Self administered medical abortion pills: evaluation of the clinical outcome and complications among women presenting with unsupervised pill intake to a tertiary care hospital in Malwa region of Punjab, India

Background: Unsupervised medical abortion pill intake is becoming a public health hazard. Because of its widespread misuse, we planned to undertake this study to evaluate the clinical presentation and outcome of such patients.Methods: Hundred patients meeting inclusion criteria were included. Clinical presentation, treatment given and, outcome and complications were analyzed.Results: Majority (53%) patients were aged between 30-39 years. Seventy-seven percent were gravida three or more. Only 26% had taken the pill within prescribed gestational age limit for MTP (<seven weeks). Mid-trimester pill intake was encountered in 13 % patients. Pill was consumed without any prior medical consultation by 73% patients. Majority (49%) presented with incomplete abortion requiring surgical evacuation. Anaemia was most common associated co-morbidity in 80% patients and 28% required blood transfusions. Twenty-four percent patients presented with life threatening shock. Sepsis was noted in 3% patients. Emergency laprotomy was required in 11% cases. Continuation of pregnancy was reported in 13% patients. Unintended pregnancy and failure of contraception were main reasons cited for abortion by 38% and 26% women. Non-contraceptive users constituted 48% patients . Over the counter easy availability was the main reason for unsupervised pill intake in 58% cases.Conclusions: Unauthorized over the counter pill availability despite legal ban and ignorance of women have led to increased number of unsafe abortions. Strict legislations need to be imposed. Increasing awareness among women regarding complications of unsupervised pill intake and easy availability of safe contraceptive methods can help control this problem

Utility of opportunistic screening to assess the impact of urinary incontinence on quality of life and barriers to seeking treatment among women attending a tertiary healthcare centre in North India

Abstract Introduction Urinary incontinence (UI) is a common but frequently neglected problem in females, significantly impacting their psychosocial health. The available estimates are an underestimation of a bigger problem. Thus, the study aimed to estimate the prevalence of UI, its associated risk factors, its impact on the Quality of life (QoL), and barriers to treatment-seeking behaviour in women attending tertiary healthcare centres. Methods We conducted a cross-sectional study using an opportunistic screening among women visiting a tertiary care hospital in Punjab recruited using multi-stage systematic random sampling. UI was classified as Stress (SUI), Urge (UUI), mixed (MUI), and No Incontinence (UI less than once a week or a month or no complaints) using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF). Bivariate analyses were done using the chi-square test to test the association between the dependent and independent variables. The predictors of UI were explored using univariable and multivariable binary logistic regression and depicted using Odds ratio with 95% confidence intervals. The impact of UI on Quality of Life (QoL) was assessed using the Incontinence Impact Questionnaire-Short Form (IIQ-7), and compared among the three UI types using One-Way ANOVA. Treatment barriers were explored using open-ended questions. Results Of the 601 women, 19.6% reported UI (stress UI: 10.1%, mixed UI: 6.0%, and urge UI: 3.5%). There were significant clinical-social factors that predicted different types of UI. The UI depicted a significant effect on QoL across all domains of the IIQ-7 (total mean score: 50.8 ± 21.9) compared to women with no incontinence (0.1 + 1.9). The score was highest in women with MUI, followed by SUI and UUI. About two-thirds of the affected women never consulted a doctor and considered it a non-serious condition or a normal ageing process. Conclusions The present study found a high prevalence of UI through opportunistic screening across all the women’s age groups with different conditions. Due to the associated stigma, clinicians should make every attempt to talk more about this, especially in women with medical conditions that can precipitate UI. Furthermore, the results call for generating more robust estimates through community-based screening studies

Cauda equina syndrome after repeated spinal attempts: A case report and review of the literature

Spinal and epidural blocks are widely used for cesarean section. Spinal hematoma causing cauda equina syndrome is a rare complication after spinal anesthesia (SA), but can lead to severe neurological deficit. It is usually associated with difficult SA and requires surgical decompression in most of the cases

Carcinoma vulva: Ten years experience in a teaching institution of North India

Introduction: Vulvar carcinoma is primarily a disease of post-menopausal women. Surgery is a primary treatment strategy. Chemotherapy and radiotherapy are a part of multimodal therapy. Presently, there is a shift towards neoadjuvant chemotherapy or radiotherapy so as to decrease the surgical morbidities. Objective: To study the surgical outcome and prognostic factors in Ca vulva patients. Methodology: A retrospective analysis of 19 vulvar cancer patients, surgically treated at a teaching institution of Punjab (2009–2019). Results: Mean age of the patients was 60.95 years. Ulcerative swelling (89.5%) over labia majora (73.7%) was the main presenting symptom. Radical vulvectomy-bilateral IFLN dissection was performed in 74% patients, hemivulvectomy-unilateral IFLN dissection in 21% patients and wide local excision in one patient. Squamous cell carcinoma was detected in all, and one had verrucous carcinoma. Thirty-seven per cent patients had FIGO stage III disease, 31.5% - stage II and 31.5% - stage I. On HPE, 78.57% (11/14) patients had positive nodes and two had ECS. Only 5/9 (55.5%) cases could receive PORT. Seven patients defaulted follow-up. Two developed nodal metastasis, and seven women developed recurrence. One patient with regional recurrence faced demise during RT course. In 10/19 regular follow-up patients, four are alive and disease free, five patients are on palliative chemoradiation, and one is undergoing adjuvant radiotherapy for regional recurrence. Estimated 5-year overall survival is 83.33%. Conclusion: Tumour stage, nodal positivity and nodal ECS were poor prognostic factors. Radical surgery-extensive groin node dissection causes significant morbidity; hence, studies evaluating the role of neoadjuvant treatment are needed so as to modify current treatment practices. HPV vaccination as a preventive measure and a thorough and extensive evaluation of patients with suspicious signs in vulvar disease is needed

An unusual case of vaginal myoma presenting with postmenopausal bleeding.

Vaginal leiomyomas are uncommon benign tumour with variable clinical presentation. These tumours arise most commonly from anterior vaginal wall. We report a case of 50-year old postmenopausal woman who presented with urinary retention, profuse vaginal bleeding and mass protruding into vagina. Local examination revealed a pedunculated mass attached to the posterior vaginal wall with vascular stalk one cm below the cervix. Mass was hanging outside vulva and vascular pedicle was profusely bleeding. The pedicle was ligated and tumour was excised. Subsequent histopathology revealed a vaginal myoma

Self administered medical abortion pills: evaluation of the clinical outcome and complications among women presenting with unsupervised pill intake to a tertiary care hospital in Malwa region of Punjab, India

Background: Unsupervised medical abortion pill intake is becoming a public health hazard. Because of its widespread misuse, we planned to undertake this study to evaluate the clinical presentation and outcome of such patients.Methods: Hundred patients meeting inclusion criteria were included. Clinical presentation, treatment given and, outcome and complications were analyzed.Results: Majority (53%) patients were aged between 30-39 years. Seventy-seven percent were gravida three or more. Only 26% had taken the pill within prescribed gestational age limit for MTP (&lt;seven weeks). Mid-trimester pill intake was encountered in 13 % patients. Pill was consumed without any prior medical consultation by 73% patients. Majority (49%) presented with incomplete abortion requiring surgical evacuation. Anaemia was most common associated co-morbidity in 80% patients and 28% required blood transfusions. Twenty-four percent patients presented with life threatening shock. Sepsis was noted in 3% patients. Emergency laprotomy was required in 11% cases. Continuation of pregnancy was reported in 13% patients. Unintended pregnancy and failure of contraception were main reasons cited for abortion by 38% and 26% women. Non-contraceptive users constituted 48% patients . Over the counter easy availability was the main reason for unsupervised pill intake in 58% cases.Conclusions: Unauthorized over the counter pill availability despite legal ban and ignorance of women have led to increased number of unsafe abortions. Strict legislations need to be imposed. Increasing awareness among women regarding complications of unsupervised pill intake and easy availability of safe contraceptive methods can help control this problem

Comprehensive coordinated community based palliative care (C3PaC) model for cancer patients in North India: a mixed-method implementation research study protocol

Abstract Background Cancer remains an escalating and challenging public health issue. The management, especially palliative care (PC), is disintegrated and out of reach of in need patients. The overall aim of the project is to develop a feasible and scalable Comprehensive Coordinated Community based PC model for Cancer Patients (C3PaC); congruent with socio-cultural, context and unmet needs in north India. Methods A mixed method approach will be used for three-phased pre- and post-intervention study in one of the districts of North India, having a high incidence of cancer. During phase I, validated tools will be used for quantitative assessment of palliative needs among cancer patients and their caregivers. Barriers and challenges for provision of palliative care will be explored using in-depth interviews and focus group discussions among participants and health care workers. The findings of phase I along with inputs from national experts and literature review will provide inputs for the development of the C3PAC model in phase II. During phase III C3PAC model will be deployed over a period of 12 months and its impact assessed. Categorical and continuous variables will be depicted as frequency (percentages) and mean ± SD/median (IQR) respectively. Chi-square test/Fischer test, independent samples Student t-tests and Mann–Whitney U tests will be used for categorical, normally and non-normally distributed continuous variables, respectively. Qualitative data will be analyzed using thematic analysis using Atlas.ti 8 software. Discussion The proposed model is designed to address the unmet palliative care needs, to empower community-based healthcare providers in comprehensive home-based PC and to improve the quality of life of cancer patients and caregivers. This model will provide pragmatic scalable solutions in comparable health systems particularly in low- and lower-middle Income countries. Trial registration The study has been registered with the Clinical Trial Registry-India (CTRI/2023/04/051357)