Evaluation of risk of malignancy index as a diagnostic tool in cases with adnexal mass

Background: Ovarian tumour usually presents as adnexal mass but often it is difficult to differentiate between benign and malignant tumour. Several diagnostic modalities such as sonography and tumours markers have been evaluated in the past, but none have been established as an ultimate diagnostic tool individually. The development of a mathematical formula using a logistic model, incorporating menopausal status, the serum level of a glycoprotein called CA-125 and USG score has been described in the form of different malignancy indices. The purpose of this study was to evaluate the various risks of malignancy indices (RMI 1, 2, 3, and 4) in the pre-operative evaluation of adnexal masses especially to differentiate between benign and malignant masses. Another objective of the present study was to compare the four RMI with each other in terms of various statistical parameters like specificity and sensitivity.Methods: Women with adnexal masses who underwent surgical treatment were included in this study as histopathological examination was taken as gold standard to calculate the accuracy of RMI. The sensitivity, specificity and positive predictive value and negative predictive value of all the four RMI were calculated and data analyzed.Results: A total of 65 patients were included in the study. RMI 1,2,3,4 was calculated according to their formula. Sensitivity of RMI- 1, 2, 3 and 4 was calculated to be 63.63%, 77.27%, 63.63% and 77.27% respectively. Specificity of RMI- 1, 2, 3 and 4 was calculated to be 69.04%, 64.28%, 64.28% and 62.79% respectively.Conclusions: Risk of malignancy index is a good diagnostic tool to differentiate between benign and malignant pelvic masses. RMI- 2 and RMI-4 had maximum sensitivity while RMI-1 had maximum specificity. Overall RMI-2 appears to be the most accurate of all the four RMI

Efficacy of prophylactic tranexamic acid administration in prevention of postpartum hemorrhage in placenta previa cesarean section: an interventional study

Background: Postpartum hemorrhage accounts for the major part of the mortality as well as morbidity like severe anemia, need for blood transfusion, hospital stay and infection. Aim and objectives of the study were to determine the efficacy and safety of prophylactic tranexamic acid and intravenous tranexamic acid in preventing postpartum hemorrhage in women undergoing caesarean section for placenta previa.Methods: Seventy women with placenta previa over 1 year, randomized into 2 groups: group 1 (n=35): Women who received 10 IU oxytocin intravenous infusion after placental delivery and group 2 (n=35): Women who received 1 gm (10 ml) tranexamic acid IV before skin incision plus 10 IU oxytocin intravenous infusion after placental delivery.Results: The mean age was similar in 2 groups i.e., 26.34±4.78 years in group 1 and 27.31±5.62 years in group 2. Most women in the present study presented with type IV placenta previa i.e., 34.3% in group 1 and 48.6% in group 2. Mean pre-operative hemoglobin was 9.57±1.54 g/dl in group 1 and 9.59±1.35 g/dl in group 2. Intra-operative mean blood loss was 729.31±172.45 ml in intravenous oxytocin group and 464.86±28.00 ml in intravenous tranexamic acid group. A total of 74.3% women in group 1 and 20% women in group 2 developed postpartum hemorrhage. Mean post-operative hemoglobin was 8.04±1.34 g/dl in group 1 and 8.85±1.26 g/dl in group 2. In group 1, 5.7% neonates were born with very low birth weight and while none in group 2. 51.4% neonates in group 1 and 45.7% in group 2 had low birth weight.Conclusions: It is concluded that tranexamic acid used prophylactically intravenously before skin incision in patients undergoing cesarean section for placenta previa significantly reduces intra-operative blood loss.

Non-descent vaginal hysterectomy versus total abdominal hysterectomy in fibroid uterus: a comparative study in tertiary care hospital in Uttarakhand, India

Background: Hysterectomy comprises one of the most common elective surgeries in hysterectomy as the operative modality. The vaginal route of hysterectomy has been largely reserved for prolapsed uteri or non-descent cases with nearly normal size uteri. In the state of Uttarakhand, where specialized health services are difficult to access, abdominal route forms the prime choice for surgical treatment of fibroid uterus. A multitude of research data has suggested the superiority of vaginal over abdominal route. Despite this, there is a definite hesitation amongst gynecologists to resort to NDVH for fibroid uterus. This study was done with the objective to compare and analyze the outcome of abdominal vs. vaginal route for uterine fibroids.Methods: A retrospective study carried out for 80 patients admitted in one year duration with the diagnosis of fibroid uterus. These patients underwent either total abdominal hysterectomy (TAH) or (non-descent vaginal hysterectomy) NDVH depending upon patient discretion after thorough discussion with the operating doctor.Results: The results displayed vaginal route to be superior in terms of operative time, intra-operative blood loss and postoperative recovery.Conclusions: We concluded from this study that patients can be safely offered NDVH, thus minimizing the need for laparotomy for fibroid uterus

Maternal and perinatal outcomes of pregnancies complicated by cardiac disease at tertiary level hospital of Uttarakhand

Background: Cardiac disease is the most common cause of indirect maternal deaths and most common cause of death overall. It complicates 1% of all maternal deaths. The maternal and neonatal risks associated with pregnancy in women with cardiac disease receiving comprehensive prenatal care have not been well defined. Objective of present study was to evaluate the burden of cardiac diseases in pregnancy in our hospital, their clinical presentation, type of cardiac lesion, associated complications, maternal and fetal outcome.Methods: A retrospective study was conducted in Obstetrics and gynecology department at Shri Guru Ram Rai Institute of medical and health sciences, Dehradun from January- 2013 to December-2015. All patients with cardiac diseases during pregnancy or developed during postpartum period were included in the study. Detailed Demographic profile of patients, mode of delivery, perinatal outcome, associated antenatal, intranatal and postnatal complications were analyzed in detail.Results: There were 37 patients with cardiac disease during pregnancy in our study period. Out of these 32.4% were diagnosed during current pregnancy. Rheumatic heart diseases were seen in 54.05% patients and congenital heart disease seen in 35.1%. out of these 81.1% patients belonged to NYHA class I and II and 18.9% patients in class III & IV. Majority of patients (78.3%) had vaginal delivery. We observed 5.4% maternal mortality and 2.7% of neonatal mortality rate.Conclusions: Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications. Multidisciplinary approach involving cardiologist, obstetrician and neonatologist improves fetomaternal outcome

Comparison between intravenous iron sucrose versus oral iron therapy in pregnant women with nutritional anemia: a prospective study

Background: In India, the prevalence of anemia during pregnancy may be as high as 80%. The objective of this study was determining the efficacy of intravenous iron sucrose and oral iron in nutritional anemic antenatal patients, presenting at Shri Guru Ram Rai Institute of Medical and Health Sciences Dehradun, Uttarakhand, India.Methods: The study was carried out in the department of obstetrics and gynecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India single center study was performed on 400 antenatal patients with nutritional anemia gestational age 14 to 36 weeks. Patients were divided in two groups A and B. Group A was treated with intravenous iron sucrose and group B was treated with oral iron sulfate.Results: There was significant improvement in the various hematological parameters in IV sucrose group as compared to patients in oral iron group. There were no significant allergic reactions in IV sucrose group.Conclusions: This study has shown a significant improvement in the iron sucrose group. Iron sucrose is safe and well tolerated

Total vaginal hysterectomy: outcome analysis of 108 cases at a tertiary centre

Background: The aim of this study is to evaluate, analyze the indications of surgery, patients profile with respect to age group, parity, and comorbidities, intraoperative techniques, intra and post-operative complications and post-operative recovery.Methods: A hospital based cross sectional descriptive study of 108 cases was conducted in the department of Obstetrics and Gynecology in a tertiary hospital over a period of one year. All patients admitted with benign gynecological conditions of the uterus were included in study. The patients with uterine prolapse, uterine size >16wks and more than one previous sections were excluded from the study.Results: Among all the indications of TVH, abnormal uterine bleeding was the most common. Mean age group was 44.89 years and the mean parity was 2. Majority of the patients had no intra and post-operative complications. Postoperative recovery was good with shorter hospital stay.Conclusions: TVH should be promoted as the route of choice for all benign gynaecological conditions. It is safe to do TVH in patients who are at poor general anaesthesia risk. In a state like Uttarakhand where medical facilities are hard to avail due to difficult geographic terrain, TVH has a special role .In lack of endoscopic facility, trained medical and paramedical staff and lack of postoperative monitoring instead of; there is a need to promote TVH. To top it all, TVH is the most cost effective route of hysterectomy. It is truly the natural orifice scarless surgery

Displaced intrauterine contraceptive device: a prospective study at tertiary level hospital of Uttarakhand, India

Background: The IUCD is a common method used for contraception. It is associated with complications like bleeding, perforation and migration to neighbouring organs as broad ligament, urinary bladder or omentum.Methods: A prospective study was carried out at SGRRIM and HS, Dehradun over a period of two years between January 2014 to December 2015. A total of 38 patients with a diagnosis of displaced IUCD were included for their detailed demographic profile, presenting complaints, required diagnostic and therapeutic modalities.Results: Ultrasound emerged as the preferred method to locate the displaced device. Majority of displaced IUCD were intrauterine (86.9%) and Hysteroscopy guided removal was the preferred method of removal regarding technique, safety, and cost and recovery time.Conclusions: Responsibility of care provider does not end at insertion of IUCD. Follow up is equally important. Every case of missing IUCD must be investigated carefully to rule out the possibility of uterine perforation

Evaluation of risk of malignancy index as a diagnostic tool in cases with adnexal mass

Background: Ovarian tumour usually presents as adnexal mass but often it is difficult to differentiate between benign and malignant tumour. Several diagnostic modalities such as sonography and tumours markers have been evaluated in the past, but none have been established as an ultimate diagnostic tool individually. The development of a mathematical formula using a logistic model, incorporating menopausal status, the serum level of a glycoprotein called CA-125 and USG score has been described in the form of different malignancy indices. The purpose of this study was to evaluate the various risks of malignancy indices (RMI 1, 2, 3, and 4) in the pre-operative evaluation of adnexal masses especially to differentiate between benign and malignant masses. Another objective of the present study was to compare the four RMI with each other in terms of various statistical parameters like specificity and sensitivity.Methods: Women with adnexal masses who underwent surgical treatment were included in this study as histopathological examination was taken as gold standard to calculate the accuracy of RMI. The sensitivity, specificity and positive predictive value and negative predictive value of all the four RMI were calculated and data analyzed.Results: A total of 65 patients were included in the study. RMI 1,2,3,4 was calculated according to their formula. Sensitivity of RMI- 1, 2, 3 and 4 was calculated to be 63.63%, 77.27%, 63.63% and 77.27% respectively. Specificity of RMI- 1, 2, 3 and 4 was calculated to be 69.04%, 64.28%, 64.28% and 62.79% respectively.Conclusions: Risk of malignancy index is a good diagnostic tool to differentiate between benign and malignant pelvic masses. RMI- 2 and RMI-4 had maximum sensitivity while RMI-1 had maximum specificity. Overall RMI-2 appears to be the most accurate of all the four RMI

Design Of Temperature Sensors For Enviromental Applications

Abstract — MEMS sensors have been widely used in automobiles, airplanes, submarines, and biomedical devices. For some applications such as aerospace and underground oil exploration, sensors which can endure extremely high temperature are required. In this paper, the design and simulation of temperature sensor for high-temperature applications is proposed. The sensor is an array of bimorph cantilevers whose deflections are sensed by application of temperature. The cantilevers are initially thermally annealed to relax the film stresses. With change in materials of bimorph, overall sensitivity also changes. Keywords—MEMS, Cantilever, Bimorph, Displacement. The Temperature sensor works on the principle that deflection occurs due to an applie

LAVH versus NDVH for benign gynaecological diseases: an experience in tertiary care hospital in Uttarakhand

Introduction: To study the outcome of Non descent vaginal hysterectomy NDVH, Laparoscopic assisted vaginal hysterectomy LAVH in benign gynaecological conditions and to determine the feasibility of both the routes in terms of safety and simplicity, indications of surgery, intraoperative and postoperative analysis. Methods: The present study is retrospective study of 86 cases of NDVH and LAVH from January 2015 to February 2016 in department of obstetrics and gynecology in Shri Guru Ram Rai Institute of Medical And Health Sciences and Shri Mahant Indiresh Hospital, Dehradun Uttarakhand. Result: Among 86 cases undergoing NDVH and LAVH the most common indication of surgery was Fibroid and DUB. The intraoperative complication rate in NDVH was more compared to LAVH. The operative time and intraoperative blood loss was significantly lower in NDVH group with p <0.001. Conclusion: The present study concludes that NDVH can be safely offered to patients with benign gynecological conditions. LAVH can be offered as a synergistic surgery in cases where difficulty in operative dissection is anticipated