A vulval leiomyoma: a rare camouflaging tumor

Uterine leiomyomas are a benign tumor of human uterus and common problem in gynecology. Despite this, leiomyomas of the vulva are rare, masquerading, and usually misdiagnosed as Bartholin cyst preoperatively. These benign smooth muscle tumors are typically painless, solitary, and well circumscribed and can affect female of any age group. We hereby present a case of a 39-year-old female that presented in OPD at ESIC model hospital, Bapunagar, Ahmedabad with left labial mass and was misdiagnosed as Bartholin cyst initially and later on histopathology final diagnosis of vulvar leiomyoma was made

Correlation of sociodemographic factors and intestinal parasites in pregnant women

Background: Pregnant women often experience more severe intestinal parasitic infections than their non-pregnant counterparts. Intestinal parasitic infections also disturb pregnancy at the maternal and fetal level. Objective of the study was to find out the prevalence of intestinal parasites in pregnant women and its relationship with various socio-demographic factors.Methods: A single stool specimen was collected. A saline and iodine mount was examined microscopically to demonstrate the intestinal parasites. Formol ether Concentration technique was performed to increase the yield of the eggs and larvae. Modified acid-fast staining was done for opportunistic parasitic infections.Results: In this study 300 pregnant women were screened for presence of intestinal parasites. The prevalence of intestinal parasites was 42.67%. Women who practiced hand washing regularly and had knowledge about parasites had lesser infection. The dietary practice of taking green leafy vegetables had protective effect during pregnancy. The prevalence of intestinal parasites was almost same in both rural and urban women. Higher prevalence of intestinal parasites was found in lower socioeconomic class. Women who used river as source of water supply had slightly more prevalence than those who used municipal water. The prevalence of hookworm infection was more in women who never wore sandals.Conclusions: The high prevalence of intestinal parasites in the pregnant women indicates faecal pollution of soil and domestic water supply.  Education and awareness regarding intestinal parasites need to be done during their routine antenatal visits. Emphasis should be made on consistent hand washing, consumption of washed leafy vegetables and use of footwear. Deworming of pregnant women should be considered in the national guidelines

Association of Partner Support and Partner Communication with Provider Prescribed Contraceptive Method Use among Heterosexual Couples in Kisumu, Kenya

We explored partner support and communication factors associated with provider prescribed contraceptive (PPC) use to inform contraception  interventions among heterosexual couples in Kenya. From April 2014 through September 2016, 252 community recruited couples in Kisumu, Kenya, were enrolled. Men and women were surveyed separately and asked about communication regarding sexual/reproductive health and relationship characteristics. PPC use was defined as female reported use of pills, injection, implant, IUD, or tubal ligation. Multivariable Poisson regression with robust variance estimate was used to identify factors associated with PPC. In multivariable modeling, women who reported discussing the future of their relationship with their partner were 2.46 (95% CI: 1.13-5.36) times more likely, and men who reported discussing condom use were 0.83 (95% CI: 0.72-0.95) time less likely, to report PPC use. These findings call for greater attention to involving male partners, incorporating communication skills, and relationship characteristics into interventions in our and similar settings.  Keywords: Family planning, male involvement, reproductive health, agency, Africa Nous avons exploré le soutien des partenaires et les facteurs de communication associés à l'utilisation de contraceptifs prescrits par le fournisseur (PPC) pour informer les interventions de contraception auprès des couples hétérosexuels au Kenya. D'avril 2014 à septembre 2016, 252 couples recrutés par la communauté à Kisumu, au Kenya, étaient inscrits. Les hommes et les femmes ont été interrogés séparément et interrogés sur la communication concernant la santé sexuelle / reproductive et les caractéristiques des relations. L'utilisation du CPP a été définie comme l'utilisation déclarée par les femmes de pilules, d'injection, d'implant, de DIU ou de ligature des trompes. Une régression de Poisson multivariable avec une estimation de variance robuste a été utilisée pour identifier les facteurs associés au CPP. Dans la modélisation multivariable, les femmes qui ont déclaré discuter de l'avenir de leur relation avec leur partenaire étaient 2,46 (IC à 95%: 1,13-5,36) fois plus susceptibles, et les hommes qui ont  déclaré discuter de l'utilisation du préservatif étaient 0,83 (IC à 95%: 0,72-0,95). Moins susceptibles de signaler l'utilisation du PPC. Ces résultats appellent à une plus grande attention à l'implication des partenaires masculins, à l'intégration des compétences en communication et des caractéristiques relationnelles dans les interventions dans notre environnement et dans des environnements similaires. Mots-clés: Planification familiale, implication masculine, santé reproductive, agence, Afriqu

Ultrasound guided fine needle aspiration cytology in deep seated lesions: an effective diagnostic tool

Background: Fine needle aspiration cytology (FNAC) is a diagnostic method used to assess various masses in the body with minimal invasion. FNAC alone has a lower yield as compared to biopsy for diagnosing deep-seated lesions. Radiological guidance improves the yield of FNAC. The aim of the study was to evaluate the diagnostic efficacy of Ultrasound (USG) guided FNAC in various deep-seated lesions in the body. We conducted a cross-sectional analytical study at the cytology section of pathology department of our hospital for indoor patients.Methods: It was a retrospective study done over a period of five years, which included 334 aspirates suspected to be of inflammatory or neoplastic origin obtained from deep-seated lesions. After a thorough clinical and radiological evaluation, USG guided FNACs were performed. Experienced pathologists processed the smears, prepared thereby, for cytological evaluation and diagnosis.Results: A total of 334 samples were collected using USG-guided FNAC. The most common site was lungs (36.5%) followed by liver (13.77%). The most common type were malignant lesions (57.19%) which were either primary malignancies or metastatic carcinomas. 29 samples were found to be acellular or had inadequate material, thus a diagnosis couldn’t be made. Out of the various lung masses, non-small cell carcinoma was the most common (66.39%). The most common liver mass was metastatic carcinoma (54.35%).Conclusions: USG guided FNAC is a relatively simple, safe, fast, minimally invasive and cost effective procedure, which provides quite a high rate of adequacy and diagnostic efficacy. It is useful for making a pre-operative diagnosis and guiding the choice of treatment.

Water, sanitation and hygiene at sex work venues to support menstrual needs

Introduction: Adequate menstrual health and hygiene (MHH) is necessary for women’s health and equity of all menstruators. Female sex workers (FSW) require good MHH to prevent discomfort and exposure to pathogens. No studies have evaluated water, sanitation, and hygiene (WASH) conditions of FSW. We report on a cross-sectional WASH assessment at FSW venues in Kisumu, western Kenya. Methods: Stakeholders identified 77 FSW venues in Kisumu, of which 47 were randomly sampled and visited between April-May 2023. A standardized structured survey of WASH conditions was deployed by trained research staff using Android tablets after proprietor’s consent. WASH scores ranging 0 – 3 were computed based on point each for direct observation of water available, soap available, and acceptable latrine. MHH scores ranging between 0-4 were computed (one point each) for direct observation of: currently available soap and water, locking door on a usable latrine, functional lighting, and a private area for changing clothes or menstrual materials, separate from the latrine(s). WASH and MHH scores were compared by venue type using non-parametric Kruskal-Wallis tests, and non-parametric Spearman rank tests. Results: Full WASH criteria was met by 29.8% of venues; 34.0% had no adequate WASH facilities; 46.8% had no female latrine, and 25.5% provided soap and water in private spaces for women. While 76.6% had menstrual waste disposal only 14 (29.8%) had covered bins. One in 10 venues provided adequate MHM facilities. Poorest WASH facilities were in brothels and in bars, and three-quarters of bars with accommodation had no MHH facilities. Discussion: WASH and MHH services were sub-optimal in the majority of FSW venues, preventing menstrual management safely, effectively, with dignity and privacy. This study highlights the unmet need for MHH support for this population. Poor MHH can deleteriously impact FSW health and wellbeing and compound the stigma and shame associated with their work and ability to stay clean. Acceptable and cost-effective solutions to sustainably improve WASH facilities for these populations are needed

AN ESSENTIAL TOOL TO BE OPTIMIZED: SYNDROMIC MANAGEMENT OF VAGINAL DISCHARGE IN HAITI

Background: Haiti, like many low-income countries in crisis, has limited resources for etiologic diagnosis of vaginal discharge. As such, we sought to characterize variability in diagnoses of women presenting with vaginal discharge syndrome, with the goal to improve standardization of syndromic management. Materials and Methods: Participants aged 18 years and older endorsing vaginitis, or dysuria were recruited at Jerusalem Clinic over two, one-week periods in April 2018 and July 2019. We calculated Spearman rank correlations among history, exam findings, and diagnoses based on clinical presentation, to understand presentation groupings and their management. Results: Among 98 women, median age was 33.5 years, and most frequent symptoms were: vaginal discharge (97%), vaginal itch (73%), and/or suprapubic pain (68%). Most common physical exam findings were vaginal discharge (86%), suprapubic/lower quadrant tenderness (29%), cervical motion tenderness (24%), and cervical erythema (20%). Most symptoms and physical exam findings were weakly correlated with each other. Nearly one-third (31%) were diagnosed with normal physiologic vaginal discharge or no diagnosis, followed by Bacterial vaginosis (31%), vulvovaginal candidiasis (15%), cervicitis/PID (13%), and STI (7%). No reported symptoms strongly differentiated diagnostic categories. Diagnoses varied considerably by exam findings. Conclusions: The weak correlations between symptoms, exam findings, and diagnoses could represent variability in assessment. In the absence of reliable and accessible laboratory testing, the importance of standardizing syndromic management becomes increasingly relevant. Results from our study support the utility of speculum examination and more standardized documentation of physical exam findings. Next steps include the development of local algorithms to promote standardization of treatment of vaginal discharge syndrome

In Vitro Study to Assess Effective Cleaning Techniques for Removing Staphylococcus aureus from Menstrual Cups

Background: We sought to determine the effectiveness of common cleaning procedures in eliminating S. aureus from silicone menstrual cups. Methods: In this in vitro study, we tested four cleaning techniques: (1) cold water; (2) cold water and liquid soap; (3) cold water followed by steeping the cup in boiled water for 5 min in a ceramic mug covered with a small plate; and (4) cold water and soap followed by steeping the cup in boiled water as in (3). Human blood was coated to the inner and outer surface of each cup, dried, and incubated with 106 S. aureus colony-forming units (CFU/mL). All tests were performed in triplicate. Viable bacterial abundance was measured with decadic dilution and drop plate or surface plating. Results: Bacteria were most effectively eliminated by cleaning cups with soap and water and then steeping in boiled water (0 CFU/cup vs. 2.075 × 108/cup no cleaning, p = 0.005). This was not statistically significantly different from washing cups with water only and steeping 5 min in boiled water (14 CFU/cup). Raised lettering on the outer surface of the menstrual cups resulted in more bacterial recovery from pieces with lettering than without lettering. Conclusions: These results advance knowledge of between-period menstrual cup cleaning recommendations, suggesting that the logistical challenges of continuous boiling may be eliminated with steeping at least 5 min

Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA).

BackgroundPatients with gastrointestinal cancers and brain metastases (BM) represent a unique and heterogeneous population. Our group previously published the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for patients with GI cancers (GI-GPA) (1985-2007, n = 209). The purpose of this study is to update the GI-GPA based on a larger contemporary database.MethodsAn IRB-approved consortium database analysis was performed using a multi-institutional (18), multi-national (3) cohort of 792 patients with gastrointestinal (GI) cancers, with newly-diagnosed BM diagnosed between 1/1/2006 and 12/31/2017. Survival was measured from date of first treatment for BM. Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios. These factors were incorporated into the updated GI-GPA.ResultsMedian survival (MS) varied widely by primary site and other prognostic factors. Four significant factors (KPS, age, extracranial metastases and number of BM) were used to formulate the updated GI-GPA. Overall MS for this cohort remains poor; 8 months. MS by GPA was 3, 7, 11 and 17 months for GPA 0-1, 1.5-2, 2.5-3.0 and 3.5-4.0, respectively. >30% present in the worst prognostic group (GI-GPA of ≤1.0).ConclusionsBrain metastases are not uncommon in GI cancer patients and MS varies widely among them. This updated GI-GPA index improves our ability to estimate survival for these patients and will be useful for therapy selection, end-of-life decision-making and stratification for future clinical trials. A user-friendly, free, on-line app to calculate the GPA score and estimate survival for an individual patient is available at brainmetgpa.com