This cross sectional study was conducted on the pregnant women attending the Gynecology and Obstetrics Department of tertiary care hospitals of Peshawar, North West Frontier Province (NWFP) Pakistan. A total of 402 pregnant women at gestational age of > 20 weeks were registered in the study after taking their informed consent. The study subjects were divided into four groups of pregnant women; with three patient groups (A, B, C) of Pregnancy Induced Hypertension (PIH) and one control group (D). History of each participant was recorded on a pre designed questionnaire. Height, weight and blood pressure was measured and 5 ml of venous blood was drawn from patients and control groups. Biochemical analysis of lipoprotein included Total Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C), Very Low Density Lipoprotein Cholesterol (VLDL-C), Triglycerides (TG), Apolipoprotein-A1 (APO-A1), Apolipoprotein- B100 (100), Lipoprotein-a (LPA) and hematological parameters including Hemoglobin (Hb) and Platelet count. These investigations were performed in PMRC Research Centre, Khyber Medical College, Peshawar and in the Pathology labs of Post Graduate Medical Institute (PGMI) Lady Reading Hospital, Peshawar. The data was processed on computer software package SPSS version 10. Statistically highly significant (P < 0.001) differences were noted in most of maternal serum lipids and lipoprotein concentrations in the three individual patient groups when compared with the control pregnant women, except changes in LDL- C (P > 0.05). Changes in the TC were non significant in group A and B, while difference in group C were significant (P < 0.05) when compared with the control group D. Similarly was non significant (P > 0.05), markedly significant (P < 0.01) and highly significant (P <0.001) in group A, B & C respectively when compared with group D. Mean concentrations of 100 were non significant in group B, while it was significant (P < 0.05) in group A and C when compared with group D. Changes in the mean values of LPA were non significant in group A and B, while it was highly significant (P < 0.001) in group C as compared to iiicontrol group D. Amongst the different lipoprotein ratio TC: HDL-C, LDL-C: HDL-C, TG: HDL-C and HDL-C: VLDL-C ratio were found highly significant (P < 0.001) in patient groups of A, B and C, as compared with group D. Women who developed hypertension (group A+B+C) had 5.45%, 3.5%, 39%, 38.6% and 26.98% higher concentrations of TC, LDL-C, VLDL-C, TG and LPA levels respectively, than control subjects. A significant decrease of (16.76%) and (18.5%) was respectively noted in HDL-C and APO-A1 of patient group when compared with control pregnant women, while no significant change in 100 levels was seen among the groups. TC: HDL ratios, LDL-C: HDL-C ratio and TG: HDL-C ratios were higher (32.3%, 29.8% & 66.4% respectively) among women with PIH and were found highly significant (P<0.001) as compared to normotensive women. In the PIH group LDL-C: 100 was raised to the marked significant level of P < 0.01, while the difference between the two groups of test and control was found non significant for LDL-C: 100 ratio (P > 0.05). HDL-C: VLDL-C ratio were decreased by 38.23% in the patients and were highly significant as compared with control subjects (P <0.001). A significant difference was found in maternal TG levels, VLDL-C, TC: HDL-C, TG: HDL-C and HDL-C: VLDL-C ratio, when the PIH group of patients with systolic blood pressure (SBP) < and > 150 mmHg were compared. Similarly PIH patients had significantly elevated serum HDL-C, VLDL-C, TG, TC: HDL-C, TG: HDL-C, HDL-C: VLDL-C and LDL-C: 100 ratio when patients with diastolic blood pressure (DBP) < 110 were compared with DBP > 110 mmHg. Undesirable TC > 240 mg/dl in 35.8% patients, undesirable HDL-C in 50% patients, high concentrations of TG (73.2%), borderline high concentration of LDL-C (23.6%), undesirable TC ratio > 5.2 in 52.3% and undesirable LDL-C ratio > 1.6 were noted all in the patients of eclampsia group ‘C’. A 1.5-fold increase in the risk of PIH among women with TC >240 mg/dl was noted, as compared with women whose TC concentration was < 200 mg/dl (95% CI (0.80-2.75) χ 2 1.81, P 0.17). Women in the lowest group of HDL-C concentration, experienced an 8.6-fold increased risk of PIH as compared with women in the highest group (95% CI (3.28-22.71) χ 2 27.9, P <0.0001) as referent. The women having LDL-C in the range of 130-159 mg/dl experienced a 1.5-fold ivincreased risk of PIH as compared with women in the lowest group (95% CI (0.67-3.40). Women in the TG concentrations (200-499 mg/dl) experienced a 3.5- fold increased risk of PIH as compared with those women in the lowest group as referent (95% CI (1.50 to 8.22) χ 2 10.82, P < 0.001). The risk of PIH increased 4.5 times for HDL-C ratio > 5.1 (95% CI (2.-8.87) χ 2 24.39, P < 0.0001). Women with the highest LDL-C: HDL-C ratio experienced an almost 2.4-fold increased risk of PIH (OR 2.43, 95% CI 1.18 to 4.98, χ 2 7.09, P 0.007) as compared with women whose ratio values were <1.21 (lower group). A significant change was seen in the concentration of HDL-C (P < 0.01), VLDL- C (P < 0.05), triglycerides (P < 0.05), 100 (P < 0.05) and LPA (P < 0.05), when PIH women in the second trimester were compared with those in their third trimester. Significant changes were observed in the systolic (P< 0.05) and DBP (P < 0.01) of PIH women, when 2 nd trimester was compared with the 3 rd trimester. In the patient group 85.6% pregnant women were anemic as compared to 84.5% in the control group. Majority of women with severe anemia (Hb < 7.7 g %) were present in the three patient groups as compared to the normal pregnant women. Normal platelet count > 150 thousand/μL was recorded in 85 (95.5%) of control pregnant women against 70 (78.3%) in the group of PIH. The number of women with severe thrombocytopenia (platelet count < 100 thousand/μL) were more in group C of eclampsia (13.6%) versus 1.1% in the control women. In conclusion, the results of our study propose that an abnormal lipid metabolism and predominantly low HDL-C and high TG concentrations, may add to the promotion of vascular dysfunction and oxidative stress seen in pregnancy induced hypertension. It is, therefore, essential that, blood lipid concentrations be estimated in pregnant women during antenatal care since it could be useful in the early revealing and prevention of obstetric complications such as pregnancy induced hypertension.
مولانا محمد سلمان خاں بھوپالی ندوی مرحوم ندوۃ العلما کے ایک اور لایق فرزند اور مولانا محمد عمران خاں بھوپالی ندوی مرحوم کے برادر خورد جناب مولانا محمد سلمان خاں ندوی مرحوم کی وفات حسرت آیات کی خبر بہت تاخیر سے ان کے صاحبزادے مولوی حافظ کلیم خاں ندوی کے ایک خط سے ملی، اناﷲ وانا الیہ راجعون۔ وہ دارالعلوم تاج المساجد کے سابق مہتمم تھے، لیکن ان کا سب سے روشن کارنامہ تاج المساجد کی تعمیر نو ہے۔ مولانا محمد عمران خاں ندوی مرحوم نے جس شاہانہ اولوالعزمی سے اس عظیم الشان مسجد کی تعمیر و تکمیل کا خاکہ بنایا تھا اس کو مولانا سلمان خاں صاحب نے حقیقتاً رنگ و روغن عطا کیا، جن لوگوں نے مسجد کی تعمیر و تکمیل میں ان کی شبانہ روز کی محنت، جانفشانی اور لگن دیکھی ہے وہ جانتے ہیں کہ اس تعمیر میں ان کا لہو تک شامل ہوگیا ایک عالم کی اس معمارانہ اور مہند سانہ مہارت پر بڑے بڑے انجینئر اور آرکی ٹیکٹ بھی حیران رہ گئے، طبعاً وہ نہایت شریف، متین، کم سخن اور مہمان نواز انسان تھے، اپنے تمام بیٹوں کو انھوں نے حفظ قرآن مجید کی دولت سے بہرہ یاب کیا اور سب کوند وہ ہیں تعلیم دلائی، وہ خود بڑے دیندار تھے متعدد بار حج بیت اﷲ کی سعادت حاصل کی۔ اﷲ تعالیٰ ان کی نیکیوں اور دینی خدمات کو قبول کرے اور جنت نعیم میں جگہ عطا فرمائے، آمین۔ ( عمیر الصدیق دریابادی ندوی ، اگست ۱۹۹۱ء)
The aim of Hijrah is not to run away from problem that occurred in the process of giving da'wah, but rather to establish the resolve in solving the problem. Hijrah as a movement carried out by the Prophet Muhammad (PBUH) and his companions from Makkah to Madinah, aimed to keep, maintain and uphold the message of Allah, in the form of Islamic aqeedah and shari’a, in order to achieve the mercy and pleasure of Allah SWT. This move, as we can see in the seerah, later brought a great impact to the success of the Islamic da’wah which was increasingly evolving. Hence the fundamental problem that has led to the migration has been solved. In fact, the Hijrah brought a significant impact not just to the Islamic world but also to world civilisation. The story and background of the migration of Rasulullah (PBUH) from Makkah to Madinah is touched in this writing to show that there were a lot of lessons and guidance that can be inferred. It did not merely signify a final destination for Makkah Muslims, but was also the beginning of a continuous effort to establish a strong and resilient ummah. The event of Hijrah in fact had changed the world after that forever. It highlighted the perseverance of the Rasulullah (PBUH) and the early Muslims through the difficult times. Hijrah demonstrates that for people with faith, there is hope for ease after difficulties. There was also a great unity model among Muslims of different backgrounds. The Hijrah had also marked the beginning of the Islamic State under the leadership of Rasulullah (PBUH) which then became a reference for all state governance everywhere in the future
Background: Uterine fibroid embolization, though a widely available option in high income countries in managing symptomatic fibroids is relatively new in the East African region. It is currently offered at only one tertiary facility for the past three years. The symptom and radiological response in these patients, who literature suggests may have bigger fibroid burden and worse symptoms, is the subject of this study.
Objective: Characterization of MRI imaging features in women undergoing uterine fibroid embolization and identification of clinical correlates in an African population.
Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short term imaging outcome and mid-term symptom scores were analysed for interval changes. Assessment of potential associations between short term imaging features and the mid-term symptom scores were also done.
Results: UFE resulted in statistically significant reductions (P< 0.001) of dominant fibroid and uterine volumes and in symptom severity scores of 43.7%, 40.1% and 37.8% respectively. Strong enhancement at baseline was a strong predictor of response to UFE.59% of respondents had more than ten fibroids. The predominant location of the dominant fibroid was intramural. No statistically significant association was found between clinical and radiological outcome.
Discussion: UFE is a new treatment option for treatment of uterine fibroids in Kenya. This study was aimed at assessing outcomes to this treatment option compared to other parts of the world. The response of uterine fibroids to embolization in the African population is good but not different from findings reported in other studies in the West. The presence of multiple and large fibroids seen here is consistent with the case mix described in studies of African-American populations. No significant association is seen between radiological and clinical outcomes to UFE.
Conclusion: UFE treatment for fibroids has good outcome. Further studies lasting beyond one year are indicated for further detailed outcome in the local African population.
Recommendations: Patient counselling should emphasise the independence of volume reduction and symptom improvement. Volume changes are of relevance for the Radiologist in aiding understanding of the evolution of the condition and identifying potential technical treatment failures but should not be the main basis of evaluation of treatment success.