bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of outcome of interdigitated versus sequential brachytherapy along with concurrent chemoradiation in locally advanced carcinoma cervix
Authors: Rani Moni , Mondal Ratindra N. , Hosen Munshi M. A. , Khatun Julekha , Ghosh Ashim K. , Khatun Rawshan A.
Published: July 2023

Background: Carcinoma cervix is a significant health concern, particularly in lower socioeconomic groups. The effectiveness of interdigitated versus sequential brachytherapy, both with concurrent chemoradiation, in treating this condition remains underexplored.
Methods: This quasi-experimental study at Rajshahi Medical College Hospital enrolled 63 patients with biopsy-proven squamous cell cervical cancer. They were randomly divided into two arms: arm a received pelvic EBRT 50 Gy in 25 fractions, followed by HDR brachytherapy (7 Gy weekly × 3 weeks) starting after 30 Gy of EBRT; arm B received the same pelvic EBRT, followed by HDR brachytherapy (7 Gy weekly × 3 weeks) starting a week after the completion of EBRT.
Results: Mean age was 47.82±8.45 years (range: 29-64 years). The mean OTT was significantly reduced in arm-A (36.58 days) compared to arm-B (59.5 days). In terms of treatment response, 90.32% of patients in arm-A and 78.12% in arm-B experienced a complete response.
Conclusions: Interdigitated brachytherapy with concurrent chemoradiation significantly reduces treatment time without compromising treatment effectiveness. Despite a shorter treatment duration, the complete response rate was slightly higher in the interdigitated arm.
Comparison of ophthalmic artery Doppler indices among hypertensive and normotensive pregnant women in third trimester: association with perinatal outcomes
Authors: Manchu Madhuri , Reddi Geeta Vandana , M. Ravali Ranjith
Published: July 2023

Background: In this study, we compared ophthalmic artery Doppler indices between normotensive and hypertensive pregnant women in third trimester and then evaluated if the alterations in ophthalmic artery doppler indices were seen in all the types of hypertensions in pregnancy or confined to preclaampsia. Further we tried to see correlation of ophthalmic artery Doppler indices with perinatal outcomes in terms of fetal growth restriction (FGR), prematurity, neonatal intensive care unit admission (NICU) and maternal outcomes and tried to arrive at mean values of ophthalmic artery Doppler indices to predict adverse outcomes.
Methods: 50 hypertensive and 50 normotensive pregnant women were recruited in third trimester. A thorough history about hypertension was taken, obstetric scan was done to know estimated fetal weight, and doppler of umbilical, middle cerebral artery, uterine arteries was done. Simultaneously maternal ophthalmic artery Doppler readings were taken, women were followed up after delivery and perinatal outcomes were recorded.
Results: Comparison of mean values of ophthalmic artery doppler parameters in women with and without hypertension showed statistically significant differences with respect to the peak systolic velocity 2 (PSV2), PI (pulsatility index), RI (resistivity index) and peak ratio (PR) (PR=PSV2/PSV1). Significant difference was found only in PR value in preeclampsia group compared to other subgroups of hypertension. In the hypertension group complicated with FGR the mean peak ratio=0.8 whereas in the hypertension group requiring preterm delivery the mean peak ratio=0.78, and in the hypertension group requiring NICU admission the mean peak ratio=0.81. At ophthalmic artery PR cut off ≤0.725, the sensitivity and specificity were 76% and 65% respectively to predict FGR.
Conclusions: Pregnancy complicated by hypertension showed alterations in ophthalmic artery Doppler indices. Among the subgroups of hypertension, ophthalmic artery PR was the best index for discriminating preclampsia from other types and it was significantly higher in hypertensive pregnant women who had adverse perinatal outcomes. Ophthalmic artery PR has almost similar performance as uterine artery PI in indicating FGR in our study. It could also indicate maternal disease severity such as hypertensive crisis requiring ICU admission, the study number was small.
Association of biochemical markers with time of onset and severity of hypertensive disorder of pregnancy
Authors: Jaiswal Aditi , Hooja Nupur , Sharma Pooja , Monika  , Verma Krupa , Panwar Babita
Published: July 2023

Background: Hypertensive disorders of pregnancy (HDP) are a common cause of morbidity and mortality. Inflammation is considered as one of the etiologic factors along with a complex interplay of multiple genetic, nutritional and other environmental agents. This study was undertaken to find association of biochemical markers with severity and time of onset of HDP.
Methods: Institutional review board and ethics committee approval was taken prior to the study. History and examination was done. Blood pressure was recorded at each antenatal visit. Blood samples were taken for the study of biochemical markers-hsCRP and interleukin 6 levels. Data was analyzed. P value <0.05 was taken as significant.
Results: Of the 80 women, 27.5% had early onset HDP. 72.5% had severe HDP. Inflammatory indices were altered as compared to the range of normal pregnant women. Mean IL-6 and hsCRP levels were found to be raised but no statistically significant association was observed between IL-6 levels or hs-CRP levels and time of onset of HDP (p value = 1 and 0.5859 respectively and severity of onset of HDP (p value = 0.197 and 0.453 respectively).
Conclusions: Biochemical indices, IL-6 and hs-CRP levels were elevated in women with HDP, indicative of increased inflammation.
Serum ferritin level and its association with gestational diabetes mellitus in pregnancy
Authors: N. Anushree , Prabhu Sujatha , Fathima Sana
Published: July 2023

Background: Short term as well as long term effects of GDM on both the mother and the child are preventable if screening and diagnosis are done at an early stage. Efforts have been made to try and identify clinical and biochemical markers that could predict GDM. Ferritin, an acute phase reactant is one such protein. This study was undertaken to know if there is an association between serum ferritin level and GDM in pregnancy.
Methods: A prospective study conducted in the Department of OBG, ESIC-MC-PGIMSR from January 2020 to June 2021. 388 gravid women satisfying the inclusion criteria were enrolled for the study after obtaining an informed written consent and maternal serum ferritin was assayed between 24 to 28 weeks of gestation and was statistically analysed.
Results: Both group demographic characters were matched and they were also matched for Hb% thereby eliminating anaemia, a confounding factor for the study. The mean serum ferritin level in GDM group was 46.4 ng/ml and in non-GDM group was 37.3 ng/ml (p<0.001). With ROC (Receiver operator characteristics curve) the cut off value of serum ferritin is 34.7 ng/ml with 95% CI, with sensitivity of 71% and specificity of 63%.
Conclusions: In this study S. ferritin value of >34.7 ng/ml at 24-28 weeks of gestation, there is 63% risk of developing GDM. Thus, we conclude that elevated serum ferritin level could be used as a biochemical marker for prediction of GDM.
New World Health Organization labour care guide in reducing intrapartum caesarean section rates at tertiary care hospital-Hassan institute of medical sciences, Hassan
Authors: H. N. Poornima , V. Nayanashree , H. L. Premalatha , Doreswamy Nirmala
Published: July 2023

Background: The Aim of this study was to assess whether labour monitoring using new WHO LCG will result in reducing intra partum caesarean sections.
Methods: A analytical study was conducted from the month of September 2022 to January 2023 among 1735 pregnant women admitted at Hassan institute of Medical Sciences, in active phase of labour (5cm cervical dilatation and above) after obtaining informed consent.
Results: In the present study, the New WHO Labour Care guide was plotted for 1735 pregnant women among which 1668 (96%) of the total patients had vaginal delivery, while 67 (4%) of the patients underwent Cesarean Section. Among the patients who underwent Cesarean Section it was found that1082 (94%) of the total Cesarean Sections were in latent phase of labour before plotting of the new WHO Labour care guide whereas only about 67 (6%) of Cesarean Section were conducted in active phase of labour.
Among the patients who underwent LSCS in the active phase of labour majority were due to fetal distress 29(43%), 21(31%) due to Cephalopelvic disproportion, 13(20%) due to Non progression of labour and about 4(6%) due to Deep Transverse Arrest
Conclusions: Majority of the caesarean sections were conducted in the latent phase of labour. The New WHO Labour Care guide has reduced the occurrence of intrapartum caesarean sections in the active phase of labour. However the overall rate of caesarean section must be controlled by reducing the number of Cesarean Sections conducted in latent phase of labour, that is before plotting the New WHO labour care guide.
Positive correlation between latent female genital tuberculosis and low anti-mullerian hormone levels in young individuals
Authors: Rahman Emrana
Published: July 2023

Background: The female vaginal tract is likely getting more like to be latently affected by tuberculosis today. By using typical tests like animal vaccinations, culture, and histology, this participation is challenging to diagnose. Some researchers have investigated the tubercular disease’s ovarian affliction bacteria, but further research is needed on hormonal affection. In those circumstances, evaluating anti-Mullerian hormone (AMH) is used to gauge how well the ovaries are functioning.
Methods: 200 patients who visited Janm IVF Centre, Bhagalpur within a year with clinically relevant indications verified infertility were intended for in vitro fertilization. 180 of these individuals who met the criteria for inclusion were recommended to have a PCR (polymerase chain reaction) and as a standard examination of their ovarian function to estimate the hormone test. A control group of 105 fertile individuals was also included.
Results: Out of the 180 subjects, 50 (44.46%) were not detected by PCR, while 130 (55.54%) were. A statistically significant difference has been found between the AMH levels in the PCR-positive group and the PCR-negative and fertile group.
Conclusions: Infertility can result from tubercular involvement of the reproductive tract because it reduces AMH secretion and ovarian reserve.
A histopathological study of hysterectomy specimens and their clinical correlation in patients at tertiary health care setup in Bundelkhand region of Uttar Pradesh
Authors: Agarwal Sippy , Sharma Seema , Pandey Divya
Published: July 2023

Background: Women in their life time are prone to develop several neoplastic and non-neoplastic lesions in her uterus and cervix basically due to hormone responsiveness of female genital tract system. The aim of the study was to evaluate all hysterectomy specimens and to study the pattern of pathological changes of different lesions occurring in cervix and uterus associated with different age groups.
Methods: This retrospective cross-sectional, study was conducted on patients undergoing hysterectomy in department of obstetrics and gynecology in MLB Medical College Jhansi and hysterectomized specimens reported to department of pathology for further evaluation. Total 35 hysterectomy specimens were included in the study with age of patients varying from 30 years to 60 years. Detailed clinical and other relevant history were taken followed by thorough gross examination and histopathological evaluation.
Results: Majority of hysterectomy specimens were sent for histopathological examination in the department of pathology, out of these 30 (85%) were total abdominal hysterectomy specimen, 5 (14.28%) were of vaginal hysterectomy specimens. Out of all these cases, in 7 (20%) cases bilateral or unilateral salpingopherectomy done.
Conclusions: In our study, most common surgical procedure for hysterectomy was abdominal hysterectomy 30 (85.7%) followed vaginal hysterectomy 5 (14.28%) All the vaginal hysterectomy was done for second- and third-degree utero-vaginal prolapse. Most prevalent endometrial histopathological finding in our study is non-secretive 15 (42.8%), secretive 7 (20%) followed by atrophic 6 (17.1%) as most of the patients in our study presents with abnormal uterine bleeding and menorrhagia 23 (65.7%).
A clinical study on management of major primary postpartum haemorrhage at tertiary care centre
Authors: Arvindar  , Sen Sangeeta , Khushi
Published: July 2023

Background: Postpartum Haemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide. It is estimated that about one quarter to one half of preventable maternal deaths are because of haemorrhage.  It is defined by the royal college of obstetrician and gynaecologist  as blood loss from the genital tract within the first 24 hours after birth of at least 500ml (minor) and at least 1000ml (major) causes of post-partum haemorrhage (PPH) are commonly ascribed to the four Ts (tone, trauma, tissue, 4 thrombin).
Methods: This study aimed to assess the clinical practices used by our hospital in managing major PPH. Observational study of the management of PPH over a period of 2 months from March 2023 to April 2023 was carried out. Criteria examined: history of previous PPH causes of PPH, use of oxytocin in the first stage for more than 6 hours. Role of blood transfusion, presence of senior faculty, and type of uterotonics used.
Results: There were 50 patients diagnosed with major PPH among which 26 had caesarean delivery. Two major risk factors were analysed, one was Use of oxytocin in first stage for more than 6 hours and history of previous PPH. Uterine atony was commonest cause in 64% of cases.
Conclusions: Uterine atony is responsible for most of cases. Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with major PPH.
A prospective randomized controlled trial to study the effect of prenatal yoga on maternal weight gain and psychological stress in pregnancy and its association with pregnancy outcomes
Authors: Shukla Akriti , Prasad Deeksha , Sharma K. Aparna , Shainy Peyyala , Singh Divya , Sharma Vinay , Vanamail P. , Sharma Gautam
Published: July 2023

Background: Objective of study was to evaluate the effect of prenatal yoga on maternal gestational weight gain (GWG) and psychological stress in pregnancy (PSS) and to evaluate the effect of prenatal yoga on labour outcomes.
Methods: Prospective randomized controlled trial conducted at AIIMS, New Delhi between May 2020-December 2021. Sixty women each were recruited in the yoga and control group. Women in the yoga group attended 60 minutes supervised yoga sessions followed by self-sessions. Women in the control group received routine antenatal care along with 30 minutes per day of walking and dietary counselling. The assessment was done for the weight(WT), dietary intake (D) and perceived stress score (PSS) at the time of recruitment (WT1, D1, PSS1), 28 weeks (WT2, D2, PSS2) and 36 weeks (WT3, D3, PSS3) and the results were then compared.
Results: At recruitment all the parameters in both groups were comparable. The difference in mean and difference in percentage in terms of gestational weight gain (GWG) at recruitment and at 36 weeks was statistically significant (p-value=0.027). The per cent weight gain in the Yoga group was significantly low (p value=0.048). The control group experienced more amount of stress both at 28 weeks (p-value = 0.021) and 36 weeks (p-value <0.0001). The difference in mean and difference in percentage in terms of PSS1 and PSS2 (p-value=0.011), PSS2 and PSS3 (p-value=0.0001) PSS1 and PSS 3 (p-value=0.0001). Labour outcomes were comparable between both groups.
Conclusions: Yoga helps in controlling excessive GWG and helps prevent many adverse feto-maternal outcomes associated with obesity.
A prospective study of association of inflammatory markers with BMI in women with polycystic ovarian syndrome
Authors: Jain Shalin , Barya Smita , Sharma Rajrani , Joshi Ruchi
Published: July 2023

Background: Many studies have demonstrated the association between polycystic ovary syndrome (PCOS) and chronic low-grade inflammation to be of unknown mechanism or an unclear cause; which could either be due to the underlying obesity, insulin resistance, or the polycystic ovary syndrome itself. The aim of our study was to find if there was any correlation between the inflammatory markers and body mass index (BMI) in women with PCOS.
Methods: Our study included 100 women aged between 18-45 years with PCOS and were recruited for the study in the obstetrics and gynecology department, Pacific Medical College and Hospital, Rajasthan from October 2020 to April 2022. The enrolled patients then underwent a series of clinical, ultrasonographic and biochemical investigations.
Results: WBC was positively correlated with BMI (r=0.453, p<0.000) Along with that, we were also able to establish a moderate degree positive correlation between BMI and serum CRP levels (r=0.396, p<0.000). A high degree significant positive correlation was found between ESR count and BMI (r=0.537, p<0.000) and platelet count and BMI (r=0.386, p<0.000).
Conclusions: We discovered that higher WBC concentration, ESR count, platelet count, and serum CRP levels are linked to PCOS. Increase in serum inflammatory cardiovascular risk markers are brought on by PCOS and obesity. In order to determine the relative contributions of various factors, such as insulin resistance, androgen status, and BMI, further studies need to be carried out with a larger sample size as the mechanism for the chronic low-grade inflammation still remains unclear.
Comparison of maternal outcome in COVID-19 positive and negative antenatal women: a comparative study
Authors: Mall Vinay , Singh Reeta , Aditya Vani , Mall Shilpa , Chauhan Mudit
Published: July 2023

Background: Coronavirus is an RNA virus causing respiratory and gastrointestinal infections. It caused SARS and MERS epidemics. In late 2019, a mutation called SARS-CoV-2 caused COVID-19, a severe respiratory illness. Pregnant women are at risk, but information is limited. The second wave affected pregnant women more. Maternal COVID-19 can lead to preterm births and caesarean sections. Vertical transmission to neonates is possible. Ongoing research is crucial to understand COVID-19's impact on mothers.
Methods: A comparative prospective hospital-based study was conducted, including antenatal women with COVID-19 symptoms in the case group. The control group consisted of antenatal women who tested negative for COVID-19. The study analyzed 150 COVID-19-positive antenatal women and 350 COVID-19-negative antenatal women, excluding those who left the study prematurely or tested positive during the study period.
Results: In the case group, no abortions were reported (0%), while in the control group, there was 1 abortion (0.29%). PROM occurred in 5.78% of cases and 1.43% of controls, with a significant difference. PPROM occurred in 2.31% of cases and 2.57% of controls, showing no significant difference. Preterm labor was observed in 11.53% of cases and 3.71% of controls, with a significant difference.
Conclusions: Pregnant women with COVID-19 experience diverse symptoms, highlighting the importance of vigilant monitoring. Adverse maternal outcomes, including preterm labor and ICU admission, are more common in infected individuals. Managing comorbidities, such as diabetes, is crucial.
A comparative study on maternal and foetal outcome between low and normal amniotic fluid index in term pregnancies
Authors: Kharakwal Sushila , Shobhane Hema J. , Agarwal Sippy , Mehboob Zainab
Published: July 2023

Background: In pre-eclampsia, there is increased uteroplacental resistance and reduced fetal perfusion due to inadequate invasion of spiral arterioles by trophoblast cells. This causes impaired fetal growth and fetal hypoxia. To assess the usefulness of fetal Doppler in predicting adverse perinatal outcome in preeclampsia.
Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio>2 standard deviation (SD) or UA-Pulsatility Index (PI) and UA-Resistive Index (RI) >2SD were taken as abnormal. The middle cerebral artery (MCA) was visualised and cerebroumblical PI ratio calculated. MCA-RI<2SD was taken as abnormal.
Results: There were 107 women in the study. Major adverse outcomes 11. Umbilical artery-S/D ratio>2SD (RR 4.46, 95%, CI 1.40-14.17) and RI>2SD (RR 3.36, 95%, CI 1.03-10.61) and MCA RI<2SD (RR 4.46, 95% CI 1.4-14.17) had a high relative risk to predict adverse major perinatal outcome. 39 babies were admitted in neonatal nursery and no parameters could predict them. Though UA-PI>2SD predicted acute fetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis.
Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted.
Case series: transverse vaginal septum with vaginal atresia
Authors: Jain Amrita , Mutyapwar Sneha Shekharreddy
Published: July 2023

This study includes case series of three cases of transverse vaginal septum with vaginal atresia. Cases presented with either primary amenorrhea or hypomenorrhea or secondary amenorrhea with complaints of cyclical abdominal pain. On examination, all cases had well developed secondary sexual characters, blind vaginal pouch with enlarged uterus felt on per rectal examination. Hormonal profile of all three cases was within normal limit. Karyotyping was done for all three cases, results were 46 XX. Radiological findings were that all cases had hematocolpos and one case had OHVIRA syndrome i.e.; absent right kidney with didelphys uterus with right hemivagina transverse septum. Management of all three cases included resection of transverse vaginal septum with vaginoplasty. Transverse vaginal septum was dissected and was used to create neovagina. Post-operatively, patients were advised to use phantom dilator, for 3-4 times in a day for atleast 3 months, to avoid vaginal stenosis. Cases were followed in OPD every monthly for 3 months, dysmenorrhea was relieved and patients were menstruating regularly with moderate flow for 3-4 days.
Acardia twin-twin reversal arterial perfusion sequence
Authors: Arjaria Tejasvi
Published: July 2023

Acardia twin is a rare, unique complication of monochorionic twin pregnancy. A 2.6% incidence among monochorionic twins has been cited. In such complications a twin with abnormal or non-functional heart is perfused by its co-twin via placental arterial anastomosis. The acardia twin has a poorly developed heart and upper torso. We present a case in which the fetal demise of one fetus of twin pregnancy has been diagnosed in the first trimester, but the patient wishes to continue the pregnancy. This resulted in the unexpected occurrence of an acardia twin after delivery along with one normal twin, placenta was single. A review is presented on therapeutic opportunities and necessity of thorough sonographic evaluation in monochorionic multifetal pregnancies.
Dermoid cyst indenting bladder: a diagnostic dilemma
Authors: Vashisth Neha , Meena Pragati , Meena Seema , Choudhary Richa
Published: July 2023

A dermoid cyst is a benign cutaneous developmental anomaly that arises from the entrapment of ectodermal elements along the lines of embryonic closure. These benign tumors are lined by stratified squamous epithelium with mature skin appendages found on their wall and their lumens filled with keratin, hair, teeth etc. They are usually benign in nature. Mature ovarian dermoid cysts are very common accounting for 25% of all benign ovarian neoplasms. Uncomplicated dermoid cysts are usually asymptomatic and easy to diagnose on imaging. Presentation of dermoid cysts are extremely rare in the urinary bladder and it is a diagnostic challenge to the gynecologist, pathologist and urologist. Only few cases are found and documented till now. We present an extremely rare case of dermoid cyst involving bladder in a 29 year old female who presented with chief complaint of pain abdomen associated with passage of hair through the urine since 2 months. Her cystoscopy showed presence of hair and caseous material on the surface of the lesion.
Large vaginal varicosities in the pregnancy without any known systemic disease: a rare case report
Authors: Soni Sadhna , Sharda Divya , Chavda Arti , Sheetal Yashika
Published: July 2023

Vaginal varices during pregnancy is a rare condition. Only a few cases have been reported in the literature. Most vaginal varices are asymptomatic, but some are associated with a sense of local mass, or severe discomfort and spontaneous vaginal bleeding. A 26-year-old woman was admitted for spontaneous vaginal bleeding at 38 weeks’ gestation. Upon pelvic inspection, we observed dilated vascular structure on the sub-urethral vaginal wall, and the trans-labial ultrasound imaging revealed a blood flow along the vaginal area, confirming the presence of a vaginal varicosity (Figure 3). We concluded that the mass was large vaginal varicosities as there was no discernible etiolgy. Instead of a normal delivery, we performed a cesarean section to prevent the potential risk of the profuse vaginal bleeding. For long-term management, close observation in postpartum period was recommended. Spontaneous resolution is a potential outcome and this is what our patient experienced.
A rare case of cervical ectopic pregnancy: complicated by haemorrhagic shock
Authors: Bhati Bijal S. , Patel Alpesh , Rathod Niketankumar , Patel Mosam
Published: July 2023

Cervical ectopic pregnancy is a rare condition that accounts for less than 0.1% of all ectopic pregnancies with high morbidity and mortality rate. We present a case of a 25 years old G5P3L2A1D1 with history of 9 weeks amenorrhoea and previous 3 caesarean sections (CS) presented with bleeding per vaginum for 2 days. Ultrasound examination revealed a ballooned-out cervical canal with a gestational sac containing foetus with cardiac activity present and an empty uterus with thickened endometrium with a typical hour-glass configuration of the uterus. Thus, the diagnosis of cervical ectopic pregnancy was made. Patient was complicated by haemorrhagic shock. Immediately hysterectomy was performed. Inj. PCV 4 unit and FFP 6 units were given and post-op- patient was shifted to ICU on ventilation support. In ICU, patient was kept on ventilation support for 4 days with vasopressor supports. Antibiotics, antacids, antiemetics, IV fluids, supportive care given. Patient was discharged on post-op day-7 with stable hemodynamics and healthy vaginal vault and stitch line. Improved ultrasound resolution and earlier detection has led to the development of more conservative treatments in non-severe cases that attempt to limit morbidity and preserve fertility.
Disseminated peritoneal leiomyomatosis-diagnostic dilemma in an acute presentation-a case report
Authors: Rajeswari K. S. Raja , Nandhana V.
Published: July 2023

Diffuse peritoneal leiomyomatosis is a rare benign condition which has a multifactorial origin with genetic or hormonal component leading to metaplasia of peritoneal mesenchymal cells. Thus, a combination of radiology with clinical correlation is an ideal approach for diagnosis. Though benign, radiologically it could give a picture of malignancy. In our case, patient came with an acute presentation resembling torsion ovary which usually needs emergency detorsion. In this scenario, multiple radiology component directed the case towards malignancy while ultimately a history, clinical correlation and biopsy revealed its benign nature. Reviewing the reported cases of disseminated peritoneal leiomyomatosis (DPL) incidence has slightly increased in recent years and is more common in patients with a past history of unconfined laparoscopic myomectomy wherein spillage of the myoma content into the abdominal cavity can trigger DPL as these are hormone sensitive tissues. The indolent course of the disease usually suggests a borderline disease, but only histological and immunohistochemical studies can confirm DPL, showing smooth muscle cells without nuclear atypia, strongly expressing estrogen and progesterone receptors. Mainstay of treatment targets in curbing the hormone influence on DPL and surgical management.
Evaluation of radial nerve palsy treatment: tendon transfer with the flexor carpi radialis combination
Authors: Sarker Abu Zaker Hossain , Hossain Sayed Nadir , Siddique Zillur Rahman , Kader Abdul , Paul Rajib , Chakma Subal Jyoti , Roy Milon Kumar , Moktaruzzaman  , Hossain Sazzad , Sarker Uday Kumar
Published: July 2023

Introduction: Radial nerve palsy, a common peripheral nerve injury, significantly impacts the quality of life of affected individuals. The standard treatment is tendon transfer, but the optimal choice of tendon transfers remains a subject of ongoing debate. This study aimed to evaluate the treatment of radial nerve palsy through tendon transfer with the flexor carpi radialis combination in a Bangladeshi population.
Methods: This observational study was conducted over 18 weeks at the Department of Orthopedic Surgery of 3 medical college hospitals in Bangladesh. Forty adult patients with radial nerve palsy were selected based on specific inclusion criteria. Participants were evaluated preoperatively and postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Complications were also recorded.
Results: The majority of participants were male (77.5%) and had right-sided injuries (72.5%). The most common cause of injury was humerus shaft injury (55.0%). The most common site of injury was middle third of the humerus shaft (67.50%). Postoperatively, 85.0% achieved an "Excellent" grade. Complications were minimal, with 90% of participants experiencing no complications.
Conclusions: Tendon transfer with the flexor carpi radialis combination appears to be an effective treatment for radial nerve palsy, with significant improvements in DASH scores postoperatively and minimal complications. Further research is needed to confirm these findings and compare the effectiveness of this treatment with other tendon transfer combinations.
Beyond the incisions: unraveling the superiority between laparoscopic versus open appendectomy
Authors: Islam Mohammad Tarequl , Hasan M. Mahboob , Ahmed Sohel , Basir Abul Kalam , Hasnat Fahmida
Published: July 2023

Background: Appendectomy is one of the most common surgical emergencies worldwide and is performed using either an open or a laparoscopic approach. Although minimally invasive surgeries are replacing open surgical procedures, laparoscopic appendectomy (LA) has not yet been established as the gold standard procedure compared to open appendectomy (OA). This study aimed to compare the outcomes of LA and OA in 100 cases and evaluate the feasibility, safety, and efficacy of LA as the preferred method for treating acute appendicitis.
Methods: This study was a prospective comparative analysis of 100 patients with acute appendicitis who underwent LA or OA. This study was conducted at a tertiary care hospital (CMH Chattogram) between January 2021 and April 2023. Patients were divided into two groups: laparoscopic (n=50) and open (n=50) appendectomy. Both groups were compared for operative time, length of hospital stay, postoperative pain, complication rate, time to return to normal activity, and cosmetic outcome.
Results: The mean operative time was significantly longer in the LA group (43 minutes) compared to the OA group (36.4 minutes) (p<0.001). However, the LA group had significantly less postoperative pain with a mean VAS score of 2.04 at 48 hours postoperatively compared to 5.7 in the OA group(p<0.001). LA group had a shorter length of hospital stay compared to the OA group (3.12 days versus 6.48 days, p<0.001) and a faster time to return to normal activities (7.68 days versus 16.58 days, p<0.001). the LA group had less surgical site infection compared to the open group, with 2 out of 50 compared to 8 in the open group (p<0.46). The cosmetic outcome was measured with the scar scale where the LA group had a significantly better-looking scar with a score of 4.28 versus the score of 8.86 (p<0.001) in the case of the OA group.
Conclusions: While the longer operative time of LA was a drawback, its benefits in terms of the better visual field of vision during operation and improved patient outcomes make it the more favorable option for appendectomy.
Platelet rich plasma: a novel therapy in chronic wounds
Authors: Sakaria Abhijeeth Dinesh , Alva Bhargavi V.
Published: July 2023

Background: Pulse oximeters are vital in healthcare, yet uncertainties remain about potential variations in oxygen saturation (SpO2) measurements depending on the finger used. Our study compared SpO2 values from different fingers in 200 young adults.
Methods: A cross-sectional survey was conducted, capturing SpO2 values from every finger on both hands using a standard pulse oximeter.
Results: Mean SpO2 differed slightly among fingers, from 98.29 (left index finger) to 98.70 (right ring finger). The majority of participants were male (59%) and 20 years old. Pulse rates ranged from 55 to 130 beats per minute, averaging at 85.23 bpm.
Conclusions: Our results indicate finger choice for pulse oximetry can affect SpO2 readings, with the highest mean reading obtained from the right ring finger. This could potentially impact clinical practice.
Comparison between single incision laparoscopic cholecystectomy using conventional laparoscopic instruments vs. four port laparoscopic cholecystectomy in patients of symptomatic cholelithiasis: a prospective randomised study
Authors: Gupta Archit , Gupta Jagdish K. , Jhobta R. S. , Mahajan Anjali
Published: July 2023

Background: The desire to reduce invasiveness, pain, discomfort and improve cosmesis and early return of patient to normal activities is the basis for single incision laparoscopic surgery. The primary aim was to compare post-operative pain and the secondary aim to compare duration of surgery, intraoperative bile spill or stone spill, duration of hospital stay, any postoperative complications and cosmetic outcome between SILC and the gold standard for symptomatic gall stone disease, FPLC (Four port laparoscopic cholecystectomy).
Methods: A total of 150 patients were randomized into two groups, A (SILC) and B (FPLC). Post-operative pain and other intra-operative and post -operative parameters were compared.
Results: The age ranged between 20 years to 76 years most of them being females with body mass index ranging between 19 and 35 kg/m2. Comparison of pain score was done using MEWS scale; which was found to be statistically significantly SILC at 6 hours, mean difference (MD)-0.833 while at 24 hours the difference was not significant (MD- 0.234). Duration of surgery was significantly more (MD-12.17 minutes) in SILC. No addition of port or conversion to open cholecystectomy was required. There were no significant difference between post-operative complications between the two groups. Cosmesis was significantly better in terms of look of the scar (MD-0.867) and recommending it to their relatives (MD-0.700) in SILC group.
Conclusions: SILC is a safe and easily learnable procedure which can be safely be done using conventional laparoscopic instruments in low risk patients. Duration of surgery even after expertise is gained remains to be more than FPLC.
Impact of bariatric surgery on total knee arthroplasty
Authors: Mohamed Awath F. , Juwaiber Ahmed A.
Published: July 2023

Obesity is a key risk factor for the development of knee osteoarthritis, and the incidence of obesity has more than quadrupled in the last 30 years. Total knee arthroplasty is used to treat severe knee osteoarthritis, and the need for initial total knee arthroplasties is predicted to expand rapidly. Total knee arthroplasty, on the other hand, is related with increased problems, longer hospital stays, and higher expenditures in obese individuals. The purpose of this study was to see if bariatric surgery affected knee symptoms in obese (BMI >30 kg/m2) adult patients. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, TRIP, BIOSIS-Previews, and reference lists of retrieved articles were thoroughly searched in English from the earliest available up to 30 December 2022 They included studies with a minimum follow-up of 4 months on the effect of surgically induced weight loss on knee symptoms in obese adult patients. Excluded were research investigating the impact of lipectomy or liposuction, as well as trials in which patients had already undergone total knee arthroplasty. This systematic review comprised 127 studies with a total of 22,229 patients. Despite the fact that several evaluation measures were utilized, an overall substantial reduction in knee pain was observed in 76% of the assessments. After bariatric surgery, all trials assessing the level of knee pain, physical function, and stiffness revealed a considerable improvement. For the majority of the included research, the quality of the evidence was extremely poor or very low, while it was moderate for one study. In obese adult patients, bariatric surgery followed by significant weight reduction is likely to improve knee pain, physical function, and stiffness. However, considering the existing data, high-quality research is required.
Functional and radiological outcome of distal tibia fractures managed with expert tibia nail: a prospective clinical study
Authors: Arora Kamal K. , Kapila Rajesh , Chaudhary Priti , Singla Rahul , Sanan Lakshay
Published: July 2023

Leg bone fractures come at the top because it is actively involved in locomotive system with distal tibia fractures having second highest incidence due to its subcutaneous location with very less muscle mass around it.  Such fractures are mostly comminuted fractures with extensive soft tissue injuries. These are the fractures which extend within approximately 4 cm. from the tibial plafond. As these fractures occur in proximity of weight bearing surface of ankle joint, a slight maladjustment may lead to permanent disability. Non operative treatment/ open reduction and internal fixation with medial or anterolateral plating of these fractures is associated with multiple post-operative complications like infection, wound dehiscence and non-union. Operative treatment allows proper length and anatomical alignment of the limb, early mobilization and hence excellent final results. The present study of 25 cases was done to evaluate the clinical and radiological functional outcome of extra-articular AO type A simple and compound (Gustilo type I and type II) fractures of distal tibia managed with expert tibial nail and complications (post-operative) if any of patients of either sex, same demographic profile admitted through emergency in a tertiary institute of Punjab. Clinico-radiologically results were assessed using Johner and Wruh’s criteria. Authors got excellent results in 88%, good to fair in 08% of the cases. Expert tibia nail provides good mechanical and rotational stability due to multiple, multidirectional distal locking options available in distal tibia fractures.
An elusive case of endoscopic retrograde cholangiopancreatography: a case report
Authors: Tailor Amit , Arain Mohammed M.
Published: July 2023

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic technique which combines endoscopy and fluoroscopy to treat many complications associated with biliary ductal systems. We present an elusive case of ERCP for choledocholithiasis where ERCP was unsuccessful due to the patient’s anatomic orientation. The patient is a 61-year-old Caucasian male who was admitted due to epigastric, right upper quadrant pain, and nausea. Abdominal imaging revealed at least 2 stones in the distal common bile duct. Upon evaluation his management plan included ERCP which was unsuccessful as the patient had a periampullary diverticulum making it difficult to visualize the ampulla. Ultimately, the next step in management was to follow up with laparoscopic cholecystectomy (LC) to alleviate the patient’s pain and symptoms. Postoperatively the patient is stable and doing well on follow up. The patient was referred to a tertiary care center for further management for postoperative ERCP. Although, the interventions attempted for this patient allowed him to become stable, the need for further advancements in ERCP must be established for patients who present with anatomical challenges in order to prevent repeated procedures as well as complications relating to delayed removal of gallstones.
Intramyocardial choristoma-a rare entity: first-ever case report and literature review
Authors: Francis Thomas , Kuthubuddeen Muhammad Hilmi , Ranganathan Radhikkhaa , Hamzah M. K. , Arif M. N. M. , Jasid Abdul Muiz
Published: July 2023

We report the first-ever case of ‘Intramyocardial choristoma’ documented in English-language literature.  A 71-year-old woman, during her preoperative echocardiogram assessment, noted to have a large left ventricle (LV) mass with severe mitral regurgitation (MR). The patient was asymptomatic, with CT scan reported a large dense calcified LV mass. She underwent mitral valve replacement with LV mass resection operation. The mass was completely excised. Histopathological examinations show intramyocardial choristoma, with the lesion shows cardiac muscle with areas of calcification and mature bone tissue, with clear margins. Discharged well post operatively. Commonest clinical scenarios for intracardiac masses are myxomas, infective endocarditis with vegetation and thrombus. Primary cardiac tumours are very rare. Choristoma are rare benign tumour, with histologically normal tissues in an abnormal location, with a very rare recurrence rate. Transthoracic echocardiogram is reliable for the evaluation of the intracardiac masses, but the use of contrast echocardiogram gives additional benefit in analysing the characteristics of the intracardiac mass. For complex lesion, such as intramural component, extension into the inflow or outflow and into pericardial/extracardiac, MRI have added benefits. The treatment of choice is complete surgical resection. Follow up surveillance scans are recommended, as there is a very low risk of recurrence with uncertain prognosis.  A multidisciplinary team approach is highly recommended in managing the patient pre-operative, intra-operative and post-operatively. Post operatively, regular follow up with imaging is recommended.
Progressive preoperative pneumoperitoneum in a patient with giant inguinal hernia: report of a case
Authors: Huerta-Velázquez Jose Miguel , Jimenez-Curiel Alexa , Avalos-González Guillermo
Published: July 2023

Giant hernias have chronic abdominal wall defects that slowly and progressively grow and alter the normal physiology of the abdominal wall. The clinical case we report is a 76-year-old male who began 7 years ago with protrusion in the left inguinal area with progressive increase in volume until reaching the inability to walk is presented. The protocol is followed by pneumoperitoneum insufflation with 500-1000 milliliters (ml) of carbon dioxide daily for 10 days. The treatment of large hernia defects of the abdominal wall produces a large increase in intra-abdominal pressure during visceral reduction, which entails an alteration in cardiorespiratory biomechanics by elevating the diaphragm and reducing venous return. This technique would be indicated in hernias greater than 10 centimeters (cm), as well as in large inguinal and umbilical hernias, with irreducible sacs, with "loss of domain". It is protocolized with preoperative preparation with pneumoperitoneum for 10 days, for subsequent inguinal plasty with Lichtenstein technique, during which a minimum of adhesions were found, managing to preserve the ipsilateral testicle, reducing surgical time and hospital stay, with no data on compartment syndrome in the abdomen after surgery, providing a good alternative in this type of condition.
Adenoid cystic carcinoma of the cribriform pattern and solid lung: case report
Authors: Rebollar Rossy M. , Noverón Diana L.
Published: July 2023

Adenoid cystic carcinoma (ACC) is a malignant neoplasm originating in the salivary glands. However, this type of tumor can be located less frequently in other sites, in this case we focus on the lung. The following case report is about a 63-year-old male, with 2 months of evolution with the presence of dry cough, fever and chest pain. Adenoid cystic carcinoma is diagnosed through biopsy, whether guided by bronchoscopy, thoracoscopy or thoracotomy and exfoliative cytology, these methods allow us to make a definitive diagnosis, which is confirmed by histology/ immunohistochemistry.
Perivascular epithelioid cell tumor of pancreas on the background of chronic liver disease: a case report and review of literature
Authors: Umesh Rohan N. , Janakiraman Saravanan , Thangasamy Selvaraj , Sathyanesan Jeswanth
Published: July 2023

Perivascular epithelioid cell tumours, known as PEComas, of the pancreas are an extremely rare group of neoplasms. This heterogenous entity includes angiomyo­lipo­ma (AML), clear cell sugar tumour (CCST), lymphangioleio­myoma (LAM), and another group of lesions originating from the soft tissues and organs with similar histological and immunophenotype characteristics. To date, only 23 cases have been reported throughout the world with different clinical presentations. We report a 52-year-old lady who presented with a symptomatic mass in the body of the pancreas on the background of hepatitis B virus (HBV)-related chronic liver disease (CLD). She presented with abdominal pain of 2 months' duration. On initial computed tomography (CT) imaging, it revealed a homogenously enhancing lesion in the body of the pancreas. It was T2 isointense on magnetic resonance imaging (MRI), and there was no uptake present in the 68Ga DOTONAC scan. Endoscopic ultrasound with fine needle aspiration (FNA) showed paucicellular material with occasional dysplastic cells. On account of suspicion of a non-functional neuroendocrine tumour, she underwent a distal pancreatosplenectomy. Intra-operatively, the lesion was encapsulated and hard in consistency, and the rest of the pancreas was soft with an undilated MPD. She had a smooth postoperative recovery. Final histopathology revealed benign PEComa of the distal body and tail of the pancreas with HMB 45 and SMA positivity on IHC. Currently, she has been on regular follow up for the last 12 months. PEComas usually present as a histological surprise and are a diagnosis of exclusion. However, knowledge of this exceptionally rare tumour makes diagnosis at the pre-operative level more certain. Resection must be considered, as it leads to a good prognosis and survival.
Colocutaneous fistula with recurrent urinary tract infection: a delayed complication following laparoscopic transabdominal pre-peritoneal repair
Authors: Kumar Santhosh R. , Jayapal Loganathan , Jebakumar Gilbert S. , Muthaiah Jeevanandham , Periyasamy Samyuktha , Tasgaonkar Siddesh S. , Kumar Aishwarya M. , Prabhakaran Raju , Swain Sudeepta K. , Tiruporurgovindasamy Balachandar
Published: July 2023

There has been an increase in incidence of delayed complications following transabdominal pre-peritoneal repair (TAPP) for inguinal hernia in the last two decades. Mesh related visceral complications (MRVCs) are difficult to diagnose and treat. Colocutaneous and colovesical fistualas are rare yet devastating delayed complications caused by mesh migration. We present the case of a 40-year-old man who presented to us after numerous hospital visits with urinary symptoms and a recurring fistula on the left abdominal wall at a previously operated site. Computed tomography revealed an ill-defined collection in left loin region abutting the sigmoid colon and urinary bladder. Owing to acute angulation, the colonoscope could not be passed beyond 30 cm. The patient was managed with cystoscopy, laparotomy, mesh explantation, and sigmoid colon resection.