A rare case of Nabothian cyst presenting as mass per vagina

Nabothian cysts are benign non neoplastic disorder rarely of any clinical significance usually appear as bumps on the surface of the cervix which may be single or in groups and they appear as a sequalae to chronic cervicitis, are asymptomatic unless they are sizeable presenting with rare and varied symptoms. Generally, Nabothian cysts do not require any therapy. The therapy is recommended when a patient becomes symptomatic with pain or when the lesion character is not clear and malignancy cannot be ruled out. Here we reported a case of 23-year young unmarried girl nulligravida with complaints of mass per vagina. On local examination an irregular polypoidal mass was seen protruding outside the introitus measuring about 4×4 cm soft to cystic in consistency. Ultrasound revealed a well-defined anechoic cyst of 3.6×5.7 cm noted in the right ovary with no evidence of internal septation/solid component and wall calcification suggestive of right ovarian simple cyst with left ovary and uterus being normal. Surgical management was planned. Diagnostic laparoscopy was performed which revealed right ovarian simple cyst of 6×4 cm which was punctured using cautery and drained. Following this vaginal exploration revealed a polypoidal structure of 5×4 cm cystic consistency seen arising from right upper anterolateral lip of cervix. Polyp was resected with cautery and haemostasis achieved. Post operative period was uneventful. Such rare presentations do pose a diagnostic dilemma and hence it should be kept in mind to ensure adequate treatment

A study on foetal outcome after diagnosis of oligohydramnios at term in tertiary care center

Background: Oligohydramnios is associated with a variety of ominous pregnancy outcomes such as foetal distress, low birth weight, perinatal morbidity and increased incidence of Caesarean section. Objective of present study was to determine the outcome of maternal and Foetal wellbeing after diagnosis of oligohydramnios at term pregnancy.Methods: 50 pregnant women aged between 18 – 27 years were screened with history of oligohydramnios by ultrasound scanning after 37 completed weeks, compared with 50 controls with no oligohydramnios.Results: The mean age of the study group was 22.7 years and of the control group was 22.4 years, respectively. Majority of the patients were primigravidae in both the groups. The mean gestational age was 39.5 weeks in study group and 39.4 in control group. The occurrence of non reactive NST was more in study group compared to the control group. The efficacy of AFI as a screening test to predict foetal distress is more significant with Positive Predictive Value of 57% and Negative Predictive Value of 80%. The mean birth weight was 2.5 kg in the study group compared to 2.75 kg in the control group which is statistically significant. 34 % of the newborns were admitted to NICU in study group compared to 14% in the control group.Conclusions: In the presence of oligohydramnios, the occurrence of non-reactive NST, meconium stained liquor, development of foetal distress are very high

Knowledge, attitude and practices about contraception among married reproductive women

Background: Total unmet need for contraception at national level has been 20.5% (DLHS 3, 2007-08).  According to NFHS 4 (2015-16), total unmet need for family planning for Bangalore Urban is 13.3%. This study has been done to assess the knowledge, attitude and practices about contraception among married women in the reproductive age group.Methods: Cross sectional study conducted from 1st March 2017 to 15th April 2017 in Bowring and Lady Curzon Hospital, Bangalore.  Married women in age group of 15 to 45 years, antenatal women were included.  Unmarried women, Hysterectomised women were excluded.Results: 72% of the clients had awareness of contraception.  Most common method known is Female sterilization followed by IUCD.  Awareness of emergency contraception was found only in 5.33%.  48% of the clients did not follow any method of contraception.  Most commonly used method is female sterilization.Conclusions: The study shows that we need to use multiple resources to educate people by intensifying IEC activities.  Women should be made aware about their right of protecting their own health and more emphasize should be given on postpartum family planning.

Clinical course of ectopic pregnancy:a tertiary centre experience

Background: Ectopic pregnancy (EP) is one of the causes of maternal mortality and morbidity in the first trimester. EP is still a major challenge and its incidence is on the rise due to changes in lifestyle and advances in medical practice. The early diagnosis and treatment of this condition over the past two decades has allowed a definitive medical management of unruptured ectopic pregnancies even before there were clinical symptoms in these high-risk women.Methods: It was a retrospective study of 100 cases of EP conducted in the Department of Obstetrics and Gynecology, Bowring and Lady Curzon Hospital, attached to Bangalore medical college, Bengaluru for a period of 3 years. The aim of the study was to study the incidence, risk factors, clinical profile and management of EP cases.Results: Incidence of EP was 1.3% of all deliveries and 5.6% of gynecological surgeries. Peak age group was between 25-30 years (37%). Most of them were multiparous (83%), 58% of the patients had identifiable risk factors. 95% had amenorrhea, followed by pain abdomen in 81%, bleeding PV in 43%. 17% presented with shock. 91% patients presented with ruptured ectopic, 9% were unruptured. Unruptured cases were treated medically using Methotrexate. Laparotomy was done for ruptured cases. Commonest site of Ectopic was ampulla (81%). Salpingectomy was done for most cases (86%). No maternal mortality observed.Conclusions: All high-risk women should be screened at the earliest with serum β-hCG and TVS. The impact on future fertility can be improved by focusing on primary prevention and early diagnosis before rupture

Abnormal uterine bleeding in relation to thyroid dysfunction

Background: Abnormal uterine bleeding is an abnormal bleeding from the uterus in absence of any organic disease of genital tract and demonstrable extra genital causes. Thyroid dysfunction is marked by large number of menstrual abnormalities. This study is aimed at detecting thyroid dysfunction in patients with provisional diagnosis of AUB (abnormal uterine bleeding).and refer positive cases to physician for further management.Methods: All patients from are from puberty to pre-menopausal age groups, presenting as menoraghia, metrorragia, polymenorrhoea, polymenorragia, hypomenorrhoea, and acyclical bleeding. Onset, duration, amount of bleeding, complaints related to thyroid dysfunction was noted in detail. A thorough clinical examination including general physical examination, neck examination, systemic and gynecological examination was carried out, with special reference to thyroid dysfunction. A provisional clinical diagnosis of DUB was made. Patients with clinical signs and symptoms of thyroid disease were excluded. All these patients were subjected to routine investigations like Hb%, blood counts, urine routine, and bleeding and clotting time to rule out coagulation defects. Then all were subjected for serum T3, T4, and TSH estimation. Patients were then grouped into 4 categories: euthyroid, subclinical lhypothyroid, hypothyroid, and hyperthyroid. Patients who had thyroid disease, on hormonal treatment, IUCD users, and bleeding disorders were excluded.Results: Among 100 patients studied with abnormal uterine bleeding, patients were distributed according to age groups from puberty to perimenopause age. Majority of patients belongs to 31-40 years of age about 40% and the least age group were between 41-45 years of age.(7%).Among different parity status AUB was more common among para three patients(26%). Out of 100 patients, 32% of patients had thyroid dysfunction of which 16% of patients had subclinical hypothyroidism. 15% of patients had hypothyroidism and only 2% of patients had hyperthyroidism. The commonest bleeding abnormality in AUB were polymenorrhoea (30%) and menorrhagia (35%). All hyperthyroid cases were oligomenorrhoeic.Conclusions: This study concludes that thyroid dysfunction should be considered as an important etiological factor for menstrual abnormality. The biochemical evaluation of T3, T4, and TSH estimations should be made mandatory in AUB cases to detect apparent and occult thyroid dysfunction

Mycobiome of the Bat White Nose Syndrome (WNS) Affected Caves and Mines reveals High Diversity of Fungi and Local Adaptation by the Fungal Pathogen Pseudogymnoascus (Geomyces) destructans

The investigations of the bat White Nose Syndrome (WNS) have yet to provide answers as to how the causative fungus Pseudogymnoascus (Geomyces) destructans (Pd) first appeared in the Northeast and how a single clone has spread rapidly in the US and Canada. We aimed to catalogue Pd and all other fungi (mycobiome) by the culture-dependent (CD) and culture-independent (CI) methods in four Mines and two Caves from the epicenter of WNS zoonotic. Six hundred sixty-five fungal isolates were obtained by CD method including the live recovery of Pd. Seven hundred three nucleotide sequences that met the definition of operational taxonomic units (OTUs) were recovered by CI methods. Most OTUs belonged to unidentified clones deposited in the databases as environmental nucleic acid sequences (ENAS). The core mycobiome of WNS affected sites comprised of 46 species of fungi from 31 genera recovered in culture, and 17 fungal genera and 31 ENAS identified from clone libraries. Fungi such as Arthroderma spp., Geomyces spp., Kernia spp., Mortierella spp., Penicillium spp., and Verticillium spp. were predominant in culture while Ganoderma spp., Geomyces spp., Mortierella spp., Penicillium spp. and Trichosporon spp. were abundant is clone libraries. Alpha diversity analyses from CI data revealed that fungal community structure was highly diverse. However, the true species diversity remains undetermined due to under sampling. The frequent recovery of Pd indicated that the pathogen has adapted to WNS-afflicted habitats. Further, this study supports the hypothesis that Pd is an introduced species. These findings underscore the need for integrated WNS control measures that target both bats and the fungal pathogen.Comment: 59 pages, 7figure

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Comparative analysis of conventional and real time PCR for detection of haemoparasites in dogs

9-15Ehrlichiosis and babesiosis are the most pathogenic tick-borne diseases of dogs worldwide. The present study reports that the development of SYBR green based real time PCR (RT-PCR) protocols with novel primers targeting small subunit ribosomal RNA genes to detect natural infections of Ehrlichia canis, Babesia vogeli and B. gibsoni in dogs and its comparison with conventional PCR. Statistical analysis revealed that RT- PCR is more superior to conventional PCR assay to detect low level rickettsaemia (p < 0.05). The high prevalence of these pathogens in the study population also warrants immediate attention to the adoption of efficient and sustainable control strategies

Clonal Genotype of Geomyces destructans among Bats with White Nose Syndrome, New York, USA

The dispersal mechanism of Geomyces destructans, which causes geomycosis (white nose syndrome) in hibernating bats, remains unknown. Multiple gene genealogic analyses were conducted on 16 fungal isolates from diverse sites in New York State during 2008–2010. The results are consistent with the clonal dispersal of a single G. destructans genotype