Levonorgestrel intrauterine system embedded within tubal ectopic pregnancy: a case report

Background: The presence of the levonorgestrel-releasing intrauterine system embedded within an ectopic pregnancy is a rare occurrence. Tubal migration of an intrauterine device is not well understood and has not been extensively studied in literature. Case presentation: A 34-year-old African woman, para 1, gravida 2, presented with symptoms of ruptured ectopic pregnancy. She underwent a laparoscopy where a ruptured left ectopic pregnancy was found with a levonorgestrel releasing intrauterine system inserted 2 years prior embedded within the tube. A left salpingectomy was performed with removal of the levonorgestrel-releasing intrauterine system. The patient recovered well and proceeded to have an intrauterine pregnancy 3 months later. Conclusion: Migration of the levonorgestrel-releasing intrauterine system into the fallopian tube is a rare occurrence that is not well understood. In the case presented, levonorgestrel-releasing intrauterine system was found embedded within the fmbrial end of the left fallopian tube, which had a ruptured ectopic pregnancy. Surgical treatment with laparoscopy is recommended for intraabdominal intrauterine device to prevent complications

Low-Grade Serous Carcinoma – The Clinical Challenge

Low-grade serous carcinoma is one of the five major histological types of ovarian carcinoma associated with a specific biology. We reviewed three cases from our institution to demonstrate the variable clinical course and provide a brief review on this disease entity

Prevalence of postpartum depression using the edinburgh postpartum depression scale at The Aga Khan University Hospital, Nairobi

Background: Postpartum depression is an illness that affects 10-20% of mothers following delivery; the impact it has on the family, partner and the new born baby is significant. There are insufficient data in Kenya as its rate and severity hence the impact is unknown. Screening could allow earlier treatment of these mothers and prevent the long term effects on the family. Objectives: The primary objective was to identify the prevalence of postpartum depression at the Aga Khan University Hospital and to identify associations between participant’s socio demographics and depression. Methods: Cross sectional study to screen postpartum women six weeks after delivery using the Edinburgh Postpartum Depression Scale (EPDS). Participants were recruited using consecutive sampling from the postpartum clinics, six weeks after delivery at the Aga Khan University Hospital from October 2010 to May 2011. Analysis: Point estimate of the disorder using results from the screening tool and the identification of patient characteristics potentially associated with the disorder. Results: 195 participants were recruited, 181 were eligible for analysis in whom a prevalence of 13.8% (95% CI: 8.8 to 18.8) was estimated. Among the patient characteristics assessed for potential associations; the neonatal sex reached statistical significance with a P value of 0.014. Conclusion & recommendations: The prevalence of postpartum depression is 13.8% among women at the Aga Khan university Hospital postpartum clinic. We therefore recommend the introduction of regular screening to identify affected mothers to avert the adverse effects that may be associated with the condition

Significant frequency of MSH2/MSH6 abnormality in ovarian endometrioid carcinoma supports histotype-specific Lynch syndrome screening in ovarian carcinomas

Aims: Lynch syndrome screening in ovarian carcinoma is controversial. This study aims to assess the frequency of deficient mismatch repair protein (dMMR) in a retrospective cohort enriched for non-high-grade serous carcinomas and its association with outcome within histological types. Methods and Results: Tissue microarrays representing 612 ovarian carcinomas were tested for mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6) by immunohistochemistry. dMMR was detected in 13.8% of endometrioid and 2.4% of clear cell carcinomas but none in other histological types. Within endometrioid carcinomas, 11/25 dMMR cases showed abnormal MLH1/PMS2, 10 cases abnormal MSH2/MSH6 and 4 cases isolated abnormal MSH6 indicating that at least 7.7% of endometrioid carcinomas have dMMR probably related to Lynch syndrome. The four dMMR clear cell carcinomas showed abnormal MSH2/MSH6 in three and isolated abnormal MSH6 in one case all probably related to Lynch syndrome. Within endometrioid carcinomas dMMR was significantly associated with age under 50 years, synchronous endometrial endometrioid carcinoma, higher CA125 level at diagnosis, higher FIGO grade, absence of ARID1A and at least 20 CD8 positive intraepithelial lymphocytes per high power field but was not associated with cancer specific death. Age under 50, higher CA125 levels at diagnosis and at least 20 CD8 positive intraepithelial lymphocytes per high power field remained significant after adjusting for multiple testing but their sensitivity to identify dMMR remained insufficient. Conclusion: Our data support the motion for a histotype-specific Lynch syndrome screening in ovarian carcinoma confined to endometrioid and clear cell carcinomas. This article is protected by copyright. All rights reserved