Two interesting cases of gestational trophoblastic disease with methotrexate failure

Gestational trophoblastic disease is group tumours that are more sensitive and respond well to a wide variety of chemotherapeutic regimes. Presented here are two interesting cases one with life threatening bleeding requiring hysterectomy and other with persistent disease post evacuation. Both being low risk were treated with single agent methotrexate, but failed to respond. They responded to alternative chemotherapy. Methotrexate resistant is seen even in low risk group

Second trimester termination of pregnancy with misoprostol alone and misoprostol with isosorbide mononitrate: a comparative study

Background: Aim of the study was to compare the efficacy of misoprostol   alone and misoprostol with isosorbide mononitrate in reducing the induction abortion time interval in second trimester termination of pregnancy.Methods: A randomized control prospective study was conducted. Patients seeking second trimester abortions were randomized in to two groups. Group A received 400 ugm of misoprostol per vaginum every 4 hours up to maximum of 5 doses. Group B patients received 400 ugm of misoprostol and 40mg of isosorbide nitrate intravaginally. Repeat dose of 400 ugm misoprostol and 20 mg of isosorbide mononitrate was given every 4 hours up to a maximum of 5 doses. The induction to abortion interval and side effects of the drugs used were noted.Results: A total 71 women seeking second trimester termination between 12 to 20 weeks gestation were recruited for the study. In group A, there were 36 patients and in group B there were 35 patients. In group A the mean induction abortion interval was 14.8±4.16 hours while in group B the mean induction-abortion interval was 12.45±3.9 hours. Patients treated with isosorbide mononitrate and misoprostol combination had statistically significantly lower induction abortion time interval when compared with misoprostol alone (p value 0.018).Conclusions: The study demonstrates that the combination of isosorbide mononitrate and misoprostol is more effective for termination of second trimester pregnancy than misoprostol alone.

Clinical outcome of unilateral versus bilateral laparoscopic ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome: a comparative study

Background: The aim of the current study is to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome in terms of clinical response, change in biochemical parameters, ovulation rate, pregnancy rate and miscarriage rate.Methods: The study was conducted on 45 women with anovulatory infertility due to PCOS with clomiphene citrate resistance. By random selection, all patients were divided in two groups. In group 1, unilateral ovarian drilling was done and in group 2, bilateral ovarian drilling was done. A maximum of 5 drills were performed using insulated unipolar diathermy needle. Patients were followed up for one year and the clinical outcome in two groups were recorded and compared.Results: Post ovarian drilling it was seen that no major differences were noted between the two groups in return of spontaneous menstruation at 6 weeks (65% vs 60%), overall ovulation rate (55% vs 65%) and pregnancy rate (45% vs 40%). The mean fall in serum LH, serum FSH and serum testosterone were also similar in the two groups.Conclusions: Unilateral laparoscopic ovarian drilling had similar efficacy as bilateral laparoscopic ovarian drilling in terms of restoration of normal menstrual pattern, ovulation and achieving pregnancy. It is an effective alternative minimally invasive procedure for patients with resistant PCOS

Prevalence of metabolic syndrome in women with polycystic ovary syndrome attending a tertiary care hospital in West Delhi, India

Background: The aim of the present study was to evaluate the prevalence of metabolic syndrome in women with polycystic ovary syndrome (PCOS).Methods: All the women attending the gynae out-patient department of our hospital were screened for polycystic ovary syndrome as diagnosed by the Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group, 2004. Two hundred women with PCOS underwent screening for metabolic syndrome as defined by the national cholesterol education program adult treatment panel III (ATPIII) (2001) definition and the prevalence of metabolic syndrome was compared with two hundred age and BMI matched healthy control subjects. A multivariate logistic regression analysis was applied, and significant predictors identified for the prediction of metabolic syndrome.Results: The prevalence of metabolic syndrome among PCOS patients was 42 % in present study group as compared to 14 % in control group (p=0.01). The prevalence of metabolic syndrome was even higher in obese PCOS Vs non obese PCOS (52 % Vs 28.6 %). But even non-obese PCOS had higher prevalence of metabolic syndrome as compared to controls (28.6 % Vs 14 %).Conclusions: The study suggests a high prevalence of metabolic syndrome in patients with PCOS & thus it is important to screen all PCOS patients for manifestations of metabolic syndrome & its cardiovascular sequelae

Two interesting cases of gestational trophoblastic disease with methotrexate failure

Gestational trophoblastic disease is group tumours that are more sensitive and respond well to a wide variety of chemotherapeutic regimes. Presented here are two interesting cases one with life threatening bleeding requiring hysterectomy and other with persistent disease post evacuation. Both being low risk were treated with single agent methotrexate, but failed to respond. They responded to alternative chemotherapy. Methotrexate resistant is seen even in low risk group

Clinical outcome of unilateral versus bilateral laparoscopic ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome: a comparative study

Background: The aim of the current study is to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome in terms of clinical response, change in biochemical parameters, ovulation rate, pregnancy rate and miscarriage rate.Methods: The study was conducted on 45 women with anovulatory infertility due to PCOS with clomiphene citrate resistance. By random selection, all patients were divided in two groups. In group 1, unilateral ovarian drilling was done and in group 2, bilateral ovarian drilling was done. A maximum of 5 drills were performed using insulated unipolar diathermy needle. Patients were followed up for one year and the clinical outcome in two groups were recorded and compared.Results: Post ovarian drilling it was seen that no major differences were noted between the two groups in return of spontaneous menstruation at 6 weeks (65% vs 60%), overall ovulation rate (55% vs 65%) and pregnancy rate (45% vs 40%). The mean fall in serum LH, serum FSH and serum testosterone were also similar in the two groups.Conclusions: Unilateral laparoscopic ovarian drilling had similar efficacy as bilateral laparoscopic ovarian drilling in terms of restoration of normal menstrual pattern, ovulation and achieving pregnancy. It is an effective alternative minimally invasive procedure for patients with resistant PCOS

Clinical Profiles of Dengue Infection during an Outbreak in Northern India

Introduction. Dengue fever is an arboviral disease, which is transmitted by mosquito vector and presents as varied clinical spectrum of dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and expanded dengue syndrome (EDS) with atypical presentations, thus posing a diagnostic dilemma. Unless we are aware of these presentations, diagnosis as well as early initiation of treatment becomes difficult. We studied the various clinical presentations of dengue infection during an outbreak of disease in 2015. Materials and Methods. A total of 115 confirmed cases of dengue infection from Department of Medicine of Deen Dayal Upadhyay Hospital, New Delhi, were enrolled in this observational study. Results. The common signs and symptoms of dengue infection were fever, headache, body ache, backache, retro-orbital pain, bleeding manifestations, and rash in 100%, 87%, 86%, 58%, 41%, 21%, and 21%, respectively. Nonspecific or warning signs and symptoms included vomiting, weakness, abdominal pain, breathlessness, vertigo, sweating, and syncope. Other possible signs and symptoms of coinfections, comorbidities, or complications included diarrhea, sore throat, and neurological manifestations. There were seven patients with coinfections and four with comorbidities. The final diagnosis of these patients was DF (73%), DHF (16.5%), DSS (1.7%), and EDS (4.3%). Among EDS patients, the atypical presentations included encephalopathy, lateral rectus nerve palsy, acalculous cholecystitis, and myocarditis. Four patients required ICU care and there was no death in this study. Conclusion. Knowledge of atypical presentations is a must for early diagnosis and timely intervention to prevent life-threatening complications