ABSTRACT
Elephantiasis, the result of chronic lymphedema, is characterized by gross enlargement of the limbs or genitalia. It occurs because of obstructive diseases of the lymphatic system. Genital elephantiasis is a common result of filariasis. Other causes are lymphogranuloma venereum. granuloma inguinale, carcinomas, lymph node dissection, irradiation and tuberculosis. Filarial elephantiasis of the female genitalia is extremely uncommon, about 1-2% of the total cases of filarial elephantiasis. Mrs. X, 25 years old female, P1L1, resident of a village in Bihar presented to gynaecology OPD of ABVIMS and Dr. RML Hospital on 06th January 2020 with complaint of huge progressively increasing vulval swelling since 3 years. Patient had come from Bihar for treatment. She had been showing in her native place for 2 years but now the lump had made her walking difficult. She did not give history of any drug given for treatment for filariasis. She gave history of being treated for pulmonary Koch 10 years back. On examination, there was a non- ulcerative, polypoidal growth of around 20×14×11 cm arising from bilateral labia majora and minora obstructing the vulval cleft. There was no associated lymphadenopathy or limb oedema. All the investigations were within normal limits. Microfilaria antigen testing done at night was negative. Patient was given diethylcarbamazine and excision of the lump was done on 14th February 2020. Histopathological report showed dilated lymphatics with non-caseating granulomas, consistent with filariasis. In endemic countries like India, filariasis is the commonest cause of elephantiasis; however genital filariasis in woman is very rare. Other cause could be tuberculosis which is still rarer. Early diagnosis and treatment of filariasis can eradicate this neglected tropical disease which causes disfigurement and severe morbidity as its sequelae.
ABSTRACT
Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.
ABSTRACT
Background: Obesity has become a new worldwide health problem and is gradually moving towards an epidemic. overweight and obesity implies an abnormal excessive fat accumulation that poses health risk. According to National Family Health Survey-4, prevalence of obesity has doubled in country over the last decade. Asian Indians stand at higher risk for development of obesity related non-communicable diseases at lower body mass index levels.Methods: It was an observational interpretive study carried on 1000 randomly selected women over 3 months in a tertiary center of urban northern India. BMI was obtained by dividing weight in kilograms and height in meters squares. Patients were enquired about any menstrual complains, known comorbidities, awareness of obesity in terms of its cause and effects, about weight reduction and benefits of exercise and its practice and details noted in a preformed performa. No prior intervention or health education was given to avoid bias.Results: Out of 1000 women, mean BMI was found to be 31.85±8.85kg/m2. BMI classification (Asian standards) stated that 8.1% were overweight and 78% of patients were pre obese and obese (maximum in age of 21-40 years). Menstrual complaints were present among 39% of overweight and obese groups. Among comorbidities, hypothyroidism was found to be maximum being 9.5% in the obese group, followed by hypertension and diabetes mellitus. Only 26.3% of obese women were aware of the factors causing obesity. Knowledge of exercise benefits was grossly limited, with only one fourth of the pre obese and obese population being aware of it.Conclusions: Rising obesity in Indian women needs measures for prevention. Though there is knowledge of the cure among Indian females but there is limited ability to implement the same. Health education of women regarding obesity related comorbidities along with the benefits of weight loss with exercises should be promoted strongly.