ABSTRACT
Background: Hysterectomy is one of the commonest gynecological surgeries being performed in India for various pelvic pathologies like fibroid uterus, endometrial hyperplasia, dysfunctional uterine bleeding, etc. But pre-operative diagnosis of adenomyosis and making it an indication for hysterectomy is not as common as pathologists find it in histo-pathology of hysterectomized specimens. The aim of the study was to study the frequency of adenomyosis in comparison to leiomyoma as a uterine pathology in hysterectomized specimens and correlate them clinically.Methods: A retrospective comparative study was carried out on 1646 hysterectomy specimens, during January 2014 to December 2016, which showed either adenomyosis or leiomyoma or both. Clinical records of these cases were retrieved and histo-pathology was correlated to clinical presentations and pre-operative ultrasonography.Results: Of the 1646 specimens taken for comparision between adenomyosis and leiomyoma, 49% showed only adenomyosis, 37% only leiomyoma and 14% had dual pathology showing findings of both. The peri-menopausal age group (45-54 years) accounted for the maximum number of patients undergoing hysterectomy (37.12%). But adenomyosis was found maximum in 35 - 44 years age group (38.04%). The clinical presentations for these two pathologies were similar and maximum patients presented with abnormal uterine bleeding and pelvic pain. Ultrasonography was able to diagnose only 32% cases of adenomyosis pre-operatively whereas this figure was 87% for fibroids.Conclusions: Adenomyosis and leiomyoma both account for the most frequent findings in hysterectomy specimens. Fibroids are easily diagnosed pre-operatively, but adenomyosis needs to be diagnosed pre-operatively by high index of clinical suspicion and imaging techniques. Adenomyosis is not just a disease of middle age, it needs to be addressed for infertility, recurrent pregnancy loss (RPL), bad obstetric history, IVF failures and adherent placenta as well.
ABSTRACT
Background: Uric acid is the final product of the purine metabolism in humans. The two final reactions in its production which catalyze the conversion of hypoxanthine to xanthine and the latter to uric acid are catalyzed by the enzyme xanthine oxidoreductase. The role of uric acid in the progression of prediabetes to diabetes has been known. Serum uric acid has been shown to be associated with cardiovascular disease, hypertension, and chronic kidney disease. The present study was done to see the level of uric acid in preeclampsia and healthy pregnant controls, to relate serum uric acid results to the severity of hypertension and its relation to fetomaternal outcome in patients attending OPD at RMC Ajmer.Methods: 100 cases of preeclampsia of age group between 20-40 year and gestational age ≥28 weeks and 100 normal healthy women with similar gestational age and age group were included in the study and maternal serum uric acid was estimated in both groups.Results: Mean serum uric acid levels in preeclampsia was 7.65±081 mg/dl and 3.21±072 mg/dl in control group. Perinatal complication was more in case group, 74 % were preterm compared to 11% in control group. Mean birth weight in study group was 2.07 kg, of which 24% babies were VLBW 52% were LBW, and 24% babies had normal birth weight, in control group mean birth weight was 2.82 kg. The difference was found to be statistically significant (p value 0.001). In the study group, the MSUA concentration is found higher in LBW and VLBW babies compared to normal birth weight babies.Conclusions: There is a positive correlation between SUA & severity of preeclampsia, and a significant adverse fetal outcome is observed with raised MSUA in preeclamptic patients.
ABSTRACT
Background: Hypothyroidism and Hyperthyroidism leads to menstrual irregularities. Females with thyroid gland abnormality have chances of reproductive abnormalities ranging from abnormal sexual development, menstrual irregularities, infertility and premature menopause. The objectives were to study the association between thyroid dysfunction and AUB in the reproductive age group (18-45 years), To study the thyroid abnormalities in different types of AUB in the reproductive age group, to establish if screening for thyroid abnormalities is justified using T3, T4 and TSH.Methods: This cross-sectional study conducted among 250 women with ‘abnormal uterine bleeding’ (AUB). Inclusion criteria for participants were females in the age group of 18-45 years, females presenting with abnormal uterine bleeding, with thyroid dysfunction, females who do not have signs of demonstrable pelvic pathologyincluding PID.Results: Majority of the patients belonged to the age group of 24 - 32 years i.e.56.8%, 9.2% cases were nullipara, 44.0% cases have menorrhagia, 32.2% have oliogomennorrhea, 19.6% have amenorrhea. Around 3.6% had Thyromegaly, 12.4% have weight gain in hypothyroidism, 28.4% have fatigue in hyperthyroidism, 6.8% cases have higher T4 level, 18.0% cases have higher TSH level.Conclusions: The risk of progression to overt hypothyroidism (about 5% per year) in patients with subclinical disease and the cost-benefit ratio also emphasises the need for selective screening. Early detection of subclinical disease by selective screening facilitates appropriate therapy early in the course of the disease.