Cryptomenorrhea due to imperforate hymen presenting with urinary retention

Cryptomenorrhea is a condition where menstruation occurs but is not visible due to obstruction of the outflow tract. One of the most common causes causing primary amenorrhoea and cryptomenorrhea include imperforate hymen. This condition usually presents in adolescent girls with cyclical abdominal pain and primary amenorrhoea. Though it usually presents as an isolated abnormality it may be associated with genetic conditions such as Mayer-Rokitansky-Kuster-Hauser syndrome. The diagnosis is usually confirmed on the basis of grayscale ultrasound however magnetic resonance imaging may be required to diagnose associated mullerian abnormalities. Once the diagnosis is confirmed the management is usually consist of virginity preserving hymenotomy. We here present case of an adolescent girl who presented with primary amenorrhea, abdominal pain and urinary retention. The clinical examination showed well developed secondary sexual characters (Tanner stage 4), distended abdomen and bulging introitus. Grayscale ultrasound and magnetic resonance imaging showed hematocolpos. Patient was planned for resection of hymen and a cruciate incision was given over the hymen and around 700 ml of collected blood was drained. Eversion and suturing of edges of incision was done to maintain patency of outflow tract. During follow up visit at 3 months patient was symptom free with regular menses.

Assessment of knowledge, attitudes and concerns to human papilloma virus vaccine among female nursing professionals in India

Background: To have a successful cervical cancer control programme in developing countries, nursing staff must be aware of the facts about the disease preventive methods and the prophylactic human papilloma virus (HPV) vaccine. The aims of the present study were to assess knowledge of, attitudes toward and concerns to HPV vaccine among female Sikkimese nursing staff in India.Methods: Between April 2012 and February 2013, a pre-designed, pretested, self administered multiple responses questionnaire survey was conducted among female Sikkimese nursing staff in India.Results: Overall, 77.4% nursing staff responded that they had ever heard of a HPV vaccine. Trainee nurses were significantly more aware of the vaccine than regular working nurses. Actual knowledge of the vaccine was poor. Recommended age of HPV vaccination was aware by only 38.7% and only 30% nurses knew number of doses of vaccine, while over 90% nursing staff were not aware of time schedule of the vaccine. According to summarized knowledge index only 13.5% nurses had actual knowledge of HPV vaccine. Sixty five percent nurses wanted to vaccinate themselves or to their daughters. Top three aspects of HPV vaccine that nursing staff were most concerned were effectiveness, effect duration and long term effects. Eighty four percent nurses wanted more education and training sessions about cervical cancer prevention and HPV vaccine.Conclusions: Nursing staff in India need to be updated urgently with continuing medical education about cervical cancer prevention and HPV vaccination.

Frequency and management of gestational diabetes mellitus according to the new diabetes in pregnancy study group of India guidelines among Sikkimese women attending tertiary teaching hospital of East Sikkim

Background: The screening of GDM is important as various pregnancy related complications are associated to it. With early screening and diagnosis, the complications associated with GDM can be reduced. Studies have shown various ethnic groups are at increasing risk of developing GDM with prevalence differing in different ethnicity. No data is available about frequency of GDM in different ethnic women of Sikkim. This study was performed to determine the frequency of GDM and its variation according to different demographic profiles of Sikkimese women.Methods: Pregnant women between 16-34 weeks of gestation, attending antenatal OPD were included for this study. All the patients were subjected to DIPSI recommended 75 gm oral glucose tolerance test. Diagnosis of impaired glucose tolerance was made when plasma glucose of ≥120-140 mg/dl and diagnosis of GDM was made when the plasma glucose of >140 mg/dl as per DIPSI guidelines.Results: A total of 202 consenting pregnant women during 16-34 weeks of pregnancy were evaluated with DIPSI recommended 75 g oral glucose tolerance test. Overall frequency of GDM was 11.9% among the Sikkimese women while 10.9% had impaired results in OGTT.Conclusions: Frequency of GDM was high (12%) in pregnant women attending tertiary hospital of Sikkim. This implies Sikkimese women should be universally screened for GDM. There was also high occurrence of GDM among Lepcha and Bhutia women which need further study to find out the contributing factors in these women.

Computed tomography features of benign adnexal mass lesions

Background: Adnexal masses originating from gynaecologic and nongynecologic sources may be benign or malignant. The objective of this study was to describe multi-detector computed tomography features of benign adnexal masses for diagnostic accuracy and disease understanding.Methods: Study retrospectively evaluates the multidetector computed tomography features of benign adnexal mass lesions, which were referred for MDCT examination with a primary diagnosis of adnexal masses on clinical or USG. Patients who underwent MDCT and subsequently underwent surgery and proved to benign adnexal mass lesion on histopathological examination were included in this study.Results: Forty five percent benign adnexal mass were in the age group of 36-50 years followed by 32.7% in the age group of 21-35 years. Common presenting symptoms of benign adnexal masses were pain abdomen or pelvic pain (65.5%) followed by mass abdomen (42%) while in one fourth of the patients it was asymptomatic and detected as incidental finding. Pathologic diagnosis of most common benign adnexal mass detected were serous cyst adenoma (54.5%), followed by mature cystic teratoma (18.2%), mucinous cyst adenoma (14.5%) and par ovarian cyst (9.1%). Benign ovarian mass had a characteristic CT appearance of cystic lesion (83.6%), unilocular (65.5%) with regular/well defined and thin wall (83.6%) with occasional septations (21.8%) and papillary projections (14.5%). Ascitis (5.5%) was an uncommon finding of a benign adnexal mass lesion. Computed tomography was most accurate to characterize mature cystic teratoma with a typical cystic lesion having fat deposition and calcifications.  Serous cyst adenoma had a CT appearance of thin walled cyst mass with no septations or solid component. Mucinous cyst adenoma ovary had a characteristic multilocular cystic lesion with different fluid attenuation and thin septations.  Endometrioma had a variable CT appearance with uni or multilocular cystic lesion and hyperdense lesion with focal calcifications.Conclusions: Multi detector computed tomography may provide accurate and valuable diagnostic information about benign nature of an adnexal mass lesion.

Assessment of quality of care provided at a tertiary hospital of Sikkim by patient's degree of responsiveness

Background: Quality of care is concerned with the interface between provider and patients, between health services and community. The aim of the current study was to evaluate the quality of provided health care and patient experiences at a tertiary hospital based on the concept of responsiveness.Methods: This was a cross-sectional survey among reproductive women of Central Referral Hospital over a period of 5 months from August 2016 to December 2016. A pre-designed, pretested, self-administered response questionnaire on rate of service utilization using the WHO health system responsiveness modulewas used.Results: A total of 450 women were approached and requested to participate during the study period of which 374 women completed the survey. According to the evaluation of in-patient care (Table 2), "able to change doctor if wanted" showed the lowest degree of responsiveness (52.7%). A significant proportion of patients experienced discrimination for different reasons: 9.6% reported feeling they had been treated worse than others because of lack of money, while a similar proportion reported they had been discriminated for the language they speak or because they were having insurance from a company.Conclusions: Health care access in terms of prolong waiting  time in the reception and before being attended by doctor, difficulty to change doctor when wanted and discriminatory experiences were identified as priority areas for actions to improve responsiveness and patient satisfaction.

Role of multi-detector computed tomography in the detection and differentiation of adnexal mass lesions

Background: The objective of this study was to evaluate the role of multi-detector computed tomography (MDCT) in the detection and differentiation of adnexal masses using post-operative histopathology findings as the gold standard.Methods: One hundred and forty five cases that were referred with a primary diagnosis of adnexal masses on clinical or USG examination were evaluated by MDCT in the Department of Radiodiagnosis from January 2013 to December 2013. One hundred twelve cases subsequently underwent surgical exploration and histopathological examination, which was used as a control for the evaluation of MDCT findings, were included in this study.Results: Majority (54.5%) of the patients were in the age group of 31-50 years. MDCT detected   adnexal masses as malignant in 56 cases, while in other 56 cases it read adnexal masses as benign. Final histopathology revealed adnexal masses in 57 (51%) cases as malignant while in 55 (49%) cases as benign. There were three cases which on MDCT appeared as malignant were subsequently found to be benign in histopathology. Similarly there were four cases which on MDCT appeared as benign were subsequently proved to malignant in histopathology. The sensitivity, specificity, Positive predictive value and negative predictive value of MDCT for diagnosing a malignant adnexal mass was 93.0%, 94.5%, 94.6% and 92.8% respectively. MDCT findings more predictive of malignancy were solid or cystic-solid mass, necrosis in a solid lesion, cystic lesion with thick, irregular walls or septa, and/or with papillary projections. The presence of ascites, peritoneal metastases, and lymphadenopathy were also helpful to confirm malignancy.Conclusions: MDCT is an excellent and accurate non-invasive modality in the detection and characterization of adnexal masses from benign and malignant

Correlates of Iron Deficiency in Women and Children in Rural Communities of Cambodia and Kenya.

Objectives: Over 2 Billion people globally are estimated to be anemic, primary due to iron deficiency anemia. The prevalence is exacerbated in rural populations, in countries with extreme resource deficiencies resulting in debilitating consequences of impaired health and productivity. In Kenya and Cambodia the national estimates are 69% and 63.4% for children under 5 years. The World Vision MCH strategy is a multifaceted targeted intervention to address major disease burden and under-nutrition including iron deficiency anemia. This study is a collaborative multi-stakeholder research engaging academic research institutions, NGO and Ministry of health to determine the impact of the interventions in Zambia, Cambodia, Kenya and Guatemala. Methods: The study was designed as a mixed methods research using a quasi-experimental design with comparison communities in World Vision's Area Development Programs in Cambodia and Kenya to explore the determinants of iron deficiency amongst the rural populations and assess coverage, capacity and quality of the delivery systems for the control of iron deficiency. Total samples of 1,180 mother and child pairs are included in baseline assessments in Cambodia while in Kenya 1582 women and 942 children are included. Results: Applying multi-level modeling, the results will document correlates of iron deficiency, and present a profile of capacity and quality of the services provided. Conclusions: The findings will provide valuable scientific evidence of multi-platform interventions addressing community oriented and health facility focused strategies to enhance service delivery and outcomes for addressing iron deficiency in rural communities with minimal access to care.

Cutaneous Leishmaniasis in an Immigrant Saudi Worker: A Case Report.

Cutaneous leishmaniasis (CL), an uncommon disorder in South-East Asia, including Bangladesh, often presents as granulomatous plaque on the exposed areas, with a high index of suspicion required for diagnosis. Here we report the first imported case of CL caused by Leishmania tropica in a migrant Bangladeshi worker in the Kingdom of Saudi Arabia (KSA). The case, initially suspected as a case of cutaneous tuberculosis, arrived at specimens reception unit (SRU) of diagnostic labs of icddr,b being referred by the physician for ALS testing for tuberculosis. At his arrival in the SRU, one of the health personnel of the unit who used to work in KSA suspected him as a case of CL. The diagnosis was confirmed by smear microscopy which revealed plenty of amastigotes within macrophages. PCR was performed to confirm the species. He was treated with sodium stibogluconate at Shahid Suhrawardy Medical College Hospital, Dhaka.

Hereditary Spherocytosis.

A 12-year old girl was brought to the Dhaka Hospital of ICDDR,B with diarrhoea. Incidentally, the parents provided a history of repeated episodes of pallor and jaundice since she was two and half years old. Three of her family members had similar problems. History, clinical examination, and laboratory findings of the girl and her family members suggested a case of hereditary spherocytosis. To our knowledge, this is the first report of such a case in Bangladesh.