A bizarre highly vascular tumor with alarming presentation: a diagnostic dilemma

An exceedingly rare, highly vascular tumor with atypical and alarming presentation posed diagnostic and management challenges. A 29 years old lady, complained of abdominal and pelvic pain, nausea, vomiting and repeated spells of fainting attacks following the jumping episode (2-3 times). Emergency admission and investigations at United States of America (USA) revealed a large, complex, highly vascular, irregular mass displaying finger like projections, filling the lower abdomen, pelvis and large amount of intra peritoneal bleed. A provisional diagnosis of arteriovenous malformation (AVM), arteriovenous fistula (AVF), and rupture/leak was made. Uterine artery angiography (UAA), preoperative embolization and possibility of hysterectomy as a life saving measure were suggested, to which the couple declined and got discharged. To save uterus and fertility they presented to us for second opinion and further management. Angiography, magnetic resonance imaging (MRI) and preoperative uterine artery embolization were done followed by exploratory laparotomy which revealed hemoperitoneum and a large weird looking vascular tumor (a veil of sea weeds/dark purple nodules of various sizes resembling cotyledons of placenta). Intra-operative tissue analysis (frozen section) suggested benign pathology. Mass was removed completely and fertility sparing surgery was undertaken. Histopathological diagnosis was cotyledonoid dissecting leiomyoma (CDL). No recurrence/metastasis has been observed on follow up of 5 years

A vaccine that prevents pregnancy in women

We report here results of clinical trials on a birth control vaccine, consisting of a heterospecies dimer of the beta subunit of human chorionic gonadotropin (hCG) associated noncovalently with the alpha subunit of ovine luteinizing hormone and conjugated to tetanus and diphtheria toxoids as carriers, that induces antibodies of high avidity (K(a) approximately 10(10) M-1) against hCG. Fertile women exposed to conception over 1224 cycles recorded only one pregnancy at antibody titers of > 50 ng/ml (hCG bioneutralization capacity). The antibody response declines with time; fertility was regained when titers fell to < 35 ng/ml. This study presents evidence of the feasibility of a vaccine for control of human fertility

Magnetic resonance imaging findings in pseudo-Meigs' syndrome associated with a large uterine leiomyoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pseudo-Meigs' syndrome is a rare pathological entity characterized by the presence of a pelvic mass other than an ovarian fibroma. The mass is associated with ascites with or without hydrothorax.</p> <p>Case presentation</p> <p>We describe the case of a 41-year-old Caucasian woman with a large uterine leiomyoma associated with massive ascites. A magnetic resonance imaging scan showed a large subserosal leiomyoma with multiple areas of cystic degeneration.</p> <p>Conclusion</p> <p>To the best of our knowledge, this is the first reported case of pseudo-Meigs' syndrome caused by a uterine leiomyoma and diagnosed using magnetic resonance imaging. The pathophysiology of this syndrome and the role of magnetic resonance imaging are emphasized in this case report.</p

A unique variant of spontaneous ovarian hyperstimulation syndrome: case report

Spontaneous ovarian hyperstimulation syndrome (SOHSS) is extremely rare in naturally conceived pregnancies and is potentially a life-threatening condition. Objective of present study was to highlight the development of new and atypical findings associated with SOHSS in a woman who conceived naturally with singleton pregnancy while taking inositols and metformin. A 35 years old lady was under pressure to conceive, so she presented to us for fertility consultation and further management. Being a case of polycystic ovary syndrome (PCOS) with irregular periods, hyperandrogenism and dyslipidemia with raised blood sugar level, she was started on inositols and metformin to aid fertility and to improve endocrine and metabolic parameters. To evaluate the status of ovaries and endometrium, ultrasound (US) was done which revealed moderate amount of free fluid in pelvis, thickened endometrium and mild enlargement of ovaries with unusually small and atypical follicles. Pregnancy test and beta-human chorionic gonadotropin (βHCG) confirmed pregnancy. She was asymptomatic and was managed conservatively. Pregnancy progressed and at term, a healthy male baby was delivered. Awareness and suspicion of SOHSS in a PCOS case aided early diagnosis and timely management. Intake of type of pharmacological and non-pharmacological agents to be monitored for their impact on fertility, ovarian enlargement, severity of ovarian hyperstimulation syndrome (OHSS), clinical presentation, laboratory profile and outcome of pregnancy

“So We Create Happy Synergies” How An Overall Enabling Environment Helped Lao Pdr Legislate The Who Code On Breastmilk Substitutes: Lessons Learnt

ABSTRACT Background: Exclusive breastfeeding rates in Lao People’s Democratic Republic (Lao PDR) remain at 44% against a global goal of at least 50%, partly due to a weak understanding of the multifactorial and multilevel determinants of breastfeeding (UNICEF, 2021). Therefore, evidence-based advocacy efforts call for a systems approach to improve the enabling environment around breastfeeding. Aim: This study aims to stitch together the comprehensive patchwork of actors and dynamic ‘gears’ in the socio-ecological environment that came together to develop a much more enabling environment to improve child nutrition through breastfeeding promotion and protection in Lao PDR. Further, it aims to tease out the specific strategies used in Lao PDR to develop a sound evidence-based advocacy approach to improve breastfeeding protection through multisectoral political will; increased investment; research, monitoring and evaluation; and stakeholder coordination. Methods: A literature review of peer-reviewed evidence and gray literature on the breastfeeding protective landscape in South-East Asia was conducted to contextualize progress in Laos. In addition, a qualitative study was conducted using semi-structured, in-depth interviews with six key informants guided by the COM-B (Capability, Opportunity, Motivation) model to identify the motivators, barriers, and facilitators of Code implementation. The Breastfeeding Gear Model (BFGM) and stakeholder mapping were used to illustrate key ‘gears’ in the environment. Qualitative coding was conducted, leading to the development of generalizable strategies and recommendations for other countries. Results: The three main themes identified were 1) Political will, 2) Multisectoral collaboration and Advocacy, and 3) Flexible funding. The key lessons and main enabling factors of the Lao PDR story were identified to be cross-sectional advocacy and partnerships between the development partners and the Lao government. Conclusion: A multisectoral approach to bring together the collaborative network of stakeholders is essential to create an overall conducive and enabling environment for breastfeeding protection. Countries with a similar socio-economic makeup may consider Lao PDR’s strategies to support child nutrition along global WHO goals

Erythromycin treatment of pregnant women to reduce the incidence of low birth weight and preterm deliveries

This article does not have an Abstract

Successful ultrasound-guided intrauterine blood transfusion in severe non-immune hydrops fetalis

Non-immune hydrops fetalis has varied etiology, high mortality and few known successful treatment modalities. A rare case of non-immune fetal hydrops with severe anemia diagnosed prenatally and treated successfully by repeated ultrasound-guided intrauterine blood transfusions is presented