Emerging Treatment Options of Regenerative Medicine in Severe Corona Virus/COVID 19 Infections.

COVID-19 pandemic has brought the whole world stand still, locked down in their homes, infecting more than 8 million people, and many thousands (449,182) -have lost their lives across the globe. Due to lack of any definitive medicine or vaccine, treatment options are supportive of oxygenation, antiviral, antiretroviral drugs, antibiotics, fluid/ electrolyte, mechanical ventilation with ICU (Intensive Care Unit) support, and chloroquine/hydroxychloroquine have been tried to fight this infection. However, mortality due to severe pneumonia, ARDS (Acute Respiratory Distress Syndrome), and multiorgan failure arising from the overactive immune response (storm) mediated by cytokines remains a treatment challenge in elderly and patients with severe medical comorbidities. Recently, anti-inflammatory, angiogenic, immune-modular, and healing properties of intravenous injections of culture derived stem cells have been proposed and shown to benefits in a small number of patients with severe COVID-19 infections. Based on previous experience with other viral infections, convalescent plasma, and serum transfusion are being used as a source of neutralizing antibody/factors to minimize the effects of inflammatory cytokines in this infection. Immunotherapy with purified monoclonal antibodies and conditioned serum with a mixture of unique cytokines are also being developed. Regenerative Medicine has emerged as a crucial adjuvant tool in promoting healing and early recovery in severe COVID-19 infections and other supportive treatments.

Alternate sequential suture tightening: a novel technique for uncontrolled postpartum hemorrhage.

Objective. The most commonly described technique of modified B-Lynch suture may not be suitable for all the patients presenting with flabby, atonic uterus. Study Design. A retrospective analysis of twelve patients with uncontrolled postpartum haemorrhage, who underwent this procedure from March 2007 to September 2012, was conducted. In this novel technique, sutures are passed in the lower uterine segment and are tightened alternately to control uterine bleeding. Results. Average duration of the procedure was 4 minutes (range 2-7 minutes). Average blood loss was 1625 mL (range 1300-1900 mL). Eleven patients (91.66%) were seen to have a successful outcome with only this technique. No patient required hysterectomy and one patient (8.33%) required additional bilateral internal iliac artery ligation. All the patients had a minimum follow-up of 2 yrs and none of them reported any infertility problems. Conclusion. This technique is simple, quick, and effective. There was no adverse effect on the fertility potential for the observed 2 years; however, a long-term follow-up is required to comment on its actual rate. This technique cannot replace the standard modified B-Lynch technique for uncontrolled postpartum haemorrhage but can be used for unresponsive, flabby, and atonic uterus.

Pelvic angiomatosis: an unusual cause of recurrent obstructed labor: a case report and review of literature.

BACKGROUND: Pelvic angiomatosis is a very rare cause of obstructive labor. MATERIALS AND METHODS: A 26-year-old P2 L2 had two cesarean sections for recurrent obstructed labor due to a large pelvic mass. Investigations after the first cesarean section suggested a benign nature of the mass for which she was advised surgical resection, but she refused due to social reasons. Tumor had pelvic and extrapelvic part extending through obturator foramen into the right thigh. Resection of the pelvic part by abdominoperineal approach led to a profusely bleeding bed which was managed by ligation of bilateral internal iliac artery. Resection of extrapelvic part was attempted but it was abandoned due to hemodynamic instability of the patient. RESULTS: Patient is asymptomatic and is having a relatively static residual extrapelvic part of pelvic tumor for last 2 years. CONCLUSION: Pelvic angiomatosis is a very rare condition but should be considered and ruled out in case of a pelvic mass of uncertain origin. MRI plays an important role in the initial diagnosis, in surgical planning and in the follow-up in order to detect recurrences. Surgical resection should be as conservative as possible, balancing the need for complete surgical extirpation with the morbidity of the procedure.

Primary invasive carcinoma of vagina with third degree uterovaginal prolapse: a case report and review of literature.

BACKGROUND: Primary vaginal carcinoma associated with third degree uterovaginal prolapse is very rare. CASE: We present a case report of a postmenopausal woman who presented with an invasive carcinoma of vagina associated with third degree uterovaginal prolapse treated by Mitra's operation. She was asymptomatic and had no recurrence during last 1 year of follow-up. CONCLUSION: Vaginal ulcer associated with long standing genital prolapse need careful evaluation (including punch biopsy) for underlying carcinoma. Treatment due to the rarity of this entity was controversial previously and current review of literature suggests surgical treatment with or without radiotherapy as the optimum treatment for early stage and radiotherapy for advanced stage vaginal carcinoma associated with genital prolapse. Early diagnosis with adequate treatment can minimize the morbidity and mortality associated with vaginal carcinoma.

Retroperitoneal adenocarcinoma of unknown origin presenting as a rare cause of obstructed labor.

BACKGROUND: Metastatic retroperitoneal adenocarcinoma presenting as obstructed labor is extremely rare. CASE: An unbooked 35-year-old multipara came to our casualty in obstructed labor at 38 weeks of pregnancy. A palpable retroperitoneal mass was found behind the gravid uterus and cervix after delivery of a live baby during emergency cesarean section. Needle biopsy was taken from the mass and abdomen was closed due to nonavailability of frozen section facility at night. Post cesarean section CT scan confirmed the pelvic mass, which was subjected to open biopsy. A diagnosis of retroperitoneal adenocarcinoma with an unknown primary was made based on histopathology and a negative workup for the possible primary sites. Patient was treated successfully with chemotherapy and did not show recurrence for last 2 years of follow-up. CONCLUSION: Surgeons should be aware of this extremely rare entity and it highlights the importance of proper antenatal care to pick up such pathology at an early stage by careful examination and ultrasound to minimize the morbidity and mortality. We also suggest frozen biopsy in a suspected pelvic mass during surgery and early cesarean section to avoid the complications of obstructed labor in such advanced stages of malignant tumor.

Congenital spinal tuberculosis associated with asymptomatic endometrial tuberculosis: A rare case report.

Spinal tuberculosis constitutes 50% of all musculoskeletal tuberculosis. However, literature regarding congenital spinal tuberculosis is very scanty. Congenital spinal tuberculosis was diagnosed in a two-month-old child on the basis of age at presentation (gibbus since three weeks of age), hepatomegaly, raised ESR, radiological destruction of D10-D11 vertebrae, asymptomatic maternal endometrial tuberculosis and tuberculous histopathology from CT guided biopsy specimen from D10 vertebra. Both child and mother were treated by antitubercular treatment. Child improved symptomatically, gibbus became less prominent and ESR became normal at the end of one year of treatment. Patient had no recurrence during last two years of follow-up. This is the first case of congenital tuberculosis of spine with a documented source of infection from asymptomatic maternal endometrial tuberculosis. CT guided core biopsy from vertebra/aspiration from the paravertebral abscess help in early diagnosis and treatment to reduce neurological morbidity and mortality. Endometrial biopsy help in establishing the diagnosis of congenital tuberculosis and adequate antitubercular treatment in such cases may provide protection to fetus in subsequent pregnancy.

Coexisting genital tuberculosis and endometriosis presenting as abdominal mass in an infertile woman: a report of a rare case.

OBJECTIVE: To document a rare case of coexisting endometriosis and genital tuberculosis. DESIGN: Case Report. SETTING: Tertiary-care center. PATIENT(S): A 24-year-old infertile woman presented with atypical clinical and radiological features that were suggestive of an ovarian malignancy. INTERVENTION(S): Exploratory laparotomy with left-sided salpingo-oophorectomy and right-sided ovarian cystectomy. Coexisting endometriosis and tuberculosis were diagnosed postoperatively on the basis of histopathology with positive polymerase chain reaction and culture for Mycobacterium tuberculosis. The patient was treated with antitubercular drugs and GnRH agonist for 6 months postoperatively. MAIN OUTCOME MEASURE(S): Impact of dual pathology of genital tuberculosis and endometriosis of fertility. RESULT(S): The patient improved symptomatically but declined infertility treatment because of financial crisis. The patient did not conceive spontaneously and is currently disease free, 1 year postoperatively. CONCLUSION(S): Coexisting endometriosis and tuberculosis simultaneously affecting tubes and ovaries is rare. Such combined pathology has a greater impact on fertility and may lead to a dilemma in diagnosis and management because of the unusual clinical picture. Early diagnosis by surgical exploration, as well as adequate treatment, may improve fertility.