The incidence detection of tuberculosis in patients with infertility and abnormal uterine bleed: a study in North Indian population

Background: Tuberculosis (TB) remains a major global health problem, responsible for ill health among millions of people each year. TB ranks as the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV). The latest estimates included in this report are that there were 9.0 million new TB cases in 2013 and 1.5 million TB deaths (1.1 million among HIV-negative people and 0.4 million among HIV-positive people). In India the incidence of genital tuberculosis is nearly about 18%. And in female genital tract it is estimated that 18% in India suffer from genital TB.Methods: The study was carried-out during November 2014 to March 2016 at Maharishi Markandeshwar deemed to be University, MMIMSR Mullana (Ambala).  A total of 100 females of reproductive age attending the Gynaecology Outpatient were finally recruited on the basis of inclusion and exclusion criteria.Results: In our study majority i.e. 39 (39.0%) patient were found in the group of 20-29 years of age followed by 38 (38.0%) patients in the group of 30-39 years of age. Only 23 (23.0%) were found in the group of 40-49 years of age. In our study majority i.e. 54 (54.0%) patients were from Haryana followed by 44 (44.0%) patients were from Uttar Pradesh and only 2 (2.0%) patients were from Punjab. Out of 100 patients majority i.e. 76 (76.0%) patients had negative TB with either of investigation and only 24 (24.0%) patients had positive TB with either of investigation.Conclusions: Female genital tuberculosis affects the females of reproductive age group. The disease manifests itself as pelvic inflammatory disease in its acute form with menstrual irregularities and later infertility, and is almost always secondary to a primary lesion elsewhere

Sociodemographic and reproductive risk factors in cervical cancer

Background: Cervical cancer is the leading cause of cancer deaths in women. In India, cervical cancer is the most common cancer in women followed by breast cancer. A numbers of risk factors reproductive as well as sociodemographic have been widely studied for cervical cancer. The countries where universal screening is restricted because of various reasons economical, lack of resources etcetera, a modified screening procedure which is targeted on the high risk population can help solve the problem.Methods: This prospective study was conducted in a tertiary institute on sexually active women attending the gynaec OPD. A total of 200 women eligible for the study underwent a cytological evaluation and those with positive findings on Pap smear were followed by colposcopy directed biopsy. A detailed proforma including risk factors was filled for each patient and at the end of study data collected was tabulated in a master chart and was analyzed statistically.Results: A total of 200 women underwent screening with Pap smear in present study. The Pap smear was normal in 93 (46.5%) of cases, 77 (38.5%) showed inflammatory smear and 3 (1.5%) subjects had an unsatisfactory smear. The Pap smear was abnormal in 27 (23.5%) of cases constituting 17 (8.5%) cases of LSIL, 2 (1%) of HSIL and 8 (4%) cases of AGS. All the women with LSIL and HSIL were subjected to colposcopy directed biopsy. Amongst 17 cases of LSIL on pap 8 came out as LSIL, 2 were HSIL and rest 7 were inflammatory after histopathological analysis. The 2 cases of HSIL on pap were confirmed as carcinoma in situ after biopsy. The maximum incidence of SIL of 16.66% was observed in age group of more than 40 years. The majority of cases of SIL, 12 (63.2%) had coitus before the age of 18 years. A positive correlation of SIL was seen with decreasing socioeconomic status, 8 (42.1%) of cases of SIL belonged to the low socioeconomic status while this group constituted only 23% of the total subjects.Conclusions: The frequency of malignant and premalignant lesions was found to be significant, further emphasizing the importance of screening of cervical cancer. The prevalence of carcinoma cervix increases with age, in those with young age at first coitus, lower socioeconomic status and with low education level. A modified screening method can be an effective strategy to control cervical cancer in a developing country like India, where cost and manpower is an issue

Eclampsia: maternal and perinatal outcomes in a tertiary care centre

Background: Eclampsia is a life threatening emergency that continues to be a major cause of maternal and perinatal mortality. The purpose of our study was to analyse the trend of eclampsia in a tertiary care teaching institute and to find out maternal and perinatal outcomes of eclampsia.Methods: A prospective study was undertaken in a tertiary care teaching institute over a period of one year. Patients of eclampsia were followed up with regard to the management and maternal and fetal morbidity and mortality. Data was recorded and analysed. Maternal outcome was measured in terms of mode of delivery, complications like pulmonary oedema, haematological disorders, renal failure, cerebral haemorrhage and maternal death. Perinatal outcome was noted in terms of prematurity, admission to NICU and neonatal deaths.Results: The incidence of antepartum eclampsia was 1.08%. High risk associated factors were primigravida, low maternal age (21-25 years), low socio-economic status, illiteracy and inadequate antenatal care. Caesarean section was the mode of delivery in 26 cases (52%). There was 4% maternal mortality & attributed to aspiration pneumonia and pulmonary oedema. Maternal Complications were observed in 38% cases, most common was status eclampticus (12%) followed by HELLP syndrome (6%). Prematurity complicated 48% pregnancies and SGA in 14%. Fourteen neonates were admitted in NICU and there were 4 neonatal deaths.Conclusions: Eclampsia is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper antenatal care, low socio-economic status and lack of education. Early attention and intensive management are essential for improving the maternal and fetal outcomes. Unless the social and educational status of women is uplifted and obstetric care is brought to the doorstep, no miracle can be expected

Laproscopic evaluation in primary female infertility

Background: Infertility is defined as inability to conceive within one or more years of regular unprotected coitus. Infertility has now a days not only a medical but a social problem as well. Ignorance and illiteracy, coupled with hesitancy to discuss the problem, complicates the matter further. WHO has listed infertility as a global health issue.Methods: The present study was conducted on 64 patients with female factor primary infertility admitted in department of obstetrics and gynecology at Rajendra Hospital, Patiala over a duration of 1 year (December 2013- November 2014). All the patients had normal semen study of their partner.Results: In our study mean age was 27.87±4.57. No patient was above 40 years of age. Duration of infertility between 1-5 years was in 47 patients (73.43%), nine patients (14.06%) were infertile for 6-10 years. Out of 64 patients of primary infertility, majority of patients were of endometriosis 15(23.43%), followed by pelvic inflammatory disease14(21.87%), tubal blockade in 7(10.9%), PCOD in 6(9.37%). 14.08% patients had normal laproscopic study. 34 patients (53.12%) had bilateral spill while no spill was seen in 12 patients (18.75%). Unilateral spill was seen in seven patients (10.93%) while six patients (9.37%) had delayed spill.Conclusions: Prevalence of infertility is increasing, so is the awareness and treatment seeking behavior. The present study assures that in evaluation and workup of primary infertility patients, after baseline noninvasive investigations, endometrial sampling and HSG, the diagnostic and operative laproscopy is an excellent tool for evaluation of tubal factor. Least expected conditions like endometriosis on clinical evaluation, can be diagnosed and treated with ease on laproscopy. Although tubal factor has been considered to be responsible for a large percentage of cases with female secondary infertility since decades, but in present study laproscopic evaluation confirmed tubal factor in 85.01% cases with female factor infertility

Elevated serum CA 19-9 levels in dermoid cyst: a predictor of ovarian torsion and tissue necrosis?

Dermoid cyst (mature cystic teratoma) with well differentiated derivatives of all the three-germ cell layer is a benign tumour with ovaries being the commonest site. Dermoid cyst accounts for more than half of ovarian tumours in girls below 20 years of age. 80% of dermoid cyst are seen in reproductive age group between 20-40 years. Size of dermoid cyst usually varies between 5-10 cm and it may be bilateral in 10% of cases. Malignant transformation is very rare occurrence only in 1-3% cases, however torsion may occur in 15% of dermoid cyst. Carbohydrate antigen or cancer antigen 19-9 is usually raised in gastrointestinal tumours, pancreatic malignancy, pseudocyst of pancreas. However, it may be raised in some other malignancies and benign condition like torsion of dermoid cyst. Authors report an unusual case of torsion large dermoid cyst with tissue necrosis along with significantly elevates levels of serum CA 19-9. A 30-year-old P1L1 female presented with chief complaint of heaviness and pain lower abdomen and loss of five kilogram weight for last three months. A provisional diagnosis of dermoid was made. Serum CA 19-9 level were 1126 IU significantly raised. An exploratory laparotomy done under regional anaesthesia. A large demoid cyst 12*10 cm with torsion and areas of gangrene in ovarian tissue was seen replacing left ovary. Large and small intestine, stomach, pancreas were explored to rule out any pathology. Histopathology confirmed diagnosis of mature cystic teratoma. There was significant fall in serum Ca 19-9 levels to 247 U/ml two weeks after surgery and levels returned to normal limit six weeks after surgery

A study of predisposing factors and microbial flora in puerperal sepsis

Background: Puerperal sepsis is the third or fourth leading cause of maternal death worldwide with maternal mortality due to infections being as high as 15%6 with maternal morbidity being 8.1%7. Meticulous aseptic techniques, modern investigative tools and use of prophylactic antibiotics have reduced the incidence of puerperal sepsis in the developed countries however it still continues as a major cause of maternal morbidity and mortality in the developing countries.Methods: This was a retrospective study over a period of 18 months from July 2010 to December 2011 which included all the post natal patients admitted in the obstetrics ward of our hospital. All the patients who fulfilled the ICD 10 criteria of puerperal pyrexia were studied for the booking status, parity, mode of delivery, maternal anemia, number of PV examinations and duration of rupture of membranes. In addition vaginal swab culture and sensitivity of these cases was analysed. The results were calculated by statistical analysis and odds ratio calculated with 95% confidence interval.Results: The incidence of puerperal sepsis was 8.68% and was responsible for 60.29% of cases of puerperal pyrexia. The common predisposing factors were unbooked status, primiparity, caesarean section, anaemia, frequent PV examination and prolonged rupture of membranes. The most common microorganisms in vaginal swab culture and sensitivity were S. aureus (36%) and E. coli (29.8%).Conclusions: Puerperal sepsis is by and large a preventable cause of maternal morbidity and mortality. From our study and review of literature we conclude that early booking of all the antenatal cases, correction of maternal anemia, better aseptic conditions, deferring undue PV examinations, recognition of all the high risk cases and prophylactic administration of ampicillin and gentamycin can go a long way in preventing puerperal sepsis

Sociodemographic and reproductive risk factors in cervical cancer

Background: Cervical cancer is the leading cause of cancer deaths in women. In India, cervical cancer is the most common cancer in women followed by breast cancer. A numbers of risk factors reproductive as well as sociodemographic have been widely studied for cervical cancer. The countries where universal screening is restricted because of various reasons economical, lack of resources etcetera, a modified screening procedure which is targeted on the high risk population can help solve the problem.Methods: This prospective study was conducted in a tertiary institute on sexually active women attending the gynaec OPD. A total of 200 women eligible for the study underwent a cytological evaluation and those with positive findings on Pap smear were followed by colposcopy directed biopsy. A detailed proforma including risk factors was filled for each patient and at the end of study data collected was tabulated in a master chart and was analyzed statistically.Results: A total of 200 women underwent screening with Pap smear in present study. The Pap smear was normal in 93 (46.5%) of cases, 77 (38.5%) showed inflammatory smear and 3 (1.5%) subjects had an unsatisfactory smear. The Pap smear was abnormal in 27 (23.5%) of cases constituting 17 (8.5%) cases of LSIL, 2 (1%) of HSIL and 8 (4%) cases of AGS. All the women with LSIL and HSIL were subjected to colposcopy directed biopsy. Amongst 17 cases of LSIL on pap 8 came out as LSIL, 2 were HSIL and rest 7 were inflammatory after histopathological analysis. The 2 cases of HSIL on pap were confirmed as carcinoma in situ after biopsy. The maximum incidence of SIL of 16.66% was observed in age group of more than 40 years. The majority of cases of SIL, 12 (63.2%) had coitus before the age of 18 years. A positive correlation of SIL was seen with decreasing socioeconomic status, 8 (42.1%) of cases of SIL belonged to the low socioeconomic status while this group constituted only 23% of the total subjects.Conclusions: The frequency of malignant and premalignant lesions was found to be significant, further emphasizing the importance of screening of cervical cancer. The prevalence of carcinoma cervix increases with age, in those with young age at first coitus, lower socioeconomic status and with low education level. A modified screening method can be an effective strategy to control cervical cancer in a developing country like India, where cost and manpower is an issue

Safe Motherhood after Cardiopulmonary Resuscitation in a Term Pregnancy with Eclampsia: A Maternal Near Miss

Cardiac arrest in a term pregnancy is rare with a survival rate of 15-20% and mortality rate as high as 42%. Eclampsia, amniotic fluid embolism, haemorrhagic shock, sepsis, pulmonary thromboembolic events, and anaesthetic complications are significant causes of cardiac arrest. We report a rarest case of a young 26-year-old unbooked primigravida, 38+4 weeks gestation with eclampsia, HELLP syndrome, thrombocytopenia with sudden cardiac arrest-A Maternal Near Miss. Prompt resuscitation with obstetric, and anaesthetist specialist team, paved the journey to safe motherhood. An emergency Lower Segment Caesarean Section (LSCS) immediately after Cardiopulmonary Resuscitation (CPR) was performed. Ventilator support was continued for 72 hours. Successful CPR and immediate caesarean section paved the way to safe motherhood with discharge of healthy mother and baby on 12th post LSCS day. With increasing trends towards high-risk pregnancy and maternal near miss cases, a thorough knowledge in the management of cardiac arrest in pregnancy with advanced resuscitation skills among obstetricians, anaesthetists, and nursing staff is need of the millennium. Repeated simulation learning and mock drills in CPR in pregnancy should be advocated

A study of predisposing factors and microbial flora in puerperal sepsis

Background: Puerperal sepsis is the third or fourth leading cause of maternal death worldwide with maternal mortality due to infections being as high as 15%6 with maternal morbidity being 8.1%7. Meticulous aseptic techniques, modern investigative tools and use of prophylactic antibiotics have reduced the incidence of puerperal sepsis in the developed countries however it still continues as a major cause of maternal morbidity and mortality in the developing countries.Methods: This was a retrospective study over a period of 18 months from July 2010 to December 2011 which included all the post natal patients admitted in the obstetrics ward of our hospital. All the patients who fulfilled the ICD 10 criteria of puerperal pyrexia were studied for the booking status, parity, mode of delivery, maternal anemia, number of PV examinations and duration of rupture of membranes. In addition vaginal swab culture and sensitivity of these cases was analysed. The results were calculated by statistical analysis and odds ratio calculated with 95% confidence interval.Results: The incidence of puerperal sepsis was 8.68% and was responsible for 60.29% of cases of puerperal pyrexia. The common predisposing factors were unbooked status, primiparity, caesarean section, anaemia, frequent PV examination and prolonged rupture of membranes. The most common microorganisms in vaginal swab culture and sensitivity were S. aureus (36%) and E. coli (29.8%).Conclusions: Puerperal sepsis is by and large a preventable cause of maternal morbidity and mortality. From our study and review of literature we conclude that early booking of all the antenatal cases, correction of maternal anemia, better aseptic conditions, deferring undue PV examinations, recognition of all the high risk cases and prophylactic administration of ampicillin and gentamycin can go a long way in preventing puerperal sepsis

Primary primitive neuroectodermal tumor of kidney: A rare case report with diagnostic challenge

Primary primitive neuroectodermal tumors (PNETs) of the kidney are quite rare and can be mistaken for a wide variety of other small round blue cell tumors which includes rhabdomyosarcoma, Wilm′s tumor, carcinoid, neuroblastoma, clear cell sarcoma of the kidney, lymphoma etc. Renal Ewings/PNET can occur in the age group from 4 to 61 years. Approximately, 90% of Ewing sarcoma (ES)/PNET have a specific t(11;22) which results in a chimeric EWS-FLI-1 fusion protein. Immunohistochemical for the carboxy-terminus of FLI-1 is sensitive and highly specific for the diagnosis of ES/PNET. Herein, we have an interesting presentation in a 23-year-old male who came with neck pain and progressive quadriparesis and was diagnosed as a case of poorly differentiated malignant tumor with a differential of lymphoma versus metastatic renal cell carcinoma. The patient′s condition deteriorated fast and he had a rapid downhill course. The final diagnosis of Ewings/PNET was confirmed at autopsy