Rare cause of unexplained hypertension in an oligomenorrheic adolescent girl with adnexal mass: case report and review of literature

A 17-year-old girl with oligomenorrhoea was detected to have hypertension and right adnexal solid-cystic mass, 6×8 cm on ultrasound. Hormone profile was normal, CA-125 was 132.5 U/mL, other tumour markers were in normal range; though RMI-4 and ROMA index suggested malignancy. Patient underwent exploratory laparotomy, peritoneal wash cytology, right salpingo-oophorectomy, pelvic lymphadenectomy and omental biopsy. Intraoperative frozen-section revealed ovarian steroid cell tumour. Later, steroid cell tumour-not otherwise specified (SCT-NOS) was confirmed on histopathology and immunohistochemistry. When followed three months post-surgery, patient had resumed 30-32 days menstrual-cycle, and she was normotensive without medications. This case is being reported to emphasize that imaging though not recommended for evaluation of PCOS in adolescence; and measuring blood-pressure which is often skipped in young women; proved crucial in this patient

Expression of Dkk 1 in Endometrial Endometrioid Carcinoma & Its Correlation with Wnt / β-catenin Signaling Pathway

Objective: Endometrial cancer is the most common form of cancer affecting female reproductive organs. Most common histologic type endometrioid carcinoma constitutes 75 to 80% of all cases. Studies on Dkk1 expression profiles and its inhibitory role in Wnt signaling pathway in genesis and development of endometrial carcinoma are very few. This study aims to investigate Dkk1 expression in endometrial carcinoma and its correlation with Wnt/β-catenin pathway. Methods: A total of 160 formalin fixed paraffin embedded samples including 50 cases each of endometrial atypical hyperplasia and endometrioid endometrial carcinoma along with 30 cases each of proliferative and secretory endometrium were included in this study. We investigated expression pattern of Dkk1, E-cadherin, β-catenin and c-myc in endometrial atypical hyperplasia and carcinoma as well as compared with that of proliferative and secretory endometrium. Immunohistochemistry and analysis were performed from July, 2018 to June, 2020. Results: We showed decreasing pattern of immunopositivity for Dkk1, E-cadherin and β-catenin from proliferative/secretory endometrium to endometrial atypical hyperplasia and endometrioid carcinoma. Increasing c-myc immunopositivity was noted from proliferative/secretory endometrium to endometrial atypical hyperplasia and endometrioid carcinoma. Moreover, decreasing Dkk1 immunopositivity was well correlated with both E-cadherin, β-catenin and c-myc immunopositivity. Conclusion: Decreasing Dkk1 positivity from benign endometrium to endometrioid carcinoma suggests a negative regulatory function of Dkk1 in endometrioid carcinoma. Dkk1 is downregulated in Wnt signaling pathway in endometrioid endometrial carcinoma. Thus, Dkk1 can show promise as a biomarker for screening endometrioid carcinoma. Future researches can study the reactivation of the Dkk1 gene that could be a valuable strategy for antagonizing Wnt signaling pathway. Keywords: Endometrioid carcinoma, Dkk1, Wnt/β-catenin pathway, β-catenin, E-cadheri

Predictors of oocyte yield in controlled ovarian hyperstimulation IVF/ICSI cycles: a retrospective analysis in a tertiary care centre

Background: The most important predictor of oocyte yield in ART cycles is female age, but other biochemical and ultrasonographic markers done before controlled ovarian stimulation may predict the oocyte yield in women undergoing COS in IVF cycles.Methods: The main aim of the study was to evaluate ovarian reserve markers before COS which can help to individualise treatment protocols to achieve optimal response and minimise risk of complications. It is retrospective observational study, 1924 women undergoing COS in IVF/ICSI cycles in tertiary care centre in India, from January 2010 to June 2017 were included. Results: Univariate analysis showed that age, D2FSH, AMH, D2AFC and E2 on the day of trigger were significant predictors of oocyte yield (p7.82 IU/ml was predictor of poor response (sensitivity 78.13%, specificity 79.53%).Conclusions: A combination of predictors demonstrated superior ability of predicting oocyte yield after controlled ovarian stimulation than compared with any single endocrine marker. D2 FSH though thought to be obsolete, but we found significant predictive ability in terms of oocyte yield in the Indian population

Correlation of incontinence impact questionnaire score in overactive bladder syndrome cases with urodynamic findings

Background: Overactive bladder syndrome (OAB) is a common condition. The aim of the present study was to correlate the incontinence impact questionnaire (IIQ) score with urodynamic studies in patients of overactive bladder syndrome.Methods: It was a prospective study performed in a tertiary referral centre on 60 women with symptomatology of OAB. IIQ score was calculated and urodynamic studies were performed in all patients in which detrusor overactivity, maximum flow rate of urine per second (Qmax) and voiding time in seconds was calculated in all women.Results: The mean age was 42.3±9.91 years, mean body mass index was 24.7±2.71 kg/m2, mean parity was 2.4 and mean serum creatinine level was 0.84±0.21 mg/dl. Symptoms seen were urgency (100%), frequency (100%), urge incontinence (95.0%) and nocturia (76.6%). IIQ score ranged from 7-20 with mean being 12.27±3.38. OAB was mild in 36.6%, moderate in 41.66% and severe in 21.66% patients. On urodynamic studies, detrusor overactivity was present in 75% cases being 59% in mild, 80% in moderate and 76.92% in severe OAB. Mean Qmax increased with severity of OAB and was 29.55ml/second in mild OAB, 30.36ml/second in moderate OAB and 31.59 ml/second in severe OAB. Mean voiding time decreased with severity of OAB and was 33.44 seconds in mild OAB, 32.14 seconds in moderate OAB and 31.47 seconds in severe OAB.Conclusions: IIQ score and urodynamic studies are useful in diagnosis and quantification of OAB syndrome

Lifestyle intervention programme for Indian women with history of gestational diabetes mellitus.

Aim: To evaluate the feasibility and potential effectiveness of a lifestyle intervention (diet and physical activity) among women with history of gestational diabetes mellitus (GDM), delivered by trained facilitators. Methods: Fifty-six normoglycaemic or prediabetic women with prior GDM were recruited at mean of 17 months postpartum. Socio-demographic, medical and anthropometric data were collected. Six sessions on lifestyle modification were delivered in groups (total four groups, with 12-15 women in each group). Pre and post intervention (6 months) weight, body mass index (BMI), waist circumference, 75 g oral glucose tolerance test, blood pressure (BP) and lipid parameters were compared. Results: The intervention was feasible, with 80% of women attending four or more sessions. Post-intervention analyses showed a significant mean reduction of 1.8 kg in weight, 0.6 kg/m2 in BMI and 2 cm in waist circumference. There was also a significant drop of 0.3 mmol/L in fasting plasma glucose, 0.9 mmol/L in 2 h post glucose load value of plasma glucose, 3.6 mmHg in systolic BP, and 0.15 mmol/L in triglyceride levels. Changes in total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and diastolic BP were non-significant. Conclusions: This study showed feasibility of the lifestyle intervention delivered in group sessions to women with prior gestational diabetes

Lifestyle intervention programme for Indian women with history of gestational diabetes mellitus.

Aim: To evaluate the feasibility and potential effectiveness of a lifestyle intervention (diet and physical activity) among women with history of gestational diabetes mellitus (GDM), delivered by trained facilitators. Methods: Fifty-six normoglycaemic or prediabetic women with prior GDM were recruited at mean of 17 months postpartum. Socio-demographic, medical and anthropometric data were collected. Six sessions on lifestyle modification were delivered in groups (total four groups, with 12-15 women in each group). Pre and post intervention (6 months) weight, body mass index (BMI), waist circumference, 75 g oral glucose tolerance test, blood pressure (BP) and lipid parameters were compared. Results: The intervention was feasible, with 80% of women attending four or more sessions. Post-intervention analyses showed a significant mean reduction of 1.8 kg in weight, 0.6 kg/m2 in BMI and 2 cm in waist circumference. There was also a significant drop of 0.3 mmol/L in fasting plasma glucose, 0.9 mmol/L in 2 h post glucose load value of plasma glucose, 3.6 mmHg in systolic BP, and 0.15 mmol/L in triglyceride levels. Changes in total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and diastolic BP were non-significant. Conclusions: This study showed feasibility of the lifestyle intervention delivered in group sessions to women with prior gestational diabetes

FIGO staging for carcinoma of the vulva : 2021 revision

To revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic Oncology reviewed the recent literature to gain an insight into the impact of the 2009 vulvar cancer staging revision. The Committee resolved to revise the staging with a goal of simplification and actively collaborated with the United States National Cancer Database to analyze prospectively collected data on carcinoma of the vulva. Many tumor characteristics were collected for all stages of vulvar cancer treated between 2010 and 2017. Statistical analysis was performed with SAS software. Overall survival was estimated based on tumor characteristics. Log-rank and Wilcoxon tests were used to analyze overall survival similarities between and within groups of tumor characteristics. Characteristics with similar survivals were then grouped into the same stages and substages. Kaplan–Meier overall survival curves were generated for the resulting stages and substages. There were 12 063 cases with available data. The resulting new staging for carcinoma of the vulva has two substages in Stage I, no substage in Stage II, three substages in Stage III, and two substages in Stage IV. The Kaplan–Meier overall survival curves showed clear separation between stages and substages. The 2021 vulvar cancer staging is the first from the FIGO Committee for Gynecologic Oncology to be derived from data analyses. This revision has a new definition for depth of invasion, uses the same definition for lymph node metastases utilized in cervical cancer, and allows findings from cross-sectional imaging to be incorporated into vulvar cancer staging. The 2021 FIGO staging for carcinoma of the vulva is data-derived, validated, and much simpler than earlier revisions.The American College of Surgeons’ (ACoS) Commission on Cancer (CoC) and National Cancer Database (NCDB).http://www.wileyonlinelibrary.com/journal/ijgohj2022Obstetrics and Gynaecolog

Asia Oceania Guidelines for the Implementation of Programs for Cervical Cancer Prevention and Control

This paper aims to provide evidence-based recommendations for health professionals, to develop a comprehensive cervical cancer program for a clinic, a community, or a country. Ensuring access to healthcare is the responsibility of all societies, and the Asia Oceania Research Organisation in Genital Infections and Neoplasia (AOGIN) is committed to working collaboratively with governments and health professionals to facilitate prevention programs, to protect girls and women from cervical cancer, a disease that globally affects 500,000 and kills nearly 300,000 women annually, just over half of whom are in the Asia Oceania region. We share the vision that a comprehensive program of vaccination, screening, and treatment should be made accessible to all girls and women in the world. The primary purpose of these guidelines is to provide information on scientific evidence on the different modalities and approaches of cervical cancer prevention programs, for high resource and low resource settings. The secondary purpose is to provide an overview of the current situation of cervical cancer control and prevention in various Asian Oceania countries: their views of an ideal program, identified obstacles, and suggestions to overcome them are discussed

Asia Oceania Guidelines for the Implementation of Programs for Cervical Cancer Prevention and Control

This paper aims to provide evidence-based recommendations for health professionals, to develop a comprehensive cervical cancer program for a clinic, a community, or a country. Ensuring access to healthcare is the responsibility of all societies, and the Asia Oceania Research Organisation in Genital Infections and Neoplasia (AOGIN) is committed to working collaboratively with governments and health professionals to facilitate prevention programs, to protect girls and women from cervical cancer, a disease that globally affects 500,000 and kills nearly 300,000 women annually, just over half of whom are in the Asia Oceania region. We share the vision that a comprehensive program of vaccination, screening, and treatment should be made accessible to all girls and women in the world. The primary purpose of these guidelines is to provide information on scientific evidence on the different modalities and approaches of cervical cancer prevention programs, for high resource and low resource settings. The secondary purpose is to provide an overview of the current situation of cervical cancer control and prevention in various Asian Oceania countries: their views of an ideal program, identified obstacles, and suggestions to overcome them are discussed