Spectrum of Gynecological Malignancies at Jamshoro.

OBJECTIVE: To describe the frequency and spectrum of different types of gynecological malignancies. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, from January 2014 to December 2015. METHODOLOGY: All patients with gynecological malignancies, admitted at the study place, whether previously diagnosed or need to establish the diagnosis on the basis of EUA, biopsy, staging and for surgery during the study period were included. All patients with benign gynecologic masses were excluded. Studied variables were age, marital status, parity, education, socioeconomic status, clinical presentation, clinical diagnosis, tumor site and surgical procedure. The diagnosis and type of malignancy was confirmed on the histopathology report of the specimen taken. RESULTS: There were a total of 65 patients (6.39%) with gynaecological malignancies. The median age was 15 years (46.26%). Ninety-four percent were married. Seventy-one percent had a poor socioeconomic status. Cervical cancer was most common as seen in 27 (41.5%) followed by ovarian malignancy in 21 (32.3%) of cases, uterine caners in nine (13.8%), vaginal cancer in six (9.2%), and vulval cancer in three (4.6%) of cases. The common histopathological type of cervical cancer was moderately differentiated squamous cell carcinoma (n=19, 29.2%), papillary serous cyst adenocarcinoma in ovarian (n=13, 20.0%), and squamous cell carcinoma in vagina and vulva. There was no case of primary fallopian tube malignancy. CONCLUSION: Gynecological malignancies are common in younger age group. The need is to strengthen screening practices, making it easy and cost-effective for all the general and at risk population, so that early detection and treatment can be possible to control the female genital tract cancers.

Effect of preoperative vaginal cleansing with an antiseptic solution to reduce post caesarean infectious morbidity.

OBJECTIVE: To determine the effectiveness of pre operative vaginal cleansing with an antiseptic solution to reduce post caesarean infectious morbidity. METHODS: An observational case control study was conducted at Department of Obstetrics and Gynaecology, Unit-III, Liaquat University Hospital, Hyderabad from February to July 2010. The 100 women in control group received the standard abdominal preparation only, while the 100 subjects in interventional group also received preoperative vaginal cleansing with 10% pyodine along with the usual abdominal scrub. All subjects received prophylactic antibiotic cover during the surgery. Maternal demographics, surgical parameters and infectious outcome were collected and data compiled on a pre-designed proforma and analysis was done using SPSS 15. RESULTS: The comparison between two groups did not show a significant difference in patient's demographics, labour and surgical variables. Post caesarean endometritis occurred in 1% of case group and 7% of controls (p value: <0.03). There was no measurable effect seen on development of fever and wound infection However, statistically significant reduction in overall composite morbidity i.e. p value: <0.02 and odds ratio 0.335 (CI=0.125-0.896) was seen in patients with vaginal cleansing group when compared with controls. CONCLUSION: Preoperative vaginal cleansing with pyodine has reduced post caesarean infectious morbidities.

Attitude and knowledge of medical students of Isra University about dysmenorrhoea and its treatment.

BACKGROUND: Dysmenorrhoea is the term for painful menstruation. It is a common gynaecological complaint among female adolescent. The objective of this study was to assess attitude and knowledge about treatment of dysmenorrhoea among medical students of Isra University. METHODS: This study was conducted at Isra University Hyderabad. Non-probability, convenient random selection from MBBS student was done. Participants included were 18-25 years of ages, irrespective of marital status. Girls with irregular menstrual cycles, primary or secondary amenorrhea were excluded from the study. Pre-designed questionnaire was filled by the students. RESULTS: A total of 197 female medical students were recruited, dysmenorrhoea was reported in 76%, of these 62.43% had primary and 13.19% had secondary dysmenorrhoea. Majority 89 (59.70%) of the girls had mild G1 to moderate 48 (32.21%) G2 dysmenorrhoea and twelve 8.05% were with sever dysmenorrhoea. The most common symptoms observed were abdominal cramps 94 (63%), irritability 91 (61.07%), headache 41 (24.5%) and vomiting 34 (22.8%). Different attitudes of students were assessed, that 40.6% of subjects can not do their routine work and 19.3% remain absent from education place. Only 69.5% students were using commercial pads, 67% girls were not taking bath and 92.4% were not doing exercise during menstruation, only 15 (7.6%) were doing exercise from the study population. Simple analgesic was the most known drug to 49.7% of participants for relief of dysmenorrhoea pain. CONCLUSION: Dysmenorrhoea is a common problem among young girls, and it significantly affects their class attendance, academic performance and routine work. Even being medical students, strong cultural believes were observed regarding menstrual cycle. Attitudinal changes are necessary to develop, educational strategies, appropriate use of medications and consultation with physician, to empower these young girls regarding healthy life-style.

Efficacy of aloe vera gel in the treatment of vulval lichen planus.

OBJECTIVE: To compare the efficacy of aloe vera gel and placebo in the topical management of vulval lichen planus. STUDY DESIGN: Randomized, double-blind, placebo-controlled trial. PLACE AND DURATION OF STUDY: Department of Dermatology, Isra University Hospital, Hyderabad, from January 2007 to January 2008. METHODOLOGY: Thirty-four female patients were randomized into two groups to receive aloe vera gel or placebo for local application for 8 weeks. Clinical data and treatment response was graded according to Thongprasom criteria. Z-test was used for comparing response between the groups. RESULTS: Thirty-four consecutive patients participated in the study. We found erosive and ulcerative lesions in 83% and 17%, respectively. The most common site of vulval lichen planus was the labia minora. Fourteen (82%) out of 17 patients treated with aloe vera had a good response i.e. clinically improved by at least 50% after 8 weeks of treatment, while one (5%) of 17 placebo-treated patients had a similar response (p < 0.001). Furthermore, one patient (5%) treated with aloe vera had a complete clinical remission. No side-effects were found in both groups. CONCLUSION: Aloe vera gel was a safe and effective treatment for patients with vulval lichen planus.

Frequency of vaginal candidiasis in pregnant women attending routine antenatal clinic.

OBJECTIVE: To determine the frequency of vaginal candidiasis in clinically symptomatic and asymptomatic cases of pregnant women attending routine antenatal clinic. STUDY DESIGN: A descriptive cross-sectional study. PLACE AND DURATION OF STUDY: The antenatal clinic of Gynaecology and Obstetric Department at Isra University Hospital, Hyderabad, from April to October 2005. PATIENTS AND METHODS: A total of 110 pregnant women were nonrandomly recruited by convenient sampling. The studied variables included the demographic data information on parity, trimester of pregnancy, presence of vaginal discharge and the presence or absence of diabetes. Vulva and vagina were inspected for signs of inflammation and discharge with sterile speculum and vaginal specimens were collected with sterile cotton tipped swabs. Swabs were subjected to Gram staining and examined microscopically for the diagnosis of candidiasis. RESULTS: The frequency of vaginal candidiasis during pregnancy was found to be 38%, in which 27% were symptomatic and 11% were asymptomatic group. Increased ratio of infection was observed in multigravida and diabetic women. There was no marked differences in results with respect to age and trimester of pregnancy. CONCLUSION: Although there is generally a high frequency of vaginal candidiasis, an increased ratio of vaginal candidiasis in multigravida and diabetic pregnant women requires these women to be routinely screened for vaginal candidiasis regardless of symptomatic status.