Urogenital myiasis - An atypical presentation

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient's unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options.

A comparison of hysterosalpingography and laparoscopy in the evaluation of tubal factors in female infertility

Background: WHO defines infertility as “failure to conceive after having regular, unprotected intercourse for one year. Factors responsible - male factors (20-30%), female factors (40-55%), combined male and female factors (10-40%) and unexplained infertility (10-20%). Amongst female factors, tubal factors are responsible for 25-30% of infertility. Hysterosalpingography and diagnostic laparoscopy with chromopertubation are widely used in the evaluation of tubal factors of infertility. The aim of this study was to compare findings of HSG and diagnostic laparoscopy with chromopertubation for tubal patency in infertile women.Methods: An observational study, done on a total of 125 females suffering from primary and secondary infertility who underwent HSG and then 97 patients who gave consent, underwent diagnostic laparoscopy with chromopertubation. The data was entered in MS excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0.Results: Primary infertility cases were more than secondary infertility cases. Mean age of patients was found to be 28.92±5.33 years. Most common tubal abnormality found on hysterosalpingography and chromopertubation was bilateral tubal block. Inter rater kappa agreement used and significant agreement found between hysterosalpingography and chromopertubation with kappa value of 0.612.Conclusions: From this study authors conclude that HSG and laparoscopy with chromopertubation are complimentary to each other. Laparoscopy helps in identification of tubal and non-tubal factors like intra-abdominal and pelvic adhesions, endometriosis etc. and simultaneously they can be treated while HSG helps in evaluation of tubal factors as well as of intra-uterine factors like synechiae, polyps etc.

Placental location and development of preeclampsia: a longitudinal study

Background: Preeclampsia is one of the leading causes of morbidity and mortality worldwide. A number of pregnant women suffer from it after 20 weeks of their pregnancy. The study was designed to know the association between location of placenta and the development of preeclampsia in pregnant women. the purpose of the study is to determine the incidence of lateral location of placenta and to study the relation between placental location and development of preeclampsia.Methods: A prospective study conducted on pregnant women who attended the antenatal clinic of SRHU Hospital over period of 12 months. The study was hospital based longitudinal study with a sample size of 100 cases presenting over a period of 12 months in Obstetrics and Gynecology Department. Simple Random Sampling was used for random selection of antenatal case at 18 to 24 weeks gestation with singleton pregnancy, after taking written consent and agreeing for follow-up till delivery.Results: Out of the total 100 cases taken for the study, there were 68 cases of lateral placenta and 32 cases of central placenta. Most of the cases belonged to middle class living in urban areas. The development of preeclampsia is mainly due to mineral deficiency and high systolic BP.Conclusions: In present study, 48.5% patients with lateral placenta and 46.9% with central placenta developed pre-eclampsia.  There was a significant association that was found between laterality of placenta and development of PIH. The laterally located placenta is associated with increased risk of developing preeclampsia. Therefore, looking for placental laterality at the time of a mandatory antenatal ultrasound scanning (level II) may serve as a non-invasive test to predict pre-eclampsia.