Prevalence of Genital Tuberculosis in Infertile Women; a Study from a Tertiary Care Center in North India

Introduction: Female genitourinary tuberculosis (FGTB) is an important cause of infertility in women of reproductive age group. The disease remains undetected due to its asymptomatic nature and lack of sensitive tests. This study was conducted with the aim of detecting the prevalence of genital tuberculosis in infertile women. Material and methods: Endometrial curetting of 193 infertile women suspected of genital tuberculosis were taken laparoscopically and sent for histopathological examination, ZN staining, culture on LJ media and GeneXpert testing. Results: Out of 193 women, 13 were positive for Mycobacterium tuberculosis making the overall prevalence of FGTB in infertile women to the extent of 6.73%. Of these 11 presented with primary infertility while 2 patients presented with secondary infertility. The histopathological examination of all the samples was non-specific. No case of positive acid fast bacilli on ZN staining was observed. Comparison of culture and GeneXpert revealed that Xpert assay was more sensitive in detecting the positive cases. Conclusion: Our study concluded that FGTB is common in our population and women presenting with infertility should be evaluated for genital tuberculosis. A high degree of suspicion and combination of histopathological and microbiological tests are important methods for the detection of genital tuberculosis

Lower Respiratory Tract Infections in Intensive Care Units. A Four Year Study from North India.

Title: Lower respiratory tract infections in intensive care units. A four year study from North India. Study Design: Prospective study Place and Duration of Study: Sher-i-Kashmir Institute of Medical Sciences, Srinagar Kashmir. Four years (July 2010 and June 2014). Methodology: A prospective analysis of respiratory specimens from various intensive care units (ICUs) was done over a period of four years. Antimicrobial susceptibility of culture positive isolates to various antibiotics was performed as per Clinical Laboratory Standards Institute (CLSI) guidelines. Gram-negative bacteria (GNB) were screened for extended spectrum β-lactamase (ESBL) and metallo-β-lactamase (MBL) production; whereas methicillin and vancomycin resistance was searched in staphylococci and enterococci isolates respectively. Results: The frequencies of Gram-positive and Gram-negative bacteria were 26% and 68% respectively with yeast recovered in 8% of the specimens. K. pneumoniae and Acinetobacter spp were the most common Gram-negative bacteria and S. aureus the most common Gram-positive one. High level resistance to all the antimicrobials was seen; with K. pneumoniae being the most multidrug resistant GNB isolated in the ICU setting. ESBL production was also highest in K. pneumoniae isolates (67.1%). Also 59.6% of Acinetobacter isolates were found to be MBL producers. Methicillin resistance was seen in 48% of S. aureus and 85.5% of coagulase negative staphylococci (CoNS) isolates with vancomycin resistance seen in 6.7% of enterococcal isolates. Conclusion: An increasing trend over the years in the antibiotic resistance of respiratory pathogens in ICUs of this north Indian state was seen that calls for urgent measures to limit their continued rise.

To asses the knowledge of women in regards to antenatal care

To evaluate the awareness of women associated to antenatal care at Asian Institute of Medical Sciences Hyderabad. Observational study. This study was conducted at Gynae/Obs Outpatient Department of Asian Institute of Medical Sciences Hyderabad and LUMHS Hyderabad from 1[st] January 2014 to June 30[th], 2014. Total 150 women were selected in the study. All the awareness regarding antenatal care of the women was documented on Performa. Total 150 women were selected in the study, mostly cases 53.3% were more than 31 years of the age. Majority of the women 64.4% were uneducated. 69% chose doctors as primary provider for antenatal care, 11% nurses, 19% trained birth attendants. 52% women wished to receive care at home while 47% said at hospital. 70% responded yes to understanding what antenatal care was while 30% had no awareness. 89% of women responded yes it is necessary to have antenatal care while 11% responded that no it is not necessary. Awareness regarding antenatal is very rare in the women. Women seek antenatal care only when they are symptomatic and not as a preventive or screening measure. The time of pregnancy is a necessary time period during which the promotion of healthy behaviours is imperative. Participation of the family members and the community can perform a very important role for healthy women during pregnancy

Complications of instrumental vaginal delivery in perimiparus patients and foetomaternal outcome

To find out complications and foetomaternal outcome in the instrumental [forceps and vacuum] vaginal delivery of the primiparus patients. Observational study. This study was conducted at Gynecological Department of Liaquat University Hospital Hyderabad and Gynecological Department of Isra University Hospital Hyderabad from August 2012 to April 2013. This study contained total 100 number of cases All the perimigravid womens were included in the study and after the admission all require able laboratory investigation were carried out. Forceps and vacuum were used in delivery and this choice between two options [forceps and vacuum] is usually been based on training and traditions. All the instrumental complications and affects on foetomarnal in parimiparus patients were noted during and after delivery and were documented on the attached Performa. Present study was contains 100 of the cases, forceps was applied on the 68% of the cases while vacuum assisted deliveries were done in 32% cases. In the forceps assisted deliveries from the maternal complications perineal tear and vaginal trauma were most common as 27% and 20% respectively, while maternal complications associated to vacuum were UTI, Perineal tear, Cervical tear, Vaginal trauma and Heavy bleeding were with percentage as, 06.0%, 06.0%, 05.0%, 04.0% and 12.0% respectively. Neonatal trauma and cephalic hematoma were most common and no deaths were recorded and in the vacuum assisted deliveries, and no deaths were recorded along with 12% neonatal trauma and 10% cephalic hematomas in forceps deliveries. In the conclusion of this study vacuum having less complication as compare to forceps deliveries but there is no highly difference so the operator should use the instrument according to situation

Can we reduce maternal mortality?

The objective of this study is to find out the maternal mortality rate in our setup and found the preventable causes of maternal mortality rate. Descriptive study. In obstetric ward of Liaquat university hospital Hyderabad from 10th Feb 2011 to 10th Jan 2014. All the women who were died due to pregnancy complications were included in the study while women who were not died due to pregnancy complications and maternal deaths due to accidental or incidental causes during pregnancy were excluded from the study. Details of patient's history especially age, parity, socioeconomic condition, reason of death, antenatal status, and distance from hospital were recorded on predesigned proforma. Total 48563 deliveries were conducted during the study period. Out of these, 103 women died, so the maternal mortality rate was 212.09/ 100,000 live birth. Majority of women i.e. 43[41.74%] died; belong from age group of 31-40 years. Majority of women i.e. 78[75.72%] belonged to poor socioeconomic group and 83[80.58%] women had not received antenatal care. Most common cause of maternal mortality in this study was hypertensive disorder which was seen in 43[41.74%] followed by APH in 39[37.86%] and PPH seen in 6[5.82%] patients .The most common cause of delay in seeking health care facility was lack of transport reported by 43[41.74%] patients and familial taboos reported by 36[34.95%] patients. Most important cause of maternal mortality in our study was hypertensive disorders, APH and PPH. Maternal mortality was highest in advancing age, increased parity and in unbooked patients

Pap smear, an important screening tool to detect precancerous stage of carcinoma of cervix

Many women can be saved from carcinoma of cervix by detecting and treating its precancerous stage. Pap smear is cheap and easily available in majority of institutes. The objective of this study is to determine the frequency of abnormal Pap smear and role of Pap smear in detecting precancerous stage of cancer cervix in women. This is retrospective descriptive study was conducted in gynaecology outpatient department of Isra University Hospital, Hyderabad, Sind from Nov 2006 to Oct 2009. All women who presented in OPD with gynaecological complaints were included in the study. Pregnant women were excluded from the study. Smear was collected with an Aryes spatula and relevant information was obtained from the patient's record and recorded on pre-designed Performa. Slides were then sent to pathology department. Data were analysed through SPSS-15 and presented as frequency and percentage. Total 981 women underwent Pap smear screening. Majority [63.3%] of the patients belonged to age group of 31-40 years. One hundred and eighty [18.34%] smears were normal and 792 [80.7%] were abnormal. Among these abnormal smears, 739 [75.33%] smears were inflammatory while 4 [0.40%] women had Ca in situ and 4 [0.40%] had squamous cell carcinoma. Pap smear is an important screening tool to detect precancerous stage of carcinoma of cervix. It should be done periodically in all married and high risk women for early detection of a precancerous stage

Attitudes towards menstruation among young women

To determine knowledge and different attitudes towards menstruation among young women. A descriptive study was carried out at Isra University Hyderabad and villages around the Isra University Hospital, from 1st April 2005 to 31st March 2006. Five hundred women from villages around Isra University Hospital and students of Isra University Hyderabad were selected by non-probability sampling who were of menstruating age irrespective of their marital and literacy status. Women with menstrual irregularities or any other gynecological or psychological problem were excluded. All information was recorded on a questionnaire Performa and analyzed on SPSS version 15.0. Out of 500 participants, 438 [87.6%] regarded menstruation as a natural process; whereas, 62 [12.4%] perceived it as a disease and curse from God. Out of 500, 415 [83%] of the participants responded that the menstruation process is good for health; however, 85 [17%] felt this process not healthy for themselves. Ignorance, false perceptions and unsafe practices regarding menstruation are not uncommon among young women, hence the importance of health education particularly of women living in rural areas. Then they will be better prepared emotionally to experience menstruation and will have less negative reactions

Perinatal outcome in diabetic mothers at Isra university hospital

To evaluate perinatal outcome in diabetic mothers in our tertiary care set up. A descriptive study. Out patients department and labour ward of Obstetrics and Gynaecology Unit, Isra University Hospital Hyderabad, Sindh- Pakistan, from 3[rd] January 2007 to 2[nd] January 2008. Total 110 pregnant women between the age of 20 and 40 years with diabetes, irrespective of their parity and previous obstetric history were selected by convenience [non-probability] sampling. Women with eclampsia, antepartum haemorrhage, pregnancy induced hypertension and medical disorders were excluded from the study. All information was recorded on preformed proforma and analysed through SPSS version 11.0. Among perinatal complications, macrosomia was seen in 41.8% of fetuses, biochemical abnormalities in 85.3% infants, moderate to severe birth asphyxia in 33.6% and congenital malformations in 6 infants of diabetic mothers. Perinatal complications of diabetic pregnancy are more common in high parity women. Macrosomia, biochemical abnormalities and asphyxia are the common perinatal complications in our set up

Silent uterine rupture at 24 weeks in twin gestation

Scar dehiscence is a preventable condition. If recognized earlier, the lives of the woman and child may be saved. We present a case of twin pregnancy with a previous lower segment caesarean section. The uterus ruptured at 24 weeks of gestation without uterine contraction