A case report of young hypertensive with primary amenorrhea: uncommon variant of congenital adrenal hyperplasia

Hypertension in young should be evaluated in detail because secondary causes are more common in this subset of patients. As on one hand it help us in treating blood pressure and its complications including stroke , coronary artery disease and renal failure, other hand we should also treat the other complications like growth, puberty and electrolyte imbalance. Here we present a case who admitted in cardiology unit with accelerated HTN and hypokalaemia, and on detailed evaluation found to have primary amenorrhea. Identification of the cause not only leads to correct hypertension with minimal drugs but she got the reason of her amenorrhea

Complex mullarian duct abnormality in a young female: a theraputic dilemma

Genital outflow tract obstruction is a rare cause of primary amenorrhoea. Cervical agenesis is a very rare condition often associated with atresia of vagina. Clinical diagnosis is usually difficult before surgery. Transverse vaginal septum or vaginal agenesis is also a rare condition that results from incomplete fusion between vaginal components of the mullerian ducts and urogenital sinus. If the septum is complete, the menstrual flow will be obstructed causing primary amenorrhoea. The septum is basically a membrane of fibrous connective tissue with both muscular and vascular components formed anywhere along the vagina during embryological development. Here we present a case of 18 year old female who presented with primary amenorrhea, cyclical lower abdominal pain and menouria since 5 years. There was no history of attainment of menarche. The clinical examination revealed a small, blind ending lower vagina with a tough transverse membrane separating the lower portion from the upper genital tract. The ultrasound examination revealed a normal size uterus with hematometra. The magnetic resonance imaging of pelvis confirmed the presence of hematometra and transverse vaginal septum. Transverse vaginal septum resection followed by abdomino-perineal cervicoplasty was done in this patient

Congenital absence of a part of the fallopian tube: a case report

Congenital malformations of female genital tract are frequently seen in Gynaecological clinics, incidence being upto 5-6% in cases of infertility. Most of these anomalies are related to uterus and vagina, abnormalities related to ovaries and fallopian tubes are of rare occurrence and the exact incidence of these anomalies are not known, only a few incidental case reports are available in literature. Here, we present a rare case report of absent mid- tubal segment of fallopian tube in a patient of infertility

A rare case of abdominal lymphangioma masquerading an adenaxal mass

Lymphangioma is an uncommon benign tumour of the lymphatic system. It can be localized (spleen, liver or thorax) or generalized. An abdominal location is exceptional (5%) and majority of cases occur in early childhood and it rarely presents in adulthood. Retroperitoneal lymphangioma account for less than 1% of all lymphangiomas here we present a rare case of retroperitoneal lymphangioma and patient presented as adenaxal mass

Assessing knowledge, attitude, and practice of contraception: a cross- sectional study among patients in a semi-urban tertiary hospital

Background: Unregulated fertility not only disrupts the health of women and child but also disrupts the economy of society and nation. To gain the knowledge about awareness and contraceptive practices in women living in semi-urban area, a cross-sectional study was conducted over one year to evaluate the awareness, acceptance and prevalence of contraceptive methods and various factors affecting the contraceptive usage.Methods: It was a cross sectional study conducted in outpatient department of obstetrics and gynaecology, in a tertiary medical college hospital. The study constituted 300 subjects. It was an interview based study. Data were collected on age, parity, literacy level, residence, knowledge about various contraception, women practicing contraception and reasons for non-use of contraceptives.Results: A total of 300 women in the age group between 18-45 years were studied. It was observed that most of the women belong to the age group of 25 to 34 years (45.33%). 70% belong to rural population. only 20% were para 2 or less.35.33% of the study population were illiterate and 21.67% had education above secondary level. 290 (96.67%) women were aware of one or multiple methods of contraception however, 126 (42%) women accepted the contraceptive practices. Of 300 women, 94 (31.33%) followed permanent methods of contraception. 66% of the study population had experienced unwanted pregnancy and among them 44% pregnancies were aborted. Number of women practicing contraception was very low, i.e. 42% and the main reason of nonpractice of contraception was family pressure mainly in laws, husband gender bias, physical abuse, etc.Conclusions: It was noted that though knowledge of at least one method of contraception was wide among the women but still actual practice was very low. More programs are required to combat the influence of various factors on contraception usage, and emphasizing on the positive effects of the use of contraception

Serous cystadenoma of ovary with xanthogranulomatous oophoritis: combination of benign ovarian tumour with chronic inflammatory non-neoplastic pseudo-tumour-a rarity

Xanthogranulomatous inflammation is a rare type of chronic inflammation. It destroys the tissue of the affected organ, mostly affecting the kidney and gall bladder. Xanthogranulomatous inflammation of female genital tract being a rare entity, only few numbered cases involving the ovary have been reported in literature. This chronic inflammation of fallopian tubes and ovaries, usually present with pelvic masses, and on imaging and macroscopic appearance, are mostly misdiagnosed as ovarian neoplasm or tuberculosis. We are presenting a case of 14-year-old girl, who presented with an abdominal lump and on clinical and radiological investigations was suspected as ovarian malignancy but histo-pathology reported it as serous cystadenoma with xanthogranulomaotus oophoritis. The rarity of this case lies in the fact that rare destructive inflammatory features was present in a benign neoplasm of the ovary (serous cystadenoma) and that too in a youngest age reported till now

Knowledge and attitude among Indian medical students towards thalassemia: a study in Delhi NCR

Background: Thalassemia can easily be prevented by awareness, education, screening, premarital genetic counselling and prenatal diagnosis. There are only a handful of articles on knowledge and awareness about thalassemia among general population or parents of thalassaemic children. Aims and objectives was to evaluate the level of awareness, knowledge and attitudes of medical students towards thalassemia as well as to analyse the differences if any between the first year and second year MBBS students and their correlation with various socio-demographic parameters.Methods: This was an institutional based cross sectional observational descriptive study regarding knowledge and attitude of first and second year MBBS students about thalassemia using a pre-designed, structured, self-administered questionnaire. Data was analyzed using SPSS software version 17. Values of p<0.05 were considered significant.Results: Mean knowledge scores of second year MBBS students compared to first year MBBS were 11.73±1.78 versus 10.8±1.92, the difference being statistically significant, however, the difference between mean attitude scores was not found to be significant. There was no effect of age, gender, region or Kuppuswamy’s socio-economic class on the knowledge or attitude of MBBS students towards thalassemia.Conclusions: Majority of the MBBS students had good knowledge and positive attitude towards thalassemia. To confirm the observations, large scale studies need to be conducted comprising of different study populations. Screening for thalassemia should be made mandatory, as part of medical examination, at entry to a medical college so that the medical college students are sensitized and can spread awareness among general population

A Correlation of Tumor Budding and Tumor Stroma Ratio with Clinicopathological Factors in Oral Squamous Cell Carcinoma

Background: Squamous cell carcinoma is the most common carcinoma in the head and neck region. Both tumor budding and tumor stroma ratio are being studied in the recent years in various solid tumors for their role as a prognostic marker, however the studies in oral squamous cell carcinoma are limited. Methods: A total of 50 patients of oral squamous cell carcinoma proved histologically were included in the study over a period of 4 months (July 2022-October 2022). Tumor budding(TB) and Tumor stroma ratio (TSR) were evaluated on routine hematoxylin and eosin stained sections and these were correlated with clinicopathological parameters. Statistical analysis was done using Chi-square test and p value &lt;.05 considered significant. Result: The mean age was 52.72 +_ 13.16 and M: F of 7.1:1. Most of the tumors were located on tongue (46%) followed by buccal mucosa (26%), gingivobuccal sulcus (12%) and retromolar trigone (8%). Palate and alveolus were the other sites involved constituting 4% each. Both TB and TSR were found to be significantly associated with grade of the tuumor, lymph node metastasis and size of the tumor. A highly significant correlation was also found between Tb and TSR with a p value &lt;.001. Conclusion: Both TB and TSR can be easily evaluated on routine H&amp;E sections and are highly reproducible and found to be reliable independent prognostic markers in OSCC. Thus, this simple and cost-effective method of prognostification which is currently lacking will help in identifying patients with poor prognosis and thus, individualise the treatment plan. Keywords: Tumor Budding, Oral squamous cell carcinoma, Tumor stroma ratio

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat