Caesarean scar ectopic pregnancy

Ectopic pregnancy is a common cause of mortality and morbidity among the women of reproductive age group. Tubal pregnancy is the commonest.  It can occur in cervix, ovaries, previous caesarean scar, interstitial portion of the tube and abdominal cavity. Here we report a case of caesarean scar ectopic pregnancy which was managed conservatively. 31 yrs old gravid 3 previous 1 LSCS and 1 tubal ectopic come for antenatal consultation at 35 days of gestation. UPT was Positive. USG showed no evidence of intra uterine sac. Repeat scan after 10 days showed a gestational sac at the lower uterine segment scar. Hence it was decided for conservative management, injection methotrexate 50 mgm X 2 doses given. This was followed by misoprost vaginal insertion. Since patient did not expel the sac, injection PG F2 alpha 125 mg x 2 doses were given. Patient expelled the products of conception partially. This was followed by hysteroscopic guided evacuation.Caesarean scar ectopic was reported in 1978. Early diagnosis is by TV USG / MRI. Early ectopic can be treated medically. In delayed diagnosis, laparoscopic excision of the scar has to be done. In rupture of the scar site ectopic pregnancy laparotomy is indicated. In the event of heavy bleeding, hysterectomy has to be done. After conservative management and excision of the scar, fertility is not altered. Caesarean section scar pregnancy is a rare form of ectopic pregnancy which can lead to life threatening complications leading to mortality and morbidity. Treatment has to be individualized according to the gestational age, haemodynamic stability and desire for future fertility

Umbilical endometriosis along with peritoneal endometriosis: a case report

Incidence of endometriosis is around 10 to 15% in women of reproductive age group. Umbilical endometriosis is a very rare entity. Extra genital endometriosis accounts to 3% of endometriosis. Incidence of umbilical endometriosis is 0.5%-4% of extra genital endometriosis. 30 years old multi gravida was referred to our hospital with c/o periodic bleeding from the umbilicus for the past 3 months. She was also having dysmenorrhoea for about 3 months. On examination, patient had a small bluish nodule in the umbilicus around 1.5x1.2 cm in size. Clinically there was suspicion of pelvic endometriosis as the uterus was retroverted and fixed. CT abdomen showed a small hypo-echoeic area in the umbilicus and uterus was adenomyotic with normal ovaries. Patient was given the option of laparoscopy and excision of umbilicus, as there was suspicion of peritoneal endometriosis and the patient also insisted upon laparoscopic sterilization. Laparoscopy showed early peritoneal endometriosis with pelvic adhesions and the same adhesiolysis was done along with cauterization of endometriosis. Sterilization was also done as per the patient’s request. Umbilical excision and layer closure was done. Umbilical endometriosis is a rare entity. This patient had associated early pelvic endometriosis. Umbilical endometriosis could be secondary to the lympho vascular spread from the pelvic endometriosis or primary umbilical endometriosis. History, clinical and imaging were pointing towards umbilical endometriosis. Surgical excision of umbilical endometriosis and cauterisation of early pelvic endometriosis were done. Patient needs follow up. Umbilical endometriosis may be primary or secondary which needs total excision and follow up

Robert’s uterus: a rare mullerian anomaly mystery unfolded

Anomalies of female genital tract may not be detected until after menarche when they present a cyclical pain due to outlet obstruction. Mullerian anomalies represent a vast array of structural abnormalities resulting from improper development and fusion of embryological mullerian ducts. 19-year-old girl attained menarche at the age of 14, had progressive dysmenorrhoea and diagnosed as right haemotosalphinx and ovarian endometrioma which were removed in 2008. As pain progressed, she underwent laparoscopic adhesiolysis in 2013. Since, pain persisted, diagnosed as right haematometra, and drainage done by laparotomy. Left adnexa were normal. She was given depot provera till she completed schooling. She developed recurrent dysmenorrhoea after stopping depot provera. USG and MRI revealed recurrent haematometra on right side with normal left horn. The possibility of atypical septum was thought about and hystero laparoscopy was done. It showed right side haemetometra with absent right adnexa. Left adnexa normal. Hysteroscopy showed normal left horn with septum with a bulge towards the left side. Hence, proceeded with hysteroscopic septostomy and haemetometra was drained to the left horn. Later patient was free from dysmenorrhea and repeat hysteroscopy was found to be normal. This case highlighting mullerian anomalies have to be considered when young girls present with severe progressive dysmenorrhoea and diagnosis remains a challenge most of the clinicians. This rare entity has to be kept in mind while evaluating such patients. Prompt diagnosis and early surgical correction are essential to avoid future morbidity in the form of repeated unnecessary surgeries

A Study on Customer Satisfaction Towards Patanjali Products in Theni District

Indian consumer segment is broadly segregated into urban and rural markets and is attracting marketers from across the world. Global corporations view India as one of the key markets from where future growth is likely to emerge. Consumers of this millennium have become more concerned about their health and also inclined to maintain the quality of life which is reflected through the preferential consumption of those products that protect the good state of their health as well as provide maximum satisfaction. To purchase a product the customer will go through a process of buying behavior. The choice and USAge of a particular brand by the consumer over the time is affected by the quality benefits offered by the brand especially when it comes to the brand of eatable and cosmetics. This study also aims at identifying customer\u27s satisfaction towards present and expected products from Patanjali

Novel methods in diagnosis of endometriosis in future

Endometriosis causes severe pain and infertility affecting quality of life. According to ASRM it is a chronic inflammatory disease that requires life-long management plan and surgery has to be restricted only once in the life time of the patient. Earlier, the diagnosis of endometriosis was confirmed by surgical method and histo-pathological examination. There is often a diagnostic delay up to 7 years or even beyond, which will affect the patients getting earlier treatment. Recently, lot of non-invasive techniques for diagnosis of endometriosis have come into vogue so that, treatment can be planned without surgical diagnosis. Apart from imaging through USG, CT or MRI, earlier lesions can be picked up by biomarkers like IL-6, IL-8, CA 125, HE4, neutrophil-lymphocytic ratio, Hs-CRP, Tumour necrosis alpha and mi RNA, neural elements in endometrium, glyco-proteins like CA-125, CA-19.9, CA-15.3, CA-73, AFP and CEA. Urocortin, activin and follistatin are growth factors and VEGF, TNF-alpha, NK cells, i-SCAM-I, MCP-1 are immunologic markers for diagnosis of endometriosis. Circulating endometrial cells are also present in the peripheral blood of patients. miRNA in endometriosis is found to be a potential biomarker in the recent years and also associated with altered vaginal microbiome. There has been up-regulation and down-regulation of certain miRNAs in endometriosis patients. In patients with symptoms of endometriosis, miRNA study in peripheral blood can be used as a biomarker for confirmation of diagnosis. There is a strong association between mitochondrial DNA variation and endometriosis which is found to be rational biomarkers

An interesting case of Phocomelia

Authors present a very rare case of tetra-phocomelia evaluated by antenatal ultrasonography. It is a condition seen in 0.62 per 100,000 live births. This is a congenital chromosomal abnormality involving the musculoskeletal system. Primi gravida with spontaneous conception after a long period of infertility underwent early anomaly scan. Patient was not aware of the last menstrual period hence; NT scan was missed. Routine early anomaly scan done between 16-18 weeks of pregnancy diagnosed a fetus with Tetra-Phocomelia. Due to the lack of associated symptoms or significant history, our case did not fit into any specific syndrome and appears to be the result of a sporadic, non-hereditary limb deficiency involving all four limb buds.  Second opinion obtained from a fetal medicine consultant who confirmed the diagnosis. Hence, decided for mid trimester termination and fetus was expelled after 8 hours. Fetus was not sent for pathological analysis. Tetra-phocomelia is a rare congenital anomaly and it may be associated with other deformity also. 1st case of phocomelia was described after the intake of thalidomide. In this condition hands and feet are seen as small flippers of a seal. The differential diagnosis includes sporadic phocomelia, Holt-Oram syndrome, thrombocytopenia-absent radius syndrome (TAR syndrome), Robert’s syndrome, and thalidomide-induced phocomelia. Here authors are presenting a rare case of Phocomelia where there is no history of drug intake or family history. This has to differentiate from thrombocytopenia-absent radius syndrome (TAR syndrome), sporadic phocomelia, Holt-Oram syndrome, Robert’s syndrome, and thalidomide-induced phocomelia

Improving health literacy about Tuberculosis among drug users. A pilot randomized controlled trial

Introduction: Despite effective treatment, tuberculosis remains among the top-10 causes of death causing ~1.3 million deaths in 2017. Furthermore, tuberculosis infection rates have increased amongst excluded populations such as people misusing substances. Objectives and design: We conducted a two London sites pilot randomized controlled trial to test interventions, recruitment, attrition rates and assessment procedures of a parallel, three-arms controlled trial to assess the effectiveness of tuberculosis health literacy interventions among drug dependent (heroin, crack cocaine or heroin and crack cocaine) population in treatment. Results: Forty-two subjects were recruited to the pilot trial (response rate = 26%) and randomized to three interventions (1st: Information booklet; 2nd: Interactive seminar; 3rd: Interactive seminar + contingency management targeting tuberculosis-health-related action). Baseline and post-intervention tuberculosis knowledge scores were obtained and re-assessed at 2-months follow up. The overall attrition rate was 43%. The knowledge scale had good internal reliability (Cronbach’s α = 0.7). Statistically significant increases in knowledge scores (baseline to post-intervention = 5.9 points, baseline to follow-up = 4.3) were recorded for the whole sample (CI = 99%; p < 0.001 for both analysis), but no statistically significant differences between-groups were observed (p = 0.7). Half of participants in the contingency management group achieved their health-action targets. Conclusion: Health literacy interventions to increase knowledge about tuberculosis among drug users are feasible and achieve promising increases in knowledge and health-related actions but measures to prevent a high attrition rate in a large-scale trial must be introduced. The absence of difference between trial-group outcomes suggests low-intensity interventions may achieve knowledge gain too. Further investigation of contingency management to promote tuberculosis-related health behaviours is needed

Multiple Slot Fractal Structured Antenna for Wi-Fi and Radio Altimeter for uncertain Applications

A multiple slot fractal antenna design has been determined communication efficiency and its multi-function activities.&nbsp; High-speed small communication devices have been required for future smart chip applications, so that researchers have been employed new and creative antenna design. Antennas are key part in communication systems, those are used to improve communication parameters like gain, efficiency, and bandwidth. Consistently, modern antennas design with high bandwidth and gain balancing is very difficult, therefore an adaptive antenna array chip design is required. In this research work a coaxial fed antenna with fractal geometry design has been implemented for Wi-Fi and Radio altimeter application. The fractal geometry has been taken with multiple numbers of slots in the radiating structure for uncertain applications. The coaxial feeding location has been selected based on the good impedance matching condition (50 Ohms). The overall dimension mentioned for antenna are approximately 50X50X1.6 mm on FR4 substrate and performance characteristic analysis is performed with change in substrate material presented in this work. Dual-band resonant frequency is being emitted by the antenna with resonance at 3.1 and 4.3 GHz for FR4 substrate material and change in the resonant bands is obtained with change in substrate. The proposed Antenna is prototyped on Anritsu VNA tool and presented the comparative analysis like VSWR 12%, reflection coefficient 9.4%,3D-Gain 6.2% and surface current 9.3% had been improved

Routine screening of antenatal population for thyroid disorders-mandatory

Background: Thyroid dysfunction is commonly seen in pregnant women causing adverse maternal and fetal effects. Routine screening of antenatal population for the same will be helpful for successful pregnancy outcomes. The objective of this study is to detect and treat antenatal women with Thyroid dysfunction to avoid deleterious maternal/ fetal effects.Methods: The present study is a hospital based prospective study conducted in the department of Obstetrics and Gynaecology of Narayana Medical College and Hospital(NMCH), Nellore, Andhra Pradesh, India. 1000 pregnant women were randomly recruited into this study. Apart from routine antenatal investigations, Thyroid function tests (TFT) - Thyroid stimulating hormone (TSH), freeT4 (fT4) and Thyroid peroxidase antibody (TPO Ab) are done for all the recruited women at the first visit of antenatal booking and individual Thyroid tests are repeated as required.Results: Following the TFT the study population is classified into pregnancies with euthyroidism‚ subclinical/ overt hypothyroidism and hyperthyroidism. The prevalence of Thyroid disorders in present study was 12.7% of which hypothyroidism noted in 10.3% (subclinical 6.9% and overt 3.4%) while hyperthyroidism seen in 2.4% (subclinical 1.8% and overt 0.6%). The various pregnancy complications, labour and neonatal outcomes have been analyzed.Conclusions: Thyroid dysfunction in pregnancy affects the health of the mother as well as the baby. Screening for Thyroid dysfunction should be performed as part of the routine antenatal work-up for successful pregnancy outcomes

Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report

Infertility is a burning problem affecting 10-15% of the couples globally. The female factors contribute to about 40- 45% among which uterine factor is up to 10%. Presence of uterine myomas also significantly contribute to infertility. A conservative surgical approach like myomectomy is indicated for women in reproductive age both for psychological reasons as well as to preserve their reproductive potential. In recent years laparoscopic myomectomy (LM) has become the procedure of choice. Pregnancy outcome after myomectomy is a more significant concern especially with regard to the obstetric calamity of sudden uterine rupture due to the presence of an operative scar. The intensity of such complication will be considerably high when a triplet pregnancy occurs with a LM scar in the upper uterine segment with history of uterine cavity being opened during the myomectomy surgery. Managing such a case will be a difficult task to the attending clinician posing many unexpected clinical dilemmas. We are reporting a unique case of triplet pregnancy occurred following a LM resulting in successful maternal and fetal outcome. During the course of this pregnancy apart from considerable maternal distress due to uterine over distension many clinical problems like cervical insufficiency, pre eclampsia, polyhydraminos, intrauterine growth restriction (IUGR) and last but not the least severe postpartum haemorrhage (PPH) have been encountered and could be managed efficiently. An elective Caesarean section was performed at 33+4 weeks gestation delivering live triplets. Mother and all the three babies discharged from the hospital in good condition