Chocolate cyst became ovarian abscess following IVF: a serious surgical emergency

We are reporting a rare case of ovarian abscess in an endometrioma following ultrasound guided oocyte retrieval during in vitro fertilization technique. Ovarian abscess within an endometrioma is a rare gynaecological problem. We are presenting a case of a giant abscess formation in an endometrioma following in vitro fertilization in a 36-year-old woman in view of secondary infertility. She presented with high grade fever with chills and rigor for more than 2 months associated with pain in abdomen with a progressively increasing lower abdominal mass. Patient was treated at a tertiary care hospital with multidisciplinary approach. Laparotomy was performed, and two litres of the foul-smelling pus was drained, followed by bilateral salpingooophorectomy. Uterus was left in situ to preserve her future fertility potential. Histology of the specimen confirmed endometriotic nature of the cyst. Pus on culture sensitivity was sterile. Patient had an uneventful recovery and was discharged on the 7th post-operative day. In our case endometrioma presented as failure of in vitro fertilization technique followed by a medical illness. This case highlights that endometrioma became not only a cause of failure of in vitro fertilization technique but also presented as a medical illness and should be dealt as one

Obstetric Doppler studies in prediction of perinatal outcome in intrauterine growth restriction

Background: Fetal surveillance of the pregnancies that are complicated by IUGR is essential to improve fetal outcome. Colour Doppler studies of uteroplacental and fetoplacental circulation are useful in identification of hypoxemic status of the fetus and allows timely intervention in at risk fetuses. The present study was aimed to know the significance of colour Doppler studies in intrauterine growth restriction cases and to correlate with the perinatal outcome thus to offer better strategies for early diagnosis of compromised fetus and timely intervention.Methods: This was a prospective study of 125 singleton pregnancies in the third trimester with IUGR. The results of last Doppler ultrasound within one week of delivery were used for analysis. Adverse perinatal outcome was studied in the form of emergency cesarean section for fetal distress, meconium stained amniotic fluid, Apgar at 5 min <7, NICU admission and perinatal mortality (stillbirths and neonatal death). Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Diagnostic accuracy of various Doppler parameters were calculated after comparing with standard.Results: In the present study 63 patients had one or more adverse perinatal outcome parameter. The diagnostic accuracy of umbilical artery was more (71.20%) than other parameters in predicting adverse perinatal outcome. Middle cerebral artery RI was having highest specificity and positive predictive value of 100% than any other parameter in predicting adverse perinatal outcome. Patients with AEDF and REDF had 33.3% and 50% perinatal deaths respectively.Conclusions: Middle cerebral artery Doppler studies shown more specificity and positive predictive value than umbilical artery Doppler in prediction of adverse perinatal outcome

Hydatid cyst of ovary: an unusual site

Discovering a hydatid cyst in pelvic region, especially as primary localization, is a rare event; as a matter of fact according to data provided by literature the incidence is between 0.2 and 2.25%. The ovarian involvement is often secondary to a cyst's dissemination localized in a different site. When possible the optimal treatment is represented by radical laparotomic cystectomy. We report a case of an old postmenopausal woman presented with intermittent dull aching pain with 16 weeks cystic pelvic mass which mimicked the ovarian malignancy even after imaging techniques. We treated the case with laprotomic cystectom

Risk of hearing loss in children exposed to gentamicin for the treatment of sepsis in young infancy: A community based cohort study in Pakistan

Objective: To determine the safety of gentamicin when used in a community setting to treat neonatal sepsis.Methods: The study was conducted in peri-urban areas of Karachi from September 2009 to April 2010. The exposed group consisted of children 6 months to 3 years of age who were treated for sepsis during 0-2 months of age in the community, with a regimen that included gentamicin for at least five days.The control group included children from the same area who never received gentamicin. The outcome measure was hearing loss, which was assessed by Brainstem Evoked Response Audiometry.Results: Of the 255 children enrolled, 125 (49%) received gentamicin, while 130 (51%) were not exposed to gentamicin. Children in the gentamicin exposed group were not at increased risk for hearing loss compared to controls (n = 30; 30.9% vs. n = 33; 31.4%, RR 0.98; 95% Cl: 0.60-1.61). Children with history of ear discharge (RR 1.7) and children with family history of deafness (RR 2.0) were more at risk for having hearing loss.Conclusion: No association was found between hearing loss and gentamicin exposure in a community setting for the management of sepsis in the first two months of life

Bad Medicine: A Panel

Papers presented: Spread the News, Do Not Abuse by Alanah Raianne Williams, Alex Do, Emma Erskine, Page Lemont & Sarah Zaidi Abuse needs to be spoken about. The community needs to take action against it, if someone does not, who will? Who will be there to protect the victims of these demeaning situations? This project focuses on the types of abuse, what abuse is, the reason they do it, how it affects the victim\u27s life, and what things can be done to stop it. Awareness and resources are the main focuses of this research project. The video focuses on statistics regarding the mistreatment of different genders, races, and age groups that are affected, as the interview provides an insight of a real experience that represent the truth of the issue. Use of Electronic Cigarettes and Vaping and Their Effect on the Lungs and Lung Function by Van Chung, Joiada Munoz, and Chelsey Damasco This paper analyzes and compiles ten separate, published articles or scholarly journals that report results from research conducted in a scientific laboratory, interviews and censuses gathered from subjects, and statistics about the usage of electronic cigarettes (e-cigarette) and vaping. It is the purpose of this paper to examine the separate articles in order to form a cohesive and cumulative report on the effects of e-cigarettes on the pulmonary system, in particular, the lungs themselves, especially on adolescent development. The articles vary on the degree to which e-cigarettes are harmful as well as the standing of current E-cigarette users and their level of dependence on nicotine usage; however, all articles present some form of caution in which e-cigarettes should be used. In order to fully understand how e-cigarettes and vaping affect lung function, every aspect of said process should be studied including production and manufacturing, the procedure of a working e-cigarette, and the outcome

Quantifying and reducing inhaler prescription errors in secondary care

BACKGROUND Junior doctors commonly prescribe inhaled medication for patients admitted to hospitals, and this may be a potential source of prescription error. Objective To determine the potential type, frequency and cost of prescription errors for inhaled medication, and ascertain if a simple educational intervention can improve junior doctors' knowledge and reduce these. METHODS We carried out a prospective study looking at the types and cost of inhaled prescription errors. Simultaneously we tested knowledge of junior doctors' using a quiz. Both the studies were carried out before and after the introduction of inhaler flash cards (pictures of devices with, instructions on use and the medication they contain) on specific wards. This was followed by an electronic feedback survey. RESULTS Error rates varied greatly (p = 6.8 × 10(-8)) by device, with 23 % of Evohaler and Accuhaler prescriptions being incorrect. The average cost of an erroneously prescribed medication was £45.50. There were 14 % incorrect prescriptions before the intervention. There was no significant improvement in junior doctors' knowledge of inhalers or the rate of prescription error after the intervention. CONCLUSION Prescription errors of inhaled medication are common and costly to rectify. There is a need for improved teaching and training of junior doctors and medical students

Immune Reconstitution Inflammatory Syndrome and the Influence of T Regulatory Cells: A Cohort Study in the Gambia

The factors associated with the development of immune reconstitution inflammatory syndrome in HIV patients commencing antiretroviral therapy have not been fully elucidated. Using a longitudinal study design, this study addressed whether alteration in the levels of T regulatory cells contributed to the development of IRIS in a West African cohort of HIV-1 and HIV-2 patients. Seventy-one HIV infected patients were prospectively recruited to the study and followed up for six months. The patients were categorized as IRIS or non-IRIS cases following published clinical guidelines. The levels of T regulatory cells were measured using flow cytometry at baseline and all follow-up visits. Baseline cytokine levels of IL-2, IL-6, IFN-(Gamma), TNF-(Alpha), MIP-1(Beta), IL-1, IL-12, IL-13, and IL-10 were measured in all patients

A double blind community-based randomized trial of Amoxicillin Versus Placebo for fast breathing Pneumonia in children aged 2-59 months in Karachi, Pakistan (RETAPP)

Background: Fast breathing pneumonia is characterized by tachypnoea in the absence of danger signs and is mostly viral in etiology. Current guidelines recommend antibiotic therapy for all children with fast breathing pneumonia in resource limited settings, presuming that most pneumonia is bacterial. High quality clinical trial evidence to challenge or support the continued use of antibiotics, as recommended by the World Health Organization is lacking. Methods/Design: This is a randomized double blinded placebo-controlled non-inferiority trial using parallel assignment with 1:1 allocation ratio, to be conducted in low income squatter settlements of urban Karachi, Pakistan. Children 2-59 months old with fast breathing, without any WHO-defined danger signs and seeking care at the primary health care center are randomized to receive either three days of placebo or amoxicillin. From prior studies, a sample size of 2430 children is required over a period of 28 months. Primary outcome is the difference in cumulative treatment failure between the two groups, defined as a new clinical sign based on preset definitions indicating illness progression or mortality and confirmed by two independent primary health care physicians on day 0, 1, 2 or 3 of therapy. Secondary outcomes include relapse measured between days 5-14. Modified per protocol analysis comparing hazards of treatment failure with 95 % confidence intervals in the placebo arm with hazards in the amoxicillin arm will be done. Discussion:This study will provide evidence to support or refute the use of antibiotics for fast breathing pneumonia paving a way for guideline change

Does malaria during pregnancy affect the newborn?

Objective: To investigate the effect of malarial infection during pregnancy on the newborn.Methods: A retrospective cohort study was conducted at The Aga Khan University Hospital (AKUH), Karachi, using in-patient hospital records over an 11-year period from 1988 to 1999. The incidence of preterm delivery, low birth weight (LBW) and intrauterine growth retardation (IUGR) in 29 pregnant women with malaria, was compared with that in 66 selected pregnant women without malaria, who delivered at the AKUH during the same time period.Results: Pregnant women with malaria had a 3.1 times greater risk of preterm labor (p=0.14). They were more likely to be anaemic compared to women without malaria (RR=2.9, 95% CI=1.6-5.4) and had a significantly lower mean haemoglobin level (p=0.0001). Maternal malaria was significantly associated with LBW babies (p=0.001). The mean birth weight of infants born to pregnant women with malaria was 461 g less (p=0.0005). No significant association was, however, found between malarial infection during pregnancy and IUGR (p=0.33).CONCLUSION: Malarial infection during pregnancy is associated with poor maternal and fetal outcome. It is significantly associated with maternal anaemia and LBW infants. Appropriate measures must, therefore, be taken to prevent malaria during pregnancy, especially in endemic areas