Robert’s uterus: a rare mullerian anomaly mystery unfolded

Anomalies of female genital tract may not be detected until after menarche when they present a cyclical pain due to outlet obstruction. Mullerian anomalies represent a vast array of structural abnormalities resulting from improper development and fusion of embryological mullerian ducts. 19-year-old girl attained menarche at the age of 14, had progressive dysmenorrhoea and diagnosed as right haemotosalphinx and ovarian endometrioma which were removed in 2008. As pain progressed, she underwent laparoscopic adhesiolysis in 2013. Since, pain persisted, diagnosed as right haematometra, and drainage done by laparotomy. Left adnexa were normal. She was given depot provera till she completed schooling. She developed recurrent dysmenorrhoea after stopping depot provera. USG and MRI revealed recurrent haematometra on right side with normal left horn. The possibility of atypical septum was thought about and hystero laparoscopy was done. It showed right side haemetometra with absent right adnexa. Left adnexa normal. Hysteroscopy showed normal left horn with septum with a bulge towards the left side. Hence, proceeded with hysteroscopic septostomy and haemetometra was drained to the left horn. Later patient was free from dysmenorrhea and repeat hysteroscopy was found to be normal. This case highlighting mullerian anomalies have to be considered when young girls present with severe progressive dysmenorrhoea and diagnosis remains a challenge most of the clinicians. This rare entity has to be kept in mind while evaluating such patients. Prompt diagnosis and early surgical correction are essential to avoid future morbidity in the form of repeated unnecessary surgeries.

An interesting case of Phocomelia

Authors present a very rare case of tetra-phocomelia evaluated by antenatal ultrasonography. It is a condition seen in 0.62 per 100,000 live births. This is a congenital chromosomal abnormality involving the musculoskeletal system. Primi gravida with spontaneous conception after a long period of infertility underwent early anomaly scan. Patient was not aware of the last menstrual period hence; NT scan was missed. Routine early anomaly scan done between 16-18 weeks of pregnancy diagnosed a fetus with Tetra-Phocomelia. Due to the lack of associated symptoms or significant history, our case did not fit into any specific syndrome and appears to be the result of a sporadic, non-hereditary limb deficiency involving all four limb buds.  Second opinion obtained from a fetal medicine consultant who confirmed the diagnosis. Hence, decided for mid trimester termination and fetus was expelled after 8 hours. Fetus was not sent for pathological analysis. Tetra-phocomelia is a rare congenital anomaly and it may be associated with other deformity also. 1st case of phocomelia was described after the intake of thalidomide. In this condition hands and feet are seen as small flippers of a seal. The differential diagnosis includes sporadic phocomelia, Holt-Oram syndrome, thrombocytopenia-absent radius syndrome (TAR syndrome), Robert’s syndrome, and thalidomide-induced phocomelia. Here authors are presenting a rare case of Phocomelia where there is no history of drug intake or family history. This has to differentiate from thrombocytopenia-absent radius syndrome (TAR syndrome), sporadic phocomelia, Holt-Oram syndrome, Robert’s syndrome, and thalidomide-induced phocomelia.

Status of Maternal Derived Antibody Against Rabies in Naive Puppies in Chennai

Thirty-six blood samples were collected randomly from puppies [18 puppies each from vaccinated (Group I) and unvaccinated (Group II) dam] brought to Immunization Unit, Madras Veterinary College Teaching Hospital, Chennai. The samples were subjected to functional antibody assay (RFFIT) to know the kinetics of maternal derived antibody (MDA) against rabies. The mean MDA titre in group I and II puppies were found as 1.07 ± 0.18 IU/mL and 0.30 ± 0.037 IU/mL respectively. The statistical analysis (Student “t” test) revealed a highly significant difference (P<0.01) between MDA of two groups. Thus, this study strongly suggests that the dogs less than three months of age in endemic regions needs to be immunized against rabies in view of maintaining the population immunity and to reduce the bioburden of rabies risk.

Umbilical endometriosis along with peritoneal endometriosis: a case report

Incidence of endometriosis is around 10 to 15% in women of reproductive age group. Umbilical endometriosis is a very rare entity. Extra genital endometriosis accounts to 3% of endometriosis. Incidence of umbilical endometriosis is 0.5%-4% of extra genital endometriosis. 30 years old multi gravida was referred to our hospital with c/o periodic bleeding from the umbilicus for the past 3 months. She was also having dysmenorrhoea for about 3 months. On examination, patient had a small bluish nodule in the umbilicus around 1.5x1.2 cm in size. Clinically there was suspicion of pelvic endometriosis as the uterus was retroverted and fixed. CT abdomen showed a small hypo-echoeic area in the umbilicus and uterus was adenomyotic with normal ovaries. Patient was given the option of laparoscopy and excision of umbilicus, as there was suspicion of peritoneal endometriosis and the patient also insisted upon laparoscopic sterilization. Laparoscopy showed early peritoneal endometriosis with pelvic adhesions and the same adhesiolysis was done along with cauterization of endometriosis. Sterilization was also done as per the patient’s request. Umbilical excision and layer closure was done. Umbilical endometriosis is a rare entity. This patient had associated early pelvic endometriosis. Umbilical endometriosis could be secondary to the lympho vascular spread from the pelvic endometriosis or primary umbilical endometriosis. History, clinical and imaging were pointing towards umbilical endometriosis. Surgical excision of umbilical endometriosis and cauterisation of early pelvic endometriosis were done. Patient needs follow up. Umbilical endometriosis may be primary or secondary which needs total excision and follow up.

Effect of neoadjuvant chemotherapy in advanced ovarian carcinoma

Background: Ovarian cancer is the second most common gynecological malignancy. Patients with ovarian tumors are often asymptomatic for a long time. Most cases are diagnosed late because effective screening methods are not available. Aim of the study: The tumor clearance effect of neoadjuvant chemotherapy in the advanced ovarian tumor in terms of optimal debulking, ascitic fluid volume reduction, blood transfusion requirements and to compare it with those who have not received neoadjuvant chemotherapy. Materials and methods: 25 Patients with advanced ovarian tumor admitted in the Institute of Obstetrics and Gynecology, ISOKGH, Chennai from February 2018 to December 2018 were included in the study. All patients enrolled in the study underwent a detailed physical examination, routine hematological, biochemical investigations, Ultrasound, and CT Scan. For those patients with ascites, ascitic fluid was sent for cytology. When cytology report confirmed that it was Epithelial ovarian tumor, the patient received Neoadjuvant chemotherapy of Cisplatin 75mg/sq. m, Cyclophosphamide 750 mg/sq. m for 3 cycles – 6 weeks. Results: In our study, injury to adjacent structures was present in 7 cases of PDS group (28%) whereas 3 cases in NACT had an injury. Out of the total 10 cases, 2 had bladder injury, 2 had an injury to the small bowel, 3 had a ureteric injury, 2 had a sigmoid colon and the other had a rectal injury. Post-op complications were present in 8 cases of PDS group (32%), 4 cases (16%) of NACT/IDS group in our study. Conclusion: Neoadjuvant chemotherapy is significantly more effective in achieving optimal cytoreduction and reducing the ascitic fluid volume in advanced ovarian cancer. Blood transfusion requirement is significantly less in the neoadjuvant chemotherapy group.

Comparative Study of Risk Factors for Cancer Cervix among Women of Reproductive Age Women in Rural and Urban Area

Background: Awareness of risk factors is not at the desired levels among the women in the age group of 15-49 years. The level of awareness regarding identification of risk factors, symptoms of disease, the importance of early treatment which are important for control and prevention of disease. The present study is conducted in urban and rural areas in and around Kurnool district with the intention to know the level of awareness present and to measure the prevalence of risk factors for occurrence of cervical cancer. Methods: A total of 1400 women (700 urban and 700 rural women) in the reproductive age group of 15 – 49 years were interviewed at their residence. Interview done by investigator, during interview study pattern was explained to study population, later the data was collected. Results: Prevalence of two or more life time sexual partners was found to be high (4.2%) among rural women compared to urban women (1.33%). Prevalence of poor genital hygiene was 37.42% in rural women as compared to 8.28% in urban women. Prevalence of RTI among women of rural area was 34.57% and in urban area was 12.58%. History of husband having STI was more in rural areas (18%) when compared to urban area (14%). Status of screening by Pap smear was significantly high in urban (5.14%) than in rural (1.72%) population. Conclusion: Health care worker should be trained to identify and prevent risk factors causing cancer cervix in both urban and rural areas.

A 5 years study of parotid gland tumors in a tertiary hospital

Background: The salivary glands, mainly parotids are the site of origin of a wide variety of neoplasms. At the same time, they are relatively uncommon and show racial and geographical variations. Majority (80%) are benign tumors, only about 20% are malignant. Histopathology of parotid neoplasms is most complex and diverse of any organ in the body. Also histopathology plays a major role in the diagnosis of these neoplasms with very few contribution using special stains, immunohistochemistry and cytogenetic studies. Aim: The aim of the present study was to analyze the relative incidence, clinical presentation and spectrum of neoplasms in the parotid glands with their micromorphology at Gandhi hospital, Secunderabad, which is a tertiary referral hospital in Telangana state. Material and methods: A retrospective and prospective study of all parotid gland tumors received in the department of pathology for histopathological examination at Gandhi hospital, Secunderabad during a period of 5 years, from January 2013 to January 2018 was done. The clinical data like age, sex, duration were recorded. Grossly representative bits from the tumors were processed, sections made, stained with routine Hematoxylin and Eosin and examined under microscope. Data of 48 cases recorded during the 5 years period was analyzed. Results: 48 cases were studied during the 5-year period. Of them 39 cases were benign neoplasms and 8 cases were malignant. Benign tumors were more common in the parotid gland compared to malignant tumors, the most common benign tumor being Pleomorphic adenoma. Mucoepidermoid carcinoma was the most common malignant tumor. Most of the benign tumors occurred in the 3rd and 4 th decade while the malignant tumors were more common in the 6th decade. B. Vijayanirmala, T. Sundari Devi, Shahistha, P.V. Ramana. A 5 years study of parotid gland tumors in a tertiary hospital. IAIM, 2018; 5(11): 8-13. Page 9 Conclusion: Pleomorphic adenoma is the most common benign tumor and Mucoepidermoid carcinoma is the most common malignant tumor.

A 3 years study of vaginal hormonal cytology at tertiary hospital

Background: Vaginal cytology is an efficient inexpensive and a rapid method for identifying diseases including establishing the hormonal condition of the patient. The Evaluation of the endocrinologic status of the female patient by means of the study of vaginal cells is actually one of the earliest diagnostic applications of clinical cytology. Though the vaginal cytologic characteristics of gynecologic patients have been studied throughout the world this subjected has received little attention. Vaginal cytology is useful for assessing ovarian function from puberty throughout the reproductive years, menopause and senium. Also it is used to estimate time of ovulation, to determine ovarian dysfunction, to assess placental function or dysfunction in obstetrics, to assist in selecting hormonal therapy and to follow hormonal treatment results. Aim and objectives: To ascertain the effective utilization of cost effective test of vaginal hormonal cytology as a supplement for costly biochemical hormonal estimation. A prospective study was undertaken with the following objectives: To study the normal hormonal patterns in females of different age groups and to study abnormal hormonal patterns in high risk pregnancies and in different clinical situations. Materials and methods: A prospective, hospital based study was done on vaginal smears obtained from One hundred and Sixty (160) patients, attending Gynecology and Obstetrics Out-patient department and few In-patients at Gandhi hospital, Secunderabad during the period of August 2004 to October 2006. The study group included randomly selected female patients of reproductive age groups (18 years to 35 years.);.with normal menstrual cycles; normal perimenopausal (36 years to 45 years.) and postmenopausal (above 45 years.) women, pregnant patients in the 1st, 2nd, 3rd trimesters T. Sundari Devi, Rajyalakshmi, S. Srujana, K.R.K. Prasad, O. Shravan Kumar. A 3 years study of vaginal hormonal cytology at tertiary hospital. IAIM, 2017; 4(8): 20-32. Page 21 and 1st stage of labour as well as post partum patients. The study group also included patients with primary infertility, menorrhagia, secondary oligomenorrhoea (scanty menstruation), threatened abortions, inevitable abortions, pre mature rupture of membranes, post maturity and patients with neoplastic lesion i.e. ovarian tumor. The material collected for the vaginal smear dried very rapidly during collection. Hence fixation was done within 30 sec. of spreading. The fixatives used were – 95% Ethanol or 80% Isopropyl Alcohol. Other fixatives used were ether / 95% alcohols; 100% methanol; Rapid fixative as cytospray; 2 to 10% carbowax in 95% ethanol (for mailing unstained smears). The stains used were Papanicolaou’s stain and Giemsa stain. Results: Vaginal hormonal cytology is a useful diagnostic aid in the female reproductive process. It may also provide a key to more effective conception control, as well as improvement in the treatment of menstrual disorders, anovulation, and other underlying disorders. In the present Indian scenario with lack of adequate clinical history available to the pathologist, in a rural setup as well the urban conditions; vaginal hormonal study is still a low cost diagnostic and prognostic test procedure. Hence the present study emphasizes the utility of vaginal smear study even today compared to the costly biochemical parameters available in the market which is a financial burden to poor patients. Conclusion: Vaginal smear collected between 4-11 days and 12-16 days of the normal menstrual cycle showed scattered intermediate and superficial cells. Vaginal smears collected between 17-28 days of normal menstrual cycle showed, predominately intermediate cells with folding and crowding. The KPI peak is between 12-16 days. This is extreme midzone shift, with clusters of navicular cells in all the three trimesters, of pregnancy. First stage of labour could be suspected with identification of increase in the number of superficial cells, with marked decrease in the intermediate cell values.

Rhinosporidiosis of the Neck: A Rare Occurrence.

Rhinosporidiosis is a chronic granulomatous disease caused by a fungus Rhinosporidium seeberi, It frequently involves the nasopharynx and presents as a painless, friable, polypoidal growth hanging anterior to the nares or posteriorly into the pharynx. Th e lesions appear pink with minute white dots, which give it a strawberry-like appearance. Histopathologically, the organisms appear as sporangia containing large numbers of round or ovoid endospores. Several drugs have been tried, but Dapsone has proven to be most eff ective. In the present case, the lesion was seen on the anterior border of the mandible which is a very rare site for this infection. Th e growth was pedunculated and proliferative mimicking an aggressive lesion. On histology, also a rare fi nding of involvement of lymph nodes by the sporangia was noted.

Biosynthesis of silver nanoparticles from Trichoderma species.

A total of 75 isolates belonging to five different species of Trichoderma viz., T. asperellum, T. harzianum, T. longibrachiatum, T. pseudokoningii and T. virens were screened for the production of silver nanoparticles. Although all the isolates produced nanoparticles, T. virens VN-11 could produce maximum nanoparticles as evident from the UV-Vis study. The highest Plasmon band was observed at 420 nm at every 24 h that attained maximum intensity at 120 h (0.543). The high resolution transmission electron microscopy (HRTEM) further provided the morphology of the nanoparticles. These nanoparticles were found single or aggregated with round and uniform in shape and 8-60 nm in size. The nitrate reductase activity of VN-11 was found to be 150 nmol/h/mL which confirmed the production of silver nanoparticles through reduction of Ag+ to Ag0.

Gastric Helicobacter Pylori Infection / Peptic Ulcers And Periodontal Disease: A Literary Overview.

H.Pylori is an important factor in pathogenesis of numerous diseases including metabolic, gastrointestinal and vascular disorders.The oral cavity has been proposed as a reservoir for Helicobacter pylori that could be responsible for refractoriness of gastric infection to triple therapy (antibiotics, antimicrobials, proton pump inhibitors). Analysis of data suggests that periodontal treatment in combination with systemic therapy could be a promising approach to increasing the therapy’s efficacy and decreasing the risk of infection recurrence. Some authors have given conflicting evidences, to date there has been no clear cut evidence / study which directly correlates H. Pylori infection of periodontal pockets / plaque leading to peptic ulcer, duodenal ulcers and stomach cancers.

Insights into the protein profiles of stress tolerant and mesophilic yeast by proteomics approach: a comparative study.

Proteins of the stress tolerant and mesophilic yeast were extracted using optimized protein extraction method and estimated by Bradford method. Immobilized pH gradient (IPG) strips were rehydrated with known concentrations of protein samples. Rehydrated IPG strips were run in isoelectric focusing (IEF) to separate the proteins on the basis of their pH gradient. 2DE gels were run, stained and image of the stress tolerant yeast was compared with the gel image of mesophilic yeast. The image analysis using the image master software resulted in the identification of differentially expressed spots in stress tolerant yeast. Among the differentially expressed spots, six were selected and characterized by MALDI-TOF as Enolase, Fructose bisphosphate aldolase, Alcohol dehydrogenase, 30KDa HSP, HSP70 and HSP90.

Bilateral spontaneous hyphema in juvenile xanthogranuloma.

This report describes a rare occurrence of bilateral, spontaneous, nontraumatic hyphema in a 6 weeks old infant, associated with a small, multiple skin lesions. The diagnosis of juvenile xanthogranuloma was confirmed by histopathological examination of the cutaneous lesions. The hyphaema cleared gradually in 2 weeks time with conservative management.

STD trends in regional institute of medical sciences, Manipur.

A study carried out among the 2230 STD patients during 1996-2000 shows the types, distribution and trends of the various STDs seen in our hospital. STDs contribute 3.30% of the total skin OPD cases. Males dominate with 89.3% of STD cases. Bolanoposthitis (22%) was the commonest STD, followed by gonorrhoea (11.8%) and nongonococcal urethritis (NGU) being 11.2%. Syphilis was seen in 6.2% of the cases. The prevalence of VDRL reactivity and HIV reactivity remains almost the some being 8.49% and 8.21% respectively. There is increased occurrence of various psychosexual disorders among the affected patients.