Laparoscopy in the diagnosis of tuberculosis in chronic pelvic pain

Background: To estimate the prevalence of genital tuberculosis in women with idiopathic chronic pelvic pain on laparoscopy, correlate laparoscopic findings with microbiological and histological diagnosis of tuberculosis and assess the response to anti tubercular treatment [ATT] in these cases

Method: In a prospective cohort study, fifty women with idiopathic chronic pelvic pain were enrolled. Diagnostic laparoscopy was done in all women and fluid from pouch of Douglas and/or saline washings were sent for acid fast bacilli [AFB] smear, conventional and rapid culture and DNA polymerase chain reaction [PCR] analysis for diagnosis of genital TB. The results of these tests were analyzed and agreement with laparoscopy was assessed using Kappa statistics. Pain scores using visual analogue scale were compared before and after treatment

Results: Pelvic pathology was present in 44 [88%] women of idiopathic chronic pelvic pain, with a 34% prevalence rate of genital tuberculosis. Pelvic inflammation was associated with positive peritoneal fluid PCR [n = 4] and AFB culture [n = 3]. Acid fast bacilli PCR had substantial agreement [kappa statistics = 0.716] with visual findings at laparoscopy. There was a significant reduction in pain scores after treatment

Conclusion: Genital tuberculosis contributes to one-third cases of chronic pelvic pain. Pelvic inflammation is an early feature of genital TB and peritoneal fluid PCR has the best co-relation with laparoscopic findings of genital tuberculosis

Genital tuberculosis: Unusual presentations

Genital tract tuberculosis is usually secondary to extragenital tuberculosis

The upper genital tract is usually involved; involvement of cervix and vulva is very uncommon

We present two such rare cases of vulval and cervical tuberculosis diagnosed on histopathology and treated with antitubercular chemotherapy

Postpartum peripheral symmetrical gangrene: a case report

Symmetrical peripheral gangrene is usually associated with under-lying medical problems and it is seldom seen in pregnancy. Sepsis though common in a setting of delivery by unskilled midwife is rarely accompanied by symmetrical gangrene. Case Presentation: We report a case of symmetrical peripheral gangrene which occurred in the winter, triggered possibly by sepsis and a single dose of ergot. A high index of suspicion, early diagnosis and intervention with appropriate measures will result in favorable outcome in such cases. Although postpartum period is of high risk for sepsis and use of ergot alkaloids is common in labor but occurrence of peripheral symmetrical gangrene is rare. A high index of suspicion for the diagnosis and timely intervention will prevent irreparable damage and loss of limb

Effect of Hormone Replacement Therapy on Memory in Post Menopausal Women.

To study the differential effects of estrogen and progestin on memory in postmenopausal women receiving hormone replacement therapy (HRT). Methods: Thirty women between ages 45 and 60 years who had attained natural menopause and received combined estrogen progestin therapy constituted group I. While group II included 30 surgically menopausal women who received only estrogen, PGI memory scale having a battery of ten subtests devised specially for Indian subjects was used. Results were analyzed by repetitive measure analysis. Results: Women showed an improved score on memory scale after 6 months of HRT in both the groups. The comparison of both groups post therapy revealed improvement in scores of delayed recall & visual retention in group II indicating that only estrogen users benefited more. Conclusion: This study supports the view that estrogens with or without progestin if given early after menopause i.e. below 60 yrs if age do have a beneficial role on memory.