Prevalence of metabolic syndrome in women with polycystic ovarian syndrome: an observational study in a tertiary care centre in Pondicherry, India

Background: Polycystic Ovarian Syndrome (PCOS) is a multifactorial, polygenic and multisystem endocrine disorder affecting women in reproductive age. PCOS diagnosis is based on 2003 Rotterdam criteria It has been noted that hyperinsulinemia is a central factor in the pathogenesis of PCOS. Many studies show evidence of a critical link between PCOS and Metabolic Syndrome (MBS).Methods: It was a hospital - based observational study done over a period of one year with a sample size of 177.An observational study was done in patients satisfying the inclusion and exclusion criteria. After taking informed and written consent, history was obtained from the patient to know the age, socioeconomic status, present and past clinical history, menstrual and obstetric history, personal and family history and any other history as deemed necessary. Patient was clinically assessed to know the height, weight, body mass index.Results: The prevalence of MBS was 37.2%. The commonest age group was between 25- 35 years.There is no statistical association between educational qualification, economic status and the prevalence of MBS and There no significant association between the presence of acne, androgenic aloepecia and the presence of PCOS.While the presence of increased waist circumference > 88cms, USG findings consistent with PCOS, high blood pressure > 130/85 mm of Hg, elevated FBS > 110 mg/dl, low HDL <50 mg/dl were statistically significant.Conclusions: The results can be used to formulate a screening policy for metabolic syndrome, particularly in the low resource settings of developing countries

A retrospective study of ectopic pregnancy

Background: Ectopic pregnancy is one of the common acute abdominal emergencies posing a serious threat to life. The overall incidence of ectopic pregnancy is on a steady increase over the last two decades. Yet the case fatality rate has come down due to early diagnosis and management. 95% of ectopic pregnancies occur in the fallopian tube, and rest 5% cumulatively in the ovary, cervix, peritoneal cavity and previous caesarean section scar. The present study was done to analyse the associated risk factors, clinical manifestations and management options of ectopic pregnancy.Methods: This retrospective observational cohort study was done in the Department of Obstetrics and Gynaecology, at Sri Venkateshwaraa Medical College, Hospital and Research Centre, Ariyur, Puducherry, between January 2018- November 2021. Data was collected from the case sheets, operative notes and a retrospective analysis of the cohort of patients with ectopic pregnancy was done.Results: This retrospective study was conducted from January 2018 to November 2021 involving a total of 50 cases. We found that majority of tubal gestation occurred in the age group 26-30 years 58.6% and 13.7% in the age group more than 30 years. Majority of patients 65.5% underwent U/L salpingectomy.10.34% underwent salpingo oophorectomy. Fimbrial expression was done for two patients. Two patients underwent fimbriectomy. Cornual stump excision was done in two patients. Hemoperitoneum was detected in 55.17% of cases.Conclusion: Ectopic gestation can become an obstetrical emergency and reproductive capacity hampering morbidity if not diagnosed and treated on time. However having a high vigilance and evaluating every woman in the reproductive age group who presents with the classical clinical triad of amenorrhea, pain abdomen and bleeding per vagina can help in curbing the incidence in future.

Retrospective audit of genital prolapse management

Background: Pelvic organ prolapse is a descent of the pelvic organs into the vagina, frequently associated with local pelvic symptoms. Pelvic floor support is essential to maintain the normal anatomy. Recent studies of genital prolapse suggests that it is more important to improve the patient satisfaction and reduce complication than to achieve anatomical success. The purpose of the audit of genital prolapse management in this retrospective study is to know and understand the decision making, selection of patients for a particular surgery and to know and avoid the complications of genital prolapse management.Methods: This retrospective descriptive study was conducted at SVMCH and RC during the period of January 2020 to December 2021. The detailed analysis of the cases, symptomatology, surgical methods, complications and follow up were studied.Results: We managed 110 cases of genital prolapse. 35 patients had massive/ huge genital prolapse (POP Q Stage 4). 75.4%were found in the age group beyond 55 years, 66.3% were multiparous. 31% of the patients came with massive prolapse (POP Q-stage IV), 5% showed cervical elongation ,7% showed vault prolapse, Majority of our patients (63%) were managed by vaginal hysterectomy with pelvic floor repair. Followed by pessary, Fothergill’s surgery, Purandare’s surgery, Le forte’s, sacrospinal fixation, hysterosacropexy, pessary with thiersch stitch.Conclusions: The choice of management of genital prolapse has to be tailored according to the patients needs and pathology. The younger trainees have to be trained to get the skills of various surgeries of genital prolapse

Retrospective study of post-operative care in pandemic in tertiary care centre

Background: COVID-19 pandemic has unfortunately changed the surgical interventions and the post-operative management worldwide. Most of the medical institutes in India had formulated their own protocols from the beginning of the pandemic in March 2020 to stop all elective surgical procedures as soon as possible. However emergencies and all types of obstetric as cases were not stopped as it was unavoidable conditions.Methods: This retrospective observational study was done in the department of obstetrics and gynaecology, at Sri Venkateshwaraa Medical College, Ariyur, Puducherry, during the period April 2020-December 2020. Data was collected from the case sheets and operative notes and retrospective analysis was done.Results: On analysing we have realised that LSCS rate was higher and induction for trial of labour was kept minimal. We had 3 infective morbidity in the form of wound infection and 1 patient was returned to the operation theatre for reexploration. Arranging the blood during the pandemic was also a tedious task.Conclusions: In the present era of pandemic, where the patient load is high, we can rely on post graduate students to look after the post-operative patients through effective communication with the available consultants

Intraosseous acinic cell carcinoma

Acinic cell carcinoma is an uncommon low-grade malignant tumor of salivary glands. It was first described by Nasse in 1892, arising in parotid salivary gland. Salivary gland tumors are also known to develop within jaw bones, arising within the jaw as a primary central lesion, and are extremely rare with only a few cases reported. We present a rare case report of 65-year-old woman with intraosseous acinic cell carcinoma of left side of the mandible.Key words: Acinic cell carcinoma, central tumor of mandible, intraosseous acinic cell carcinom

Obliterative le fort’s colpocleisis for acute kidney injury caused by pelvic organ prolapse in elderly woman

Pelvic organ prolapse (POP) is the descent of pelvic organs through the vagina, which sometimes causes hydronephrosis. Here authors report a case of an eighty five year old woman with a fourth degree uterine prolapse with obstructive uropathy. She was treated with a conservative surgery Le Fort’s colpocleisis. Following which the patient’s renal functions and symptoms improved. Hence authors conclude that colpocleisis can be considered as the option for elderly women who have completed the family with no desire to preserve the sexual function especially in women with co morbities where pelvic reconstructive surgeries pose a challenge

An unusual case of massive vaginal eversion complicated by obstructive uropathy

Pelvic organ prolapse is the descent of the pelvic organs (uterus or bladder or rectum) from their normal anatomical position, in varying combination, into or beyond the vagina as a result of failure of the ligamentous and fascial supports. Sometimes the resulting vaginal eversion or protrusion is so massive it may cause outflow obstruction of one or both ureters. Here authors present a case of a 62 year postmenopausal woman having massive vaginal eversion leading to obstructive uropathy and chronic renal insufficiency. The prolapse was corrected by Sacrohysteropexy

A CASE REPORT OF SHADBINDU TAILA NASYA AND TRIKATU DHOOMAPANA ON APEENASA-ATROPHIC RHINITIS

Acharya Sushruta stated 28 Nasagata rogas. Out of these 28 Nasagata rogas some features of Pootinashya, Dushtha Pratishyaya and Apeenasa are similar to the clinical features of Atrophic Rhinitis (AR). Apeenasa is a Nasagata Roga characterized by nasal obstruction, running nose, Dryness of nose, anosmia, and loss of taste. This condition can be co-related with Atrophic Rhinitis. Though there are many modalities described in modern ENT, still it is not possible to cease the Permanent Impairment. In Ayurved many modalities are being described for Urdhwajatrugata Rogas and for Nasagata Vikara. Among them Nasya (administered of drugs in to nasal cavity) is best. As it is a Kapha Pradhana Vikara, Katu Dhoomapana can also be added to this procedure. The Nashya procedure is explained by Brihatrayees. The complete procedure of Nashya includes Poorva Karma (Snehana and Swedana), mobilizes the Doshas to the site of elimination and causes vasodilatation which helps in elimination of Doshas and provides better channel for absorption of the Oushadhi. Pradhana Karma (Nashya) eliminates the Doshas. Kavala as Paschat Karma eliminates the remaining Doshas and causes better absorption of the Oushadhi which ultimately eliminates the symptoms of the disease. A clinical observation has shown effective result in the treatment of AR with Shadbindu Taila Nasya and Trikatu Dhoomapana. And here we are revalidating the statement of our Acharyas. A case report of a female, aged 38 years with complain of nasal obstruction, foul smell from nose, anosmia, headache, nasal discharge, sneezing and general weakness has been presented here

A rare case of caesarean scar ectopic pregnancy: a case report

Scar ectopic pregnancy is a condition where the gestational sac implants into the previous caesarean scar site. Although it is a rare entity, its incidence is increasing due to rising rates of caesarean deliveries. Here authors report a case of caesarean scar ectopic pregnancy managed by laparotomy with caesarean scar ectopic excision following failed medical management. The patient recovered without any intraoperative or postoperative complications. An early diagnosis and management are vital in preventing maternal morbidity and mortality