Abstract: Worldwide, vaginal route is the gynaecologist’s route of surgery. However, abdominal route is the favoured route of hysterectomy in Nigeria inspite of the advantages of vaginal route. This descriptive review is to awaken interest in the teaching and surgical exposure of residents in obstetrics and gynaecology in the field of vaginal surgeries. The ratio of vaginal hysterectomy to abdominal hysterectomy in Nigeria ranges from 1:4 to 1:9. The frequency of vaginal hysterectomy in centres in Nigeria ranges from 10-23%. These rates are lower than the figures quoted from the United States (25%), France (50%), Australia (40-50%) and Saudi Arabia (28%). Vaginal hysterectomy is under-utilized in Nigeria. Most centres hardly do up to five vaginal hysterectomies in a year. Residents in training hardly perform vaginal hysterectomy and may not have watched or assisted in up to ten vaginal hysterectomies before the residency programme is completed. This is completely inadequate for acquisition of proficiency. There is inadequacy and under exposure of residents in the art of vaginal surgeries in Nigeria. There is need for workshops, training and retraining of residents in the field of vaginal surgeries to meet these challenges. This would ensure production of quality gynaecologists with skills and proficiency in vaginal surgery.

Abstract: Purpose: Our purpose was to identify the predictors of refractory epilepsy (RE) and the typical clinical findings in Bulgarian patients with RE. Patients and Methods: We studied 70 adult patients with refractory epilepsy and 70 patients with pharmaco sensitive epilepsy. The Liverpool Seizure Severity Scale was completed by 84.29% of the patients with RE. Results: The typical clinical findings and significant predictors of RE on univariate analysis were: high initial seizure frequency (OR = 2.45), heredity for epilepsy (OR = 8.90), febrile seizures (OR = 4.50), partial epilepsy (OR = 5.98), low or lacking seizure reduction with the first AED (OR = 44.0), clusters of seizures and/or epileptic status in the disease course (OR = 16.5), childhood onset (OR = 8.0), great number of ineffective antiepileptic drugs (AED) – OR = 232.88, poly therapy (OR = 61.0). On multivariate analysis significant predictors of RE were poly therapy (B = 4.86), childhood onset (B = 2.79), and great number (> 4) of ineffective AED (B = 5.44). Frequent clinical findings were: moderate seizure severity, high seizure frequency despite the prescribed treatment, polymorphic seizures. Conclusion: The most significant predictors of RE are: great number of ineffective AED, treatment with poly therapy, and early disease onset. This conclusion may be useful for a timely identification of patients with epilepsy who are likely to be refractory to medical therapy.

Abstract: Allogeneic hematopoietic stem cell transplant is safe and curative treatment modality for many hematologic diseases. Expanding alternative donor options such as haploidentical hematopoietic stem cell transplantation and umbilical cord blood, taken together with enhanced outcomes of matched unrelated donors, has resulted in a advisable donor for most patients with an hematopoietic stem cell transplantation indication. This review article provides improved patient selection, offers hope for decreasing relapse and improving outcomes for in patients applied allogeneic hematopoietic stem cell transplant.

Abstract: Objective: Investigate the influence of permeability of low-flux versus high-flux dialysis membranes on intact PTH during hemodialysis. Background: Hyperparathyroidism is a common finding in patients with renal insufficiency and parathyroid hormone (PTH) is considered a uremic toxin responsible for many of the abnormalities of the uremic state and bone disease. Materials and Methods: Forty adult patients on regular hemodialysis were enrolled in a prospective study. Low-flux polysulfone membranes were used for at least 6 months and then the patients were switched to use high-flux polysulfone membranes for 1 month. Serum electrolytes and intact PTH before and after dialysis were compared before and after changes in dialysis membrane. Results: At the end of the 1-month use of high-flux filters, predialysis intact PTH level (415.96 ± 226.72 ng/dL) showed a significant decline (P < 0.05) compared to the predialysis intact PTH (312.28 ± 191.98 ng/dL) with low-flux membranes. Intact PTH level correlated negatively with serum calcium and positively with serum phosphorus levels only in the predialysis samples with the use of low-flux but not high-flux filters. Conclusion: High-flux dialysis membranes are more efficient in removal of intact PTH, one of the middle-sized uremic toxins, than low-flux membranes.

Abstract: Background and Study Aim: In several studies non-steroidal anti inflammatory drugs (NSAIDs) showed reduction of post (ERCP) pancreatitis incidence and severity. Our aim is to study the effect of NSAIDs in reducing post ERCP pancreatitis (PEP). Patients and Methods: A double blind placebo controlled study was conducted, patients who underwent ERCP in Specialized Arab Hospital (SAH), collected over one year, from June 2012 to June 2013 . Patients were randomized by an endoscopy nurse to receive IM Diclofenac 75 mg, or IM isotonic saline 3 ml as placebo. 12 hours after completing the procedure all patients were evaluated for abdominal pain and serum amylase. Results: The total number of patients was 199 patients, 17 patients were excluded, 182 patients completed the study, diclofenac group (89), placebo (93), the two groups were comparable for the following: age, sex, ERCP finding, pancreatic duct cannulation, failure of common bile duct (CBD) cannulation, number of pancreatic duct cannulation, ERCP time, sphincterotomy, and stenting. The overall incidence of pancreatitis was (18/182) 10%, (6/89) 6.9% for the diclofenac group and (12/93) 12.9% for the placebo group. There was no significant difference in the incidence of pancreatitis between the two groups; the P value was 0.164. In all the cases in which pancreatitis occurs, it was mild or moderate; there was no severe pancreatitis among the two groups. But in subgroup analysis the frequency of pancreatitis in patients with multiple pancreatic duct cannulation was significantly lower in the diclofenac group than in control group with p value = 0.021. Conclusion: Intramuscular diclofenac does not lower PEP rate or severity. But it significantly decreased PEP in patients with multiple pancreatic duct cannulations.

Abstract: Background: Hypothyroidism in pregnancy is increasing and is a major cause for concern because of its association with adverse maternal outcome if untreated. The literature related to the burden of adverse pregnancy outcomes associated with hypothyroid pregnant women on thyroxine replacement therapy is limited. Hence, this study was designed. Objective: The primary objective was to study the maternal outcome of hypothyroidism in pregnancy. Methodology: This study was conducted in the Department of Obstetrics & Gynecology in Govt. Medical College Trivandrum. This was a mixed method study that included retrospective patient data collection and a prospective matched case control study. Seventy-eight pregnant women were recruited as cases based on diagnosis of hypothyroidism prior to pregnancy from the medical department records. They were compared with 78 euthyroid pregnant women, approximately age matched. History and pregnancy outcome were assessed. Data was analyzed using SPSS statistical package. Results: Hypothyroidism was associated with 3.6 times higher risk of developing threatened abortion and 3.8 times higher risk of developing gestational hypertension (P=0.001). Rate of caesarian section (51.3%) and postpartum hemorrhage (12.8%) were higher among cases. Conclusions: Based on our study we conclude that hypothyroid mothers, in spite of thyroid replacement therapy, are at significantly higher risk of obstetric complications. A multidisciplinary team approach, where the services of an endocrinologist and an obstetrician experienced in high risk pregnancy care are used, and a tertiary level institution with good facilities for ante partum and intrapartum care, is essential to improve the outcomes.

Abstract: The differentiation of therapies for nocturnal enuresis responds to peculiarities of children and their families. In this study three modalities of approach to enuretic symptom were evaluated: the sole behavioral approach, the alarm treatment and the use of desmopressin; we have envisaged the response to treatment for 90 children. In particular, the effectiveness of desmopressin suggests that the cause of monosymptomatic nocturnal enuresis often lies in the structure of the sleep.

Abstract: Objective: To determine the frequency of Helicobacter Pylori infection on histopathology in patients presenting with dyspepsia. Background: Helicobacter Pylori is associated with dyspepsia in patients who have gastric mucosal abnormalities and this infection can be diagnosed by invasive and non invasive test. Histology of endoscopically taken biopsy, for exploration of this organism is used in this study. Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Emergency Medicine, Ziauddin University Hospital, Karachi for Six months from March 2013 to August 2013. Methodology: A total of 362 cases with dyspeptic symptoms were underwent an upper gastrointestinal endoscopy after fulfilling the selection criteria. H. Pylori infection would be defined by the presence of dyspeptic symptoms with detection of the bacterium on histopathology. All the data was collected by using a proforma and different parameters were assessed for a minimum follow-up period of one month. Data was analyzed by descriptive statistics using SPSS software version 19. Result: Out of 362 cases of dyspepsia 218 (60.2%) males and 144 (39.8%) females (Male: Female was 1.5: 1). Two fifty one (69.3%) patients with dyspepsia were H. Pylori positive on histopathology. Out of 251 cases having H. Pylori infection 165 (75.7%) were male and 86 (59.7%) female. High percentage was found in the age between 31 – 50 years, 160 (77.3%). Conclusion: In this study 69.3% of the patients examined were H. Pylori positive on histopathology. Male sex and older age (> 30 years) are independent risk factor of H. Pylori infection in dyspeptic patients.

Abstract: Background: Malpositioning during total hip arthroplasty may cause dislocation, pain, and other complications. To evaluate the potential of sacral slope (SS) as a reliable parameter of pelvic flexion. Methods: We developed a model of pelvic flexion to determine the intraobserver and interobserver variability and reliability of SS measurements by lateral radiography by three independent observers. Results: Measurement error was 1.2 and the intraobserver reliability was moderate to substantial (Interclass correlation coefficient: 0.31 to 0.66). Based on the Spearman-Brown formula, the measurement is reliable if it is done at least seven times by two observers, and four times by three observers. Conclusions: The data suggest that measurement of SS of pelvic flexion is a clinically useful parameter for the optimization of THA conditions.

Abstract: Background: Many studies worldwide have reported prevalence of atopic sensitization and its international variations. A positive skin prick reaction, however, does not always correlate with clinical symptoms. Positive skin tests (SPT) reveal rather atopy - specific IgE presence, than an atopic disease itself. When combined clinical manifestation and SPT are a powerful instrument for defining allergic diseases. Such data for Bulgaria are, however, scarce. The objective of the present study is to assess prevalence patterns and clinical relevance of sensitization to environmental and food allergens in a cross-sectional community sample in Bulgaria. Methodology and results: Patients, 225 men and women, age 4-81 years, were included. They completed a questionnaire to define asthma and rhinitis. Patients were skin prick tested to 18 commercial inhalant and food allergen extracts. The clinical relevance of each of the positively tested allergens was assessed. Among 225 patients 129 (57.3%) were sensitized to at least one allergen, using cut-off level ≥3 mm. In the inhalant allergens group the highest were rates of sensitization to 12 grasses – 26.6% and 4 cereals – 24.0%, followed by these to DFR – 18.2%, DPT – 17.8% and cockroach -16.4%. Among food allergens the highest rates of sensitizations were found to pork – 16.9%, walnut – 15.1%, apple – 13.3%, egg whole – 10.7%, celery – 9.8% and milk – 9.3%. The highest proportions of relevant tests in the inhalant allergens group were for DPT - 72.2%, DFR - 62.9%, 4 cereals - 69.2%, 12 grasses - 69%, Penicillium mix – 61.9, cockroach - 54.8%, Betulaceae - 52.4%. Among food allergens the highest proportions of relevant sensitization were found for walnut – 32.3%, peanut 29.4%, Milk - 22.2%, egg whole - 21.1%. Conclusions: We found rates and patterns of sensitization which were in line with data from other studies. The percentage of clinically relevant sensitizations differed significantly depending on the allergen.