Myomectomy for uterine preservation and fertility

Background: Leiomyomas are benign monoclonal smooth muscle tumors that are characterized by cellular mutations, growth factor dysfunction, and abnormalities in the extracellular matrix. The objective of this study was to analyse the patient selection, feasibility, complications and the outcomes of myomectomies done for uterine preservation and fertility.Methods: Out of 606 myomectomies performed over 23 years at a tertiary care endoscopy centre, retrospective analysis of 358 cases of laparoscopic myomectomy (LM) and 96 cases of abdominal myomectomy (AM) was done.Results: Myomectomies were done for symptomatic women who wanted to preserve their uterus either to improve fertility or pregnancy outcome. Sizes of myomas tackled by myomectomy ranged from 1 cm to 20 cms. The largest number removed by laparoscopy was 19. 9 out of 358 cases scheduled for LM were converted to AM. 6 patients had repeat myomectomy of myomas. About 0.44% had STUMP and 0.44% had leiomyosarcoma on HPE. Only 10/199 or 5% of patients who wanted to preserve their uterus had subsequent hysterectomies. 95% were satisfied with good symptom relief. 40.1% in LM and 37% in AM group conceived.Conclusions: Majority of the cases were successfully done by laparoscopy. With increasing experience more cases with bigger and multiple myomas could be tackled by laparoscopy. 10.3% in LM and 45.9% in AM were 10 cms-20 cms. The main method of retrieval was morcellation. There were no major complications. Both the methods were found to be safe, feasible and provided good result. With increasing experience bigger and multiple myomas could be tacked by LM, which has several advantages over AM.

Effect of Foliar Nutrition on Water Potential, Photosynthetic Rate, Dry Matter Production and Yield of Mung Bean Under Receding Soil Moisture Condition.

A field experiment was conducted during Rabi season of 2012-13 at Regional Agricultural Research Station, Lam, Guntur, with an aim to find out the effect of foliar nutrition on water potential, photosynthetic rate, dry matter production and yield of mung bean under receding soil moisture conditions in split plot design with irrigation and no irrigation as main treatments and foliar sprays as sub treatments. Under receding soil moisture condition (moisture stress) KNO3 @ 1% proved superior over other foliar sprays by recording more plant height, leaf area, shoot dry weight, and photosynthetic rate by maintaining high chlorophyll content, high proline and high leaf water potential. KNO3 @ 1% gave higher yields under receding soil moisture condition compared to other foliar sprays. Under irrigated conditions urea @ 2% recorded higher yield. Among all treatments controlled (no spray) under unirrigated conditions recorded lower yields due to moisture stress and nutrient deficiency.

The Social Construction of Identity in HIV/AIDS Home-based Care Volunteers in Rural KwaZulu-Natal; South Africa

Home-based care volunteer (HBCV) identity and how it is shaped was the main focus of the study. Fifteen HBCVs were interviewed about their work and personal life stories and then interviewed reflectively using a narrative interviewing style. Specific attention was paid to contextual meta-narratives and social field narratives in understanding the women's stories. Findings indicate that social field narratives of the women's stories were dominated by negative aspects of gender; poverty and socio-political factors. These were seen to coincide with the 'feminisation of responsibility' in this context effectively coercing the women into agency which manifested as their home-based care work. Meta-narratives influencing the women's lives were dominated by stories of communal motherhood; aspirations to service-oriented work and religious beliefs and commitment. The question of how it is possible for women who are seemingly constrained by oppressive narratives to voluntarily engage in community participation was answered in the women's personal life stories about being compassionate; hopeful; helpful and ambitious and having initiative. These characteristics collectively pointed to personal agency. Exploring connections between the different aspects of identity and context revealed that the women made sense of their community participation through their personal identities as strong and loving mothers. Connections between volunteer personal identity; agency and volunteer group identity were explored to make sense of the link between HBCV identity and volunteerism. The mother identity; encompassing personal agency (strength or power) and love (the meta-narrative of communal motherly love); was salient in influencing community participation of the group

Doctor and law.

After the Consumer Protection Act, 1986, came into effect, a number of patients have filed cases against doctors. This article presents a summary of legal decisions related to medial negligence: what constitutes negligence in civil and criminal law, and what is required prove it. Public awareness of medical negligence in India is growing. Hospital managements are increasingly facing complaints regarding the facilities, standards of professional competence, and the appropriateness of their therapeutic and diagnostic methods. After the Consumer Protection Act, 1986, has come into force some patients have filed legal cases against doctors, have established that the doctors were negligent in their medical service, and have claimed and received compensation. As a result, a number of legal decisions have been made on what constitutes negligence and what is required to prove it.

Study of crime against women: Role of forensic medicine.

Due to rise in crowds naturally there is fall in cultural values and escalation in crimes. Crime against women is on the rise especially sexual crimes. Though crime is prevalent in every country and society, most of them either goes undetected or unreported. As per National Crime Records Bureau (NCRB), New Delhi, a crime take place every 17 seconds, among them one dowry death every 77 minutes, one crime against women every 3 minutes and finally one rape or sexual assault every 27 minutes. With above crime scenario, Forensic Medicine plays an important role in helping to prevent, early detection, providing expert medicolegal and scientific reports at earliest, which will result in quick trial and instant administration of justice to victims. Due to lack of legal or medicolegal and scientific awareness and knowledge among victims, investigating agencies, medical and paramedical staff, the end result is either ‘justice hurried is justice buried’ or ‘justice delayed is justice denied’ to the victim. There is need to give importance to Forensic Nursing, impart medicolegal knowledge to paramedical and health workers in rural and semi-urban levels as to how to handle case of crimes committed against women and report them. One accused acquitted means breeding of hundred criminals. Prevention and detection is better than conviction.

A peculiar case of bullet, burns and boot.

Medico legal study of different cases of burns. In this case, the accused tried to hide the actual cause of death, by burning the car along with the body, after shooting him. However careful examination has brought the accused to justice. It is very important for forensic specialist to visit the scene of crime and get detailed history of cases burns from investigating officers and use all branches of forensic medicine to solve crime.