Evaluation of adnexal masses: correlation of clinical examination, sonographic assessment and histopathological findings

Background: Prevalence of symptomatic adnexal masses is 1:1000 in premenopausal women and 3:1000 in post –menopausal women. Benign diseases of ovaries and fallopian tube are commonest etiology. However, as risk of neoplastic lesions increases with age and further after menopause The primary goal of diagnostic evaluation of adnexal masses is to exclude malignancy. Methods: This one-year prospective observational study was carried out on 100 female patients attending gynaecology OPD with the clinical diagnosis of adnexal mass. Female patients presenting with symptoms like lower abdominal pain, menstrual irregularity and palpable mass or asymptomatic patients with incidental finding of adnexal mass were included in the study. The aim of the study was to compare the sensitivity, specificity and predictive value of clinical examination, ultrasonography and to compare it with the histopathology. Results: Ultrasound of pelvis was done for all patients. Laparotomy was done for all cases and the specimen was sent for histopathological examination. 70% tumours were benign and 30% tumours were malignant. As per our study, ultrasonography has the highest diagnostic accuracy (93%) followed by pelvic examination (86%) and RMI score (86%). Clinical examination has highest sensitivity of 93.33% followed by CA-125 (86.66%) and ultrasonography (83.33%). Conclusions: Thus, ultrasound is the primary modality used for detection and delineation of pelvic masses. The study also showed that RMI has better performance than CA 125 in the prediction of malignancy. Thus, with such simple methods we can diagnose precisely without advanced radiological imaging

Temporal Trends, Predictors, and Outcomes of Disseminated Intravascular Coagulation in Hospitalizations With Sepsis.

Background This retrospective study was conducted to analyze the temporal trends, predictors, and impact of disseminated intravascular coagulation (DIC) on outcomes among septicemic patients using a nationally representative database. Methods We derived data from the National Inpatient Sample (NIS) for the years 2008-2017 for adult hospitalizations due to sepsis. The primary outcomes were in-hospital mortality and discharge to facility. The Cochran-Armitage test and multivariable survey logistic regression models were used to analyze the data. Results Out of 12,820,000 hospitalizations due to sepsis, 153,181 (1.18%) were complicated by DIC. The incidence of DIC decreased from 2008 to 2017. In multivariable regression analysis, demographics and comorbidities were associated with higher odds of DIC. During the study period, in-hospital mortality among patients with sepsis decreased, but the attributable risk percent of in-hospital mortality due to DIC increased. We observed similar trends for discharge to facility; however, the adjusted odds of discharge to facility due to DIC remained stable over the study period. Conclusion Although the incidence of sepsis complicated by DIC decreased, the attributable in-hospital mortality rate due to DIC increased during the study period. We identified several predictors associated with the development of DIC in sepsis, some of which are potentially modifiable