Diagnosing genital tuberculosis in female infertility by clinical, histopathological, culture and polymerase chain reaction techniques: an evaluative study

Background: In developing countries, the genital tract tuberculosis is one of the common causes of tubal damage leading to infertility. Objective of present study was to evaluate the efficacy of Histopathological examination (HPE), culture and Polymerase Chain Reaction Technique in diagnosing genital tuberculosis.Methods: It was a prospective evaluative study. 173 women were subjected to investigations for tuberculosis. AFB smear, culture and HPE examination and PCR testing were carried out on 173 endometrial samples, 81 POD fluid and 52 urine samples. Based on the clinical profile and laparoscopic findings a diagnostic criterion was derived to suspect GTB and the specific diagnostic tests were evaluated against this diagnostic criterion.Results: Based on the diagnostic criteria, tuberculosis was suspected in 61 of the 153 cases.   AFB smear was positive in 4.6%, culture was positive in 3.5%, HPE positive in 4.0% and PCR was positive in 28.1% of cases. On evaluating against the diagnostic criteria, the sensitivity of PCR, HPE, culture and AFB smear were; 44.3%, 8.2%, 6.6% and   6.7% respectively.  PCR was positive in 18 of the 92 cases in whom GTB was not suspected. The PCR results were negative in 34 of the 61 clinically suspected cases.Conclusions: This study has shown that HPE, AFB smear and culture have low pick up rates. PCR is found to be useful in confirming diagnosis in clinically suspected cases. False negative PCR was an important limitation in this study

Florid genital tuberculosis co-existing with adenomyosis and evading diagnosis

When tuberculosis affects genital organs of young females, the disease often remains silent or may present with symptoms which are common to other Gynaecological conditions as well. The diagnosis of genital tuberculosis is challenging and the diagnosis can be missed even with extensive investigations including molecular studies. A case of florid tuberculosis affecting the uterus, cervix, ovaries and tubes, co-existing with adenomyosis of the uterus and the cold abscess masquerading as bilateral ovarian endometriomas is reported

Evaluating iron deficiency anaemia in the third trimester of pregnancy with haematological parameters and serum ferritin concentration

Background: Iron deficiency is the commonest cause of anaemia and at least half of anaemia cases will have causes other than iron deficiency. The objective of this study was to determine the prevalence of iron deficiency anaemia among antenatal mothers based on haematological parameters and serum ferritin levels.Methods: This was a hospital based cross sectional study, conducted at Meenakshi Medical College and Research Institute, Kancheepuram from January 2017 to June 2018. Two hundred antenatal mothers who were diagnosed with anaemia in the third trimester of pregnancy were evaluated by haematological parameters and serum ferritin assay.Results: 38% of women had mild anaemia, 50% had moderate anaemia and 12% had severe anaemia. On peripheral smear, 60% had microcytic hypochromic anaemia indicating iron deficiency, and 12% had megaloblastic anaemia. In 41% of cases, the mean corpuscular volume was 160µg/lit in 19% of cases.Conclusions: Based on the haematological parameters and serum ferritin estimation, in 60% of cases, anaemia was due to iron deficiency. Before initiating treatment, it is important to differentiate various types of anaemia, so that appropriate treatment can be given

A study to evaluate serum 25-hydroxy vitamin D3 and calcium levels in maternal and cord blood and their effect on pregnancy outcome

Background: To determine the prevalence of vitamin D deficiency among pregnant mothers and their neonates and to study the effect of vitamin D deficiency on maternal and perinatal outcome.Methods: This prospective cohort study conducted in a teaching hospital included 223 pregnant mothers and their offspring born in 2017. Detailed history was taken to ascertain the causes of vitamin D deficiency.   vitamin D3 and calcium levels were estimated in maternal and cord blood samples. To study the association between the vitamin D status and the various maternal and neonatal parameters.Results: 91.9 % of women were house wives involved in indoor activities. Pre-eclampsia and GDM were seen in 4.5% of cases each. 5.41% were obese and 84%  were of medium complexion,  and 8% were  dark. 93.7% were non- vegetarians,  and fish, egg and milk consumption was adequate in 61.3% , 64% and 71% respectively. Only 5.40% of women had adequate exposure to sunlight.  The mean birth weight was 3.08± 0.36 Kg. and 14 babies were admitted to NICU for neonatal asphyxia.77.40% had deficient levels of vitamin D  <20 ng/ml. Only four pregnant mothers (1.8%) had sufficient levels vitamin D. There was no statistically significant association between vitamin D deficiency and various maternal and neonatal parameters.Conclusions: This study has shown that the prevalence of vitamin D deficiency among south Indian pregnant mothers and their newborn is very high and the ways to improve the vitamin D status among pregnant mothers should be looked at

Clinical significance of umbilical cord abnormalities: an observational study

Background: The well being of a foetus depends on the uncompromised placental function and normal blood flow through the umbilical vessels. If there are umbilical cord abnormalities, it can lead to perinatal complications. The aim of the study was to analyse the prevalence of umbilical cord abnormalities and to study the relationship between the cord abnormalities and intrapartum complications.Methods: This was a prospective observational study conducted at a tertiary care hospital, Chennai, from September 2020 to August 2021. Four hundred mothers who met the inclusion and exclusion criteria were included in the study. At the time of delivery, umbilical cord , intrapartum and neonatal details were noted. The association between the cord length and parameters such as nuchal coiling, FHR changes, mode of delivery, APGAR at birth and NICU admissions were analysed and the statistical significance was derived.Results: The mean cord length was 57.44±20.11 cms. 65% had normal cord length, 15% had short cords and 20% of babies had long cords. Nuchal coiling was seen in 31.75%, cord prolapse in 0.75% and true knot in 1% of cases. Cases with long cords were associated with statistically significant increase in the incidence of nuchal cords, multiple cords, FHR abnormalities, operative interventions and birth asphyxia. The presence of short cord was not associated with significant adverse maternal and perinatal outcome.Conclusions: This study showed that 35% of all deliveries were complicated by abnormal cord length and other cord complications. It is important to document these findings in the event of antenatal or intrapartum complications

A community-based study to evaluate the prevalence and risk factors for osteoporosis among menopausal and pre-menopausal women

Background: To determine the prevalence of osteoporosis among pre and post menopausal women using quantitative ultrasound of calcaneal bone and to identify the risk factors associated with osteoporosis.Methods: This prospective community based epidemiological study was conducted during 2019 in a suburban area attached to Sri Muthu Kumaran Medical College Hospital and Research Institute, Chennai. 305 subjects met the inclusion and exclusion criteria. Using a structured questionnaire, demographic details, obstetric, gynaecological and medical history were collected. Quantitative ultrasound of the calcaneal bone was used to calculate the bone mineral density. Using statistical methods, risk factors for osteoporosis were analysed.Results: The mean age of the participants was 52.67±9.41 years, 62.2% were post menopausal and 37.38% were premenopausal. The BMD ‘T’ score was normal in 29.8%, osteopenia was diagnosed in 38.4% and osteoporosis in 31.8% of participants. 14% of premenopausal women and 42.4% of postmenopausal women were osteoporotic. Age, menopausal status, duration of menopause, and previous history of fractures emerged as significant risk factors for osteoporosis.Conclusions: The prevalence of osteoporosis is high among both pre-menopausal and menopausal women, but the awareness is limited. This study highlights the need for screening all women after the age of 40 years which is feasible using portable and easily available technology such as quantitative ultrasound of peripheral bones

Hysterosalpingographic findings in infertile women diagnosed with genital tuberculosis

Background: Objectives of the study were to describe the hysterosalpingographic (HSG) findings among infertile women with genital tuberculosis (GTB).Methods: This is a retrospective analytical study conducted at Sri Muthu Kumaran Medical College Hospital and Research Institute, Chennai, from January 2016 to January 2020. Study population included 51 infertile women with genital tuberculosis. GTB was diagnosed by either culture/histopathological examination (HPE) or polymerase chain reaction (PCR) studies. In these proved cases of tuberculosis, HSG findings were analysed. Permission from the institutional review board was obtained for the retrospective analysis of the hospital data.Results: Among 113 women who underwent hysterosalpingography, 51 were diagnosed with GTB. In these 51 women, the HSG finding were normal in 23.5% and were abnormal in 76.5% of cases. The abnormal HSG findings noted in association with GTB were calcification (3.9%) , distorted uterine cavity (3.9%), beaded tubes, intravasation with blocked tubes (5.9%), fimbrial block with hydrosalpinx (15.6%), cornual block (35.3%) and mid tubal block.Conclusions: Though imaging findings may be highly suggestive of tuberculosis, some of the features such as tubal block and hydrosalpinx are not specific for tuberculosis and may be seen in other infective causes of tubal damage also. Therefore, specific investigations for tuberculosis are still required to make a de­finite diagnosis. The presence of HSG features indicate that considerable tubal damage has occurred

Knowledge and awareness of cervical cancer prevention and HPV vaccination among medical and nursing students in a tertiary care hospital

Background: This study was done to assess the level of knowledge and awareness about cervical cancer and its prevention among medical and nursing students. Methods: This descriptive cross-sectional study was conducted during 2022 in a tertiary care hospital in Chennai. The study included 407 subjects; 224 medical students, and 183 nursing students and consent was obtained from each participant prior to the study. A questionnaire survey was used to assess their knowledge on cervical cancer and its prevention. Results: Out of the 407 participants, 95.5% of the medical students and 30.6% of the nursing students knew that HPV virus causes cervical cancer. Medical students had more knowledge on risk factors. 84.38% of medical students and 43.72% of nursing students were aware that vaccine is available for the prevention of cervical cancer. Overall nursing students had limited knowledge on cervical cancer and its prevention. 51.79% of the medical students and 27.87% of the nursing students acquired their knowledge about HPV vaccine through social media. The uptake of HPV vaccine was very low among both medical and nursing students. Conclusions: The results of our study demonstrate that there is a need for creating more awareness about cervical cancer and its prevention among medical and nursing students

Diagnosing genital tuberculosis in female infertility by clinical, histopathological, culture and polymerase chain reaction techniques: an evaluative study

Background: In developing countries, the genital tract tuberculosis is one of the common causes of tubal damage leading to infertility. Objective of present study was to evaluate the efficacy of Histopathological examination (HPE), culture and Polymerase Chain Reaction Technique in diagnosing genital tuberculosis.Methods: It was a prospective evaluative study. 173 women were subjected to investigations for tuberculosis. AFB smear, culture and HPE examination and PCR testing were carried out on 173 endometrial samples, 81 POD fluid and 52 urine samples. Based on the clinical profile and laparoscopic findings a diagnostic criterion was derived to suspect GTB and the specific diagnostic tests were evaluated against this diagnostic criterion.Results: Based on the diagnostic criteria, tuberculosis was suspected in 61 of the 153 cases.   AFB smear was positive in 4.6%, culture was positive in 3.5%, HPE positive in 4.0% and PCR was positive in 28.1% of cases. On evaluating against the diagnostic criteria, the sensitivity of PCR, HPE, culture and AFB smear were; 44.3%, 8.2%, 6.6% and   6.7% respectively.  PCR was positive in 18 of the 92 cases in whom GTB was not suspected. The PCR results were negative in 34 of the 61 clinically suspected cases.Conclusions: This study has shown that HPE, AFB smear and culture have low pick up rates. PCR is found to be useful in confirming diagnosis in clinically suspected cases. False negative PCR was an important limitation in this study