Dermoid cyst indenting bladder: a diagnostic dilemma

A dermoid cyst is a benign cutaneous developmental anomaly that arises from the entrapment of ectodermal elements along the lines of embryonic closure. These benign tumors are lined by stratified squamous epithelium with mature skin appendages found on their wall and their lumens filled with keratin, hair, teeth etc. They are usually benign in nature. Mature ovarian dermoid cysts are very common accounting for 25% of all benign ovarian neoplasms. Uncomplicated dermoid cysts are usually asymptomatic and easy to diagnose on imaging. Presentation of dermoid cysts are extremely rare in the urinary bladder and it is a diagnostic challenge to the gynecologist, pathologist and urologist. Only few cases are found and documented till now. We present an extremely rare case of dermoid cyst involving bladder in a 29 year old female who presented with chief complaint of pain abdomen associated with passage of hair through the urine since 2 months. Her cystoscopy showed presence of hair and caseous material on the surface of the lesion.

Role of serum folic acid and vitamin B12 levels in abruptio placentae and the fetomaternal outcome

Background: Over the course of pregnancy, there is a steady decline in maternal plasma folate concentration and vitamin B12 concentration about 50%of non pregnant levels. Insufficient folate and vitamin B12 status has been associated with many reproductive complications including abruption, IUGR, pre eclampsia, early pregnancy loss. The aim of the study was to determine the role of serum folic acid and vitamin B12levels in patients with abruptio placentae and to study the feto-maternal outcome in these patients. Feto maternal outcome is seen in terms of mode of delivery whether vaginal or caesarean, period of gestation whether term or preterm, need of blood transfusion, stillbirths. Methods: In this prospective observational study conducted in a tertiary hospital from 2018-2020, 50 pregnant women with abruptio placentae were included and their serum folic acid and vitamin B12 levels were measured by ELIZA method using commercially available kits. Results: Serum folic acid levels were not low in the cases of placental abruption with range= 25 ng/ml to 80.5 ng/ml. Mean folic acid level ±SD is 47.98±13.15 ng/ml and median is 48 ng/ml. In this study vitamin B12 levels were low in the cases, range 14 pg/ml to 70 pg/ml. Mean vitamin B12 value ±SD is 27.15±11.63 pg/ml and median is 25 pg/ml.The rate of caesarean section was 44%, preterm delivery was 64% and stillbirth was 38% in these cases with mean folic acid levels of 48.7±15.4 ng/ml, 46.94±13.85 ng/ml and 46.03±8.13 ng/ml respectively and mean vitamin B12 levels of 23.34±6.74 pg/ml, 28.73±13.44 pg/ml and 28.32±11.75 pg/ml respectively. There was a significant association (p=0.006) between vitamin B12 and mode of delivery. No other significant association was seen between serum folic acid and vitamin B12 levels and the different fetomaternal outcome. Conclusions: Low levels of vitamin B12 is seen in cases with abruptio placentae. The rate of caesarean section, preterm delivery, stillbirth and need of blood transfusion is high but no significant association is seen