A prospective study on the role of Hysterolaparoscopy in the evaluation of infertility

Background: Infertility affects about 10-15% of couples of reproductive age groups. The current evidence indicates a 9% prevalence of infertility with 56% of couples seeking medical care. Hysterolaparoscopy provides a comprehensive investigative procedure in which various factors causing female infertility can be assessed at one sitting.Methods: A total 100 infertile women between 20-40 years of age including primary and secondary infertility were evaluated. Patients would be investigated thoroughly for infertility and in preparation for anaesthesia. Tests include follicular study, Ultrasound pelvis. Hysterolaparoscopy was performed in the pre ovulatory period between days 6-10 of the cycle for infertility evaluation.Results: In the present study out of 100 cases for infertility evaluated, primary infertility were 57(57%) and secondary infertility were 43(43%). In our study out of 100 patients, Hysterolaparoscopy showed tuberculosis in 24 (24%) patients, remaining were endometriosis, polycystic ovarian syndrome, congestion, intra-pelvic adhesions, hydro-salpinx.Conclusions: It is concluded that while treating the causes of female infertility combined simultaneous diagnostic laparoscopy and hysteroscopy should be performed in all infertile patients as” seeing is believing” and if any pathologies found to be operable the gynaecologist can perform operative hystero-laparoscopy at that time, hence anticipating the pathologies after pre-operative work up is very important

Isolated twisted hematosalphinx misleading with ovarian cyst torsion

Normal or chronically inflamed fallopian tube can undergo torsion and present as acute abdomen, simulating clinically as ectopic gestation. Torsion of the fallopian tube is less frequent but significant cause of lower abdominal pain in reproductive age women that is difficult to recognize preoperatively. Authors present a rare case of hematosalpinx with torsion at its pedicle with hemoperitonium who presented as 28 years old female with acute abdomen that was successfully treated. In cases presenting with hemoperitoneum diagnosis of ruptured ectopic pregnancy should be made unless proved otherwise during reproductive age. Rarely ruptured ovarian cyst may also be a cause. Unfortunately, hematosalpinx sometimes can undergo torsion due to circulatory imbalance and can present as hemoperitoneum and circulatory collapse due to rupture. There have been no specific symptoms, clinical findings, imaging or laboratory characteristics identified for this condition. Imaging findings are non-specific in the preoperative diagnosis of torsed fallopian tubes. Therefore, most of cases with isolated fallopian tubal torsion had a delayed diagnosis and a subsequent delay of timely intervention that may result in failure to save tubal function. Torsion of tube can lead to hematosalpinx, hemoperitonium and necrosis of tube which necessitates urgent surgical management. This case report describes a twisted hematosalpinx presentation without any predisposing high-risk factors. A tubal torsion should be suspected in females with acute pelvic pain, of any age group. An early diagnosis and treatment are required to prevent complications. This rare case may highlight a new insight into pathogenesis of tubal torsion associated with hematosalpinx

Effect of chewing gum on the postoperative recovery of gastrointestinal function after gynaecological laparoscopic surgery

Background: The incidence of postoperative ileus (POI) after gynaecological surgery is 10-15%. Chewing gum following general surgery improves outcomes, including early flatus, early bowel sounds, and shortening of the hospitalisation period. This study aims to investigate the effect of postoperative gum chewing on bowel motility after laparoscopic gynaecologic surgery.Methods: 101 women who underwent laparoscopic surgery for benign gynaecological conditions under general anaesthesia were recruited. 50 patients received sugar free chewing gum post operatively and the outcomes were compared with the control group. The study’s primary end points were the time to first regular bowel sounds and time to passage of flatus after surgery. Secondary end points were the time to first defecation, patient satisfaction, and potential side effects of postoperative gum chewing.Results: We found a significantly shorter interval between surgery and passage of flatus in the intervention group (median 10 hours compared with 13 hours p=0.0151) and a significantly higher rate of regular bowel sounds 3 hours (74% compared with 45%; p= 0.003) and 5 hours after surgery (91% compared with 78%; p=0.01). There was no significant difference in time to first defecation between groups (median 18 hours compared with 20 hours; p=0.222).Conclusions: Gum chewing seems to have beneficial effects on bowel motility when used in postoperative care after minimally invasive surgery. Gum chewing should be recommended to patients after gynaecological laparoscopic surger

Knowledge, attitude and behaviour of women towards abnormal menstrual bleeding and its impact on quality of life

Background: Abnormal menstrual bleeding has a major impact on a woman's quality of life. Any intervention therefore should aim to improve this rather than focusing on the amount of menstrual blood loss. The aim of this study was to gain an in depth understanding of women’s current knowledge, attitudes and beliefs around abnormal menstrual bleeding. Also, to understand how it affects their lives, while identifying current misconceptions and gaps in knowledge and their expectations and attitudes towards the treatment so that treatment can address their most bothersome complaint.Methods: A total of 200 women, between 18-55 years of age, not on any hormonal treatment attending the gynaecology OPD at a tertiary care centre between Jan 2017 to May 2017 were interviewed by a questionnaire. Women who had undergone hysterectomy were excluded from the study.Results: Of the 200 women interviewed, 49 women felt that their bleeding was heavy and formed the heavy menstrual bleeding group (HMB) while 151 women who perceived their bleeding to be normal formed the normal bleeding group. In the (HMB) group, a significantly greater proportion of women identified their menstrual bleeding as being an inconvenience and a disruption to their lives. HMB also significantly affected their relationships, social life and productivity at work place.Conclusions: Despite its common occurrence, awareness and understanding of HMB and its treatment within the survey population was poor

Pre-operative diagnosis of ovarian ectopic pregnancy: a challenge to practicing clinician

The first case of primary ovarian ectopic pregnancy was reported by St. Maurice in 1689. Primary ovarian ectopic pregnancy is rare entity, with incidence of around 3% of all ectopic pregnancies. The aim of present case report is to study the role of different modalities like clinical findings, biochemistry, sonography, surgery and histopathology in diagnosis of primary ovarian ectopic pregnancy. Authors present a case of a 24 years old female with history of 2 months amenorrhoea, per vaginal spotting and mild intermittent abdominal pain in RIF. Examination was unremarkable and serum βHCG was 2007.5IU/ml. An ultrasound scan showed an ectopic mass in the right adnexa suggestive of a tubal ectopic pregnancy and she underwent surgical management at our institute.  At laparoscopy, both fallopian tubes were noted to be normal with an ectopic mass attached to the right ovary with a pedicle. With these unusual laparoscopic findings, possibilities of tubal miscarriage, ovarian pregnancy, or abdominal pregnancy were suspected. Ectopic mass was coagulated and cut through the pedicle with bipolar cautery and specimen was sent for HPE. Our patient made an uneventful recovery and no further medical management was indicated. The diagnosis of right ovarian ectopic pregnancy was finally confirmed by histopathological evidence of the presence of chorionic villi in a background of ovarian stromal tissue, in consideration with Spigelberg’s criteria. Present case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on ultrasound scan. Pre-operative diagnosis of ovarian ectopic pregnancy still remains a challenge in spite of current medical advances. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be made at surgery. However, histopathological examination is confirmatory and always mandatory

Total laparoscopic hysterectomy: why surgeon teachers must learn and train residents

Background: The purpose of the present study is to demonstrate the feasibility of laparoscopic surgery for hysterectomy and elaborate our experience.Methods: Between September 2017 and April 2018, 15 patients who were counselled for and opted for total laparoscopic hysterectomy our hospital enrolled in this study. Surgeons used a four-port system with, one 10mm and three 5-mm trocars. All surgical procedures were performed with 30°, 10-mm laparoscope and conventional laparoscopic instruments including monopolar and bipolar cautery system and the LigaSure system.  Patient’s history, clinical findings and surgical outcomes were prospectively tabulated, evaluated and analyzed.Results: Out of 15 patients under the study with age range of 40-55years, only 2 patients had hypertension and diabetes mellitus and 2 had anaemia. All 15 patients underwent conventional laparoscopic surgery. Operative time was in a range of 6O–240 min.  There were no intra operative complications in 6 patients (40%) and no post op complications in 11 women (73%).Conclusions: The results from our 15 women show that, in experienced hands, laparoscopic hysterectomy is not associated with any increase in major complication rates

Correlation between ultrasonographic, hysteroscopic and histopathological findings in patients with abnormal uterine bleeding

Background: Menstrual disorders are common indication for medical visits among women of reproductive age and heavy menstrual bleeding affects up to 30% of women throughout their reproductive lifetime. This study aims at evaluating the different causes and, the clinical presentation of AUB and to compare the role of hysteroscopy, ultrasonography and histopathology in patients with AUB.Methods: 100 women above 45 years of age, presenting with abnormal bleeding per vaginum were evaluated. All patients underwent transvaginal scan to note down the endometrial thickness and to rule out uterine and adnexal pathology. All the patients underwent diagnostic hysteroscopy, followed by a biopsy of the endometrium using a curette. The endometrium was sent to the pathologist. Findings of these diagnostic modalities then correlated.Results: Incidence of AUB was present between the age groups of 45-49 years of age (66%). The commonest presenting complaint in this series was menorrhagia or heavy menstrual bleeding (60%). The finding of thickened endometrium as the most common abnormality on USG (44%) and also on hysteroscopy (45%). As per present study the sensitivity of hysteroscopy is 97.78% and specificity was 34.55%, the negative predictive value of the test is 95%.Conclusions: TVS may be the first line of investigation while evaluating the endometrium in a perimenopausal AUB. It helps to triage the patients into high risk or low risk. Endometrial thickness >4mm as per the present study needs further evaluation. Patients with endometrial thickness less than 4 mm can be reassured. Hysteroscopy is the gold standard in the diagnosis of focal pathology like sub mucous fibroid, polyps or anomalies. Histopathology probably is an indispensable tool specially to rule out premalignant and malignant conditions. Thus, all the modalities instead of being competitive to one another, are complimentary to each other. For complete evaluation of patient with AUB all the three modalities should be used together to come at exact diagnosis

Phytochemical screening and antimicrobial activity of plant leaf extract against enteric bacterial pathogens

Punica granatum, a fruit-bearing shrub belonging to the Lythraceae family, offers various benefits to humans, with both its fibers and seeds being valuable. The seeds contain important oil acids such as palmitic, punica, stearic, and oleic acids. In India, P. granatum (pomegranate) leaves have been investigated for their potential antibacterial activity against enteric pathogens. These pathogens are responsible for causing gastrointestinal infections and are often associated with antibiotic resistance. The study aims to explore whether pomegranate leaves possess properties that can combat these enteric pathogens effectively. This research holds promise in identifying a natural and alternative approach to address antibacterial challenges, potentially contributing to the development of novel antimicrobial agents pomegranate is commonly used as a traditional remedy for treating enteric bacterial pathogens. To investigate its antibacterial properties, researchers studied the aqueous extract of P. granatum leaf against enteric pathogens, conducting tests like biochemical examinations and microscopy on the isolates. The phytochemical analysis of P. granatum (pomegranate) leaf aqueous extract revealed the presence of various bioactive compounds. These compounds include amino acids, carbohydrates, alkaloids, steroids, flavonoids, terpenoids, saponins, tannins, and phenols. To evaluate its antimicrobial activity, the researchers used antibiotic discs, including chloramphenicol, vancomycin, and gentamicin, employing the standard Kirby Bauer method. Results showed that vancomycin had the highest zone of inhibition, followed by chloramphenicol and gentamicin, with respective measurements of 20 mm and 19 mm. Chloramphenicol exhibited sensitivity against Escherichia coli (19 mm), while gentamicin showed sensitivity against Salmonella typhi (20 mm), Staphylococcus aureus (19 mm), and E. coli (18 mm). Vancomycin demonstrated sensitivity against S. aureus (21 mm). The aqueous leaf extract displayed significant antibacterial activity at concentrations of 20, 40 mcg, and 60 μg, showing effective zones of inhibition ranging from 15 mm to 22 mm against Pseudomonas aeruginosa, E. coli, S. aureus, Shigella dysentriae, Proteus vulgaris, and S. typhi. In conclusion, the study established that P. granatum leaf extracts possess remarkable antibacterial properties and contain valuable pharmaceutical bioactive compounds. Due to its efficacy in treating gastrointestinal disorders, it is utilized as a natural remedy in traditional medicine

A comprehensive review on Nipah virus infection control measures

Nipah virus (NiV) has emerged as a deadly zoonotic pathogen, causing sporadic outbreaks with high mortality rates. The patient typically exhibits thrombocytopenia, leukopenia, and transaminitis along with fever, encephalitis, and/or respiratory involvement. This comprehensive review delves into the multifaceted realm of Nipah virus infection control measures. We explore the latest research, strategies, and practices aimed at preventing, containing, and mitigating the impact of NiV outbreaks. From surveillance and diagnosis to treatment and public health interventions, this review offers a holistic perspective on the ongoing efforts to combat this deadly virus

Myocardial infarction protective effect of xyloglucan on Drosophila melanogaster: A review

Myocardial infarction, more often known as cardiac arrest, occurs when the supply of blood to the heart’s coronary artery decreases or ceases, causing damage to the heart muscle. Xyloglucan is a plant polysaccharide. Xyloglucan has been proven in several studies utilizing model organisms to reduce the risk of coronary heart disease by avoiding post-occlusion phases inhibiting apoptosis and enhancing energy metabolism. Many studies utilize Drosophila melanogaster because its SRY-related HMG-box 5 (SOX5) gene encodes a SOX family transcription factor; the human SOX5 ortholog, Sox102F, is well conserved in Drosophila melanogaster. Suppressing Sox102F in flies resulted in significant heart dysfunction, structural defects, and a disturbance in notch signal transduction. This demonstrates that SOX5 serves an important functional part in the heart and that variations in SOX5 concentrations may contribute to the possibility of myocardial infarction. Xyloglucan activity is significant in myocardial infarction and may be lowered in the myocardium after H/R damage by stimulating Notch signaling, which may benefit myocardial survival, angiogenesis, and cardiac function. This review discusses the roles of the human SOX5 and Drosophila SOX102F genes, the notch signaling system, and how xyloglucan in tamarind seeds may defend against heart damage by preventing apoptosis along with improving energy metabolism