Navigating antenatal complexity: a case report of Bombay blood group and anaemia challenges

The Bombay blood group is a rare blood type, predominantly found in regions with a high prevalence of consanguineous marriages due to its autosomal recessive inheritance pattern. This blood group is unique because individuals lack the H antigen, a precursor to the A and B antigens found in other blood types, making their blood type exceptionally rare. Managing antenatal patients with the Bombay blood group presents significant challenges, especially in cases of anaemia or any instance of blood loss. The primary difficulty arises from the scarcity of compatible blood for transfusion, as individuals with the Bombay blood group can only receive blood from other Bombay group donors. This rarity complicates the management of potential complications during pregnancy, labour, and delivery. To address these challenges, minimizing blood loss is essential during all stages of pregnancy, particularly during labour, Caesarean sections, and in the prevention of postpartum haemorrhage. Effective management requires a multidisciplinary approach, involving obstetricians, haematologists, and blood bank services. One potential strategy to mitigate the risk of blood shortages is autologous blood transfusion. This option can be particularly valuable during pregnancy; however, it requires careful consideration of the potential risks and benefits. The procedure should be conducted under the guidance of healthcare professionals experienced in managing such cases, ensuring the safety and well-being of both the mother and the foetus. In our case report, we present an antenatal patient with anaemia and the challenges encountered during the antenatal and postnatal periods. This case highlights the complexities of managing pregnancies involving the Bombay blood group. It underscores the importance of a well-coordinated, multidisciplinary approach to optimize outcomes for both mother and child.

Association of breastfeeding related musculoskeletal pain, sleep quality and physical activity among postpartum women: a literature review

Women often report musculoskeletal ailments during perinatal period resulting in less sleep hours and decline in physical activity. It has been speculated that physical activity can lower the frequency of muscular pain and enhance good quality sleep among women. Hence, the review aimed to investigate the association of breastfeeding related musculoskeletal pain, sleep quality and physical activity thus refining quality of life among women. Literature search was performed using search strategy on PubMed, Scopus and Pedro databases during 2019-2023. A total 54,037 articles were found via database searching out of which only 16 studies were relevant meeting the inclusion criteria. All the studies found that breastfeeding related musculoskeletal pain, sleep quality and physical activity are associated with each other. To lower the incidence of muscular pain and improve sleep quality, physical activity can be incorporated thus preventing occurrence of future complications. Hence, it has been suggested that physical activity is key solution of emerging musculoskeletal pain and broken sleep quality. Evidence from this literature supports that prenatal education emphasizing necessity of physical activity should be routinely integrated into maternal care in an effort to reduce chances of future complications.

A review on potential adverse effects associated with Janus-kinase inhibitors

Rheumatoid arthritis (RA) is a chronic, symmetrical, inflammatory autoimmune disease that affects small joints. RA has a population prevalence of 0.5% to 1% in the U.S. The annual cost of care for chronic treatment of RA in the United States is estimated at $12,509. Pharmaceutical companies have developed drugs to treat RA using Janus kinase (JAK) inhibitors. These drugs can have potential adverse effects. Forecasting a better output to JAK inhibitors (JAKI’s). Therapy duration of JAKI’s and Problems regarding to strategies of dose reduction or if the discontinuation of therapy takes place in case of low disease activity. The accurate pharmacological profile and interactions of other drugs with JAKI’s have to establish. Proper safety, efficacy profile of JAKI’s and when administered in combination with DMARD’s. The safety, efficacy data of JAKI’s when compared to non-anti-TNF biologics. Obtaining of experience on JAKI’s that were already existed in the market and further experimental findings on newer compounds and which may clarify many of the aspects which are to be solved in nearer future as these JAKI will have greater application in treatment of RA. Regardless of significant developments in latest years in the pharmacotherapy of RA in the use of JAK inhibitors, yet the adverse effects of JAK inhibitors are unanswered. Therefore, one of the main concerns associated with JAK inhibitor is the potential adverse effects. The challenges can be addressed by clinical pharmacist mediated interventions related to dosing of JAK inhibitors and proper management of adverse drug reactions (ADRs).

A COST VARIATION COMPARISON AMONG ORAL ANTI-MIGRAINE DRUGS AVAILABLE IN THE INDIAN MARKET

Objective: Our study aimed to evaluate the cost percent variation and cost ratio of different brands of oral anti-migraine drugs available in Indian market.Methods: The cost of various commonly used oral anti-migraine drugs were taken from the latest issue of Current Index of Medical Specialities January 2022, Drug Today January-April 2022 and 1 mg online site. Cost percent variation and Cost ratio were calculated.Results: A total of 7 single anti-migraine drugs and 9 Fixed-Dose Combinations (FDCs) showed a wide range of cost variation. The highest cost percent variation of 433% was seen in Sumatriptan 50 mg with a cost ratio of 5.33, whereas Amitriptyline 10 mg showed the lowest cost percent variation of 47.9% with a cost ratio of 1.47. Among FDCs Naproxen 500 mg+Sumatriptan 85 mg showed the highest cost per cent variation of 400% with a cost ratio of 5.25 and Propranolol 40 mg+Flunarizine 10 mg showed the lowest cost per cent variation of 46.56% with a cost ratio of 1.46.Conclusion: Our study showed a wide variation in the cost of oral anti-migraine drugs available in the Indian market, which provides insight to the healthcare professional and gives Drug Price Control Order (DPCO) authorities to minimize the financial burden and improve patient compliance.

A rare case of advanced abdominal pregnancy with good maternal and fetal outcome

Advanced abdominal pregnancy is an uncommon and potentially precarious variant of ectopic pregnancy in which the fetus develops in the abdominal cavity. A 30-year-old multigravida presented at 33+5 weeks of gestation with abdominal pain. Ultrasonography revealed a single live fetus lying in the abdominal cavity, with the uterus seen separately. Previous ultrasonography done at 15 weeks of gestation was suggestive of intrauterine pregnancy. She underwent emergency laparotomy at 33+6 weeks, which confirmed secondary abdominal pregnancy with the placenta deriving its blood supply from the left uterine artery and omental vessels. A peripartum hysterectomy was performed. The postoperative period was uneventful, and both mother and baby were discharged after one week. Despite notable advancements in prenatal care and medical imaging technologies, abdominal pregnancies, even if advanced, may remain undiagnosed, emphasizing the necessity for healthcare professionals to maintain a heightened level of suspicion regarding this condition. If conservative management has to be sought, the case selection should be done carefully due to the high risk to both the mother’s and fetus’s life. There is a pressing need for the standardisation of treatment protocols in order to optimise maternal and fetal outcomes in abdominal pregnancy.

Gastrointestinal perforations induced by long-term non-steroidal anti-inflammatory drugs use: a case series analysis and discussion

Non-steroidal anti-inflammatory drugs (NSAIDS) are used in a wide range but may cause harm to the gastrointestinal mucosa, which leads to various complications. This study shows the impact of long term NSAID use on small and large intestine and presents 2 cases of patients with NSAID induced perforations. The first case involves a 62-year-old male patient with RA on long term Ibuprofen use, presented with abdominal pain, vomiting, and lower limbs pain. Laparotomy revealed a 5 mm perforation in the proximal jejunum. The second case, a male patient of 65 years of age using diclofenac without a prescription, which lead to a 4×4 cm sigmoid colon perforation. The comparison of both the cases presents a difference in examination and laboratory findings. Long-term NSAID use has been associated with various GI complications, including perforations. The case presents the importance of considering NSAID related complications, mainly in older patients and the persons with ulcers. Combining NSAIDS with other drugs, like misoprostol may minimize the risk of the GI complications. NSAIDs are also linked with cardiovascular events, and heart related issues. This study shows the need of careful NSAID prescription, with their association with preventable adverse effects. 30% of hospitalizations for adverse drug reactions are only by the NSAIDs. PPIs and H2 receptor antagonist are commonly used to protect the gastrointestinal mucosa which minimizes the occurrence of ulcers. Healthcare professionals should be careful particularly in case of high risk patients to minimize the NSAID related complications.

Characterization of laccase from Trichoderma sp. UBDFT12 isolated from a Bornean tropical forest

Aims@#This study was aimed to characterize laccase from a selected fungal strain and examine the enzyme’s ability to remove lignin from paper pulp. @*Methodology and results@#Twelve fungal strains were screened for laccase production, resulting in the selection of Trichoderma sp. UBDFT12. The highest laccase activity (103 U/L) was observed from the culture filtrate on the fourth day of incubation. The optimum temperature and pH for the enzyme were 40 °C and pH 4, respectively. However, the enzyme stability was found to be reduced with time after 1 h incubation. At 1 mM, it was found that AgNO3, CaCO3, CuSO4, KCl, MgSO4, MnSO4 and ZnSO4 increased the laccase activity to 107, 107, 111, 112, 106, 105 and 107%, respectively, whereas FeSO4 and NH4Cl reduced the activity to 84 and 99%, respectively. The addition of 1% H2O2, 1% NaCl, 1% sodium dodecyl sulphate (SDS), 1 mM ethylenediaminetetraacetic acid (EDTA), 10 mM EDTA, 1 mM phenanthroline and 10 mM phenanthroline reduced the activity to 95, 73, 0, 79, 79, 73 and 37%, respectively. The culture filtrate was partially purified via ammonium sulphate precipitation and the recovered enzyme had a specific activity of 0.176 U/mg. Using sodium dodecyl-sulfate polyacrylamide gel electrophoresis (SDS-PAGE), the molecular weight of the enzyme was approximately 65 kDa and its activity was confirmed by zymography. The culture filtrate was also found to be able to remove lignin from different types of paper pulp.@*Conclusion, significance and impact of study@#Laccase produced by Trichoderma sp. UBDFT12 was found to have the ability to remove lignin from paper pulp.

Association of tumor budding and tumor infiltrating lymphocytes with clinicopathological parameters in gallbladder carcinoma

Purpose@#Gallbladder carcinoma (GBC) poses significant challenges in oncology due to its aggressive nature and limited treatment options. The lack of effective biomarkers for early detection and prognosis exacerbates the prognosis for GBC patients. Tumor budding (TB) and tumor infiltrating lymphocytes (TILs) have emerged as potential prognostic indicators in various cancers, reflecting tumor-host immune interactions and tumor aggressiveness. The study of TB and TILs in GBC is particularly important due to the limited literature available. @*Methods@#This retrospective observational study aimed to evaluate the association of TB and TILs with clinicopathological parameters in GBC patients. Clinicopathological data were collected from patients with histologically confirmed GBC who underwent surgical resection. The sections were evaluated for TB and TILs using standardized methods. Statistical analysis was performed to assess associations between these parameters and clinicopathological variables. @*Results@#Tumor stage and grade showed significant associations with TB and TILs, indicating their potential as prognostic markers. High TB correlated with advanced tumor stage and higher grade, while high TIL infiltration was associated with early tumor stage and lower grade. Additionally, TILs exhibited a significant association with lymphovascular invasion. Interestingly, an inverse association was observed between TB and TILs, highlighting the dynamic interplay between tumor aggressiveness and host immune response. @*Conclusion@#TB and TILs hold prognostic significance in GBC, offering insights into its pathogenesis and potential therapeutic targets. Future research exploring the mechanistic underpinnings of tumor-host immune interactions in GBC is crucial for translating these findings into clinical applications and improving outcomes for patients.

Therapeutic potential of sulforaphane: modulation of NRF2 mediated PI3/AKT/mTOR pathway in oral fibrosis / Potencial terapêutico do sulforafano: modulação do NRF-2 mediado o pela via PI3/AKT/mTOR na fibrose oral

Oral Submucous Fibrosis is a potentially malignant disorder caused by habitual areca nut chewing, which contributes to the dispersion of active alkaloids into subepithelial tissues, stimulating excessive extracellular matrix deposition. Various treatment modalities are available; however, their efficacy in inhibiting fibrosis progression remains limited. Sulforaphane (SFN), an isothiocyanate found abundantly in cruciferous plants, is known to have effective antifibrotic properties. Objective: The present study investigated the antifibrotic effect of SFN via phosphatidylinositol 3 kinase (PI3K), Serine/Threonine Kinase 1 (AKT-1), mammalian target of rapamycin (mTOR) pathway in arecoline (AER) induced fibrosis in human gingival fibroblasts [HGFs]. Material and Methods: MTT assay determined the half-maximal inhibitory concentration of AER and SFN at 24h in the HGF cell line. Expression levels of transforming growth factor ß1 (TGFß1), collagen type 1 alpha 2 (COL1A2), hydroxyproline (HYP), PI3, AKT, mTOR, and nuclear factor erythroid 2­related factor 2 (NRF2) were assessed post-AER and SFN treatment using qPCR and western blot analysis. Results: The findings of the study revealed that AER elicited a stimulatory effect, upregulating TGFß1, COL1A2, HYP, PI3K, AKT, and mTOR and downregulating NRF2 expression. Conversely, SFN treatment significantly upregulated NRF2, inhibiting TGFß1 mediated PI3/AKT/mTOR pathway. Conclusion: These observations suggest that SFN can be used as a promising synergistic antifibrotic agent to combat fibrogenesis via the non-Smad pathway (AU)

Fibrose submucosa oral é uma desordem potencialmente maligna causada pelo habito de mascar a noz da areca, o que contribui para a dispersão de alcalóides ativos nos tecidos subepiteliais, estimulando a deposição excessiva de matriz extracelular. Há várias modalidades terapêuticas, no entanto, com eficácia limitada no controle da progressão da fibrose. O sulforafano (SFN), isotiocianato encontrado abundantemente em plantas crucíferas, é conhecido por suas propriedades antifibróticas. Objetivo: Investigar os efeitos antifibróticos do SFN na via fosfatidilinositol3-quinase (PI3K), via quinase serina/treonina 1 (AKT-1), via do alvo da rapamicina em mamíferos (mTOR), na fibrose induzida por arecolina (AER) em fibroblastos gengivais de humanos (HGFs). Material e Métodos: A meia concentração inibitória mínima de AER e SFN em 24 horas nas células HGFs foi determinada por MTT. Os níveis de expressão de ß1 (TGFß1), colágeno tipo 1 alfa 2 (COL1A2), hidroxiprolina (HYP), PI3K, AKT, mTOR, fator nuclear eritroide 2 relacionado ao fator 2 (NRF2) foram analisados após tratamento com ERA e SFN através de qPCR e western blot. Resultados: O ERA apresentou efeito estimulatório aumentando a expressão de TGFß1, COL1A2, HYP, PI3K, AKT e mTOR e diminuindo a expressão de NRF2. Por outro lado, tratamento com SFN aumentou significativamente a expressão de NRF2, inibindo a liberação de TGFß1 mediada pela via PI3/AKT/mTOR. Conclusão: Esses achados sugerem que o SFN pode ser um agente antifibrótico promissor no combate à fibrogênese decorrente da via não-Smad (AU)

Salivary biomarkers in non-invasive oral cancer diagnostics: a comprehensive review

Abstract Objective This review aims to provide a comprehensive analysis of the effectiveness of saliva as a non-invasive diagnostic marker for oral cancer. Despite progress in oral cancer diagnosis and prognosis, the 5-year survival rate remains low due to the resistance to treatment and delayed diagnosis, which can be attributed to various factors including tobacco and alcohol consumption, genetic damage, and human papillomavirus (HPV). The potential use of saliva as an easily accessible non-invasive screening and diagnostic method arises from its direct contact with the lesion site. Methodology Data for this study were gathered via a comprehensive literature evaluation using search engines such as the PubMed, Web of Science, Google Scholar, and SciFinder. Results Identifying salivary biomarkers shows potential to transform oral cancer diagnostics by offering a reliable alternative to the traditional invasive methods. Saliva is an abundant reservoir for both cell-bound and cell-free organic and inorganic constituents. Thus, saliva is an appropriate field for research in proteomics, genomics, metagenomics, and metabolomics. Conclusion This review provides a comprehensive elucidation of salivary biomarkers and their function in non-invasive oral cancer diagnosis, demonstrating their potential to enhance patient outcomes and reduce the impact of this devastating disease.

Association between maternal obesity and gestational diabetes mellitus and their related outcomes

Background: Gestational diabetes mellitus (GDM) has a direct correlation with maternal body mass index (BMI). Pre-pregnancy BMI is ideal for studying the outcomes of obesity in pregnancy. Unlike the west, in countries like India, pregnant women approach health facilities during first trimester making it appropriate to consider first trimester BMI, as a parameter to study outcome variables. In this study we correlate BMI and GDM in pregnancy as GDM has significant impact on mother and baby. Aim of study was to study maternal and neonatal outcomes in obese women who have conceived among two groups, GDM and non-GDM.Methods: Observational study conducted at tertiary care teaching hospital over a one-year period (2021-2022). All pregnant women in first trimester with Body Mass Index (BMI) ?30, calculated in first visit, was included in this study for follow-up. According to the results of GDM screening at 24-28?weeks of gestation by DIPSI method, pregnancies were divided into the GDM and non-GDM group. They were observed for risk of GDM. The obstetric and neonatal outcomes were noted and compared between the two groups. Data was analysed using SPSS software.Results: Mean BMI (32.79�47) among GDM group is greater than Non GDM (31.15�22), with p-value 0.00005 is significant. In obstetric outcomes, GDM is associated with increased incidence of preterm deliveries (p-value=0.004), gestational hypertension (p-value=0.002). In case of perinatal outcomes, increase incidence of hyperbilirubinemia (p-value=0.002), hypoglycemia (p-value=0.048) and sepsis (p value=0.046) in neonates born to GDM is seen.Conclusions: BMI calculation in early pregnancy is good indicator to monitor for complications in pregnancy including GDM. Therefore, identification of patients with high BMI and GDM requires regular follow up during pregnancy so that early intervention minimises complications.

Impact of Auxin and Gibberellin on Vegetable Crops: A Review

Plant growth regulators, also known as phytohormones, are a class of organic chemicals, either naturally occurring or artificially synthesised, that exert control over specific physiological processes in plants. The application of these substances elicits a range of effects on vegetables, encompassing seed germination, the disruption of seed dormancy, the commencement of flowering, the induction of gametocidal effects, the promotion of fruit set, the stimulation of parthenocarpy, and the facilitation of fruit ripening, among others. Auxin plays crucial factor in the development of several vegetable crops, including cucurbits. Notably, the application of Naphthalene acetic acid at a concentration of 10 ppm has been observed to exert a significant influence on sex expression, fruit set, and overall production in cucumber plants. The application of 4-CPA resulted in the greatest quantity of commercially viable fruit in tomato plants. The application of Naphthalene acetic acid at a concentration of 40 ppm exhibited the most substantial enhancements in leaf area, percentage of fruit set, total fruit production, as well as the quantity and weight of seeds per fruit in chilli plants. The treatment involving the application of 80 ppm Naphthalene acetic acid in brinjal resulted in the observation of increased fruit length, average weight of fruit per plant, and greatest fruit diameter. Gibberellin is also of significant importance, since it participates in using the gibberellic acid route to produce tomato plants that exhibit enhanced performance in both irrigated and water-limited environments, hence increasing their drought tolerance. The application of GA3 at a concentration of 75 ppm has been found to be highly beneficial in improving vegetative growth and yield characteristics in brinjal, as well as in several other vegetable crops as detailed in the present study. Additionally, they serve a crucial function in augmenting the output and productivity of many vegetables breeding programmes, and ensuring food safety.

An Examination of the Effects of Different Transplanting Dates, Planting Geometry and Training Techniques on the Yield Traits, Productivity and Quality of Cucumber (Cucumis sativus L.) under Naturally Ventilated Polyhouse

An experiment was conducted to investigate the effect of date of transplanting, planting geometry and training system on the fruit yield and quality of cucumber (Cucumis sativus L.) under naturally ventilated polyhouse at the Research Farm of Department of Agricultural Engineering, College of Agriculture, CSK Himachal Pradesh Krishi Vishvavidyalaya, Palampur, The experiment was laid out in Factorial Randomized Block Design with three replications and eighteen treatments, comprised of three date of transplanting (1st fortnight of March, 2nd fortnight of March and 1st fortnight of April), two planting geometry viz., 60 cm x 30 cm, 75 cm x 30 cm and three training systems viz., two shoots, three shoots and four shoots. Results revealed that plants transplanted earlier (1st fortnight of March) at a wider spacing of (75 cm x 30 cm) recorded significantly higher number of fruits per plant, fruit length, fruit weight and total soluble solids, while maximum fruit yield was recorded under closer spacing of 60 cm x 30 cm. With regards to the number of shoots per plant, plants with three shoots recorded significantly higher fruit yield. So it can be concluded that plants transplanted in the 1st fortnight of March, trained to three shoots and spaced at 60 cm x 30 cm apart were found to be the best for higher fruit yield and better quality of the produce.

Evaluation of Silage Quality of Forage Maize (Zea mays L.) and Sweet Sorghum (Sorghum bicolor L. Moench) Varieties at Different Phenophases

Aim: To evaluate the green fodder production potential of forage maize and sweet sorghum varieties at different phenophases.Experiment Design: Factorial Randomized Block Design (FRBD).Place and Duration of Study: AICRP on Forage Crops and Utilization, Agricultural Research Institute. Duration from July 2022 to Nov 2022.Methodology: Field experiment was conducted at AICRP on Forage Crops and Utilization, Agricultural Research Institute (ARI), Rajendranagar, Hyderabad during kharif 2022. The treatments consisted of four maize varieties (African tall, J –1006, TSFM 15-5 and DHM-117) and two sweet sorghum varieties (CSH-22SS and CSV-49SS) and three harvest stages (S1: Milky stage, S2: Soft dough stage and S3: Dent stage) laid out in randomized block design with factorial concept with two factors. Factor (A) as six varieties and factor (B) as three harvest stages (phenophases) with three replications. Texture of the soil was sandy loam with the pH of 7.0, low in available nitrogen (199.3 kg ha-1), medium in available phosphorous (39.12 kg ha-1) and potassium (195.30 kg ha-1).Results: Fodder maize variety African tall recorded significantly higher plant height (265.8 cm) at dent stage, leaf-stem ratio (0.36) at milky stage, green fodder yield (438 q ha-1) at soft dough stage and dry fodder yield (122.7 q ha-1) at dent stage of harvest. while J-1006 recorded significantly highest dry matter content (29.8%) at the dent stage of harvest. CSH 22SS recorded significantly higher crude protein content (10%) in the milky stage.Conclusion: African tall variety has recorded significantly higher green fodder yield (438 q ha-1) at soft dough stage and dry fodder yield at the dent stage (122.7 q ha-1).

Effect of Phosphorus Levels on Growth and Yield of Maize Hybrids

A field experiment was conducted at the Crop Research Farm, Department of Agronomy, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj during Rabi season 2022 on Maize crop. The experiment was laid out in Randomized Block Design with ten treatments and three replication. The treatment consisted of Maize hybrids (Govinda 111, Hybrid corn 4226, DKC 9133) with soil application of phosphorus (40 kg/ha, 60 kg/ha and 80 kg/ha) and a control (120:60:40 kg NPK/ha). The results of the experiment showed that, plant height (125.65 cm), dry weight (96.59 g/plant), crop growth rate (39.91 g/m2/day), No. of cob/plant (1.33), No. of grains/row (21.36), seed index (23.44 g), grain yield (5.90 t/ha) and stover yield (9.91 t/ha) and harvest index (37.12%) were significantly highest recorded in ‘Hybrid DKC 9133’ with the application of phosphorus 80 kg/ha. Maximum gross returns (1,32,865.00 INR/ha), net returns (89,392.55 INR/ha), and B:C (2.06) were also obtained with the same treatment.

Association of colposcopy with pap smear in evaluation of unhealthy cervix- a prospective study

Background: Unhealthy cervix is a very common finding in our country due to poor genital hygiene, malnutrition and multiparity. The cervix is the commonest site for female genital cancer. Gynaecologists who work in tertiary care institutes in the developing countries to get referrals from practitioners and peripheral health centres for patients with a clinical diagnosis of an “unhealthy cervix. An “unhealthy cervix” or grossly abnormal cervix can harbour premalignant cervical lesions or invasive carcinoma. That’s why present study was planned to evaluate colposcopy role in relation to PAP smear in symptomatic patients.Methods: The present study was a prospective, analytical study. After institutional committee approval this study was conducted from January 2021 to January 2022 in department of obstetrics and gynecology at RNT Medical college, Udaipur. Total 140 women were assessed for this study.Results: Our study results based on combined cytology and colposcopy with histopathology- sensitivity =100%, specificity =87.03%, PPV=84.09%, NPV=100%, accuracy =92.30%. The result of current study supports that, PAP smear demonstrates premalignant and malignant lesions, whereas colposcopy shows the exact site for biopsy for histopathological diagnosis and for further management.Conclusions: Colposcopy and cytology are complementary to each other. Best result in early detection of pre-invasive carcinomas could be obtained by combined use of cytology, colposcopy and colposcopy guided biopsy. So, use of ‘single visit approach’ in which cytology, colposcopy and guided biopsy all are done in one setting and treated accordingly in resource poor countries will enable maximum utilization of scarce medical resources.

Incidental finding of bilateral lateral vaginal wall fibroid, in an antenatal patient during course of labor

Vaginal leiomyomas remain an uncommon entity with only about 300 reported cases since the first detected case back in 1733 by Denys de Leyden. We report a case of 25-year-old G2P1L1 (Previous FTNVD), who presented inpatient department with c/o 10 months amenorrhea with lower abdominal pain for one day. On general physical examination, no pallor, no Jaundice, no edema and vitals were stable. On per abdominal examination 1-2 uterine contraction for 10 second in 10 min was observed. On per vaginal examination internal OS was 2 cm dilated, 20-30% effaced, vertex at-3, medium consistency, mid position, membrane intact and pelvis adequate noted. She was admitted in labor room and kept watched for spontaneous progression of normal labor. After 6 h of admission, she started having adequate uterine contractions 2-3 for 30 sec in 10 min. On PV examination she was 6 cm dilated with 60-70% effaced, vertex at -1, soft consistency, anterior position. Artificial rupture of membrane was done. Liquor was clear. Inj oxytocin in drip was started at 8 drops/min. During vaginal examination, A firm sessile, painless mass with smooth surface of size 1×1 cm was felt on both right and left vaginal wall which suggestive of vaginal leiomyoma grossly. During course of labor, progression of labor was halted during second stage of labor. Inj oxytocin drop rate increased at 32 drops/min to achieve adequate uterine contraction. A male baby of 2.8 kg was delivered in stable condition. Right mediolateral episiotomy was repaired with rapid vicryl suture 2,0. Patient was informed and vaginal fibroid finding was mentioned on discharge summary. Patient was called after 6 weeks for follow-up.

Association of colposcopy with pap smear in evaluation of unhealthy cervix- a prospective study

Background: Unhealthy cervix is a very common finding in our country due to poor genital hygiene, malnutrition and multiparity. The cervix is the commonest site for female genital cancer. Gynaecologists who work in tertiary care institutes in the developing countries to get referrals from practitioners and peripheral health centres for patients with a clinical diagnosis of an “unhealthy cervix. An “unhealthy cervix” or grossly abnormal cervix can harbour premalignant cervical lesions or invasive carcinoma. That’s why present study was planned to evaluate colposcopy role in relation to PAP smear in symptomatic patients.Methods: The present study was a prospective, analytical study. After institutional committee approval this study was conducted from January 2021 to January 2022 in department of obstetrics and gynecology at RNT Medical college, Udaipur. Total 140 women were assessed for this study.Results: Our study results based on combined cytology and colposcopy with histopathology- sensitivity =100%, specificity =87.03%, PPV=84.09%, NPV=100%, accuracy =92.30%. The result of current study supports that, PAP smear demonstrates premalignant and malignant lesions, whereas colposcopy shows the exact site for biopsy for histopathological diagnosis and for further management.Conclusions: Colposcopy and cytology are complementary to each other. Best result in early detection of pre-invasive carcinomas could be obtained by combined use of cytology, colposcopy and colposcopy guided biopsy. So, use of ‘single visit approach’ in which cytology, colposcopy and guided biopsy all are done in one setting and treated accordingly in resource poor countries will enable maximum utilization of scarce medical resources.

Incidental finding of bilateral lateral vaginal wall fibroid, in an antenatal patient during course of labor

Vaginal leiomyomas remain an uncommon entity with only about 300 reported cases since the first detected case back in 1733 by Denys de Leyden. We report a case of 25-year-old G2P1L1 (Previous FTNVD), who presented inpatient department with c/o 10 months amenorrhea with lower abdominal pain for one day. On general physical examination, no pallor, no Jaundice, no edema and vitals were stable. On per abdominal examination 1-2 uterine contraction for 10 second in 10 min was observed. On per vaginal examination internal OS was 2 cm dilated, 20-30% effaced, vertex at-3, medium consistency, mid position, membrane intact and pelvis adequate noted. She was admitted in labor room and kept watched for spontaneous progression of normal labor. After 6 h of admission, she started having adequate uterine contractions 2-3 for 30 sec in 10 min. On PV examination she was 6 cm dilated with 60-70% effaced, vertex at -1, soft consistency, anterior position. Artificial rupture of membrane was done. Liquor was clear. Inj oxytocin in drip was started at 8 drops/min. During vaginal examination, A firm sessile, painless mass with smooth surface of size 1×1 cm was felt on both right and left vaginal wall which suggestive of vaginal leiomyoma grossly. During course of labor, progression of labor was halted during second stage of labor. Inj oxytocin drop rate increased at 32 drops/min to achieve adequate uterine contraction. A male baby of 2.8 kg was delivered in stable condition. Right mediolateral episiotomy was repaired with rapid vicryl suture 2,0. Patient was informed and vaginal fibroid finding was mentioned on discharge summary. Patient was called after 6 weeks for follow-up.