Endosalpingiosis with concurrent endometriosis of ovary masquerading as ovarian malignancy

Endosalpingiosis is a rare gynecological disorder of müllerian origin, characterized by the presence of tubal epithelium outside the fallopian tube, which involves structures of the female genital tract, peritoneum, and sub-peritoneal tissues. Endosalpingiosis can be associated with endometriosis or endocervicosis, although it often appears alone. Authors report a case of endosalpingiosis with concurrent endometriosis in a 42-year-old P2L1 patient. The patient presented to us with complaints of heaviness in lower abdomen, a feeling a lump in the lower abdomen and low-grade fever for 15 days. On per abdominal examination, a large solid cystic mass up to 20 weeks size was felt, which was more on the left side. Cervix was normal on speculum examination, the same mass was felt on per vaginal examination, separate from the uterus, the right fornix appeared free. Patient was asked to get a set of investigations done and to review as early as possible. An exploratory laparotomy with peritoneal wash cytology, total abdominal hysterectomy, bilateral salpingo-ophorectomy with supracolic and infracolic omentectomy and bilateral pelvic lymph nodes dissection was done on 18/07/18. Per operatively, there was a large cystic mass occupying the abdominal cavity adhered to the bowel and to posterior wall of the uterus, adhesiolysis followed by staging laparotomy was done.Patient’s postoperative course was uneventful and she was discharged on the 5th day of surgery in stable condition. The final histopathology report was suggestive of endosalpingiosis with concurrent endometriosis

Successful vaginal delivery in a woman with longitudinal vaginal septum: a case report

Anomalies of vagina may present with primary amenorrhea, dysmenorrhea, infertility, dyspareunia or can be detected as an incidental finding on physical examination or imaging study for another indication. We present a case report of a 21-year-old pregnant woman who was diagnosed with longitudinal vaginal septum on vaginal examination during her antenatal visit at term. At 38 weeks 2 days period of gestation, patient presented with labour pain. Resection of the longitudinal vaginal septum was performed during the second stage of labour which facilitated vaginal delivery. Both mother and baby were discharged from hospital in good health

Use of oxidized regenerated cellulose (Surgicel Nu-Knit) as a hemostat in laparoscopic endometriotic cystectomy: a case report

Ovary is one of the common sites for occurrence of endometriosis. Endometriosis contributes to a major cause of infertility in young women. Apart from infertility, endometriosis is one of the important causes of severe secondary dysmenorrhea and chronic pelvic pain. Endometriotic cystectomy is often required in endometriotic cysts more than 3 cm in size.  A 33 year old patient married for 4 years with primary infertility was diagnosed to have an endometriotic cyst of the ovary measuring 4x3 centimeters. Patient underwent laparoscopic endometriotic cystectomy under general anesthesia. Intraoperatively, the right ovary was enlarged and was adherent to the posterior surface of uterus and the uterosacral ligament of the same side. Adhesiolysis was done followed by removal of the ovarian endometriotic cyst. Post cystectomy oozing was controlled by application of Oxidized regenerated cellulose (Surgicel Nu-Knit) on the bleeding points. Postoperative course of the patient was uneventful and she was discharged after 7 hours in stable condition

From Traditional to 360-Degree Feedback in Performance Evaluation of Bhutan

Performance evaluation of tutor is important at universities and colleges. At College of Science and Technology, Royal University of Bhutan, all tutors receive feedbacks of performances from the students of which they are teaching and the feedback results are too vague to serve the purpose of performance evaluation. 360-degree feedback concept is useful for performance evaluation in which the tutor is evaluated from different points of view (subordinate, students, peer, supervisor and beneficiary). Thus, to identify the clear evaluation, it is important to build web-based 360-degree feedback system in performance evaluation. In this paper, we introduce web-based application titled “Feedback Analytic System” in the college to realize 360-degree feedback concept. It also presents the current working of traditional feedback system in Bhutan and problem associated with it, methodology, design and the implementation. The proposed system was created using Laravel 5.3 framework, PHP 7.0.1, SQL (Structure Query Language), Bootstrap, CSS (Cascading Stylesheet) and JQuery

Vaginal Rhabdomyosarcoma in a patient with advanced cervical cancer; a case report and review of literature

Rhabdomyosarcoma is very rare in adults accounting for less than 5% of all soft tissue tumours and less than 1% of all malignancies. Vagina is one of the least common sites for occurrence of Rhabdomyosarcoma in the genital tract. We present a case of a 53-year-old woman who is a follow up case of cervical cancer stage IIIB, managed by radiotherapy and chemotherapy. She was doing well till 5 years of her treatment for cervical cancer when she presented with complaints of pain lower abdomen and discharge per vaginum for 10 days. On examination she was found to have an abdominal mass of 18 weeks size and on local examination there was 4X4 cm fixed mass on lower third of vagina arising from left side. MRI abdomen and pelvis was done. Biopsy from the vaginal mass showed features of Rhabdomyosarcoma. Further follow up of the patient was not possible due to lockdown in view of the pandemic. She was last contacted telephonically on 25th March 2020; she said she was waiting for the lockdown to be lifted so that her further management can take place. This is just one patient; there are many more with other medical conditions all over the world who are losing their lives because of not being able to access medical care due to the present pandemic. New growth in the region of local recurrence in a known malignancy cannot necessarily be the recurrence of the primary tumour. It is important to keep our mind open to other differentials apart from the recurrence of primary malignancy, sometimes it can turn out to be a very rare tumour as we encountered in our case

Total laparoscopic hysterectomy in patients with previous caesarean section: experience at a tertiary care center in India

Background: With a surge in the rate of caesarean deliveries, the number of patients undergoing hysterectomy with a previous caesarean section for gynecological complaints has also increased. The presence of intra-abdominal and bladder adhesions to the uterus is the main concern in such cases, resulting in higher complication rates. This study aimed to determine the challenges and complications encountered during TLH in patients with previous caesarean sections. Methods: We conducted a retrospective study analysing data from the medical records of 243 patients who had undergone TLH for various gynecological conditions in a single tertiary care center from January 2018 to January 2021. Patients were categorized into two groups namely no previous CS (n=193) and previous CS (n=50). The surgical outcomes of those patients including major complications were measured. Results: The clinical characteristics of the two groups were comparable except for the patient’s age with younger patients in the previous CS group (p=0.001). There was no difference in terms of surgical indications, intraoperative and postoperative complications, and hospital stay between the groups. Operating time was significantly more in the previous CS group (p=0.001). One patient sustained a bladder injury in a previous CS group. The conversion rates to laparotomy in the previous CS and no CS groups were not statistically significant. Significant hemorrhage requiring blood transfusion was noted in two patients (4%) in the previous CS group and one (0.51%) patient in the no CS group (p=0.108). Conclusions: TLH can be safely performed with lower complication rates by an experienced surgeon in patients with prior history of caesarean section

Reaching the one billion mark: accomplishing the success story of COVID vaccination through public interrogation

Background: The COVID vaccination drive in India has recently crossed the one billion mark which is certainly a tremendous feat. Although women were initially hesitant, public propaganda and behaviour change communications encouraged them to come forward. The aim of the study was to assess the vaccination status of female population of the country through interrogation in obstetrics and gynaecology out patient departments (OBG OPD).Methods: Through this cross-sectional study, all women visiting OBG OPD were asked about type and number of vaccine doses received, dates of administration of first and second doses and whether they had any significant side effects following immunization.Results: A total of 1456 women were recruited in the study. Mean age of participants was 33.24±4.65 years. 36.26% participants were pregnant. 89.97% women had received at least one dose of vaccine and 48.76% participants were fully vaccinated. Majority received Covishield vaccine. Majority of the participants received first shot during the months of July, August and September. No women suffered from any adverse effect following immunization. Most women got motivated for vaccination from television (76.91%) and alert messages in mobile phones (61.59%). The results of our study reflects the success story of vaccination campaign as almost 90% of the participants had received at least one dose of vaccine.Conclusions: The proactive participation and untiring efforts of the frontline workers has been instrumental in achieving this remarkable landmark. India's successful vaccination campaign is a lesson to the world at large

Yoga and stress profile for women undergoing infertility treatment: review

Infertility is a silent struggle rising rapidly. Women undergoing treatment for infertility experience tremendous stress not only emotionally but socially also. It has been hypothesized that stress can hamper fertility and studies indicate an effective role of yoga in reducing stress. Hence, the review aims to assess if yoga has an effect on stress levels in infertile women thus improving the clinical outcome. Present review was registered on Prospero prospectively (CRD42022336237). A review was carried out to summarize the interventions assessing role of Yoga in reducing stress among women undergoing infertility treatment. Literature search was performed using a pre-defined search strategy on PubMed, Embase, and CTRI along with a manual search of references during the last decade. A total of 2959 articles via database searching and 202 via manual and citation searching were screened. Only two studies were found relevant meeting the inclusion criteria. Three studies with a similar intervention were retrieved but had different study designs and outcomes. All studies supported the recommendation of yoga as a complementary intervention. The review concluded yoga may have the potential in reducing stress thus improving clinical outcomes and suggests Ayush to conceive and plan large scale RCTs on this area to see the effect on clinical outcome

Incidental gonadoblastoma in swyer syndrome: a case report with brief review of literature

Swyer syndrome is a disorder of sexual differentiation with an incidence of 1 in 80,000 population. Dysgenetic gonads have a propensity for malignant transformation particularly in the presence of Y chromosome and hence need prophylactic removal. We report a case of an adolescent girl who presented with primary amenorrhea who was identified as a case of 46 XY dysgenesis after karyotype studies. Extirpation of gonads were done laparoscopically and on histopathological assessment gonadoblastoma was detected. This case report aims to reiterate the importance of gonadectomy in patients with swyer syndrome as tumors could arise even in the absence of frank adnexal masses

Uterine inversion during caesarean section: a case report

The present report aim to sensitise the obstetrician regarding risk of uterine inversion in a scarred uterus and the importance of immediate manual replacement. Represented case is of 40 years gravida five with previous one spontaneous abortion and previous history of three ectopic pregnancies with history of open left salpingectomy for ruptured left tubal ectopic pregnancy and history of laparoscopic right tubal clipping and uterine rupture repair for cornual pregnancy underwent an emergency caesarean section at 34 weeks. Since there were no signs of placental separation, controlled cord traction of placenta was attempted and uterine inversion was noticed. Manual replacement of uterus was done followed by manual removal of the adherent placenta. There was no postpartum haemorrhage. Inversion of uterus during caesarean section is a rare obstetric complication. If unrecognized it could lead to serious morbidity due to haemorrhage and shock. Prompt diagnosis and repositioning of the uterus are important measures in management