7 The pap smear screening is not replicable in developing countries because of its cost, scarcity of trained cytopathologist and multistage nature of the procedure. These potential difficulties in cytology-based programme have prompted the investigations of alternative low-cost screening technology such as visual inspection with acetic acid (VIA). The result of VIA is immediately available and does not require lab support. Numerous studies have been conducted on its accuracy and its ability to detect precancerous cervical lesions when compared with Pap smear. The outcome evaluation of these studies indicate that sensitivity of VIA ranges from 66% to 96%, and specificity between 64% and 98%. 6-10 Authors comparing cytology with VIA have concluded that overall usefulness of VIA compares favourably with Pap test. Majority of these are conducted in primary healthcare facility and thus are not applicable to tertiary care hospitals. 11 VIA was introduced in the Maternal and Child Health Centre (MCHC) at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, in 2006 as a cervical screening tool. However, the test is being used in conjunction with Pap smear and has not yet been able to replace the Pap test due to lack of controlled trials. This study was conducted to determine the potential of VIA to supplement or replace Pap smear at our tertiary care hospital where all modalities, including Pap smear and colposcopy, are available and yet majority of patients are lost to followup
Update Dental College Journal, Sep 27, 2018
Purpose:The Pediatric Outpatient department (POPD) of a dental hospital deals with children with ... more Purpose:The Pediatric Outpatient department (POPD) of a dental hospital deals with children with different tooth related complaints. Dental treatment of a child patient requires three way interactions between the child, the parent and the dental surgeon. Though health of the patient remains the top priority for caregivers, satisfaction with the delivery system is vital for long lasting doctor-patient relationship. Thepurpose of the study was to evaluate the performance of Pediatric OPD by the accompanying parents of children receiving treatment at the OPD of a private dental college hospital. Methods: A cross sectional study was carried out at the POPD of Sapporo Dental College Hospital, Uttara Model Town of Dhaka city during May-July 2017. Sampling was done by simple random sampling method .Data were collected from the parents of 122 children aged between 1-12 years by using a self-administrated questionnaire. Results: Majority of the participating parents were residents of Uttara Model Town or areas in the vicinity and were employed, educated and are middle are middle socioeconomic class. More than sixty percent (62.3 %) of the respondents were parents of children between 4-7 years of age. More than 90% of the patients had waiting time at the department between 0-30 minutes. Treatment cost was described as 'low or 'reasonable' by 87% of the parents. Only 8.2% mentioned 'unsatisfactory' regarding the cleanliness of Pediatric OPD. More than 95% of the respondents expressed 'Satisfactory' and 'good' level of satisfaction with general performance of OPD and the treatment provided by the dental team.Conclusion: Parents expressed general satisfaction with the
BJOG: An International Journal of Obstetrics & Gynaecology, 2006
Objective The aim of this study was to assess long‐term effects for women following the use of m... more Objective The aim of this study was to assess long‐term effects for women following the use of magnesium sulphate for pre‐eclampsia.Design Assessment at 2–3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998–2001, ISRCTN 86938761), which compared magnesium sulphate with placebo for pre‐eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the follow‐up centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow‐up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially relat...
Journal of SAFOG with DVD, 2009
Objective To determine the efficacy and safety of oral misoprostol with intravenous oxytocin and ... more Objective To determine the efficacy and safety of oral misoprostol with intravenous oxytocin and syntometrine in the active management of third stage of labor. Methodology 325 women were randomly allocated by convenient sampling to receive either 10 IU of intravenous oxytocin or 10 IU of oxytocin with 0.2 mg of Methergine (syntometrine) or 400 mcg of oral misoprostol at the delivery of anterior shoulder. Main outcome measures were estimation of blood loss > 500 ml, drop in hemoglobin/hematocrit levels and adverse effects of drugs. Results Estimated blood loss was significantly higher in group misoprostol group (p = 0.016) but comparable to oxytocin group (p = 0.40). Drop in hemoglobin level was comparable in all the three groups (p = 0.106). Drop in hematocrit value was significant for misoprostol and syntometrine (p = 0.022) but comparable to oxytocin. Nausea and vomiting was common in oxytocin and syntometrine group whereas fever and shivering was the leading adverse effect in ...
PubMed, Apr 1, 2002
Objective: To test the hypothesis that women with multiple gestations are at increased risk of ad... more Objective: To test the hypothesis that women with multiple gestations are at increased risk of adverse maternal and perinatal outcomes when compared with singletons. Design: From January 1999 to December 2000, all multiple pregnancies delivering > 28 weeks gestation in the labour ward of Mother and Child Health (MCH) Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, were taken as cases. Singleton pregnancy > or = 28 weeks gestation period delivered immediately after each case was chosen as control. Prenatal complications, gestation at delivery, mode of delivery, birth weight and perinatal morbidity and mortality of the two groups were compared. Results: There were 6831 deliveries including 120 twins and 2 triplets. The data of the two triplets are presented separately and further comparison is between 120 twins and singleton controls. Pretem labour was the commonest prenatal complication in twin pregnancies (21 vs 62) followed by anaemia (11 Vs 39). The mean gestational age of singletons was 38.3 weeks compared to 35.9 weeks for twins. The mean birth weight of singletons was 2.9 kg vs 2.1 kg for twins. Six (4.9%) singletons and 46 (19.2%) twins had caesarean section. Thirty one (13%) of the twins and I (1.6%) singleton had vaginal breech delivery. Five (4%) singleton infants and 40 (17%) twins required admission. Ten singletons and 26 twins died perinatally resulting in a PNMR/1000 births of 82 and 108 respectively. Conclusion: Women with multiple gestations are at a higher risk of antepartum and intrapartum complications and their infants require special care. There is need to identify these cases early in order to provide good prenatal care and deliver them in hospitals with facilities for neonatal and maternal intensive care.
Rawal Medical Journal, 2021
Journal of Bahria University Medical and Dental College, 2017
Objective: To determine the responsiveness of Pelvic Floor Distress Inventory (PFDI) and Pelvic F... more Objective: To determine the responsiveness of Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women with pelvic organ prolapse, undergoing vaginal reconstructive surgery versus women with no surgery. Methodology: This study was a cross sectional comparative study carried out in the department of Obstetrics and Gynecology, Pakistan Air Force Hospital, Mianwali in a period from January 2011 to December 2015. Prolapsed women with stage II or more and with willingness for surgery were included in the surgery group. Those willing for conservative management (pelvic floor exercises) were included in the non-surgical group. All patients in both groups completed the PFDI and PFIQ at baseline and 6 month follow-up. Results: Mean (±SD) age, weight, and parity of the patients were 51.42 (±9.07) years, 58.60 (±6.8) kg and 4.00 (±2.14) respectively. More than half of the patients (61%) belonged to low socio economic status, followed by middle class 34% and ...
Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients thr... more Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients through multidisciplinary meetings (MDM) at MCH centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Material and Methods: MDM is a regularly scheduled meeting of core and limited team members for the purpose of prospective treatment and care planning of newly diagnosed cancer patients. It was started in 2009 in order to improve the management of the cancer patients according to the international recommendations. In a total of 1 year study period 24 meetings were held. The major audit tool was the documentation of the meeting and its outcomes, patient communication and record of the Nuclear Oncology and Radiotherapy Institute of Islamabad (NORI). A postgraduate student was deputed for documentation. Results: The study identified that MDM helped in achieving many of the best practices of international recommendations which include team approach to treatment planning as well as t...
Abstract: Enlargement of clitoris is often a prominent manifestation of disorders of sexual devel... more Abstract: Enlargement of clitoris is often a prominent manifestation of disorders of sexual development. Removal of the clitoris has been accepted as the standard procedure for severe clitoromegaly in infants and young children but clitoroplasty especially in adults is rarely done. This case report is about a 39-year-old woman with symptomatic clitoromegaly since childhood. We performed a clitoral reduction procedure for her in which the corpora cavernosa is partially removed while neurovascular supply and glans clitoris is preserved. The procedure is aimed at achieving a normal clitoral morphology without compromising sexual function.
JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2014
To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intr... more To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intravenous syntocinon and 0.25 mg intramuscular ergometrine in the prevention of atonic uterine haemorrhage during caesarean section. The quasi-experimental study was conducted at the Maternal and Child Health Centre, Unit I, Pakistan Institute of Medical Sciences, Islamabad, from November 1, 2010 to February 28, 2011. All women undergoing caesarean section were included in the study. Patients were given intravenous 10 units syntocinon alone intraoperatively from November 1 to December 31,2010, while 0.25 mg ergometrine intramuscular was added to 10 units intravenous syntocinon from January 1 to February 28, 2011. Frequency of postpartum haemorrhage, adverse effects of drugs and maternal morbidity and mortality were assessed by using chi square test. P < 0.05 was taken as statistically significant. Of the total number of 701 subjects, 378 (54%) women were given 10 units syntocinon and 32...
Journal of Ayub Medical College
HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease w... more HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease with immense social, psychological, economic and public health consequences. Since we are living in a global village where human interactions has become fast and frequent, diseases like HIV are no more alien to us. HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. Objectives of this study were to determine the prevalence of HIV in pregnant women identified with a high risk factor/behaviour at a tertiary care hospital. It is a Descriptive study. All pregnant women attending antenatal booking clinic were assessed via a pre-designed 'Risk assessment questionnaire'. Women identified with a risk factor were offered HIV Rapid screening test (Capillus HIV1/2). Positive (reactive) results on screening test were confirmed with ELISA. During the study period (March 2007-May 2008), out of 5263 antenatal bookings 785 (14%) women were identified w...
Journal of the College of Physicians and Surgeons, 2005
Advanced abdominal pregnancy is a complex condition demanding challenging management. High index ... more Advanced abdominal pregnancy is a complex condition demanding challenging management. High index of suspicion may reduce the diagnostic error. Management varies from patient to patient. Expectant management is a feasible option in a well-equipped tertiary care hospital in case of alive viable fetuses. This evidence-based report describes the author's experience of managing a series of advanced abdominal pregnancies at 24 weeks or more of gestation.
JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2011
To compare the efficacy, safety and cost-effectiveness of Manual vacuum aspiration (MVA) with Ele... more To compare the efficacy, safety and cost-effectiveness of Manual vacuum aspiration (MVA) with Electrical vacuum aspiration (EVA) in the management of first trimester pregnancy loss. A single-centre randomized controlled trial (RCT) was conducted at Maternal and Child Health Centre (MCHC), Unit-I, Pakistan Institute of Medical Sciences (PIMS), Islamabad from April 2007-Dec 2008. A total of 176 cases with early pregnancy loss at < 12 weeks gestation, with a diagnosis of anembryonic pregnancy, incomplete, missed or septic induced abortion and molar pregnancy were randomly allocated to either MVA or EVA in the operation theatre. A total of 176 women were included out of which 70 underwent EVA and 106 had MVA. Baseline characteristics were similar in the two groups except significantly higher gestational age and gestational sac diameter in MVA group. Majority of EVA were performed under general anaesthesia (95.7%) while majority of MVA were performed under paracervical block (60.3%). ...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
Advanced abdominal pregnancy is a complex condition demanding challenging management. High index ... more Advanced abdominal pregnancy is a complex condition demanding challenging management. High index of suspicion may reduce the diagnostic error. Management varies from patient to patient. Expectant management is a feasible option in a well-equipped tertiary care hospital in case of alive viable fetuses. This evidence-based report describes the author's experience of managing a series of advanced abdominal pregnancies at 24 weeks or more of gestation.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
OBJECTIVE To determine an association between reduced prenatal visit frequencies and pregnancy ou... more OBJECTIVE To determine an association between reduced prenatal visit frequencies and pregnancy outcome in women, found to be at low-risk of obstetric complications at initial prenatal visit. DESIGN Prospective cohort study. PLACE AND DURATION OF STUDY Mother and Child Health Center, Pakistan Institute of Medical Sciences, Islamabad. from January to December 2002. PATIENTS AND METHODS The hospital case records of 1290 women, who were found to be at low risk of obstetric complications at their first prenatal visit. Prenatal visits were categorized into '<3', '3-6' and 'z 7 visits groups'. 'z7 visits were taken as controls. The main outcome measures were peripartum maternal complications, obstetric interventions and perinatal outcome. RESULTS The median number of prenatal visits was four, (range 1-14; lower quartile 2, upper quartile 6). Women with less than 3 prenatal visits had significantly higher risk of antepartum complications, low birth weight neon...
Pakistan Armed Forces Medical Journal, 2016
Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients thr... more Objective: To determine the impact of multidisciplinary care in Gynecological cancer patients through multidisciplinary meetings (MDM) at MCH centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Study Design: A pre and post intervention comparative study. Place and Duration of Study: The study was conducted at MCH centre, PIMS and Nuclear Oncology and Radiotherapy Institute, Islamabad from 1st April 2009 to 31st Mar 2010. Material and Methods: MDM is a regularly scheduled meeting of core and limited team members for the purpose of prospective treatment and care planning of newly diagnosed cancer patients. It was started in 2009 in order to improve the management of the cancer patients according to the international recommendations. In a total of 1 year study period 24 meetings were held. The major audit tool was the documentation of the meeting and its outcomes, patient communication and record of the Nuclear Oncology and Radiotherapy Institute of Islamabad (NORI). A po...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2014
OBJECTIVE To compare the efficacy and safety of Manual Vacuum Aspiration (MVA) performed as outpa... more OBJECTIVE To compare the efficacy and safety of Manual Vacuum Aspiration (MVA) performed as outpatient versus inpatient procedure in terms of success rate, blood loss, hospital stay and procedure related complications. STUDY DESIGN A quasi-experimental study. PLACE AND DURATION OF STUDY Maternal and Child Health Centre (MCHC), Unit-I, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from December 2009 to December 2010. METHODOLOGY Cases with early pregnancy failure (incomplete, missed and an embryonic) at gestational age less than 12 weeks were allocated to MVA as outpatient or elective procedure performed in the operation theatre. Studied variables were noted as above. RESULTS A total of 177 women were eligible for study, out of whom 78 underwent MVA as outpatient procedure and 99 as indoor procedure. The baseline characteristics were comparable in both groups except significantly high multipara in the indoor group. Complete evacuation was achieved in 96.1% in outpatient v...
JPMA. The Journal of the Pakistan Medical Association, 2014
OBJECTIVE To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 ... more OBJECTIVE To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intravenous syntocinon and 0.25 mg intramuscular ergometrine in the prevention of atonic uterine haemorrhage during caesarean section. METHOD The quasi-experimental study was conducted at the Maternal and Child Health Centre, Unit I, Pakistan Institute of Medical Sciences, Islamabad, from November 1, 2010 to February 28, 2011. All women undergoing caesarean section were included in the study. Patients were given intravenous 10 units syntocinon alone intraoperatively from November 1 to December 31,2010, while 0.25 mg ergometrine intramuscular was added to 10 units intravenous syntocinon from January 1 to February 28, 2011. Frequency of postpartum haemorrhage, adverse effects of drugs and maternal morbidity and mortality were assessed by using chi square test. P < 0.05 was taken as statistically significant. RESULTS Of the total number of 701 subjects, 378 (54%) women were given 1...