Real-world evaluation of safety and effectiveness of dydrogesterone in the management of threatened abortion

Background: Threatened abortion is a relatively common complication during pregnancy. Inadequate production of endogenous progesterone is implicated as a risk factor for miscarriages. Thus, supplementation of external progesterone can be used as a preventive strategy in these women. Dydrogesterone a stereoisomer of progesterone has a good safety and tolerability profile and is known to effectively prevent pregnancy loss in women with threatened miscarriage, however, real-world data safety and effectiveness analysis of dydrogesterone in Indian patients was lacking. Therefore, this real-world retrospective analysis of the case reports was done to evaluate the safety, effectiveness, compliance, and tolerability of oral dydrogesterone in the treatment of women with threatened abortion.Methods: Data was collected from 194 obstetricians and gynaecologists in India, on the use of oral dydrogesterone in women presenting with threatened abortion in the first trimester of pregnancy.Results: Completed case report forms of patients who met the eligibility criteria (n = 617) were considered for the analysis. The main presenting symptom was vaginal bleeding/spotting with an additional symptom of abdominal cramp/pelvic pain/low back pain in 364 (69.07%) patients. Miscarriage was reported in 45 (7.29%) patients and 23 (3.98%) patients needed surgical intervention before 20 weeks of gestation with dydrogesterone treatment. The median time for relief of symptoms from the start of dydrogesterone tablets was 3.32 days for low back pain, 3.9 days for abdominal pain, and 4.37 days for the establishment of hemostasis. Treatment with dydrogesterone was found to be well-tolerated and adverse events were reported in 3.72% of the patients.Conclusions: This retrospective analysis suggests that dydrogesterone is safe and effective in reducing the incidence of pregnancy loss in women with threatened abortion

Squamous Cell Carcinoma Complicating Vitiligo in an Indian Man

An elderly man, a known case of generalized vitiligo of long duration, presented to us with an ulcerated exophytic growth arising from the vitiliginous skin. The histopathological study confirmed the clinical suspicion of squamous cell carcinoma. Cutaneous neoplasia arising from the vitiliginous skin is a rare situation. Lack of melanin leaves the skin vulnerable to ultraviolet radiation damage, which may predispose to cutaneous neoplasia. Therefore, the importance of photoprotection has been stressed upon through this illustration

Obstructive jaundice: Its etiological spectrum and radiological evaluation by magnetic resonance cholangiopancreatography

Background: Magnetic resonance cholangiopancreatography (MRCP) has reached a level of resolution and reliability where it may replace diagnostic endoscopic retrograde cholangiopancreatography. We studied the role of MRCP in adult patients with obstructive biliopathy to analyze its etiological spectrum and radiological findings. Materials and Methods: Total fifty patients referred for mrcp with a clinical diagnosis of obstructive jaundice were included in our study. Imaging findings were correlated with the final diagnosis made by histopathological or cytological findings and with the therapeutic outcome. Aim: To evaluate the role of MRCP in the determination of the etiological spectrum, to evaluate level and degree of biliary obstruction in cases of obstructive jaundice and to correlate findings on mrcp with surgical findings where possible. Results: Of fifty patients, 29 were benign lesions and 21 were malignant lesions. Among the benign lesions, 12 had choledocholithiasis and 16 had benign strictures. One case was of a choledochal cyst. Among the malignant lesions, 12 were gallbladder carcinoma, six were cholangiocarcinoma, two were periampullary carcinoma, and one was a case of metastatic deposit. The overall sensitivity of MRCP was 96.5%, specificity was 95.2%, and with an accuracy of 96% for benign lesions. The accuracy, sensitivity, and specificity of MRCP in the diagnosis of benign strictures was 92%, 93.7%, and 91.2%, for choledocholithiasis was 92%, 75%, and 97.3%, and for malignant lesions was 95.2, 96.5%, and 96%, respectively. Conclusion: MRCP is a relatively quick, accurate, and noninvasive imaging modality for the assessment of obstructive jaundice, in ruling out potentially correctable underlying cause