EPIGENETICS, SOCIAL DETERMINANTS AND TRANSFORMATION – NATURE AND NURTURE

There is emerging scientic research and evidence which visibly demonstrates that internal body environmental inuences can not only impact genes but also how they are expressed. Scientists have discovered that early experiences can determine how genes are turned on and off and even whether some are expressed at all. Epigenetics is the study of how behaviours and environment can cause changes that affect the way the genes work. Unlike genetic changes, epigenetic changes are reversible and do not change the DNA sequence, but they can change how our body reads a DNA sequence. There is strong inuence of the epigenetics on social life. The ancient Indian systems of Ayurveda and Yoga indeed have strong bases for the same. It would be appropriate to further explore the same through inter disciplinary research

Study of tear function before and after laser-assisted in-situ keratomileusis

Purpose: This work assesses the change in tear function after LASIK surgery. Methods: This prospective, observational study was conducted in the Refractive Clinic of a tertiary care rural hospital. Tear dysfunction symptoms and the tear function tests were assessed in 269 eyes of 134 patients, OSDI score was used to document the tear dysfunction symptoms. Tear function was assessed by tear meniscus height, tear film break?up time (TBUT), Lissamine green staining, corneal fluorescein staining, Schirmer test 1 without anesthesia before and at 4–6 weeks and 10–12 weeks after LASIK surgery. Results: Preoperatively OSDI score was 8.54 ± 7.71. It increased to 15.11 ± 9.18 postoperatively at 4–6 weeks after LASIK surgery and 13 ± 9.56 at 10–12 weeks after LASIK surgery Mean TBUT preoperatively was 7.82 ± 3.57 sec which decreased to 5.34 ± 2.56 sec at 4–6 weeks and to 4.53 ± 2.63 sec at 10–12 weeks postoperatively. The number of eyes with clear secretion decreased from 40.5% preoperatively to 23.4% at 4–6 weeks and to 22.3% at 10–12 weeks postoperatively, whereas the granular and cloudy secretions increased significantly in eyes after LASIK surgery. The prevalence of eyes with Lissamine green score >3 (dry eye) increased from 17.1% preoperatively to 27.9% at 4–6 weeks and to 30.5% at 10–12 weeks. Similarly, the number of eyes showing positive fluorescein corneal staining increased from 5.6% preoperatively to 19% postoperatively at 4–6 weeks. Mean Schirmer score was 28.83 ± 6.39 mm preoperatively, 22.47 ± 5.38 mm at 4–6 weeks, and 21.27 ± 4.99 mm at 10–12 weeks after LASIK surgery. Conclusion: The prevalence of dry eye increased after LASIK as was assessed by an increase in the tear dysfunction symptoms using OSDI score and the deranged values of various tear function tests after LASIK surgery

Solution-focused approach towards improved access to assistive mobility technology and devices in low and middle-income countries: A narrative review

BACKGROUND@#The article focuses on the main challenges for low and middle-income countries (LMICs) and approaches that need to be implemented to achieve assistive mobility devices for all. World Health Organization (WHO) estimates that about one billion (15%) of the world’s population lives with some form of disability, with projections for the same to double by 2050, a significant proportion (approx.840 million) of them residing in low- and middle-income countries. As per WHO, it is estimated that only 5-15% of the people requiring assistive technology have access to it. In low and middle-income countries, the rate of accessibility is expected to be worse due to the high cost of the products, diminished awareness, lack of trained personnel, inadequate availability, and ineffective policy implementation due to lack of funds. The current developments in assistive mobility technologies and devices available at a high cost for consumers in high-income countries have neglected the requirement of persons with disabilities in low and middle-income countries. The improved rehabilitation methods of assistive mobility devices may deliver economic and health benefits to individuals and lessen the financial burden on governments in the future. Therefore, multidisciplinary research is greatly needed to measure and prove the effectiveness of rehabilitation treatment methods and to develop an evidence-based sustainable treatment, particularly in LMICs. Also, a detailed service model assessment can identify the lack of current service provision. The online databases were searched to find relevant articles for the purpose.

Comparison of prevention of parent-to-child HIV transmission programme & national biennial HIV sentinel surveillance data for tracking HIV epidemic in India

Background & objectives: HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking. Methods: Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The sociodemographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics. Results: The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001). Interpretation & conclusions: High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT.

Noncardiogenic Pulmonary Edema As Sequel Of Venous Air Embolism In A Case Of Operative Hysteroscopy - A Case Report.

Hysteroscopy is minimally invasive procedure performed widely for diagnosis and treatment of intrauterine and endocervical pathologies.Venous air embolism, though rare complication, is catastrophic if encountered.We report one such case of venous air embolism leading to non-cardiogenic pulmonary edema encountered by us during hysteroscopic uterine septum resection done for infertility under general anaesthesia. Quick identification, preventing further gas entry and timely intervention saved our patient.

Comparison of Clinical, Biochemical, and Sonological Parameters in Adolescents with and without Polycystic Ovarian Syndrome

Objectives?The Pediatric Endocrine Society consensus criteria was developed in 2015 to diagnose adolescent PCOS. There are no Indian studies that use these criteria for diagnosis and then compare the clinical characteristics with those of normal controls. The objective of this study was to compare the clinical and biochemical profile in adolescents with and without PCOS and to study the ovarian morphology in adolescents with and without PCOS. Materials and Methods?We conducted a prospective case–control study on 60 adolescents who attended the outpatient department/adolescent immunization clinic. Group A included 30 adolescent girls with PCOS diagnosed as per the consensus criteria and Group B included 30 adolescents without PCOS. All participants were clinically evaluated and called empty stomach in the follicular phase for metabolic (Serum TSH, prolactin, FSH, LH, and testosterone) and endocrinal workup (2-hour OGTT, lipid profile) followed by ultrasonic examination. Results?In group A, 40% were overweight and 36.7% were obese and in group B, 20% were overweight and 20% were obese. There were no significant differences noted in gonadotropin levels in two groups. Mean testosterone levels were higher in PCO adolescents. The mean ovarian volume and ovarian follicle number were significantly higher in adolescents with PCOS. We found that if ultrasound criteria were added to the diagnosis, there would be about 7% lesser PCOS diagnosis. Conclusion?PCOS alters the fat distribution and lipid distribution in the body. These are features that lead to long-term metabolic alterations and life-threatening diseases. All PCOS adolescents thus be screened for these abnormalities and advised lifestyle modifications to keep these parameters under control

Diagnosis and Management of Acquired Aplastic Anemia: Consensus Statement of Indian Academy of Pediatrics

Justification: In India, there is a lack of uniformity of treatment strategies for aplastic anemia (AA), and many children are managed only with supportive care due to non-availability of hematopoietic stem cell transplantation (HSCT). Process: Eminent national faculty members were invited to participate in the process of forming a consensus statement in Hyderabad in July, 2016. Draft guidelines were circulated to all members, and comments received in a online meeting in October, 2020 were incorporated into the final draft. These were approved by all experts. Objective: To facilitate appropriate management of children with acquired aplastic anemia. Recommendations: Key recommendations are: i) A bone marrow biopsy is must to make a diagnosis of AA; ii) Rule out inherited bone marrow failure syndromes (IBMFS), connective tissue disorders, viral infections, paroxysmal nocturnal hemoglobinuria (PNH), drug or heavy metal induced marrow suppression in all cases of AA; iii) Conservative approach to transfusions should be followed, with a target to keep hemoglobin >6 g/dL in children with no co-morbidities; iv) HLA-matched sibling donor HSCT is the preferred choice of treatment for newly diagnosed very severe/ severe AA; v) In absence of HLA-matched family donor, a matched unrelated donor (MUD) transplant or immunosuppressive therapy (IST) should be considered as alternate choice based on physician expertise; vi) Fludarabine, cyclophosphamide and anti-thymocyte globulin (ATG) based conditioning with cyclosporine and methotrexate as graft versus host disease (GvHD) prophylaxis is the preferred regimen; vii) Horse ATG and cyclosporine are the recommended drugs for IST. One should wait for 3-6 months for the response assessment and consideration of next line therapy.

Evaluation of Different Pre-treatment Behaviour Modification Techniques in 4–7-year Olds: A Randomised Controlled Trial

Purpose: The aim of this study is to evaluate and compare the effectiveness of five pre?treatment behaviour modification techniques in 4–7?year olds in reducing dental anxiety by evaluating pulse rate, partial pressure of oxygen, systolic blood pressure, diastolic blood pressure, salivary flow rate, salivary pH, and through modified facial anxiety scale. Material and Methods: Using simple random sampling technique (drawing of lots), 125 children were equally distributed into 5 groups of 25 each: Group 1: tell?show?do (control); Group 2: tell?show?play?doh; Group 3: Playmobil Dentist; Group 4: mobile dentist games; Group 5: role play as dentist. Samples in each group were treated in a single appointment after using the behaviour modification techniques. Class I or Class II cavities were prepared on carious primary molar and restored using glass ionomer cement. Patient’s anxiety level was assessed by recording blood pressure, pulse rate, oxygen saturation, salivary pH, salivary flow rate, and facial anxiety scale at different time intervals, that is before the treatment, during the treatment, and after the treatment. Results: All the intervention Groups (Groups 2–5) showed reduced anxiety scores in both physiological and facial anxiety compared to the control group, that is tell, show do. The modified distraction techniques aid in better modification. Conclusion: Tell?show?play?doh, Playmobil dentist games, mobile dentist games and role play as dentist are effective distraction techniques as compared to conventional tell?show?do techniques which can be incorporated in day?to?day clinical practice to reduce dental anxiety in paediatric patients

Wild mushroom poisoning in Kumaon region of Uttarakhand: a case series

Mushrooms have been dietary source in hilly and ethnic tribes of India. More than 5000 mushroom species are known worldwide and nearly 100 species are known to be poisonous for humans. Mushroom poisoning occurs due to unintentional and accidental ingestionof poisonous mushroom due to misidentification of poisonous variety as edible one. There has been increasingly incidence of reporting of mushroom poisoning cases nowadays. Here we are reporting case series of 4 patients admitted hailing from same village with accidental ingestion of poisonous mushrooms with clinical-laboratory profile and outcome at our institution. Mushroom Poisoning is an emerging healthcare concern nowadays. Education and mass awareness for identification of poisonous mushrooms is an important preventive measure. Early hospitalization, proper hydration, gastric decontamination, silibinin and N-acetyl cysteine therapy with hepato-renal support constitutes mainstay of treatment. Delay in treatment and complications results in poor prognosis and mortality.

Binocular summation in comitant exotropia: Change after surgery

Purpose: To assess the change in binocular summation (BiS) in comitant exotropia (XT) after strabismus surgery. Methods: This is a prospective study on 20 patients who underwent surgery for comitant XT over a one year period. Patients with sensory exotropia and nystagmus were excluded. Best?corrected visual acuity (VA) and contrast sensitivity (CS) of both eyes separately and together (binocularly) were recorded. BiS score was calculated as binocular score minus better eye score. BiS score at the end of 3 months was compared with the preoperative data. Results: The mean ± SD of BiS score increased from 2.95 ± 0.88 to 4.55 ± 0.68 (P?value < 0.0001) for VA (on ETDRS letters) and from 2.75 ± 0.44 to 4.5 ± 0.76 (P?value < 0.001 for CS (on Pelli–Robson chart) after surgery. Conclusion: There is significant improvement in BiS in XT after strabismus surgery. Authors recommend its inclusion in evaluation of functional outcome of XT surgery

Improvement in awareness levels and periodontal health among patients undergoing fixed orthodontic appliance therapy with established gingivitis and periodontal health maintenance program: a questionnaire based study / Mejora de los niveles de conciencia y salud periodontal entre pacientes sometidos a terapia con aparatos de ortodoncia fijos con gingivitis establecida y programa de mantenimiento de la salud periodontal: un estudio basado en cuestionarios

Objetive: Home oral care practices in patients undergoing orthodontic therapy are often ineffective in maintaining optimal plaque control. The aim of the present study was to assess the effectiveness of periodontal maintenance program in subjects with established gingivitis undergoing fixed orthodontic appliance therapy for one year. Material and Methods: Forty patients undergoing fixed orthodontic appliance therapy with established chronic gingivitis were recruited for the study. As a part of a periodontal maintenance program, a pre-validated structured questionnaire evaluating oral hygiene and periodontal health was administered at the baseline as well as at the end of the study. At the baseline Gingival Bleeding Index, Gingival Index, and Bonded Bracket Plaque Index scores were recorded, Scaling and polishing procedure was performed followed by a customised Oral Hygiene Advice (OHA) session was conducted for all the study subjects. Clinical indices were assessed and OHA was conducted at the 3rd, 6th, 9th, and 12th months of orthodontic treatment visits. Results: There was significant improvement in the clinical indices and awareness regarding oral hygiene and periodontal health level in the patients at the end of the 12th month. Conclusion: The periodontal maintenance program appeared to be effective in improving the periodontal health and awareness health awareness level about oral hygiene among patients undergoing fixed orthodontic therapy at the end of 12 months in our study population.

Objetivo: Las prácticas de cuidado bucal en el hogar en pacientes sometidos a terapia de ortodoncia suelen ser ineficaces para mantener un control óptimo de la placa. El objetivo del presente estudio fue evaluar la efectividad del programa de mantenimiento periodontal en sujetos con gingivitis establecida sometidos a terapia con aparatos de ortodoncia fijos durante un año. Material y Métodos: Se reclutó para el estudio a 40 pacientes sometidos a terapia con aparatos de ortodoncia fijos y con gingivitis crónica establecida. Como parte de un programa de mantenimiento periodontal, se administró un cuestionario estructurado pre-validado que evaluaba la higiene bucal y la salud periodontal al inicio y al final del estudio. En la línea de base, se registraron las puntuaciones del índice de sangrado gingival, el índice gingival y el índice de placa de soporte adherido, se realizó el procedimiento de raspado y pulido seguido de una sesión personalizada de consejos de higiene oral (CHO) para todos los sujetos del estudio. Se evaluaron los índices clínicos y se llevó a cabo la CHO a los 3, 6, 9 y 12 meses durante las visitas de tratamiento de ortodoncia. Resultados: Hubo una mejora significativa en los índices clínicos y la conciencia sobre la higiene oral y el nivel de salud periodontal en los pacientes al final del 12º mes. Conclusión: El programa de mantenimiento periodontal pareció ser eficaz para mejorar la salud periodontal y el nivel de conciencia de la salud sobre la higiene bucal entre los pacientes sometidos a terapia de ortodoncia fija al final de los 12 meses en nuestra población de estudio.

Workplace Violence against Healthcare Professionals - A Cross-Sectional Study to Assess the Current Scenario in Chennai City, India

Workplace violence against health workers is offensive and harms the psychological and physical well-being of health-care staff. It affects their job motivation leading to compromise in the quality of care provided. The present study was conducted to assess the prevalence and potential risk factors associated with workplace violence against medical and dental healthcare professionals in Chennai city. MethodsA descriptive cross-sectional survey was done among 440 healthcare professionals from medical and dental settings. A specially designed validated questionnaire consisted of 15 questions divided into 3 sections was used to collect the demographic details, experience and factors associated with workplace violence. ResultsThe overall prevalence of workplace violence in the current study was 38 %, with male participants reporting a higher prevalence than females. 51.4 % of the respondents believe that the lack of proper communication and negligence of the doctor also plays a crucial role in violence against them. More than half of the participants (61.4 %) recommended doctors to carry weapons for self-defence against violence and these values rise to 71 % among individuals with more than 10 years of clinical experience. Around 70.5 % believed that media publicity plays a crucial role in the increasing trend of violence against healthcare professionals. ConclusionsWorkplace violence against doctors in Chennai is frequent although in most of the situations it is psychological. Healthcare staff should be trained to identify, manage and prevent violent situations adequately. A nationwide law for the prevention of violence against healthcare professionals and institutions should be developed.

A Study of the Impact of the COVID-19 Pandemic on Anxiety Levels of Young Adults in India.

Since the end of December 2019, when a cluster of pneumonia cases due to a novel coronavirus was reported from China, coronavirus disease (COVID-19) has rapidly gained pandemic proportions, leaving death and extensive lifestyle changes in its wake. This, along with economic standstill and social isolation has led to anxiety, especially among the susceptible young adult population. We conducted a survey to assess the prevalence of anxiety among the young adult population in India. MethodsA questionnaire consisting of 74 questions was floated via Survey Monkey among the Indian community using the chain-referral sampling method, targeting young adults between the ages of 18 and 34 years. The level of anxiety was assessed using the Generalized Anxiety Disorder (GAD-7) scale. Responses were tabulated and analysed using IBM SPSS Data Editor. ResultsA total of 618 respondents completed the survey. There were 352 (57%) males, and 442 (72%) were living in an urban setting. Nearly 66% (405) hailed from Uttar Pradesh and Delhi. There were 190 students (31%), and 123 healthcare workers (20%) among others. 281 (46%) of these 618 young adults had some level of anxiety as per the GAD-7 scale, but only 120 (19.4%) had clinically significant anxiety (GAD-7 scores ≥ 5). 247 respondents (41%) said that television and newspaper reports added to their anxiety. Further, females were significantly more anxious than males (25.6% vs 14.8%; p 0.001). The prevalence of anxiety was also significantly different in urban and rural setting (21.7% vs 13.4%; p 0.02), in patients with presence of comorbidities versus healthy people (33.8% versus 17.5%; p 0.004) and in income loss versus stable income source (24.4% vs 14.8%; p 0.04). All these factors remained as independent predictors of anxiety after regression analysis. Interestingly, 78% of the young adults were eventually able to adjust to the lifestyle changes. ConclusionsThis survey confirms that young adults have impressionable minds and are prone to anxiety, which was prevalent in 46%. Female sex, urban setting, comorbidities, income loss and media reports were independent predictors of anxiety among the young adult Indian population.

Obstetric outcome in twin pregnancies complicated with single intrauterine fetal demise

Background: It has been reported that single intrauterine fetal death in twin pregnancy occurs in 3.7-6.8% all twin pregnancies. The objective of this study was to evaluate the maternal and fetal demographic features and feto-maternal outcomes in twin pregnancies complicated with single intrauterine fetal demise and evaluation of available management guidelines.Methods: This retrospective study was conducted at obstetrics and gynecology department of SGRRIM and HS, Dehradun, Uttarakhand between January 2015 and December 2019. There was a total of 182 twin deliveries at study hospital during this period and 35 of these cases were complicated with single intrauterine fetal demise. Maternal age, parity, chorionicity of twin gestation, gestational age at single intrauterine fetal demise, gestational age at delivery, mode of delivery, birth weight, Apgar Score at birth, neonatal intensive care unit stay of newborn,  maternal fibrinogen levels during pregnancy and delivery time and associated obstetric complications were analyzed in these cases of single intrauterine fetal demise with twin gestation. All monochorionic twin pregnancies were included in the study Group A and dichorionic twin in Group B.Results: The mean age of 32 patients included in study was 29.7±4.6 years. Twenty (62.5%) of these patients were dichorionic and 12 (37.5%) of these were monochorionic twin gestation. Single intrauterine fetal demise occurred in first trimester in 8 (25%) patients, during the second trimester 20 (62.5%) and 4 (12.5%) patients had third trimester single intrauterine fetal demise. Preterm deliveries occurred in 18 (56.3%) of patients and 8 (44.4%) of patients were of monochorionic and 10 (55.6%) of dichorionic twin patients. Among thirty-two patients, 11 (34.4%) patients had caesarean delivery and 21 (65.6%) patient had vaginal birth. No maternal or fetal mortality noted and none of the patients had maternal coagulation disorder.Conclusions: This study indicates that in cases of twin pregnancies with single fetal intrauterine demise with individualized management plan at higher centre and close maternal and fetal surveillance live fetus can be saved without any maternal risk.

To Determine the Effect of Sleep on Anxiety, Depression and Its Correlation with Academic Performance in First M.B.B.S Students

Introduction:Sleep deprivation causes serious health hazards. Anxiety and depression are common correlates found. There had been direct correlation with sleep quality and academic performances. Objectives:To determine the effect of sleep on the mental health i.e. anxiety and depression amongthe firstyear medical students and also to see the effect of sleep, anxiety and depression on academic performance Methods:A cross sectional study was conducted atMedical college, Questionnaire was asked regarding the time to fall asleep and duration of sleep.Hamilton’s anxiety scale and Hamilton’s depression scale was applied to the study group. Results: Mild anxiety (83%) is common than the depression (20%) in study group which may be the result of academic stress. Thestudy also demonstrate severity of anxiety and depression goes hand in hand. The result also shows,depression and anxiety have indirect relationships with the duration of sleep that is as sleep hours decreases the anxiety, and depression score increases. The anxiety and the depression score werehigher in the students who’stiming to sleep was after midnight, but the difference was not statistically significant as compared to the students who’stiming to sleep was before midnight. The study finding related to sleep and the academic score was not significant. Conclusion: Bed time may not affect the mental health but the duration of sleep is important to reduce the level of anxiety and depression. Duration of sleep may not affect the academic performance, but sound and adequate sleep is important for the mental health which may ultimately affect the academic performance

T cell/histiocyte rich large B cell lymphoma of ascending colon: a rare entity

Colonic T cell/histiocyte rich large B cell lymphoma (THRLBCL) is a very unusual occurrence never described before. A 41-year anaemic male presented with loss of weight and appetite for 7 months and fever with Malena for 1 month. Abdominal examination revealed a 4×6 cm retroperitoneal lump in the right iliac fossa. Radiological investigations (USG and CECT whole abdomen) reported an asymmetrical ill-defined growth in ascending colon and caecum with loco-regional lymphadenopathy. Surgical exploration revealed an ascending colon mass with retroperitoneal lymphadenopathy. Right hemi-colectomy with end ileostomy was done and specimen was sent for histopathology which diagnosed it to be a case of THRLBCL of colon. Patient was followed up after 2 weeks and was planned for chemotherapy.

Prevalence of Hypertension in Children 10-18 Years of Age in Private Schools of Delhi and Their Associated Risk Factors.

Prevalence of non-communicable diseases were considered to be rare in children. But they have increased recently in developing countries, with increase in the prevalence of paediatric overweight and obesity. Body Mass Index (BMI) is commonly used to define overweight and obesity. Positive associations have been repeatedly reported between BMI and Hypertension.METHODSWe have conducted an observational cross sectional study of hypertension in 1250 students in the age group of 10-18 years studying in class 6 to 12 during school hours from July 2013 to June 2014. The values were recorded in multiples of 2 mmHg and levels greater than 95th percentile of age and gender were considered using the definition of the fourth report of NHBPEP. The association of risk factors were also evaluated.RESULTSOut of a total 1250 children, 239 (19.1%) had systolic hypertension, and 216 (17.3%) has diastolic hypertension. Prevalence of overweight and obesity were 11.8% and 7.5% respectively. Highly significant statistical association was found between body mass index (BMI) and both systolic and diastolic hypertension (p value 0.001).CONCLUSIONSPrevalence of both systolic and diastolic hypertensions were significantly high in overweight and obese children in comparison to normal weight children. Strong positive association was found between body mass index (BMI) and both systolic and diastolic hypertension. Association of other risk factors such as sex, family history, dietary habits like junk food intake and extra salt intake, were also observed

The inevitable and incidental caesarian myomectomy

The management of fibroid encountered during caesarean remains controversial. The traditional approach has always been, not to perform myomectomy, because of the fear of haemorrhage due to increased vascularity and uterine atonicity of pregnant uterus and increased morbidity. Caesarean section was performed in 27-year G2P1 in view of previous LSCS, short inter-conception period, frank leaking and poor bishop score. After delivery of baby a fibroid of 6 cm by 5 cm was seen jutting out of left side of incision line. Myomectomy was performed, without any complication, as it was not possible to approximate the incision line without that. No excessive hemorrhage or postoperative complications were encountered.

Diagnostic accuracy of ultrasonography with laparoscopy for assessment of benign adnexal masses

Background: Adnexal masses are one of the most common pathologies among women of all age groups. Objective of this study was to assess efficacy of ultrasonography in diagnosing adnexal pathology, rule out malignancy and its comparison with laparoscopy and pathology results.Methods: A total 32 women with benign adnexal mass were evaluated by clinical examination, ultrasonography and laparoscopy. Findings of ultrasound were compared with laparoscopy and histopathology reports and diagnostic accuracy was calculated.Results: Sensitivity of USG in diagnosing simple ovarian cyst is 20% and specificity is 88.9% while laparoscopy has sensitivity of 100% and specificity of 94.4%. USG versus laparoscopy has sensitivity of 50% versus 100% and specificity of 94.1% versus 100% in diagnosing endometrioma. Sensitivity of USG in diagnosing dermoid cyst is 66.7% and specificity is 95% while laparoscopy has both sensitivity and specificity of 100%. USG and laparoscopy, both have 100% sensitivity and specificity in diagnosing ectopic pregnancy, para-ovarian cyst and TO abscess. Benign serous cystadenoma is a histopathological diagnosis and is missed by both laparoscopy and ultrasonography.Conclusions: Ultrasonography should be the primary imaging modality used to identify and characterize adnexal masses, as it is readily available, and noninvasive.