bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative study on efficacy of myo inositol over metformin in Polycystic ovary syndrome patients
Authors: Shivani D. , Sravanthi Pandala , G. Naga Jyothi
Published: April 2021

Background: Study aimed to determine the effectiveness of Myo-Inositol over Metform in women with established diagnosis of PCOS. Method: A total of 90 women diagnosed with PCOS with Vitamin D deficiency included in the study and divided into 3 groups of 30 each. Group A received Tab. Metformin 500mg thrice daily for a period of 24 wks. Group B women received Tab. Myoinositol 2 gm twice daily for a period of 24 wks. Group C women received Tab. Metformin 500mg twice daily with Tab. Myoinositol 2 gm twice daily. Results: After treatment, 26%, 50%, and 80% were showed regular menstrual cycles (p= 0.001).  After 6 months of treatment, there was a reduction of polycystic ovaries in 50% in group A, 80% reduction in group B, and 93.33% reduction in group C respectively. There was a significant reduction in Acne, Hirusitism, BMI, serum LH, FSH, LH/FSH ratio, free testosterone, total testosterone, serum insulin levels, total cholesterol levels were seen at the end of 24 weeks in 3 groups, but higher significance seen in group C. Conclusion: It is thus evident that Myoinositol administration helps to improve insulin sensitivity and can be used in women with PCOS having insulin resistance. Myoinositol helps in reducing metabolic and endocrine abnormalities in PCOS patients. Myoinositol is safe, inexpensive and easily available, its addition to Metformin can contribute for normalization of the dysregulated metabolism in various tissues including ovaries, pancreas, muscle and enhance the action of Metformin in improving the clinical, biochemical features of PCOS.
Pregnancy outcome in isolated oligohydramnios diagnosed in third trimester
Authors: Singh Pratibha , Pipal Vibha Rani , Pipal Dharmendra Kumar , Ghuman Navdeep Kaur , Yadav Garima , Gothwal Meenakshi
Published: April 2021

Background: The aim of this study was to compare the outcomes of pregnancies complicated by isolated oligohydramnios with the low risk pregnancies with normal amniotic fluid volume.Methods: The present study is a retrospective cohort study of singleton pregnancies diagnosed with Isolated oligohydramnios (AFI≤5) in their third trimester (N=35). Pregnancy outcome was compared with a matched control group of low risk pregnancies with amniotic fluid volume >5 (N=30).Results: The overall incidence of Isolated oligohydramnios was 0.7-0.8%. In oligohydramnios group, significant association were found in null-parity (60% vs 23.33%, p-value<0.005), Fetal growth retardation (25.71% vs 0% p-value<0.02), preterm delivery (22.85% vs 3.33%, p-value 0.025), rate of Induction of labor (40% vs 10%) and cesarean rate for non-reassuring fetal heart rate (20% vs 3.33%, p-value<0.001). Likewise, the incidence of low birth weight was (54.28% vs 13.33%, p-value<0.001) and NICU admissions was (20% vs 0%, p-value<0.01), but there was no difference in Apgar score finding. NICU stay was of short duration and all babies discharged in stable condition, there were no stillbirth or early neonatal death in both groups.Conclusions: Isolated oligohydramnios has an adverse influence on pregnancy and neonatal outcome in the form of FGR, preterm delivery, increased rate of Induction and cesarean section. Despite the high incidence of low birth weight and NICU admissions, the overall early neonatal outcome was similar to the other low risk pregnancies.
Klippel trenaunay syndrome-an obstetric challenge
Authors: K. Kanmani , M. Meena , D. Narmadha , A. Geethu V.
Published: April 2021

Klippel Trenaunay Syndrome is a rare congenital disease characterized by triad of extensive cutaneous haemangiomas (most common), venous varicosities and hypertrophy affecting a leg and/or arm on one side. We report two cases of pregnant women with Klippel Trenaunay syndrome of which one patient presented with Kasabach Merritt Syndrome (refractory coagulopathy). 24-year-old primigravida of 29 weeks with KTS presented with bleeding gums for two days. Known case of diabetes, hypothyroid on treatment and treated TB lymphadenopathy. She had hypertrophy with varicosities and haemangiomas on left lower limb and vulvar region. She was treated for thrombocytopenia at 19 weeks gestation with steroids. Laboratory studies revealed thrombocytopenia. Steroids were given as per haematologist opinion for thrombocytopenia. She had emergency caesarean section with platelet transfusion at 35 weeks as per vascular surgeon opinion. Postoperatively she was given anticoagulants and steroids. 28-year-old primigravida of 39 weeks with KTS admitted for safe confinement. She had surgery for haemorrhoids at 14 years of age and had bleeding per rectum two years back. She had hypertrophy of left lower limb and cutaneous nevus in multiple dermatomes on left half of body. Doppler left lower limb shows superficial varicosities. Laboratory studies revealed normal. With multidisciplinary approach, she had elective caesarean in view of primigravida/breech-footling presentation. Post operatively she was given anticoagulants. The success in the management of these patients requires the participation of multidisciplinary approach. The use of prophylactic anticoagulant is generally advised during the pregnancy and postpartum period.
Association of serum placental growth factor and pregnancy associated plasma protein A between 11 to 14 weeks and pre-eclampsia
Authors: Kumar Namrata , Das Vinita , Agrawal Anjoo , Pandey Amita , Agrawal Smriti
Published: April 2021

Background: Pre eclampsia complicates around 5-10% of pregnancies worldwide. Many countries in the world are far away of having interventions to predict and prevent preeclampsia. A number of biochemical, biophysical and sonographic parameters are emerging as a potential tool which can help us in a long way. This study was aimed to study association of biochemical markers of preeclampsia in early pregnancy with the development of preeclampsia.Methods: This cohort study was conducted over a period of one year in the Department of Obstetrics and Gynecology at King George’s Medical University, Lucknow.Results: Total number of women enrolled at 11-14 weeks were 56. The mean age of women enrolled was 28±4.2 years. Out of total 44.6% women were nulliparous. Mean crown rump length at testing was 60.55±11.26mm. There was a significant correlation between the levels of Placental growth factors and development of PE (p<0.01) and especially severe early onset disease, however we did not found a significant correlation between Pregnancy associated plasma protein and Preeclampsia.Conclusions: Placental growth factor is an emerging marker which could be incorporated in essential bundle of care at 11 to 14 weeks testing in order to enhance the detection rates of preeclampsia.
Effectiveness of low dose versus high dose oxytocin regimen for induction of labour
Authors: Gupta Paridhi , Chawla Indu , Gupta Sonal
Published: April 2021

ABSTRACTBackground: Induction of labour is an indispensable part of modern obstetrics and certainly one of the most frequently performed obstetric procedure in the world. Oxytocin, being the most common inducing agent with multiple protocols being practiced, further research is required for the establishment of better protocol with optimal maternal and neonatal outcomes.Methods: Randomized comparative study including 100 term nulliparous women (randomized into high dose, group-I and low dose, group-II with 50 patients in each group) was done. High dose regimen was started with 4mu/min with increment of 4mu/min up to a maximum of 32mu/min and low dose regimen was started with 2mu/min with increment of 2mu/min up to a maximum of 32mu/min. Induction to delivery interval was the primary outcome. Secondary outcomes noted were rate of caesarean section, tachysytole with or without fetal distress, failed induction, maternal outcomes like need for instrumental vaginal delivery, PPH and choriamnionitis, neonatal outcomes like NICU admission, umbilical cord pH and apgar score.Results: There was significant reduction seen in induction to delivery interval among those induced with high dose oxytocin regimen. It was found to be 6.96±3.77 hours in group-I and 9.05±4.65 hours in group-II (p value 0.034). Though incidence of tachysystole was more in high dose regimen, it was not statistically significant. No significant difference was seen in secondary outcomes.Conclusions: On the basis of present study, high dose oxytocin regimen can be considered for induction of labour as it has same effects as that of low dose regimen with lesser induction to delivery interval.
Fetomaternal outcome of pregnancy complicated by first and second trimester vaginal bleeding
Authors: Jakhetiya Bhamini , Khan Ruhina , Gupta Arun , Chundawat Rama , Singh Meenakshi
Published: April 2021

Background: To determine the effects of vaginal bleeding occurring in first and second trimester on maternal and fetal outcome.Methods: The present prospective observational study was conducted at department of obstetrics and gynecology, Geetanjali medical college and hospital, Udaipur and 90 Patients with first and second trimester pregnancy (till 24 weeks of gestation) presented with  the complaint of vaginal bleeding at antenatal clinic or emergency were included in this study.Results: In our study the result showed that bleeding in early pregnancy is associated with high rate of abortion (32.22%) in which first trimester abortion constitute 44.83% while second trimester abortion constitute around 55.17%.  Outcome observed in women having bleeding with SCH 58.4% had caesarean delivery followed by 25% had vaginal delivery, 16.7% had preeclampsia, 8.3% had PPROM and 5.6% had APH. Similarly, in women having bleeding without SCH 64% had caesarean delivery followed by 36% had vaginal delivery, 12% had preeclampsia, PPROM and APH in 8% each  and also women having bleeding with SCH, 37.1% had low birth babies, 22.8% had NICU admission and 8.6% had birth asphyxia. Similarly, in women having bleeding without SCH, 16% had low birth babies, 16% had NICU admission and 8% had birth asphyxia.Conclusions: First and second trimester vaginal bleeding is an independent risk factor for an adverse obstetric outcome and this risk factor should be taken into consideration when deciding upon antenatal surveillance and management.
Gestational diabetes mellitus - need for universal screening - a clinical study in a tertiary care centre
Authors: Veena Kondapuram , Ambarkar Srilakshmi , Ambarkar Srilakshmi
Published: April 2021

Background: To study the prevalence of gestational diabetes mellitus among antenatal mothers and to assess the importance of universal screening to detect gestational diabetes mellitus (GDM).Methods: A total of 300 antenatal women irrespective of gestational age were screened for GDM at their antenatal visit during the period of January 2020 to June 2020. All women were screened with 75gm oral glucose load irrespective of last meal followed by blood glucose estimation by glucose oxidase peroxidase method 2 hours following glucose load. A cut-off of 140mg/dl or more were labelled as gestational diabetes mellitus as per DIPSI guidelines.Results: Out of 300 antenatal women tested, 24 women (8%) were positive for gestational diabetes mellitus. During the first, second and third trimesters 12.5%, 33.33% and 54.17% were diagnosed with gestational diabetes mellitus respectively. The number of gestational diabetes mellitus patients for the age groups ≤20 years, 21-25 years, 26-30 years and >30 years are 2 (8.33%), 3 (12.5%), 8 (33.33%) and 11 (45.83%) respectively. The number of pregnant women tested positive for gestational diabetes mellitus with BMI ≤18.5, 18.6-24.9, 25-29.9 and 30-35 are 2 (8.33%), 4(16.67%), 8(33.33%) and 10(41.67%) respectively.Conclusions: Prevalence of GDM in our study is 8%. About 29.16% of GDM did not have any risk factors. This emphasizes the importance of universal screening for GDM of all pregnant women irrespective of gestational age. There is an increased association of GDM with age, BMI, family history and parity according to our study.
Decoding the learning curve of non-descent vaginal hysterectomy in the era of laparoscopy- experience at a Zonal Hospital
Authors: Sharma Shikha , Husain Jafar , Jain Anshul , Bhaskaran Sruthi , Singh Raj , Pandey Kavita
Published: April 2021

Background: Despite of the increasing popularity of laparoscopic hysterectomy, vaginal route still stays pertinent. Non descent vaginal hysterectomy (NDVH) involves d steep learning curve and hence, should be a fundamental part of every Gynaecology residency program. Objective of the study was to assess the learning curve of NDVH surgery skill at a Military Zonal Hospital by a single Specialist over a period of two years.Methods: Retrospective study conducted at Military Hospital, Agra between June 2015 to June 2017 on 30 patients who underwent NDVH for benign gynaecological conditions.Results: The average blood loss was noted to reduce from a mean of 285ml (±108.94) in the first 20 cases (Group 1) to 227ml (±110.89) in the next 10 cases (Group 2) despite of the average uterine size increasing from 8.5 (±1.43) weeks in Group 1 to 10.2 (±2.39) weeks in Group 2. The average time taken in minutes was also seen to reduce from 89.75 (±12.62) in Group 1 to 70.5 (±16.50) in Group 2 indicating an improvement of surgical skills. The average 24 hr post-operative haemoglobin fall of 0.8gm% was similar between the two groups.Conclusions: Acquiring NDVH skills is a slow but rewarding process. NDVH involves no incisions, no elaborate set-up, avoids complications of general anaesthesia and pneumo-peritoneum and displays similar results as of laparoscopy. In limited resource countries vaginal route may be the only available minimally invasive option for hysterectomy. Hence, it’s pertinent that Gynecologists are trained in the same.
The impact of interpregnancy interval on occurance of preterm births in the present pregnancy
Authors: Elumalai Balaji Thanjavur , Govindarajan Vaishnavi
Published: April 2021

Background: The pregnancy outcomes are influenced by the inter pregnancy intervals. Both short and long inter pregnancy intervals are known to adversely affect the mother and the baby. The main aim of birth spacing was to achieve ideal inter pregnancy intervals and thus to decrease maternal, neonatal morbidity and mortality.Methods: It is a prospective observational study. In this study, about 500 gravida 2 women who has delivered vaginally in the index pregnancy, with gestational age more than 28 weeks of gestation and with known interpregnancy interval were included in the study. They followed up to to delivery and occurance of preterm births in relation to maternal characteristics and interpregnancy interval were analysed.Results: Our study showed that Inter pregnancy intervals of 18-24 months were found to have the least number of preterm births when compared to intervals <18 months and >24 months. This association was found to be statistically significant (p value, Pearson chi square 0.0008). This relationship between inter pregnancy intervals and preterm births persisted when stratified according to maternal age, education, residence and BMI.A previous preterm birth was associated with increased risk of recurrent preterm birth (p value -0.034) and was statistically significant. The history of PROM in present pregnancy associated with preterm birth (p value -0.001) and association was statistically significant.Conclusions: From this study it was found that the 18-24 months birth to pregnancy interval is associated with the least incidence of preterm births.
A cross sectional study to evaluate serum calcium levels among pregnant women and it's association with preeclampsia and delivery outcomes at tertiary care Hospital Bikaner, Rajasthan
Authors: Poonia Laxmi , Kochar Swati , Chaudhary Shweta , Gaur Priyanka , Solanki Kirti
Published: April 2021

Background: Hypertensive disorders of pregnancy, including preeclampsia complicates about 10% of pregnancies worldwide. Preeclampsia is one of the major cause of maternal and perinatal morbidity and mortality worldwide. According to the National Health Portal of India, the incidence of preeclampsia is reported to be about 8-10% among pregnant women. The present study was aimed to compare mean serum calcium levels in preeclamptic and normotensive pregnant women at third trimester of gestation and assess relationship between maternal serum calcium levels, severity of disease and overall maternal and perinatal outcome.Methods: This was a cross sectional study conducted on 200 females divided into two groups (i.e. Study and Control Group) from 1st November 2019 to 31st October 2020. Informed consent was obtained for subjecting. Detailed history and clinical examination were performed. Serum calcium level was measured in both groups by spectrophotometric method.Results: Mean serum calcium level in study group (preeclamptic) was 7.84+0.74mg/dl while in control group (normotensive) mean serum calcium level was 9.68+0.97mg/dl. Serum calcium level was significantly lower in preeclamptic women than normotensive pregnant women (p<0.001).Serum calcium showed significant negative correlation with systolic and diastolic blood pressure.Conclusions: This study concludes that hypocalcaemia may have a role in aetiology of preeclampsia and adverse maternal and perinatal outcome. Thus intake of calcium supplements may help in reduction of incidence of preeclampsia especially in a population of a developing country.
KAP study on cervical cancer and human papillomavirus vaccine acceptability among adolescent girls of Eastern UP: a cross sectional study
Authors: Kumari Seema , Singh Aradhana , Sangal Renu , Sharma Neela R.
Published: April 2021

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection and is a causal factor for cervical cancer in virtually 100% cases. Despite the availability of highly effective vaccine against HPV, the burden of this dreaded disease remains high in our country. The aim of this study was to study the knowledge, attitude and practices on cervical cancer and HPV vaccine among adolescent girls of Eastern UP and to study the factors influencing knowledge, attitude and practices towards HPV vaccination among adolescent girls of this region.Methods: This was a questionnaire based cross-sectional study. Purposive sampling was used. Sample consisted of adolescent girls attending Gynecological OPD of a tertiary care center of Eastern UP, for a period of one year and the sample size was 384.Results: The results showed that, only 8.07% participants had heard of HPV infection and 2.08% participants had HPV vaccine knowledge. 35.95% participants agreed that their parents would pay for vaccine and 79.17% participants agreed for vaccination, if it would be free of cost. In total, most of the participants in the sample were found to have a positive attitude towards the vaccine.Conclusions: Although the knowledge and awareness of cervical cancer and its prevention through HPV vaccination, was poor among adolescent girls of Eastern UP region, it was encouraging to find, that most of them had a positive attitude towards HPV vaccination. It was also concluded, that the acceptability would increase, if the Government includes HPV vaccination in the National Immunization Program. If the cost constraint is dealt with, this completely preventable disease could be controlled in our country.
Colposcopic evaluation of cervix with abnormal papsmear findings: prospective analytical study at our tertiary care centre
Authors: Verma Bhawna , Rastogi Radha , Srivastava Dipti , Saharan Saroj
Published: April 2021

Background: Pap test has been successful in reducing the incidence of cervical cancer by 80% and mortality by 70%. Any women with a cytologic specimen suggesting the presence of HSIL on Pap smear should undergo colposcopy and dissected biopsy. Prevention of invasive cancer by early detection and treatment of cervical intraepithelial neoplasia (CIN) currently offers the most cost effective, long term strategy for cervical cancer control. The aim of study was to minimise disagreements and make colposcopy assessment quick, accurate and easy for follow-up.Methods: Prospective analytical study of 300 gynaecological patients with abdominal Pap smear findings between June 2020 to Dec 2020 at R.N.T. Medical College, Udaipur. All of them were subjected to colposcopy and dissected biopsy from the abdominal areas. The incidence of CIN/invasive carcinoma was calculated by proportion/percentage.Results: Incidence of invasive carcinoma was <1% but the incidence of premalignant lesion CIN was high (20.9%), CIN 2/3 and CIS were present in 6.9%.Conclusions: Patients with persistent inflammation pap smear can harbour high proportion of CIN and hence these patients need further evaluation through colposcopy.
Uterine inversion - an obstetrician’s nightmare: a series of 3 cases of uterine inversion and a review of management options
Authors: Jalvee Rashmi G. , Wani Reena J.
Published: April 2021

Acute puerperal uterine inversion is an extremely rare but potentially life-threatening complication in which the uterine fundus collapses within the endometrial cavity and beyond. Although the causes of uterine inversion are unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is recognized and corrected. We present here a series of three cases of uterine inversion managed in our hospital over a period of 3 years. Our first case, Mrs XYZ referred to our hospital after vaginal delivery followed by postpartum collapse. The patient was in hypovolemic shock with 2nd degree uterine inversion. Second case, Mrs ABC referred to our hospital after vaginal delivery and mass coming out of the vagina. The patient had postpartum haemorrhage with 2nd degree uterine inversion. Our third case, Mrs DEF, c/o full term vaginal delivery at our hospital with 2nd degree uterine inversion with postpartum haemorrhage. In all three cases, the patients were explored in the OT under general anaesthesia and uterine reposition was done vaginally. Two of the patients required mechanical ventilation post operatively and all the patients required blood and blood product transfusion. The clinical management, treatment options and surgical nuances of management of uterine inversion are discussed.
Vaginal Rhabdomyosarcoma in a patient with advanced cervical cancer; a case report and review of literature
Authors: Kumari Archana , Zangmo Rinchen , Garg Deepali , Bharti Juhi , Vatsa Richa , Saha Sushmita , Berwa Sonam
Published: April 2021

Rhabdomyosarcoma is very rare in adults accounting for less than 5% of all soft tissue tumours and less than 1% of all malignancies. Vagina is one of the least common sites for occurrence of Rhabdomyosarcoma in the genital tract. We present a case of a 53-year-old woman who is a follow up case of cervical cancer stage IIIB, managed by radiotherapy and chemotherapy. She was doing well till 5 years of her treatment for cervical cancer when she presented with complaints of pain lower abdomen and discharge per vaginum for 10 days. On examination she was found to have an abdominal mass of 18 weeks size and on local examination there was 4X4 cm fixed mass on lower third of vagina arising from left side. MRI abdomen and pelvis was done. Biopsy from the vaginal mass showed features of Rhabdomyosarcoma. Further follow up of the patient was not possible due to lockdown in view of the pandemic. She was last contacted telephonically on 25th March 2020; she said she was waiting for the lockdown to be lifted so that her further management can take place. This is just one patient; there are many more with other medical conditions all over the world who are losing their lives because of not being able to access medical care due to the present pandemic. New growth in the region of local recurrence in a known malignancy cannot necessarily be the recurrence of the primary tumour. It is important to keep our mind open to other differentials apart from the recurrence of primary malignancy, sometimes it can turn out to be a very rare tumour as we encountered in our case.
Case report of venous air embolism in complete placenta previa in a case of lower segment caesarean section
Authors: Noureddine Korichi , Ramanathan Lakshmi , Thode Aboobaker , Reghunatan Vipin , . Vijyakumari
Published: April 2021

Thromboembolic episodes in the pregnant and postpartum period in patients remain rare but fatal causes of maternal morbidity and mortality. They can be either venous air embolism, venous thrombo-embolism which include deep vein thrombosis and pulmonary embolism and last but not the least amniotic fluid embolism. The incidence of embolic episodes is more in LSCS patients than in patients coming for normal vaginal deliveries for all the type of embolisms, ranging from 10-97% for air embolisms depending on the surgical position and diagnostic tools with a potential for life threatening events, for venous thromboembolism (VTE)  it is 0.5-2.2%  patients per 1000 deliveries and increased  5-10-fold in pregnancy and 15-35% in postpartum period as compared to   the non-pregnant  women, the highest being during the 1st 3-6 weeks postpartum. After that the risk declines rapidly, although a small risk increase persists up to 12 weeks. After delivery, incidence of pulmonary embolism ranges from 0.11-0.73% per 1000 deliveries. It is rare, unpredictable, and unpreventable life-threatening complication of pregnancy. According to the International Cooperative Pulmonary Embolism registry, the death rate from massive PE among hemodynamically unstable patients is 52%. Last but not the least, incidence of amniotic fluid embolism ranges from 1/8000 to 1/15000. Delayed diagnosis, delayed treatment or inadequate treatment and inadequate thromboprophylaxis account for many of these deaths. Hence, early detection and proper management helps to prevent maternal mortality and morbidity in our patients. Also, thrombotic prophylaxis helps in preventing the fatal outcome and morbidity and mortality in our patients. Here, we report a case of a patient with complete placenta Previa scheduled for elective Lower segment caesarean section who developed venous air embolism (VAE) but with prompt detection and treatment a fatal outcome was prevented.
Scar endometriosis: a mystery entity
Authors: Kankanala Jyoti
Published: April 2021

Scar Endometriosis is described as having an active endometrial tissue at the scar area outside the uterine cavity. Corner stone for diagnosis is proper history, clinical examination and suspicion-based imaging. Caesarean scar endometriosis (CSE) usually seen following procedures like caesarean sections, hysterectomies. Time of presentation can be very variable so yet times difficult to suspect. Once suspected Convincing patient that they have active glands other than in uterine cavity is not easy. Hence proper imaging and biopsy is needed to backup for thorough counselling and treatment to improve the quality of life.
Successful intracytoplasmic sperm injection with testicular spermatozoa using pentoxifylline and HOS from a male with necrozoospermia: a case report
Authors: Nampalli Usharani , Fyzullah Syed , R. Chinmayie , Vijay Asha Srinivasan , R. Rajsri T.
Published: April 2021

The study was done to compare fertilization, cleavage, and pregnancy outcome of a man affected with necro zoospermia  using pentoxifylline and a hypoosmotic swelling (HOS) test to select viable spermatozoa from testicular biopsy specimens. A patient was diagnosed with necrozoospermia by semen analysis, and testicular spermatozoa were injected intracytoplasmically, using pentoxifylline and HOS (Hypo osmotic swelling test) and the following ICSI results were observed. Significantly higher fertilization rates (pentoxifylline 100% vs HOS 80%) were observed. There was no significant difference observed in cleavage rates among both groups. Finally, a healthy female infant with birth weight 3 kg was delivered at the second frozen embryo transfer cycle.it was found that selecting viable spermatozoa using pentoxifylline was more effective in fertilization and pregnancies than obtaining it through a HOS test. ICSI is effective for necrozoospermic man.
Pregnancy with extrahepatic portal venous hypertension
Authors: Nabapure Shilpa , S. Sapna I. , Sai Balumuri Pooja
Published: April 2021

We are reporting a case of pregnancy with extrahepatic portal venous hypertension. Portal hypertension in pregnancy is an uncommon event. It presents a challenge to the obstetrician in management as physiological hemodynamic changes associated with pregnancy worsen with portal hypertension. Thus, increasing risk of life threatening complications like variceal haemorrhage and hepatic decompensation to many folds during pregnancy. Management requires knowledge of effects of portal hypertension on maternal and fetal outcome and vice-versa.
Rare case report of mermaid baby: sirenomelia
Authors: Mazumdar Pinki , Nath Pranoy
Published: April 2021

Sirenomelia or mermaid baby is a rare and fatal congenital anomaly. It is characterized by varying degrees of fusion of lower limbs, thoracolumbar spinal anomalies, sacrococcygeal agenesis, genitourinary malformations, lower gastrointestinal tracts anomalies (e.g. renal agenesis, absent bladder, anorectal atresia) and absent internal genitalia. Most of the cases are associated with Potter’s facies and pulmonary hypoplasia. The incidence of the disease was 0.8-1 case/1,00,000 births and male to female ratio being 3:1. We reported a case of 19 years old primi at 35 weeks 3 days of gestation with history of tobacco intake during pregnancy who delivered a 1.24 kg baby with single fused lower limbs with a rudimentary tail and multiple congenital anomalies .There was also evidence of Potter’s facies .The baby died within 20 mins after birth. Sirenomelia is a rare but lethal congenital anomaly. Prevention is possible and when diagnosed antenatally, termination should be offered.
A case of recurrent thanatophoric dwarfism
Authors: Devi L. Thulasi , S. Athul R.
Published: April 2021

An interesting case of Recurrent Thanatophoric Dwarfism in a Multigravida; reporting to this hospital in second trimester which was terminated. It was confirmed on anomalies scan and was lethal. Genetic testing of the couple was advised; however, they refused and were lost to follow up. Long-term survivors are rare and require aggressive intervention for complications. In such cases couple should be informed of prognosis and extensively counselled for termination based on complications in long-term survivors as reported in literature. Management should be done after counselling and consultation regarding complications, clinical course, and prognosis of the condition. Due considerations may be given based on the parent’s desire for extreme life-support measures based on availability and affordability for provision of comfort care for the newborn. End of Life Support issues should be considered based on prevailing laws governing the nation.
A rare case of successful twin pregnancy in bicorporeal septate uterus with co-existent septate cervix
Authors: Raman Srimathy , Gururaj Shreelakshmi , Authreya Ashwini J. , Venkataram Padmalatha
Published: April 2021

Pregnancy occurring in patients with uterine malformations need to be managed with care as they are at risk of developing adverse outcomes. Multiple pregnancies in patients with uterine abnormalities further increase the risk of complications.  Due to the rarity of this problem, there are no recommendations to guide and plan the management of these patients. Delivery planning is also tricky and needs to be individualised as either mode of delivery can be associated with complications. We discuss the management of a twin pregnancy in a primigravida (conceived after ovulation induction) with Mullerian abnormality- Septate uterus with co-existent septate cervix; ESHRE type U-2B C-1.
Large fibroid complicating pregnancy: a case report
Authors: Saketha Lingampalli Naga , . Lopamudra
Published: April 2021

Uterine fibroids are the most common benign tumors of the female reproductive system and are known to occur in 0.1-10.7% of pregnant women and incidence increases with increasing maternal age. Fibroids when present are associated with complications in 10-40% of pregnant patients like abdominal pain, spontaneous abortion, fetal malposition, placental abruption, premature rupture of membranes, cesarean deliveries, postpartum hemorrhage, preterm delivery and low birth weight infants.
Scar endometriosis-rare and painful entity: a case report
Authors: Yadav Anita , Baghel Jyoti , Rawat Rajneesh , Prakash Avinash
Published: April 2021

Scar endometriosis is a rare type of extra-pelvic endometriosis that develops following obstetrical and gynecological surgeries. It is a rare entity, though probably on the rise, due to the increase in caesarean sections performed worldwide. This manuscript reports a rare case of scar endometriosis involving rectus sheath following repeat caesarean section and was managed at a tertiary level centre. The patient required surgical excision of the lesion and was kept on regular follow-up following surgery. The physiopathology of scar endometriosis is complex; its symptomatology is rich and diverse but detailed history, thorough clinical examination along with imaging and histopathological evaluation is usually efficient in diagnosing the condition.
Incidental gonadoblastoma in swyer syndrome: a case report with brief review of literature
Authors: Suresh Gayatri , Zangmo Rinchen , Roy Kallol Kumar , Rai Rakhi , Garg Deepali , Mathur Sandeep , . Jayati
Published: April 2021

Swyer syndrome is a disorder of sexual differentiation with an incidence of 1 in 80,000 population. Dysgenetic gonads have a propensity for malignant transformation particularly in the presence of Y chromosome and hence need prophylactic removal. We report a case of an adolescent girl who presented with primary amenorrhea who was identified as a case of 46 XY dysgenesis after karyotype studies. Extirpation of gonads were done laparoscopically and on histopathological assessment gonadoblastoma was detected. This case report aims to reiterate the importance of gonadectomy in patients with swyer syndrome as tumors could arise even in the absence of frank adnexal masses.
Splenic artery aneurysm rupture in pregnancy: a learning experience
Authors: Patel Nidhi , Barot Ketul S. , Patel Jayesh , Patel Sweety , Sapre Shilpa
Published: April 2021

Splenic artery aneurysm (SAA) is a rare clinical entity that carries a risk of rupture and life threatening hemorrhage. The objective of this clinical case report is to highlight this rare occurrence during pregnancy to avoid misdiagnosis. A 25 year old primigravida in her 3rd trimester of pregnancy was brought to trauma and emergency care with severe epigastric pain with rapid onset of unexplained shock. The shock was out of proportion to external or visible blood loss or any other injury. She was taken for emergency laparotomy. Intra-operatively, hemoperitoneum was encountered in peritoneal cavity due to ruptured splenic artery aneurysm. Massive transfusion protocol was activated and aneurysmectomy with splenectomy was performed. Post operatively, the patient was transferred to intensive care unit. Unfortunately, the patient succumbed due to complications of irreversible shock. Pregnant women with SAA can present with non-specific symptoms and hypovolemic shock. In such cases of hemorrhage, obstetricians should always keep in mind the other non-obstetric causes of intra-abdominal bleeding.
A case of multiple fibroid uterus, complete placenta praevia, antepartum haemorrhage, myomectomy and obstetric hysterectomy: a near miss
Authors: Devi L. Thulasi , Mahajan Shivani , R. S. Athul
Published: April 2021

An interesting case of young unbooked, unregistered, primigravida with multiple fibroid uterus, placenta praevia type IV, presented with APH in haemorrhagic Shock, impacted large fibroid in Lower Uterine Segment and Multiple fibroids on Anterior wall, fundus for which myomectomy was performed. Preterm Caesarean Section with extremely low birth weight infant delivered followed by life-saving Emergency Obstetric hysterectomy. She had uneventful recovery without any complications of massive transfusion or surgery. Case is being reported as an obstetric near miss.
Prevalence and associated risk factors of gestational diabetes mellitus
Authors: Sivasarupa Irkm , Kumarapillai Sivankumar
Published: April 2021

Gracelyn et al conducted a cross-sectional hospital-based study regarding the prevalence and significant risk factors of gestational diabetes mellitus in South Indian women.1 This study is important at this time because of the high frequency of gestational diabetes in South Asian ethnic groups especially in South Indian women.
Indian perspective about COVID-19 vaccine: an elixir bringing ray of hope to the dark pandemic
Authors: Thakur Vivek , Vanya Vidhi , Sarkar Avir , Mazumdar Basanti
Published: April 2021

India has finally begun its colossal coronavirus vaccine drive, desperately hoping to end a deadly pandemic that has killed around 1.5 lakh of its population. With an aim to vaccinate about 300 million people across the subcontinent by July, India has a huge task ahead. This large number roughly amounts to almost the entire US population.
The degree of concha bullosa pneumatization and its association with severity of deviated nasal septum in patients of southern region in Saudi Arabia
Authors: Mubarki Musleh , Shamakhi Radeif , Daghriri Ramzi , Alzarei Ali , Hakami Khaled
Published: April 2021

Background: To determine the degree of concha bullosa pneumatization and its association with deviated nasal septum in patients of southern region in Saudi Arabia.

Methods: This study used a retrospective radiological design to analyze computed tomography scans of 117 patients aged between 18 and 80 years of southern region in Saudi Arabia were used in this study. Patients with altered anatomy (iatrogenic or pathological) were excluded, CT scans were analysed to determine. The degree of concha bullosa and its association with deviated nasal septum in patients of southern region in Saudi Arabia, and the correlation between them.

Results: Forty percent (40%) cases were male and sixty percent (60%) were female. Concha bullosa (CB) were found in 17(14.5%) cases, of which 4 cases (23%) were bilateral and 13(76%) were unilateral. 7(53%) of unilateral cases were on right side, 6(47%) on left side. From all CB patients in this sample size, 15 (88%) cases have deviated nasal septum that range from mild to severe type whereas 2(12%) cases have no deviated nasal septum. Only 1 of those patients with severe deviated nasal septum has extensive type of concha bullosa.

Conclusions: Our findings revealed that there is no relationship between degree of pneumatization of CB and severity of deviated nasal septum.
Is reconstruction of composite defects of nose and cheek following tumor excision utilizing subunit principle the best?
Authors: Arora Viresh , Ashfaq Faisal , Rafique Atif
Published: April 2021

Background: Composite defects of nose and cheek are best stage reconstructed with separate nose and cheek flaps to recreate a blended nose-cheek junction, achieved by cheek advancement flap for cheek and forehead flap or local grafts for the nasal defect. This article analyses whether reconstruction of defects utilizing well-known subunit principle is cosmetically the best?

Methods: Case records of fifteen patients of nasal cancers extension into the cheek from January 2011 to December 2015 were analyzed retrospectively.

Results: Out of fifteen patients 8 were men and 7 women, two patients had SCC, rest had BCC. Average size of defect was 4.5 cm. Modified Imre’s cheek advancement flaps was used in all to reconstruct cheek defects while paramedian forehead flap was used for nasal reconstruction in 13 patients, skin graft and nasal advancement flap in one each. Eight patients underwent single stage reconstruction while seven with full thickness nasal defects had a delayed reconstruction. 13 patients rated their final appearance as satisfactory, while surgeon rated 12 patients with well-blended nose-cheek junction as satisfactory and lateral migration of junction being unsatisfactory. Alar retraction was observed in two patients with full thickness nasal defects. Two patients who underwent inner nasal lining reconstruction developed wound dehiscence while simultaneous reconstruction of nose and cheek was performed.

Conclusions: Subunit principle application for composite nose and cheek results in symmetrical nose-cheek junction and appears excellent technique in achieving a satisfactory aesthetic outcome. Optimal results in full thickness nasal defects are achieved where reconstructing is delayed.
Demographic, radiological and pathological profile of head and neck cancers
Authors: S. Prahlad M. , Appaji Mohan K. , Y. Kavitha
Published: April 2021

Background: Objective of the current study was to assess incidence of various head and neck cancers, their demographic, radiological, pathological characteristics and patterns of regional lymph node metastasis.

Methods: This is a retrospective analysis of data available from medical records department in our institution from the period of January 2017 to November 2020. Patients as per inclusion and exclusion criteria, were selected, the disease was staged and analyzed.

Results: Males were more commonly affected (78%). Among the upper aerodigestive tract cancers, lip and oral cavity cancers were most common (26%). Most common stage at presentation was stage IV A. Cervical lymph node metastasis was present in 69% of cases. Most common upper aerodigestive tract cancer was squamous cell carcinoma. Most common thyroid malignancy was papillary carcinoma.

Conclusions: Head and neck cancers have high morbidity and mortality owing to advanced stage of presentation and cervical lymph node metastasis affects the outcome of the disease adversely. Every case of head and neck malignancy, hence, need to be evaluated thoroughly and staged appropriately before taking treatment decisions.
Prevalence and impact of allergic rhinitis in school going children
Authors: Gupta Sucheta , Gupta Vinod , Gupta Akhil
Published: April 2021

Background: Allergic rhinitis (AR) is a chronic inflammatory disorder affecting the nasal mucosa. There is negative impact of AR on several aspects of day to day living and quality of life (QoL), which include: daily functioning, sleep, absenteeism, school productivity and academic performance. Almost 40% of children are being affected by AR.

Method: An observational study was conducted on randomly selected 100 parents of school going children aging 2 to 15 years, attending OPD in community health center, Chenani, district Udhampur, J and K, for a period of one year from June 2018 to Nov 2018. Children having frequent episodes of allergic rhinitis were enquired about their history of sneezing, runner itchy nose and eyes, thick mucus, nasal blockage or breathless with associated symptoms were selected.

Results: 81% of subjects had a worse problem during specific months of the year; and 67% had itchy-watery eyes. In 15% of subjects, AR impacted daily activities. A prevalence of 28% for nasal symptoms and 14% for allergic rhino-conjunctivitis was found. Study also showed significantly higher proportion of blockers (61%) than sneeze runners (39%). 56% children had one or more co morbidity, whereas 44% had ‘nil’ co-morbidities. The most common allergens were: pollens (grass, trees and weeds), house dust mites, pets, molds, fungi and food.

Conclusions: AR adversely affects quality of life of patients and furthermore studies should be conducted for more clarity on the subject, besides a timely medical intervention and treatment could possibly avoid the rising morbidity associated with the disease.
Comparative study on the effects of pre-operative intranasal steroid spray versus oral steroid on intraoperative bleed in FESS for nasal polyposis
Authors: B. Jagannath , Pillai Nikitha , K. L. Bharath Kumar
Published: April 2021

Background: Nasal polyps are associated with chronic inflammation of the nasal cavity and sinus mucosa. Steroids are the main stay of medical treatment. FESS is indicated when medical treatment fails. Bleeding during surgery can impair the surgical field during operation and increase the time duration and risks of complications. Pre-operative corticosteroids help reduce bleeding during surgery. The objectives of the study was to study and compare the effects of pre operative intra nasal steroid spray and oral steroid on intra-operative bleed in FESS for nasal polyposis.

Methods: 60 patients diagnosed with nasal polyposis were sequentially divided into 2 groups. Group A received intranasal steroid spray and Group B received oral steroid each for 7 days. Patients of both groups underwent FESS under general anaesthesia. Bleeding volume and quality of surgical field were assessed during the procedure to evaluate the effect of pre operative steroids in bleeding in FESS.

Results: Majority of our study patients of both the groups had moderate bleed. 33.3% of Group B patients showed the best outcome of surgery with just slight bleeding while 33.3% patients of Group B had moderate to severe bleed. Majority of our study patients (53.3%) had a blood loss of about 50-100 ml, of which 66.7% patients belonged to Group B.

Conclusions: Preoperative steroids are truly beneficial. Oral steroids has been found to be relatively better than intra nasal steroid spray in improving symptoms, reducing intra operative bleeding, and in providing better quality of surgical field.  

 
Clinicoradiological correlation between preoperative high-resolution computed tomography findings and intraoperative findings in chronic otitis media (squamous type)
Authors: Mishra Girish , Sharma Yojana , Patel Sona , Patel Viral
Published: April 2021

Background: Chronic otitis media is a major health problem with significant morbidity. High-resolution computed tomography (HRCT) is extremely useful for middle ear pathology and extension of the disease. The objective was to study the correlation between preoperative HRCT and intraoperative findings in chronic suppurative otitis media (squamous type).

Methods: This analytical study included 61 cases of chronic otitis media (squamous type). Preoperative HRCT findings were correlated with intraoperative findings. Sensitivity, specificity, PPV, NPV and kappa value were estimated.

Results: Out of 61 cases 32 were males and 29 were females. Presence of cholesteatoma found on HRCT with 80% sensitivity with k value 0.83 suggesting very good agreement. About ossicular status k value of incus, malleus and stapes were 0.76, 0.65 and 0.54 respectively with sensitivity of 91%, 85% and 58% respectively. Other critical areas on HRCT like sigmoid sinus plate erosion, tegmen tympani dehiscence, scutum erosion, lateral semicircular canal erosion, facial canal erosion and jugular bulb were seen with k value was about 1, 0.8, 0.9, 0.82, 0.72 and 0.65 respectively. So, HRCT shows perfect radiosurgical agreement for sinus plate erosion, very good agreement for disease extension, incus erosion, tegmen tympani erosion, scutum erosion and LSCC erosion and fair agreement for malleus erosion, facial canal erosion and jugular bulb dehiscence and poor agreement for stapes erosion.

Conclusions: HRCT is a reliable preoperative investigation in cases of chronic otitis media, squamosal type which would provide  a bird’s eye view in the disease process in the ear.