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Biomedical subjects

T A Mahmood

Publications and source records attributed to T A Mahmood.

At least 19 recordsLinked to original sources
PubMed2004

Tension-free vaginal tape: 162 cases in a district general hospital.

From March 1999 to July 2002 a prospective study was carried out of 162 consecutive cases of urodynamically confirmed stress and mixed incontinence who underwent the tension-free vaginal tape (TVT) procedure. Patients were followed up at 6 weeks and 6 months and with a quality of life questionnaire at 1 year. The intraoperative complication rate was 7.6% and the postoperative complication rate was 18.8%. The subjective cure rate for patients suffering from urodynamic stress incontinence was 85%, with a further 11% experiencing significant improvement in their symptoms. The subjective cure rate for patients with mixed incontinence was 88%, with a further 9% experiencing significant improvement. The TVT procedure appears to be safe and effective for both stress and mixed incontinence for up to three years in a district general hospital. Complications in the short term are uncommon and can be managed easily.

Adult↗
PubMed2003

Evaluation of an experimental midwife-led unit in Scotland.

This paper reports on the outcome of pregnancy among 3322 low-risk women managed in an 'experimental midwife-led unit' at Forth Park Hospital, Kirkcaldy, Scotland. All women were allocated to receive midwife-led antenatal and intrapartum care. Of the 3322 women, 1786 were nulliparous and 1536 were parous. Of the 1786 nulliparous women, 532 (30%) were transferred to consultant care antepartum, 488 (27%) were transferred intrapartum and the remaining 766 (43%) were delivered in the midwife-led unit (MLU). Of the 1536 multiparous women, 343 (22%) were transferred to consultant care antepartum, 158 (10%) were transferred intrapartum and the remaining 1035 (68%) were delivered in the MLU. Among the intrapartum transfer group, 14% delivered during the first hour after the decision to transfer and another 14% gave birth during the second hour (28% between 0-2 hours). More than half of the women transferred during the second stage delivered within the first hour. Of the 2447 admitted to the MLU, 32% were seen by obstetric team on more than one occasion. Of the 1801 babies delivered in the MLU, 9% required resuscitation and 2% of all the babies were admitted to the special care baby unit. This study suggests that present antenatal criteria are unable to determine who will remain at low risk throughout pregnancy and labour, especially among nulliparous women. The clinical situation could change adversely during labour, requiring the involvement of medical staff. Commissioners of maternity services may wish to utilise these data to formulate local protocols for stand-alone midwife-led units.

Female↗
PubMed2002

A biodegradable composite scaffold for cell transplantation.

Cell transplantation is rapidly becoming a therapeutic option to treat disease and injury. However, standard techniques for cell seeding on non-woven polymer meshes or within gels may not be suitable for immediate implantation or surgical manipulations of freshly isolated cells. Therefore, a biodegradable composite system was developed as a way to rapidly entrap cells within a support of predefined shape to potentially facilitate cell delivery into a target site (e.g. meniscal tears in the avascular zone). The composite construct consisted of freshly isolated cells, in this case pig chondrocytes, entrapped in a fibrin gel phase and dispersed throughout the void volume of a polyglycolic acid (PGA) non-woven mesh. Composites were cultured for up to 4 weeks. In vitro degradation of fibrin gel was evaluated via gel-entrapped urokinase. At 28 days in culture, glycosaminoglycan (GAG) content per cell in the composite scaffolds was 2.6 times that of the PGA-only cell construct group and 88% that of native pig cartilage. Total collagen content per cell in the composite scaffolds was not significantly different from the PGA-only cell construct group (P > 0.02) and represented 40% of the value determined for native cartilage. Varying the concentration of entrapped urokinase could effect controlled degradation of fibrin gel.

Absorbable Implants↗
PubMed2002

Current practice of hysterectomy and oophorectomy in the United Kingdom and Republic of Ireland.

The purpose of this study was to estimate current surgical practice of hysterectomy and prophylactic oophorectomy of UK and Irish consultant gynaecologists. Individual and regional variation in surgical practice and factors influencing surgical practice were assessed. A postal questionnaire was sent to all 1536 consultants in obstetrics and gynaecology currently practising in the United Kingdom and Ireland, with a 52.7% response rate. Approximately 60% of hysterectomies were abdominal, 37% vaginal and 4% laparoscopic-assisted, with junior consultants performing a greater proportion of hysterectomies vaginally. There was a wide variation in method of hysterectomy, both individually and regionally. Only 21% of consultants would routinely consider performing prophylactic oophorectomy and of these the majority would perform this procedure in women aged between 46 and 50 years old. This large variation in surgical practice indicates a need to form a consensus on optimal surgical techniques and to ensure adequate surgical training for all gynaecologists.

Female↗
PubMed2001

Medium-term clinical outcome of women with menorrhagia treated by rollerball endometrial ablation versus abdominal hysterectomy with conservation of at least one ovary.

BACKGROUND: To compare patients' satisfaction, health related quality of life, and sexual function among women who were either treated with rollerball endometrial ablation or abdominal hysterectomy with conservation of at least one ovary for the treatment of menorrhagia. METHOD: Between March 1992 to June 1997, 91 women underwent rollerball endometrial ablation and 78 women had abdominal hysterectomy with preservation of at least one ovary for the treatment of intractable menorrhagia. Each was sent a detailed questionnaire at least 18 months (range 18-60) after surgery. Case notes were reviewed to collect additional data relating to pre-operative management and operative details. RESULTS: Of 169 women, 120 (71%) returned a completed questionnaire [80/91 women (88%) had ablation and 40/78 women (51%) had hysterectomy]. Non-response analysis did not reveal any differences in prognostic characteristics between responders and non-responders. The length of hospital stay and time taken to return to normal daily activity were significantly less in the ablation group. Pre-menstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvement in general health higher. Women who had hysterectomy were more satisfied (100% versus 79%) and would be more likely to recommend it to a friend (100% versus 91%). CONCLUSION: Both procedures are effective for the treatment of menorrhagia but hysterectomy is associated with better general health and fewer pre-menstrual symptoms. Rollerball ablation is a useful alternative with many short term benefits and acceptable satisfaction rate. Further work is required to evaluate long term effects.

Adolescent↗
PubMed2001

Understanding factors influencing request for a repeat termination of pregnancy.

OBJECTIVE: To assess factors influencing request for a termination of pregnancy (TOP). DESIGN: A questionnaire based, prospective study of 150 women requesting a TOP. This questionnaire contained a modified version of the Edinburgh Postnatal Depression Scale (EPDS). SUBJECTS: Of the 150 women requesting a TOP, 100 were seeking a TOP for the first time and the remaining 50 had at least one TOP in the past. RESULTS: Forty-five percent of women requesting termination of the first pregnancy were under the age of 20, 62% earned less than 10,000 Pounds per year and 12% did not use any form of contraception. Ninety-eight percent knew about emergency contraception but only 3% used it. The repeat termination group were older (only 24% under the age of 20). Fifty-five percent earned less than 10,000 Pounds per year, 15% did not use any contraception, 92% knew about emergency contraception but only 10% used it. Both groups were highly satisfied with the counselling, explanation about the procedure and future contraception advice. However, about 60% of women in both groups had suffered from mild to moderate depression as a consequence of termination. CONCLUSION: This study confirms the need for easy availability of emergency contraception and emphasises the importance of education about contraception in general.

Abortion, Induced↗
PubMed2000

Incorporation of amino acids within the surface reactive layers of bioactive glass in vitro: an XPS study.

Surface reaction layers grown on bioactive glass (Bioglass), by immersion in either simulated body fluid (SBF) or minimal essential medium (alpha-MEM) for 2, 5, 32 and 72 h, were analyzed by scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). Layers grown in alpha-MEM exhibited delamination when observed in SEM. Low resolution XPS analysis detected nitrogen at the surface of the Bioglass exposed to alpha-MEM for 72 h (8 relative at%), whereas insignificant nitrogen was found at the surface of any sample immersed in SBF. XPS depth profiling (argon) showed the presence of nitrogen throughout the depth of the surface layer of the sample incubated in alpha-MEM for 72 h. Deconvolution of the nitrogen envelope in a high resolution XPS spectrum demonstrated nitrogen characteristic of the amine bonds present in amino acids. Carbon concentration also considerably increased over time with exposure to alpha-MEM (24-55%), whereas it remained in the 20-25% range in SBF. These results demonstrate that the amino acids contained in the culture medium were incorporated within the growing calcium phosphate rich surface reaction layer of Bioglass.

Journal Article↗
PubMed2000

Simultaneous presentation of ectopic pregnancy and hyperthyroidism.

Hyperthyroidism is known to occur uncommonly in pregnancy (about 0.5 per 1000). The incidence of ectopic pregnancy is approximately 9.6 per 1000 pregnancies. Both conditions, if unrecognised and untreated can have potentially fatal consequences. We describe a case of hyperthyroidism and ectopic pregnancy presenting concurrently, and highlight the difficulties encountered in diagnosis when two clinical conditions present with indistinguishable clinical signs.

Adult↗
PubMed2000

Do practice guidelines guide practice? A prospective audit of induction of labor three years experience.

BACKGROUND: To examine the effect of implementation of guidelines for induction of labor on the process of care and outcome measures. METHOD: Guidelines for induction of labor were implemented in January 1996 following an audit report identifying inconsistency in clinical practice. A prospective audit was carried out following the implementation of a new strategy directed towards pre-induction cervical ripening in nulliparae with unfavorable cervices and the use of low dosages of vaginal prostaglandin E2 for induction of labor. Level of compliance and outcome measures were compared before and after implementation of guidelines. RESULTS: In the period of January 1995 to November 1997, 1,230 women were induced with a singleton viable pregnancy in a cephalic presentation with a gestational age > or = 37 weeks with no history of rupture of membranes or cesarean section. Completed forms were available for 1,147 women (370, 421 and 356 in 1995, 1996 and 1997, respectively). Among nulliparous women, there was a reduction in the number of women who were admitted with cervical score of < or = 4 (24%, 40%, and 54% in 1997, 1996, and 1995, respectively; p=0.0001), an increase in the number of women who had amniotomy on admission (32%, 25% and 12% in 1997, 1996, and 1995, respectively; p=0.0001) and a shorter induction-delivery interval. No change in outcome measures was noted among multiparous women despite reduced dose of prostaglandin E2 used for induction of labor. A marginal reduction of both Cesarean section and failed induction rates were noted in both nulliparae and multiparae. Level of compliance improved with successive rounds of audit. CONCLUSION: Explicit guidelines do improve clinical practice, when introduced and monitored in the context of rigorous evaluations. However, the size of improvement could vary.

Adolescent↗
PubMed2000

Medium-term follow-up of women with menorrhagia treated by rollerball endometrial ablation.

BACKGROUND: To assess medium-term efficacy of rollerball endometrial ablation in a district general hospital. METHOD: From March 1992 to June 1997, 91 women underwent rollerball endometrial ablation for uncontrolled menorrhagia unresponsive to medical treatment. Each was sent a detailed questionnaire after at least 18 months (range 18-55). There was an overall response rate of 88% (80/91). Case notes were reviewed to collect additional data related to pre-operative management and actual operative procedure. The main outcome measures included treatment satisfaction, relief of symptoms, improvement in health related quality of life, at least 18 months after surgery. RESULTS: Thirty-five of the 80 women (44%) had achieved amenorrhea. Ten women required further treatment; of these seven had a hysterectomy (9%). None of the non-responders had a hysterectomy. Following rollerball endometrial ablation, many women reported improvement in cyclical pelvic pain (73%), pre-menstrual symptoms (65%), ability to do housework (85%), and an improved sexual life (96%). Seventy-nine (99%) women were able to return to normal work within 4 weeks following surgery. The majority of them remained satisfied with treatment (79%) and they would recommend it to a friend (91%). CONCLUSIONS: Rollerball endometrial ablation is a simple, effective, and acceptable procedure for the treatment of menorrhagia in selected cases. Longer-term follow up is still needed to establish the ultimate effectiveness of the procedure.

Adolescent↗
PubMed1995

A randomized prospective trial comparing single dose prostaglandin E2 vaginal gel with forewater amniotomy for induction of labour.

A prospective randomized parallel-group study was carried out to compare the efficacy of a single dose vaginal prostaglandin E2 gel with forewater amniotomy for induction of labour at term in 260 parturients (110 primigravid and 150 parous women) with low risk pregnancy and favourable cervix. In the prostaglandin E2 (PGE2) managed group, the primigravidae were treated with 2 mg PGE2 gel and parous patients with 1 mg PGE2 gel. Forewater amniotomy was performed 4 h later, or sooner if women requested analgesia. In the amniotomy group, artificial forewater amniotomy was carried out and a repeat cervical assessment done 4 h later, or sooner if women requested analgesia. In both groups, intravenous oxytocin was established if there was evidence of disordered uterine activity, 6 h after the start of initial intervention. An assessment of consumers' views was carried out by using a standardized questionnaire completed 48 h after delivery. There was a significant reduction in the requirement for oxytocin augmentation in women treated with PGE2: primigravidae, odds ratio (OR), 0.27 and 95% confidence interval (CI), 0.12-0.61; multiparae, OR, 0.19 and 95% CI, 0.08-0.45. Fewer primigravidae managed with PGE2 gel required epidural analgesia (OR, 0.16; 95% CI, 0.06-1.00). Fewer parous women managed with PGE2 gel required parenteral opiates (OR, 0.44; 95% CI, 0.23-0.85) and more women required inhalation analgesia or no analgesia (OR, 2.22; 95% CI, 1.76-2.79). The intervention to delivery intervals were shortened in PGE2 groups independent of parity but the differences were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

A randomized trial of management of pre-labor rupture of membranes at term in multiparous women using vaginal prostaglandin gel.

OBJECTIVE: To compare conservative management of pre-labor spontaneous rupture of membranes (SROM) with the use of prostaglandin (PG) E2 in healthy parous women at term (gestational age at least 37 weeks). METHODS: An open randomized study was conducted with 100 parous women; 50 were treated conservatively for 24 hours, and 50 were managed actively using PGE2 gel (1 mg), administered at admission and repeated 6 hours later if labor was not established. Both groups received intravenous oxytocin if labor did not start within 24 hours after admission. RESULTS: The use of PGE2 gel led to a significant reduction in the mean interval (+/- standard error of the mean) from SROM to onset of labor: 17.26 +/- 1.51 hours in the conservative group versus 6.50 +/- 1.23 in the PGE2 group. A significantly smaller proportion of subjects required oxytocin in the PGE2 group (12 versus 38%, P < .02). The two groups were comparable with respect to analgesic requirements. Within 24 hours of SROM, 80% of the women in the PG group and 56% in the conservative group had delivered (P < .02). Most women delivered vaginally, 96% of those managed conservatively and 100% of those managed actively with PGE2. CONCLUSION: Active management using PGE2 gel in parous women with pre-labor SROM significantly improves the time to delivery without influencing the cesarean rate or fetal-maternal infective morbidity.

Administration, Intravaginal↗