Role of levonorgestrel releasing intrauterine device in management of heavy menstrual bleeding: A safe and effective option for all PALM COEIN variants

Introduction: Heavy menstrual bleeding (HMB) is defined as prolonged (>7 days) or excessive menstrual blood loss greater than or equal to 80 ml per menstrual cycle. Levonorgestrel-releasing intrauterine device (LNG-IUS) has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists and decreasing the need for operative gynecological surgery. Aim: To study the efficacy of levonorgestrel intrauterine system (LNG-IUS) in conservative management of abnormal uterine bleeding (AUB). Materials and Methods: Fifty women between 40 and 50 years with AUB were included in a study conducted over a period of 2 years. Response was assessed monthly for first 6 months and then bi annually for total 2 years. Results: LNG IUS caused 80% decrease in median menstrual blood loss (MBL) at 6 months, 95% decrease in MBL by 1 year, and 100% decrease (amenorrhea) by 2 years. Mean hemoglobin (Hb) % showed a significant rise of 10.0% from baseline 6 months post insertion. LNG IUS is as an effective alternative in women with AUB of varied etiology. Hysterectomy could be avoided in most of the women. Conclusion: LNG IUS provides an incredible nonsurgical alternative in treatment of menorrhagia

Assessment of cardiovascular hemodynamics in gestational hypertension and preeclampsia.

Preeclampsia is a multisystem disease complicating 5-10% of pregnancies and remains in the top three causes of maternal morbidity and mortality globally. During pregnancy mean arterial pressure and vascular resistance decrease, while blood volume and basal metabolic rate increase resulting in increased cardiac output In hypertensive disorders of pregnancy there is currently no consensus on the systolic and diastolic parameters of cardiac function and the literature is conflicting regarding whether there is increased, decreased or any change in cardiac output. Women with a history of preeclampsia/eclampsia have approximately double the risk of early cardiac, cerebrovascular, and peripheral arterial disease, and cardiovascular mortality. This study was undertaken to evaluate cardiovascular hemodynamic alterations in hypertensive disorders of pregnancy in comparison with appropriately age, parity and gestational age matched control normotensive pregnancies. In women with preeclampsia cardiac work index and left ventricular mass index are increased as a result of increased workload on heart to maintain cardiac output against increased after load. Systolic function is well preserved. Diastolic function is reduced and those with global diastolic function are at increased risk of developing pulmonary edema. Advanced techniques like speckle tracking echocardiography can better identify those with compromised cardiovascular function.

Deeply infiltrating endometriosis in an young woman - A case report.

Endometriosis is one of the most important causes of chronic pelvic pain in both adolescent and adult woman. Deeply infiltrated endometriosis is tough case with poor response to medical treatment and associated with complication of visceral damage after surgical treatment. Retroperitoneal fibrosis subsequent to deeply infiltrating endometriosis lesion may encase the ureter and can present as obstructive uropathy. In such cases it is necessary and the only option to free the ureter or else the function of the affected kidney compromises. Such expensive surgeries require skill and competence with a team work in the urological surgeries. Such rare case of gross pelvic endometriosis with left obstructive uropathy was successfully managed and treated by our team.

Extensive pelvic hydatid disease mimicking ovarian malignant tumour.

Hydatid disease is one of the commonest parasitic infections of the liver, endemic in many countries. Rupture into the peritoneal cavity leading to secondary echinococcosis is a difficult problem to manage. A case of 37 year old female patient presenting with disseminated intra-abdominal hydatid disease mimicking malignant multilocular cystic tumor of the ovary involving the mesentery of the small intestine, omentum and spleen is presented along with a brief review of literature.

Patterns of epithelial cell abnormalities in Pap smears and its clinicopathological and demographic association: a descriptive study from Visakhapatnam city, Andhra Pradesh, India.

Background: Cervical cancer is one of the leading cancers amongst women. Periodic pap screening is the simplest way to diagnose precancerous lesions. Factors such as ignorance, poverty poorly developed public healthcare delivery system put women in urban slums at a disadvantage for receiving any health screening activity. Objectives of the present study were to know the prevalence of epithelial cell abnormalities of the cervix among the subjects and to study the association with clinical and demographic characteristics. Methods: A camp based descriptive study was conducted in an urban ward. All women above the age of 20 years were included in the study. Data was recorded using a pretested questionnaire. Study variables included socio-demographic characteristics, symptoms of reproductive tract infection, findings of clinical examination, and Pap smear collection and evaluation. The latter was done from 194 women aged between 20-69 years. Pap smears were made by conventional Pap smear technique and reported according to The Revised Bethesda System of classification 2001(TBS). Results: Among the 194 women, in 8 subjects, the smears collected were unsatisfactory for evaluation. Analysis was done in the remaining 186 subjects. Among the latter, in 83.9%, the smears were negative for intraepithelial lesions (NIEL) and 16.1% revealed epithelial cell abnormalities (ECA). Among those with ECA, Atypical cells of undetermined significance (ASCUS) was identified in 66.67%, Low grade squamous intraepithelial lesions(LSIL) in 16.67%, Atypical squamous cells-cannot exclude HSIL (ASC-H) and Atypical glandular cells-not otherwise specified (AGC-NOS) in 6.67% each and High grade squamous intraepithelial lesions (HSIL) in 3.33%. Epithelial cell abnormalities were more common in women in the age group of 30-60 years (80%), they were more common in those with age at marriage between 13-18 years (63.3%) and in those with age at first child birth between 15-19 years (56.7%). Conclusions: Therefore there is a need for Pap screening at regular intervals through camp based approach in these populations to motivate the women, increase their awareness, ensure follow up and referral and timely intervention in appropriate cases.