Non decent vaginal hysterectomy: personal experience of 105 cases

Background: Objective of current study was to evaluate the feasibility of performing vaginal hysterectomy for non-prolapsed uterus as a primary route.Methods: A hospital based prospective study was conducted at department of obstetrics and gynaecology of SMS & R from 1st January 2011 to 31st August 2014. All the patients undergoing non-descent vaginal hysterectomy for benign indication, without suspected adnexal pathology were included in the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size, estimated blood loss, length of operation, complication and hospital stay were recorded.  Results: A total of 105 cases were selected for non-descent vaginal hysterectomy. All 105 cases successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 48.6%. All patients were parous. Uterus size was 8 weeks in 33 cases. Commonest indication was AUB (45.7%). Mean duration of surgery was 90 minutes. Mean blood loss was 205 ml. The most common complication was post –operative pain in 21.9% of cases. Febrile morbidity was present in 9.5% of cases. Blood transfusion was required in 4 cases. Average duration of hospital stay was four days.Conclusions: Vaginal hysterectomy for benign gynecological causes other than prolapse is safe and feasible, more economical and effective. For successful outcome size of uterus, size in all dimensions and location of fibroid should be taken into consideration. Today in the era of minimally invasive surgery, non-descent vaginal hysterectomy needs to be considered and seems to be a safe option.

Awareness and acceptance of contraception in post-partum women in a tertiary care hospital of Delhi

Background: India is second most populous country of the world and in next few decades it will cross china if it will keep on increase by this exponential growth. This calls for steps to stabilize India’s population. India was the first country in the world to launch the Family Planning Programme in 1951. Despite this fact, India still lags behind in practicing contraception and limiting their family size.  Methods: A prospective cross-sectional interview based study was conducted on a sample of 492 post partum women who underwent their deliveries in this hospital in six months duration in the department of Obstetrics and Gynecology, Safdarjung Hospital, New Delhi. The women were counseled regarding post-partum contraception after assessment of their knowledge and practices. The interview included socio demographic profile of the participants, their awareness for contraceptive methods and reasons for its acceptance/refusal.Results: Out of 492 post-partum women, 56.9 % accepted one of the contraceptive methods during their hospital stay only. The most common contraceptive method chosen was intrauterine device (45.0%). The main reason for non-acceptance of contraception was expectation of a male child.  Conclusions: Providing effective, high quality antenatal and post-partum contraceptive counseling can reduce unintended pregnancies, decrease maternal and fetal morbidity and mortality and prevent unsafe abortions. In order to improve the situation, health authorities should be encouraged to provide counseling on postpartum contraceptive methods during antenatal and immediate postpartum period

Science with the Daksha High Energy Transients Mission

We present the science case for the proposed Daksha high energy transients mission. Daksha will comprise of two satellites covering the entire sky from 1~keV to $>1$~MeV. The primary objectives of the mission are to discover and characterize electromagnetic counterparts to gravitational wave source; and to study Gamma Ray Bursts (GRBs). Daksha is a versatile all-sky monitor that can address a wide variety of science cases. With its broadband spectral response, high sensitivity, and continuous all-sky coverage, it will discover fainter and rarer sources than any other existing or proposed mission. Daksha can make key strides in GRB research with polarization studies, prompt soft spectroscopy, and fine time-resolved spectral studies. Daksha will provide continuous monitoring of X-ray pulsars. It will detect magnetar outbursts and high energy counterparts to Fast Radio Bursts. Using Earth occultation to measure source fluxes, the two satellites together will obtain daily flux measurements of bright hard X-ray sources including active galactic nuclei, X-ray binaries, and slow transients like Novae. Correlation studies between the two satellites can be used to probe primordial black holes through lensing. Daksha will have a set of detectors continuously pointing towards the Sun, providing excellent hard X-ray monitoring data. Closer to home, the high sensitivity and time resolution of Daksha can be leveraged for the characterization of Terrestrial Gamma-ray Flashes.Comment: 19 pages, 7 figures. Submitted to ApJ. More details about the mission at https://www.dakshasat.in

ISSN 2347-954X (Print) Clinicopathological Correlation of Adenomyosis and Leiomyoma in Hysterectomy Specimens as the Cause of Abnormal Uterine Bleeding: A Retroprospective Study

Abstract: The objective was to study adenomyosis and leiomyoma as the cause of abnormal uterine bleeding in hysterectomy specimens. This was a retrospective study carried out on 218 hysterectomy specimens of subjects who presented to the department of obstetrics and gynaecology at SMS & R, Sharda University with the complaint of abnormal uterine bleeding not responding to conservative treatment from January 2011 to December 2013. Data including age, symptoms and clinical indication for hysterectomy was collected for the study. These women were evaluated and clinical,ultrasonographic and histopathological finding were correlated. Women in the perimenopausal age (41-50 years) accounted for the highest number of cases (52.71%) presenting with symptoms of AUB. In this age group adenomyosis was the found to be the commonest cause of AUB (52.9%). The most common symptom was heavy menstrual bleeding (77.5%) followed by dysmenorrhea(35.6%). Adenomyosis was clinically suspected in 119 cases of which 96 cases were confirmed on histopathology. Fibroid was clinically diagnosed in 99 cases and confirmed in 91 cases histologically .Clinical, radiological and pathological evaluation correlated well to diagnose fibroid but were not of as much help to diagnose adenomyosis. Adenomyosis was found to be the most common cause of abnormal uterine bleeding in possibility of these lesion women of perimenopausal age group. Adenomyosis still remains a clinical challenge. So has to be kept in mind by both clinician, as well as pathologist in women with AUB

Prospects of measuring Gamma-ray Burst Polarisation with the Daksha mission

The proposed Daksha mission comprises of a pair of highly sensitive space telescopes for detecting and characterising high-energy transients such as electromagnetic counterparts of gravitational wave events and gamma-ray bursts (GRBs). Along with spectral and timing analysis, Daksha can also undertake polarisation studies of these transients, providing data crucial for understanding the source geometry and physical processes governing high-energy emission. Each Daksha satellite will have 340 pixelated Cadmium Zinc Telluride (CZT) detectors arranged in a quasi-hemispherical configuration without any field-of-view collimation (open detectors). These CZT detectors are good polarimeters in the energy range 100 -- 400 keV, and their ability to measure polarisation has been successfully demonstrated by the Cadmium Zinc Telluride Imager (CZTI) onboard AstroSat. Here we demonstrate the hard X-ray polarisation measurement capabilities of Daksha and estimate the polarisation measurement sensitivity (in terms of the Minimum Detectable Polarisation: MDP) using extensive simulations. We find that Daksha will have MDP of~$30\%$ for a fluence threshold of $10^{-4}$ erg cm$^2$ (in 10 -- 1000 keV). We estimate that with this sensitivity, if GRBs are highly polarised, Daksha can measure the polarisation of about five GRBs per year.Comment: Submitted to Journal of Astronomical Telescopes, Instruments, and Systems (JATIS