Recurrent vaginal discharge: an unusual presentation of embryonal rhabdomyosarcoma of uterine cervix in an adolescent girl

Embryonal rhabdomyosarcoma (ERMS) is a rare tumor of the female genital tract. It tends to occur during childhood in the vagina and rarely it can arise in the uterine cervix, with a peak incidence in the second decade. We report a case of 15 year old adolescent girl who presented with recurrent vaginal discharge not responding to medical treatment. Examination under anesthesia showed friable growth arising from the cervix. Histopathological examination revealed embryonal rhabdomyosarcoma (botyroid variant) of the cervix. Patient underwent local excision of growth followed by IRS-4 protocol based chemotherapy and now patient is under follow up at our side and pediatric oncology and doing well. Young girls presenting with recurrent vaginal discharge not responding to medical treatment must undergo proper clinical examination and EUA and any suspicious lesions should be examined so as to avoid missing rare but aggressive etiology like rhabdomyosarcoma. Due to the young age of affected patients, embryonal rhabdomyosarcoma (sarcoma botyroides) poses a management challenge as the preservation of hormonal, sexual and reproductive function is essential. Awareness of such as uncommon lesion and its clinical implications is important for the counseling and management of the patient

Importance of examination under anaesthesia in adolescent age group for effective diagnosis and treatment in diagnostic dilemma: case series

Problems of the adolescent girls like discharge and bleeding per vaginum (BPV) are usually underestimated and under diagnosed and are considered as physiological. Often diagnosis not settled due to incomplete or absent examination. In such situations Examination under anaesthesia (EUA) is an invaluable method in the lower genital tract assessment of adolescent females. The aim of this study was to discuss Importance of EUA in adolescent age group with persistent complain of discharge and bleeding for aiding the diagnosis. Present case series discusses three cases of girls of adolescent age group who presented to tertiary care centre of Northern India over a period of six month with complain of discharge per vaginum and on and off bleeding p/v which was refractory to medical management. After initial examination and investigations they were planned for Examination under Anaesthesia. Gynecological complaints such as vaginal discharge, irregular BPV are common complains in adolescent age group. Many complaints can be dealt with by reassurance, whereas most others respond to medical therapy. To facilitate diagnosis in recurrent or unresponsive patients EUA is recommended. In diagnostic dilemma and in unusual presentation in young age EUA is invaluable

Term pregnancy with large anterior wall intramural fibroid: an intra-operative challenge

Leiomyomas are the most common benign smooth muscle tumors of the uterus. The incidence during pregnancy ranges between 1.6 to 10%. The management of fibroids encountered during caesarean section poses a therapeutic dilemma. We present a case of giant anterior wall lower segment leiomyoma complicating term pregnancy which posed a great surgical challenge. Myomectomy was performed before delivering the baby by lower segment caesarean section by locating the tumor free area using preoperative ultrasound. The tumor mass weighed 3kg. This case highlights the preoperative use of ultrasound in emergency caesarean section to avoid classical caesarean section and to prevent fetal mortality and morbidity by avoiding time consuming caesarean myomectomy before the delivery of the baby

Review of hysterectomies in Department of Obstetrics and Gynaecology at tertiary care hospital in Northern India

Background: With the advancement of newer and conservative approach in the management of many gynaecological conditions, hysterectomy still remains the chief modality of treatment. The aim of this study was to analyze the various indications, clinical profile, and outcome of all the patients who underwent hysterectomy at premier teaching hospital in Northern India.Methods: This study involved all the patients who underwent hysterectomy from 1st Jan 2017 to 31st Dec 2017 in tertiary care hospital India.Results: Out of total 513 hysterectomies, 105 were obstetric and 408 were gynaecological hysterectomies. In obstetric hysterectomies 40% were due to rupture uterus, 38% were due to abnormal placentation. In gynaecological hysterectomies, 75.5 % abdominal & 24.5 % were vaginal.75.7 % were for benign conditions and 24.3% were for malignant conditions. Most common indication was AUB.Conclusions: Hysterectomy is commonly done to improve the quality of life but at the same time in obstetrics emergencies it’s a lifesaving procedure. So, its indications should be clearly evaluated, and patient should be clearly counselled about conservative options, risk and benefits of the procedure

Polyvinylpyrrolidone-Capped Silver Nanoparticle Inhibits Infection of Carbapenem-Resistant Strain of Acinetobacter baumannii in the Human Pulmonary Epithelial Cell

Acinetobacter baumannii, an opportunistic ESKAPE pathogen, causes respiratory and urinary tract infections. Its prevalence increases gradually in the clinical setup. Pathogenicity of Acinetobacter is significantly influenced by its ability to infect and survive in human pulmonary cells. Therefore, it is important to study the infection of A. baumannii in human pulmonary host cell (A-549), monitoring surface interacting and internalized bacteria. It was found that during infection of A. baumannii, about 40% bacteria adhered to A-549, whereas 20% got internalized inside pulmonary cell and induces threefold increase in the reactive oxygen species production. We have synthesized polyvinylpyrrolidone (PVP)-capped AgNPs using chemical methods and tested its efficacy against carbapenem-resistant strain of A. baumannii. PVP-capped silver nanoparticles (PVP-AgNPs) (30 µM) have shown antibacterial activity against carbapenem-resistant strain of A. baumannii and this concentration does not have any cytotoxic effect on the human pulmonary cell line (IC50 is 130 µM). Similarly, PVP-AgNPs treatment decreases 80% viability of intracellular bacteria, decreases adherence of A. baumannii to A-549 (40 to 2.2%), and decreases intracellular concentration (20 to 1.3%) of A. baumannii. This concludes that PVP-AgNPs can be developed as a substitute for carbapenem to control the infection caused by carbapenem-resistant A. baumannii

Estimation of serum 25 hydroxy vitamin D level and its correlation with metabolic and endocrine dysregulation in women with PCOS

Background: Polycystic ovarian syndrome is the most common hormonal disturbance in the reproductive age women, with prevalence of 5-10%. Vitamin D deficiency is common in women with or without PCOS. The aim of this study was to assess association of serum vitamin D level with metabolic and endocrine dysregulation in women with PCOS.Methods: This cross-sectional study was done over a period of one year. 100 women of age group 20-40 years were divided in group A 30 (BMI >30 mg/m2) with PCOS, group B 20 (BMI <25 mg/m2) with PCOS, group C 50 controls and were investigated for serum FSH, LH, LH/FSH ratio, S. total testosterone, S. postprandial insulin level, glucose insulin ratio, 25 hydroxy vitamin D level.Results: LH/FSH ratio >2 (33.33% in obese and 50% in non-obese), serum total testosterone level >0.8ng/ml (80% in obese and 75% in non-obese) (p value was significant between study group as well as between study and control group). Serum fasting, postprandial blood glucose, postprandial serum insulin level was elevated in obese than non-obese PCOS. 25 (OH) vitamin D deficiency <20 ng/ml (56.675% in obese and 45% in non-obese). So, vitamin D deficiency was more common in obese PCOS.Conclusions: PCOS is more common in age group of 20-40 years. There is more Insulin resistance in obese PCOS as compared to non-obese PCOS. Vitamin D deficiency is comparatively more common in obese PCOS population than in non-obese PCOS.

Widespread fear of dengue transmission but poor practices of dengue prevention : A study in the slums of Delhi, India

Background This study has been conducted to throw light on the knowledge and practices related to dengue fever among the poor population living in Delhi's slums. Materials A household survey was conducted in 2013 among 3,350 households. The households were stratified by a number of variables related to socio-economic status and health events such as hospitalisation. The data collection was completed through face-to-face interviews conducted with the help of 25 field investigators. Results About 8% of the households had at least one diagnosed dengue case. In comparison to the population surveyed, teenagers (15-19 years) and adults (30-34 years) were more affected whereas children under four years of age were underrepresented. Housewives are more affected by dengue (24%) compared to their share of the population surveyed (17%). Despite the fact that 77% of the respondents are worried about mosquitoes, only 43% of them monitor environment to avoid the presence of breeding sites. Conclusion One cannot exclude the possibility that though young children under the age of four years are exposed to the virus, either their cases were asymptomatic or family members infected during this period had potentially more serious symptoms leading to hospitalisation. This result could thus be explained by budget-related health choices made by this population which do not favour small children. Educational programs should target housewives to improve their impact, as they are the ones mostly responsible for water storage and cleanliness of the house and its neighbourhood. Even with a dengue experience and potentially an acute perception of the risk and its factors, a proper management of environmental conditions is lacking. This along with the fact that word-of-mouth is the main source of information quoted should be a message for municipality health workers to give door-to-door information on how to prevent breeding sites and dengue infection

A Study of Relationship between Arterial Blood Pressure and Mid Arm Circumference in Young Adults

The present study was done to find out the correlation between mid-arm circumference (MAC)and blood pressure, {systolic blood pressure (SBP), diastolic blood pressure (DBP); pulse pressure(PP) and mean arterial pressure (MAP)} values. There is paucity of information on the variation in blood pressure and pulse rate parameters of normal individuals. The aim of the study was to assess the correlation between MAC and BP. The study was conducted in 184 healthy young adults. There were 119 male and 65 female participants. In view of gender differences in autonomic regulation, data of male and female subjects were analyzed separately. We used analysis of variance to compare differences between Mean± SD, maximum, minimum values and correlations of MAC and blood pressure values. Conclusion: The Mean±SD of blood pressure values were higher in those subjects who had high mid arm circumference and least in those subjects who had lower mid arm circumference. A p value *0.05 and * 0.01 were considered statistically significant for both male as well as in female subjects. There was significant spearman`s correlation between MAC and BP in both male as well as in female subjects

Holt-Oram syndrome: Anesthetic challenges and safe outcome

Holt-Oram syndrome (HOS) is an autosomal dominant disease with skeletal and cardiac manifestations. We here are presenting a 31-year-old man and a diagnosed case of HOS, with an ulceroproliferative lesion on lateral border of the tongue, was posted for wide excision of lesion with primary closure and left side radical neck dissection