Risk of uterine rupture after the partographic 'alert' line is crossed--an additional dimension in the quest towards safe motherhood in labour following caesarean section.

To determine if prolonged active phase of labour is associated with increased risk of uterine scar rupture in labour following previous lower segment caesarean section, a retrospective cohort study (1988-91) was done to analyse active phase partographs of 236 patients undergoing trial of labour following caesarean section, 7 (3%) of whom had scar rupture. After onset of active phase (3 cm cervical dilatation), a 1 cm/h line was used to indicate "alert". A zonal partogram was developed by dividing the active phase partographs into 5 time zones: A (area to the left of "alert" line), B (0-1 h after "alert" line), C (1-2 h after "alert" line), D (2-3 h after "alert" line) and EF (> 3 h after "alert" line).

Dynamic and steady state response of heart rate to orthostatic stress in normotensive and hypertensive pregnant women.

We determined the dynamic and steady state responses of heart rate (HR) to orthostatic stress (standing up) in normotensive and hypertensive pregnant women. Using a continuous recording with servo-photosphygmography, HR response to change in posture from left lateral recumbent position to standing was analysed. The subjects were divided into five groups comprising: Groups I, II and III: normotensive pregnant women in each of the three trimesters of pregnancy (total n = 77); Group IV: women with gestational proteinuric hypertension (GPH) in the third trimester (n = 16); Group V: age-matched non-pregnant normotensive controls (n = 15).

Bronchodilator response in pulmonary disease at two different states of respiratory mechanics.

It would be convenient to be able to measure airway responsiveness to bronchodilator drugs with a sequential use of oscilloresistometry and spirometry, which may allow the comparison of the response to bronchodilator at two different states of respiratory mechanics i.e., resting tidal breathing at functional residual capacity (FRC) versus forced expiratory manoeuvre from total lung capacity to residual volume.

Audit changes clinical practice! Impact on rate of justification of hysterectomy indication.

After performing a baseline audit in 1986-89, an ongoing quality assurance process was initiated in January, 1990 and all hysterectomies performed over the next 2 year period were analyzed. Hysterectomy indications were divided into two groups: one in which the uterine specimen was expected to show pathology and another in which no pathology was expected. The hysterectomy was considered justified in the former if the pathology report verified the indication or showed a significant alternate pathology.

Are non-diabetic women with abnormal glucose screening test at increased risk of pre-eclampsia, macrosomia and caesarian birth?

To determine, in non-diabetic women, the relationship of abnormal glucose screening test, with the incidence of pre-eclampsia, macrosomia and caesarian delivery, from 1988-92, 5646 consecutive women attending antenatal clinic were screened with a glucose challenge test (GCT) on their first visit (usually at 16-20 weeks); those with risk factors i.e., history of unexplained perinatal loss, macrosomia or family member with diabetes and an initial abnormal screening test were rescreened at 28-32 weeks.

Percutaneous nephrostomy using hospital modified catheters for cost containment.

This paper describes our experience of percutaneous nephrostomy (PCN) using self-fabricated catheters. Our effort is to restrain the cost of this common procedure, and at the same time, deliver results comparable to other studies in the literature. In 152 patients, 175 PCN were performed for various indications using simple tools for "pulling catheters".

Morphine induces reproductive changes in female rats and their male offspring.

The effect of intrauterine morphine exposure on the development of reproductive functions has been investigated in the rat. Female rats were treated daily ip with morphine sulfate, doses increasing at 10-d intervals from 5, 7.5, 10, to 15 mg/kg.

Feticide followed by successful removal of pregnancy products in early abdominal pregnancy.

Patient presented with an acute abdomen at 18 weeks gestation. Ultrasound and CT scan confirmed single extra uterine gestation. Considering the maternal hazards associated with surgical removal of viable abdominal pregnancy feticide was performed with ultrasound guided intracardial injection of KCl solution.

Effectiveness of percutaneous nephrostomy in reversing obstructive renal failure.

A retrospective analysis of 34 patients of obstructive renal failure, initially managed by percutaneous nephrostomy was performed. Pre procedure blood biochemical profile was compared with upto one week follow-up of blood chemistry. There was a decline of 71.

Peculiar histopathological features of giardiasis in distal duodenal biopsies.

Histological changes in 20 Giardia positive duodenal biopsies (Group A) were compared with 50, Giardia negative duodenal biopsies (Group B), taken during the same period. Stool examinations in Group B were negative for Giardia. Surface epithelium, villous and crypt architecture and cellular infiltrates were examined and compared between the groups.

Intestinal obstruction in adults at the Aga Khan University Hospital.

During the period January, 1987 to June, 1991, 208 adults with mechanical bowel obstruction were managed at The Aga Khan University Hospital (AKUH). Post-operative adhesions accounted for 34% of the cases and were the most frequent cause of intestinal obstruction. External hemia (16%), malignancy (13.

Cardiovascular risk factors in school children from low middle income families in Karachi, Pakistan.

Serum levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were determined on 239 school children aged 5-19 years belonging to lower middle class families. The mean TC, LDL-C, HDL-C and TG ranged from 3.70-4.

Amoebic appendicitis--a rare entity.

Appendectomy is the most common surgical procedure performed in routine general surgical practice. However, not all the appendices removed, are submitted for histopathological examination in this part of the world. We reviewed 1400 appendices received by our department from within our hospital and from outside the hospital.

Anaemia in pregnancy--its cause in the underprivileged class of Karachi.

A prospective study of the frequency and type of anaemia amongst poor urban parturients of Karachi was done. It was performed at 2 large teaching hospitals over the time span January to September, 1990. Out of 318 women studied, 104 (32.

Macrosomia: maternal and fetal outcome.

This retrospective case--control study analyses the prevalence and outcome of macrosomia in a part of the underdeveloped world. Out of 6,093 deliveries at a large tertiary care centre, 234 (3.8%) were macrosomic.

Preterm birth--its etiology and outcome.

This is a retrospective case control study. Out of a total of 1238 births occurring over a period of 8 months at the Aga Khan University Medical Centre, Karachi, 9.4% were preterm.

Laparoscopic appraisal of infertility and pelvic pain in Pakistani women: a 5 years audit.

Five hundred and nine Laparoscopic examinations performed between 1987-91, (147 procedures for evaluation of gynaecologic pelvic pain and 313 for infertility) revealed ectopic pregnancy (27%), twisted ovarian cyst (18%) and acute pelvic inflammatory disease (14%) in cases of acute gynaecologic pain, and endometriosis (17%) and chronic pelvic inflammatory disease (16%) in chronic pelvic pain. Adhesions (20%), tubal block (15%), endometriosis (9%) and polycystic ovary (7%) were common findings in cases of infertility. These data support the usefulness of this minimally invasive procedure in accurate diagnosis of gynaecological disorders and provides insight into the spectra of diseases seen in Pakistani women with pelvic pain and infertility.

A view of HIV-I infection in Karachi.

A prospective study on the prevalence of HIV-I infection in Karachi, Pakistan was conducted over a period of six years (1986-1992). Over 15,000 individual samples and more than 32,000 donor units of individuals residing in Karachi at the time of sample collection were tested for HIV-I infection by our screening test EIA which revealed a positivity rate of 0.23% and 0.

The diploma in family medicine examination; a scientific exercise.

The Diploma in Family Medicine (DFM) Examination is a new certification offered by the College of Physicians and Surgeons of Pakistan, and its Department of Medical Education designed a scientific examination. First, the Expert Advisory Committee for Family Medicine was formed, relevant training objectives were determined, a training programme to achieve the objectives was designed and a valid syllabus was chosen. Then the examination was designed, where the candidates must pass the objective theory papers before taking the clinical examination.

Is anemia an accurate predictor of vitamin A status in Pakistani children?

Serum retinol and hemoglobin levels were determined in 532 children aged 6-60 months living in urban slums of Karachi, Pakistan. Overall 67% (358 of 532) of children had hemoglobin levels of less than 11 g/dl, the World Health Organization definition of anemia for this age group. Estimations for red blood cell indices (hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red blood cell count) were done on a sample of 391 children to classify anemia morphologically.

Does red blood cell distribution width (RDW) improve evaluation of microcytic anaemias?

The red cell distribution width (RDW) is an index of the variation in red cells size (anisocytosis). A study was conducted to examine the validity of using RDW in improving classification of microcytic anaemias. A total of 300 blood samples collected from a patient population aged 3 months to 55 years who were referred for haemoglobin electrophoresis were examined at the Aga Khan University Hospital (AKUH).

Malabsorption of nutrients in children with diarrhoea due to unknown aetiologies.

Intake and coefficient of absorption of nutrients were measured in 72 children during acute diarrhoea and 2 weeks after recovery. No diarrhoeal pathogens could be identified in 18 (25%) children (group I). Aetiology of diarrhoea was identified in rest of the 54 children (group II).