Comparison of RMI 3 and RMI 4 in pre-operative evaluation of ovarian masses

Background: To differentiate ovarian mass as benign or malignant could change clinical approach. Finding a screening and diagnostic method for ovarian cancer is challenging due to high mortality and insidious symptoms. Risk malignancy index (RMI) has the advantage of rapid and exact triage of patients with ovarian mass.Methods: Prospective study carried for 2 years at NRI Medical College and General Hospital, Chinakakani, Mangalagiri, Andhra Pradesh, India. 79 patients with ovarian mass were investigated and risk malignancy index (RMI-3 and RMI-4) calculated. Final confirmation was done based on histopathological report. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for RMI 3 and RMI 4 taking histopathology as control and comparison was done.Results: (n=79); 50 (63.29%) cases were benign and 29 (36.70%) were malignant based on histopathology. RMI 4 is more sensitive (68.96%) than RMI 3 (62.06%), but RMI 3 is more specific (94%) than RMI 4 (92%).The positive predictive value of RMI-3 and RMI-4 were 85.71%  and 83.33% respectively. The negative predictive value for RMI-4 and RMI-3 were 83.63% and 81.03% respectively.Conclusions: With increasing age, chance of malignancy increases. RMI 4 was more sensitive than RMI-3, however less specific than RMI 3 in differentiating benign and malignant tumors. The positive predictive value is slightly more for RMI 3, than RMI 4. Negative predictive value is slightly more for RMI 4, than RMI 3.

Case report of a successful term pregnancy following renal transplantation

Pregnancy with renal disease is associated with high risk for both mother and fetus with adverse outcomes. Criteria for considering pregnancy in renal transplanted patients include good post-transplant health for 2 years, stable allograft function with a serum creatinine <1.5 mg/dl, absence of rejection, control of blood pressure, absence of proteinuria. Authors report a case of 26-year-old, primigravida had renal transplantation done in NRI Medical College and treated with immunosuppressive therapy with tablets Tacrolimus 1mg twice daily, Azathioprine 50mg twice daily, Prednisolone 10mg once daily and continued till delivery. Developed gestational hypertension treated with tablet Amlodipine 5mg once daily. Elective caesarean section done for contracted pelvis. Post-natal period was uneventful and discharged on immunosuppressive therapy and contraceptive advice. Post-renal transplantation pregnancy should have multidisciplinary approach for. With close medical and obstetric follow up, successful outcome for both mother and infant is possible

Evaluation of Outcome of Pregnancy Complicated with Thrombocytopaenia- A Prospective Observational Study

Introduction: Thrombocytopaenia occurs in 7-12% of pregnancies at the time of delivery. Knowledge, regarding the causes and effects of thrombocytopaenia on mother and newborn, facilitates proper diagnosis and management of thrombocytopaenia in pregnant women for better maternal and foetal outcomes. Aim: To determine the incidence, causes and outcome of pregnancy with thrombocytopaenia. Materials and Methods: A prospective observational study was conducted among women attending Outpatient Department for an antenatal checkup at NRI Medical College and General Hospital, Chinnakakani, Guntur, Andhra Pradesh, India, from October 2017 to October 2019. A total of 44 antenatal women with platelet count less than 1,50,000/cumm were included in the study. They were followed-up throughout the antenatal period until delivery to record any complications that developed due to low platelet counts in the mother and neonate. A neonatal platelet count was done on day one of life. Data was subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) version 22.0, all qualitative variables were expressed in terms of proportion. Results: A total of 500 cases were studied of which 50 cases had thrombocytopaenia with an incidence of 10%. Out of 50 cases, six were lost for follow-up and the remaining 44 cases were included in the study. Out of 44 patients, 23 (52.27%) had mild thrombocytopaenia, 12 (27.27%) had moderate and 9 (20.46%) had severe thrombocytopaenia at the time of diagnosis. Common causes seen were Gestational Thrombocytopaenia (GT) 17 (38.6%), Preeclampsia (PE) 8 (18.18%), Gestational hypertension 4 (9.09%). A total of 5 (11.36%) required intensive care unit care, 3 (6.81%) had multiorgan dysfunction syndrome (MODS), 2 (4.54%) underwent hysterectomy, 2 (4.54%) had postpartum haemorrhage (PPH), 2 (4.54%) had secondary suturing done for wound infection, 1 patient (2.27%) underwent laparotomy (for rectus sheath haematoma), and mortality was seen in two cases. A total of 14 cases (31.8%) required blood and blood product transfusions. Eight neonates were admitted to the neonatal intensive care unit. There was no case of neonatal thrombocytopaenia. Conclusion: Thrombocytopaenia is a significant problem in pregnancy; hence, the routine antenatal platelet count should be done for a timely diagnosis of thrombocytopenia