Department Of Gynecology Research Articles

Clinical implications of dual therapy of acarbose plus myo-inositol on the thyroid profile in women with polycystic ovary syndrome

Context: Polycystic ovary syndrome (PCOS) and thyroid are the most common endocrine disorders affecting women of childbearing age, causing anovulation and infertility. There is an increased prevalence of thyroid dysfunction reported among PCOS women. Aims: To evaluate the benefits of acarbose plus myo-inositol therapy on the thyroid profile of PCOS. Methods: An open-labelled, parallel randomised clinical trial on 80 PCOS women based on inclusion and exclusion criteria was performed at the Department of Gynaecology, SRM Medical College Hospital and Research Centre, Kattankulathur. Institutional ethics committee approval and prior informed consent were obtained. The trial was registered in CTRI (No: CTRI/2022/04/041877). Group A (n = 38) received metformin 500 mg TID, and group B (n = 39) received acarbose 50 mg TID along with myoinositol 1000 mg BID. Assessment of metabolic and hormonal profile was done at baseline and at the end of six months. Results: Both groups showed significant reductions in luteinising hormone (p <0.0001), total testosterone (p<0.05), thyroid stimulating hormone (p<0.05), fasting insulin (p<0.05), and homeostatic model assessment for insulin resistance (p<0.0001). The follicle-stimulating hormone was increased only in the metformin group. No significant changes in body mass index, free triiodothyronine, free tetraiodothyronine, and fasting glucose were observed in any group. Both therapies were safe, and no side effects or hypoglycaemia were recorded. Conclusions: In consideration of the beneficial effects of the study, we conclude that the administration of acarbose plus myo-inositol exerts positive effects on the thyroid and other endocrinological profiles in PCOS women.

The role of gynecologic oncology providers in intraoperative consultations in obstetrics and gynecology department

The role of gynecologic oncology providers in intraoperative consultations in obstetrics and gynecology department

Association between vulvar lichen sclerosus and celiac disease in woman.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition involving mainly the genital area with an undetermined aetiology. Recent studies show that in up to 34% of cases in adult women, VLS coexists with allergies or autoimmune diseases like celiac disease (CD), among others. However, literature data relating strictly to the co-occurrence of celiac disease and Duhring's disease (DH) in patients with VLS are very limited. In our study, we sought to clarify the possible relationship between vulvar lichen sclerosus in adult women and celiac disease in its cutaneous form. The aim of the study was to demonstrate the presence of celiac disease-specific antibodies in women with VLS. The control group consisted of 41 healthy women, and the study group consisted of 50 women aged 24-83 years with diagnosed vulvar lichen sclerosus who were hospitalized in the Department of Gynaecology, Obstetrics and Gynaecologic Oncology of the Bonifraters Medical Centre in Katowice. There were no significant differences in blood serum levels of CD-specific antibodies between both groups. The study conducted did not confirm the association between vulvar lichen sclerosus and celiac disease or Duhring's disease. The main limitation of the research was the small size of the study and control groups. Further studies on a larger group of patients are needed. They could clarify the possible mechanisms behind the co-occurrence of these two conditions. Earlier diagnostic will help prevent the development of severe and irreversible complications.

Associations between maternal health literacy and prenatal micronutrient intake in Hungarian women

Abstract Background Adequate level of health literacy (HL) is an important factor in pregnancy. Low HL may increase the risk of maternal and fetal complications (e.g., gestational diabetes mellitus, low birth weight). This study aimed to measure the levels of maternal HL and its associations with the consumption of folic acid (FoA), vitamin D (VD), and omega-3 fatty acids (FAs) during pregnancy in Hungarian women. Methods The questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University of Szeged among women who gave birth between June and September 2023 (N = 294). Sociodemographic, lifestyle, conception and pregnancy related questions were asked. HL was measured by the Maternal Health Literacy Inventory in Pregnancy (MHELIP) questionnaire (after the Hungarian adaptation); it contains 48 items representing four subscales (maternal health knowledge, search for maternal health information, assessment of maternal health information, and maternal health decision making and behavior). Data analysis was performed by SPSS 29.0. (Ethical permission: 5351) Results The mean age of women was 31.53 +-4.75 years. During pregnancy 84.5% of women consumed FoA, 61.8% VD and 41.8% omega-3 FAs. The total mean score of MHELIP on a scale 0-100 was 78.93 (95%CI: 77.77-80.08); the score of “search for maternal health information” subscale was the lowest [57.68 (95%CI: 56.20-59.16)], and the score of “maternal health decision making and behavior” was the highest [86.75 (95%CI: 85.62-87.87)]. Omega-3 FAs and VD consumption was significantly higher in women with higher total and subscales mean scores (except “search for maternal health information”), while FoA consumption was significant in case of “assessment of maternal health information”. (The results are preliminary.) Conclusions The association between micronutrient consumption and HL supports that using this tool during pregnancy the mothers who needs more support and health information can be identified. Key messages • The Maternal Health Literacy Inventory in Pregnancy questionnaire is a reliable tool for measuring health literacy in Hungarian pregnant women. • Maternal health literacy plays an important role in the healthier lifestyle, including prenatal vitamin/micronutrient consumption.

Histological Change of Placenta in Diabetic Pregnant Women in Comparison to Normal Pregnant Women

Background: The placenta is a foeto-maternal organ and its alterations is directly related to the disease’s length and severity. The human placenta experiences a number of functional and structural pathologic alterations when complicated by metabolic disorder such as diabetes mellitus. Methods: This cross-sectional comparative study was conducted over a period of threeyears from January 2019 to December 2021 at the Department of Anatomy, Rajshahi Medical College, Rajshahi, in collaboration with the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital and Diabetic Hospital Rajshahi, Bangladesh. The study was carried out on 70 pregnant women, among them 35 diabetics and 35 non-diabetics. The fibrinoid necrosis, syncytial knot and immature villi of the placenta were studied in diabetic and non-diabetic pregnant women. SPSS software, version-24 was used for data analysis, with a p-value < 0.05 indicating statistically significance for all tests. Results: The diabetic and non-diabetic pregnant women groups were almost identical in terms of attachment of umbilical cord to placenta with marginal attachment being more often found in either group (p = 0.829). Histological examination of placenta showed that fibrinoid necrosis was common in placenta of diabetic mothers than that of the normal mothers (p < 0.001). Syncytial knot and immature villi were higher in the former group than those in the latter group, here p values were also less than .001. Conclusion: Histological findings (fibrinoid necrosis, syncytial knot and immature villi) were more in placenta of diabetic mother and they were highly significant different between the groups. EWMCJ Vol. 12, No. 1&2, January-July 2024: 27-33

Comparative Diagnostic Value of 18F-FDG–PET–CT and Intraoperative Examination in Cervical Cancer Staging

Background and Objectives: The primary objective of this study is to assess the effectiveness of 18F-FDG–PET–CT in preoperative staging of cervical cancer, focusing on determining surgical operability and exploring the correlation between its quantitative parameters and clinicopathological characteristics. Materials and Methods: This retrospective study included 62 cervical cancer patients treated at the Department of Gynecology, Clinic for Operative Oncology at the Institute of Oncology Vojvodina between January 2016 and January 2020, where preoperative clinical examinations and 18F-FDG–PET–CT were performed to assess the extent of cancer, followed by intraoperative and pathohistological examinations of surgically removed specimens to provide a comprehensive evaluation. Results: The mean tumor size measured by 18F-FDG–PET–CT was slightly greater than that obtained through clinical examination (26.4 mm vs. 26.0 mm), with a strong linear correlation (r = 0.678, p < 0.001) observed between the two measurement methods. The overall prediction accuracy of 18F-FDG–PET–CT for primary tumors is 88.7% (55/62) [sensitivity 86.8%, specificity 100.0%, PPV 100.0%, NPV 56.2%] and for intraoperative examination is 88.7% (55/62) [sensitivity 98.1%, specificity 33.3%, PPV 89.7%, NPV 75.0%]. The agreement with histopathological examination was good for 18F-FDG–PET–CT and moderate for intraoperative examination for primary tumors. Regarding lymph nodes, the overall prediction accuracy of 18F-FDG–PET–CT is 82.2% (51/62) [sensitivity 53.8%, specificity 89.8%, PPV 58.3%, NPV 88.8%] and for intraoperative examination 66.1% (41/62) [sensitivity 76.9%, specificity 63.3%, PPV 35.7%, NPV 91.2%]. The agreement with histopathological examination was moderate for 18F-FDG–PET–CT and poor for intraoperative examination for lymph node metastasis, highlighting that the overall accuracy of 18F-FDG–PET–CT (82.1%) was significantly higher than that of intraoperative examination (66.1%) (p = 0.002). Conclusions: In conclusion, 18F-FDG–PET–CT provides high accuracy in detecting primary tumors and superior predictive value for lymph node metastases compared to intraoperative examination, highlighting the importance of incorporating this imaging modality into the preoperative evaluation process to enhance diagnostic precision and inform treatment decisions.

Association of Spexin Hormone Levels with Metabolic Disturbance in Women with Polycystic Ovarian Syndrome

Background: Polycystic ovarian syndrome is affecting around 5–15% of females. Spexin hormone, identified as neuropeptide Q, has been newly recognized by bioinformatics methods. Objective: To evaluate the relationship concerning levels of spexin hormone with metabolic disruption in women with polycystic ovarian syndrome. Patients and Methods: A case-control study carried out in the department of Obstetrics and Gynecology in Al-Imamain Al-Khademain medical city/Baghdad, Iraq, from Jan 1, 2022, to the end of Dec 31, 2022. The study sample comprises, 192 participants aged 18-45 years were joined and allocated into a case group (96 women with PCOS) and a control group (96 women without PCOS). Results: Mean value of spexin hormone was (2.7±0.3 ng/mL) in the PCOS group, while it was (3.5±0.7 ng/mL) in the control group; fasting blood sugar shows significant association with a negative, weak correlation with Spexin in patients (P-value= 0.005), Insulin shows significant association with inverse correlation with Spexin in patients (P-value= 0.04), Homeostasis model valuation of insulin resistance (HOMA-IR) shows significant association with inverse correlation with Spexin in patients (P-value= 0.003). Spexin had a significant inverse correlation with LH, SHBG, testosterone, FAI, and Dehydroepiandrosterone. Conclusion: Serum level of spexin hormone was meaningfully decreased in patients with PCOS than that in healthy women.

Antimicrobial Stewardship Programmes: Healthcare Providers’ Perspectives on Adopted Hospital Policies That Combat Antibacterial Resistance in Selected Health Facilities in Uganda

Background: This study aimed to determine healthcare providers’ perspectives on adopted hospital policies that support establishing antimicrobial stewardship programmes (ASPs) in selected health facilities in Uganda. Results: In this study, 63.1% of healthcare providers had a low-level perspective regarding adopting hospital policies to facilitate the establishment of ASPs. The low-perspective was significantly associated with females (aOR: 17.3, 95% CI: 1.28–2.34, p < 0.001), healthcare practitioners aged 50 + years (aOR: 1.92, 95% CI: 1.22–3.01, p = 0.004), individuals in the Obstetrics and Gynaecology department (aOR: 1.73, 95% CI: 1.03–2.90, p < 0.037), and Uganda’s Eastern (aOR: 1.47, 95% CI: 1.03–2.09, p = 0.034) and Northern regions (aOR: 2.97, 95% CI: 1.63–5.42, p < 0.001). Methods: We conducted a cross-sectional study where 582 healthcare providers (response rate (76%) were interviewed using a questionnaire to assess their perspectives on hospital policies that support ASP in 32 selected health facilities. We performed ordinal logistic regression on factors associated with adopted policies, and these were reported with odds ratios (ORs) and 95% confidence intervals (CIs). Conclusions: there was a low-level perspective on adopted hospital policies to support ASPs, which were significantly associated with the sex of healthcare providers, departments, age, and region of the country.

Factors associated with positive human papillomavirus (HPV) test results in cervical precancer screening: a cross-sectional study at Souro Sanou National Teaching Hospital (SSNTH) in Bobo Dioulasso, Burkina Faso.

Human papilloma virus testing is a new method of screening for precancerous cervical lesions. Here we identified factors associated to the positive Human papilloma virus-testing in the context of cervical precancer screening at the Souro Sanou National Teaching Hospital in Burkina Faso. Conducted from June 2021-May 2022, this was a cross-sectional study, including patients aged between 25 and 55years-old and screened for precancerous lesions and received HPV-testing at the Department of Gynecology, Obstetrics and Reproductive Medicine (DGORM) of the SSNTH. The proportion of positive HPV-test was calculated, and we identified factors associated to positive HPV-test using logistic regression. Of the 759 patients came for precancerous lesions screening, 559 patients were included. Their mean-age was 38.8 ± 7.9years-old, 94.3% were from urban area and 50.3% identified as housewives. Regarding the past medical history, it noted: number of gestures (3.2 ± 2.0), parity (2.8 ± 1.9), number of living children (2.8 ± 1.9), having abortion experience (24.0%), age of first-sexual-intercourse(18.6 ± 2.3years), alcohol (9.1%) and tobacco (1.0%) consumption, sexually-transmitted-infection (27.0%), Human immunodeficiency virus (HIV)infection (5.0%); none had been vaccinated against HPV. Biologically, 16.6% [95% CI: 13.6-20] of the women had a positive HPV-test. The factors significantly associated with positive HPV-test were: occupation in the private sector [OR: 0.06(0.0-0.5); p < 0.001], having a sexually-transmitted-infection [OR: 3.9(2.0-7.7); p < 0.001], age of first-sexual-intercourse [OR: 0.7(0.6-0.9); p < 0.001], sexual-multiple-partnership [OR: 17.5(8.1-39.6); p < 0.001], and HIV status [OR: 13.2(4.4-40.5); p < 0.001]. These results call for health actions through the reinforcement for behavioral change mainly about sexually-transmitted-infections, and for the raising awareness of the population for the screening related to the precancerous lesions and HIV.

Outcomes of Laparoscopic versus Robotic-Assisted Sacrocolpopexy for Pelvic Organ Prolapse-A Comprehensive Retrospective Analysis.

Minimally invasive abdominal sacrocolpopexy (SC) is the gold standard for managing symptomatic pelvic organ prolapse (POP). Robot-assisted laparoscopy (RSC) offers a promising surgical option compared to conventional laparoscopy (LSC). This study compares the clinical and operative outcomes of these techniques to determine if RSC is superior to LSC. We conducted a retrospective, single-center study in the Gynecology Department at the Citadelle Hospital in Liège, Belgium. Data from all patients who underwent SC between January 2019 and December 2023 were collected. We evaluated demographic and clinical data, perioperative complications, operative time (OT), length of stay, risk of recurrence and follow-up duration. Statistical analysis was performed to compare outcomes between the groups. Data from 208 patients (97 LSC and 111 RSC) were analyzed. No significant differences were found between the groups. A higher body mass index trend was observed in the RSC group (mean BMI: 26.63, range: 20-43) compared to the LSC group (mean BMI: 25.45, range: 15-34; p = 0.0625). The median OT was similar (LSC: 111min vs RSC 119min; p = 0.104), with a notable reduction in OT compared to the literature. Additionally, more RSC procedures could be performed per day (3 RSC vs. a maximum of 2 for LSC). Robot-assisted laparoscopy was not demonstrated to be superior to LSC. However, both procedures had comparable OT, significantly shorter than previously reported. RSC's operational efficiency might allow for a higher number of daily procedures, translating into practical benefits in clinical settings.

Evaluation of serum inhibin B and inhibin B/FSH ratio in the diagnosis of non-obstructive azoospermia and oligozoospermia.

Infertility affects approximately 15 % of couples globally, with 50 % cases of male factor infertility. Precise assessment of spermatogenesis is essential for evaluating male infertility. Recent studies suggest serum inhibin B as a promising biomarker for testicular function. This study aims to evaluate the diagnostic utility of serum inhibin B in predicting male infertility, particularly focusing on its relationship with sperm count. A cross-sectional study was conducted on 80 adult men (mean age 31.4±6.89 years) presenting with infertility at gynecology and urology outpatient departments. Semen analysis was performed following WHO (2010) guidelines, and serum inhibin B levels were quantified. The correlation between serum inhibin B levels and sperm parameters was assessed using Pearson's correlation test. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of serum inhibin B and the inhibin B/FSH ratio for non-obstructive azoospermia (NOA) and oligozoospermia. A significant positive correlation was observed between serum inhibin B and sperm count (r=0.94, p<0.001). ROC analysis demonstrated that the inhibin B/FSH ratio had the highest diagnostic accuracy for NOA and oligozoospermia (AUC=0.986), with sensitivity of 100 % and specificity of 91.67 %. Serum inhibin B alone also showed high diagnostic value (AUC=0.965 for NOA and 0.969 for oligozoospermia). Serum inhibin B is a reliable biomarker for assessing male infertility, particularly in evaluating spermatogenic function. The inhibin B/FSH ratio provides superior diagnostic accuracy for NOA and oligozoospermia, offering valuable clinical utility in male infertility diagnosis.

Department-specific patterns of bacterial communities and antibiotic resistance in hospital indoor environments

The hospital indoor environment has a crucial impact on the microbial exposures that humans encounter. Resistance to antibiotics is a mechanism used by bacteria to develop resilience in indoor environments, and the widespread use of antibiotics has led to changes in the ecological function of resistance genes and their acquisition by pathogens. By integrating the 16S rRNA Illumina sequencing and high-throughput-quantitative PCR approaches with water and air dust samples across seven departments in Peking University Shenzhen Hospital, China, this study yields intriguing findings regarding the department-specific variations, correlations and source tracing of bacteria, antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) within the hospital indoor environment. A notable observation was the pivotal role played by seasonal variations in shaping the bacterial composition across the entire hospital indoor environment. Another department-specific finding was the correlation between ARGs and MGEs abundance, which was evident in the overall hospital indoor environment, but not found in the blood test room, ophthalmology, and gynecology departments. Notably, as an important source of bacteria and ARGs/MGEs for the blood test room, the gynecology department also presented a close link between bacterial communities and the presence of ARGs/MGEs. Additionally, the results reiterate the importance of surveillance and monitoring of antibiotic resistance, specifically in Legionella spp. in man-made water systems, and highlight the significance of understanding genetic elements like Tp614 involved in gene transfer and recombination, and their impact on antimicrobial treatment efficacy. Key points•The department-specific variations, correlations and source tracing of bacteria, ARGs, and MGEs were uncovered in the hospital’s indoor environment.•Although each department exhibited consistent seasonal impacts on bacterial compositions, the co-occurrence between the presence of ARGs and MGEs was exclusively evident in the emergency, surgery, pneumology and otolaryngology departments.•The gynecology department emerged as a crucial source of bacteria, ARGs and MGEs within the hospital. Additionally, it was found to exhibit a significant correlation between bacterial communities and the presence of ARGs and MGEs.

Study of Association of PPH due to Uterine Atonicity and Serum Calcium levels

Background: Uterine atonicity stands out as a primary and leading factor contributing to maternal morbidity and mortality. Postpartum hemorrhage (PPH) resulting from uterine atony poses a life-threatening risk. Oxytocic drugs, by elevating intracellular calcium, enhance uterine tonicity, with optimal calcium levels playing a crucial role in facilitating effective uterine contractions. The study aimed to explore the relationship between the concentration of calcium in the bloodstream and the occurrence of PPH associated with inadequate uterine contractions admitted during the 1st and 2nd stages of labour at a tertiary care facility such as the Combined Military Hospital in Dhaka. The study likely involved analyzing data to identify any patterns or connections between serum calcium levels and the incidence of uterine atony-related PPH. Methods: The study follows a randomizing controlled trial (RCT) design within the Department of Obstetrics and Gynecology at Combined Military Hospital, Dhaka. The study duration spans from January 2016 to January 2019, involving a total of 306 subjects. Group A includes those with serum calcium levels between 8-10.4 mg/dl without uterine atonicity, while Group B comprises individuals with serum calcium levels below 8 mg/dl experiencing uterine atonicity, either post cesarean or vaginal delivery. Atonicity features include a soft, distended uterus with a lack of muscle tone. Results: A total of 306 patients were included in the study, with 153 having serum calcium levels exceeding 8 mg/dl and another 153 having levels below 8 mg/dl. Among women with serum calcium levels below 8 mg/dl, 37 patients experienced uterine atonicity. In contrast, it was observed that among women with serum calcium levels exceeding 8 mg/dl, only one patient experienced uterine atonicity. This highlights a potential association between higher serum calcium levels and a reduced likelihood of developing uterine atony in the studied population. Conclusions: The study findings indicate a strong association between low calcium levels and reduced uterine tonicity, establishing low calcium as a significant risk factor for uterine atony. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 28-34

Obstetric Outcome and its Relationship with Mode of Delivery in Preterm Labour- A Study of 86 Patients in Combined Military Hospital, Dhaka

Background: Caesarean section in preterm pregnancy may add further pressure to the already existing poorly developed facilities for intensive perinatal care in low resource countries. The objective of the study was to determine the feto-maternal outcome and its relationship with mode of delivery in preterm labour. Methods: This was a descriptive type of cross-sectional study conducted at Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka, during March to August 20l8. The study population was total eighty-six patients having 28 to 36 weeks of gestation who were admitted in the above department and were in labour. Data were edited and analyzed by using computer-based software, statistical package for social sciences (SPSS) version 20.0. Results: Majority of the patients belonged to 26-30 years age group and were from low socioeconomic family (71.4 to 72.7) % and had below average nutritional status (88.1 to 93.2) %. The mean gestational age was 31 weeks and 35 weeks. Nulliparous (77.3 to 85.7) % and patients taking irregular antenatal check-up (69.0 to 72.8) % were predominant. About (59.1 to 66.7) % patients had vaginal delivery and (33.3 to 40.9) % patients had undergone caesarean section. Maternal morbidity was more in caesarean section (37.5%) than vaginal delivery (33.3%). Live birth babies were found 100% in caesarean section and 94.4% in vaginal delivery and among them 95.7% were from group I and 97.6% were from group ll. Perinatal mortality was higher in vaginal delivery than caesarean section (7.40% vs 2.7%) and also higher in group I than group ll (8.3% vs 2.3%). But late perinatal complications were more in caesarean section (47.2%) than vaginal delivery (45.1%) baby, and majority (60%) of them were from group l. Conclusion: Preterm pregnancy when leads to an early delivery, brings a grave consequence for both the mother and foetus. After birth, the premature newborn is at risk for complications related to incomplete development of its organ system. Caesarean section delivery in preterm labour improves foetal outcome to some extent, but not significantly, and leads the mother to more maternal morbidity. Perinatal mortality and morbidity is also inversely related to the gestational age at the time of delivery, in preterm labour - more the gestational age, less the perinatal mortality and morbidity. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 43-49

Outcomes of acetaminophen infusion on visual analogue scale with varying pain intensity during labour, A randomized controlled trial

Objective: Acetaminophen (Paracetamol) is the most widely used analgesic. We aimed to determine its efficacy in labour with varying pain intensity, to make labour less painful for women. Methods: This randomized controlled trial was conducted on primigravida’s in their active phase of first stage of labour at Pharmacology department of Army Medical College, National University of Medical Sciences in collaboration with Gynecology department of Pak Emirates Military hospital, Rawalpindi. It was a registered trial with trial number of IRCT20220308054220N1. Duration of study was from May 2022 to October 2022. Patients were divided into two groups, Group-I received two doses of I/V 100 ml normal saline whereas Group-II received I/V two doses of 1000 mg acetaminophen in 100 ml normal saline. Calculated sample size was 130, 65 in each group. Visual analogue scale was used as a tool for data measurement. Data was analysed using split plot anova test. Results: Mean VAS in acetaminophen infusion group was found to be less than placebo for 1st dose, but this effect was apparent only one hour after 2nd dose intervention. The difference in means between groups was statistically significant only for 1st dose with p-value of 0.003 (for second dose p-value 0.21). In acetaminophen infusion group, for both doses mean VAS decreased as an immediate effect of drug, but then it increased with time. The difference in VAS between intervals had p-value of &lt;0.001 for 1st dose and 0.005 for 2nd dose. Conclusion: Acetaminophen is an effective non opioid labour analgesic in active phase of first stage of labour. doi: https://doi.org/10.12669/pjms.40.10.8425 How to cite this: Najeeb W, Komal N, Noor M, Khan MA, Chaudry A. Outcomes of acetaminophen infusion on visual analogue scale with varying pain intensity during labour, A randomized controlled trial. Pak J Med Sci. 2024;40(10):2163-2169. doi: https://doi.org/10.12669/pjms.40.10.8425 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

GC-MS quantification of fecal short-chain fatty acids and spectrophotometric detection of indole: Do rectal swabs produce comparable results as stool samples? - A pilot study.

The exploration of the gut microbiome and related metabolites holds an exciting future in health science. The challenges associated with fecal sample testing are proper sample collection, sterile transportation, optimal transport conditions, and processing as all these factors could potentially change the microbiome composition, further exacerbated by the patient's customary discomfort regarding feces samples. The study aimed to compare the usage of rectal swabs and stool samples for short-chain fatty acid estimation using gas chromatography-mass spectrometry (GC-MS) and indole estimation using spectrophotometry. From May 2022 to June 2022, three women were recruited from the Department of Obstetrics and Gynecology (OBG) in a secondary care hospital in coastal Karnataka. During their clinical visit, a rectal swab was collected, and the stool sample was transported to the hospital from the patient's home in sterile containers provided. After the extraction, short-chain fatty acids (acetate, propionate, and butyrate) were quantified using GC-MS. The fecal indole concentration was determined using a hydroxylamine-based assay. The GC-MS analysis failed to detect the concentrations of short-chain fatty acids in rectal swab samples. Indole concentrations in stool and swab samples were significantly different. The study's findings do not support the use of rectal swabs to analyze gut metabolites.

Invasive Micropapillary Carcinoma of the Breast: Comparison of Clinical, Epidemiological, Anatomopathological and Therapeutic Features with Infiltrating Carcinoma of Non-Specific Type

Invasive micropapillary carcinoma (IMCC) is a rare histological subtype of invasive breast cancer, its frequency ranges from 1.0 to 8.4% of all breast cancer cases. It is identified as a particularly aggressive tumor since frequent invasion of vessels, skin and lymph nodes is often reported. The aim of the work is to describe and compare the epidemiological, clinical, anatomopathological and molecular aspects of CMPI compared to CINS. Compare the overall survival of the two groups in order to identify the prognostic factors for CMPI. This is a retrospective, descriptive and analytical study spread over 6 years from January 2015 to December 2020, involving all cases of CMPI and CINS of the breast collected at the Obstetrics and Gynecology department of the Maternity and Neonatology Center of Monastir. The frequency found was 5.5% for CMPI and 72.69% for CINS. In our series we found the average age to be more advanced in CINS compared to CMPI without having a statistically significant difference (p=0.49). CMPI tends to be slightly larger than CINS with an average size of 3.7 compared to 3 for CINS. The right breast was the predominant tumor site for the 2 types of cancer p=0.71. CMPI presents a higher frequency of locoregional ADP and vascular emboli with p=0.001. Distant metastases were more frequent in CINS but without having a statistically significant difference. The overall survival of CMPI is 76% versus 86.4%. % of CINS. CMPI represents a particular variety of breast carcinomas; in this study we tried to dissect its different epidemiological, clinical, radiological and therapeutic characteristics which were largely in agreement with the literature.

When Giant Lymphangioma Meets Hydrops Fetalis: An Uncommon Case Report of Lower Extremity Involvement

Abstract Approximately 75% of lymphangiomas manifest in the head and neck region, with limb and bone involvement observed in only 2% of cases. This case report presents a rare instance of fetal lymphangioma associated with hydrops fetalis, affecting the left lower extremity and abdomen. A 22-year-old secundigravida woman was referred to the gynecology department at 31.2 weeks of gestation. Initial fetal ultrasound revealed a live fetus with a large lymphangioma involving the left lower extremity, gluteal region, and abdomen. Additional ultrasound findings included subcutaneous edema, pericardial effusion, ascites, placentomegaly, and tricuspid regurgitation. Postnatal clinical examination confirmed the diagnosis of lymphatic malformation. Notably, only one other similar case has been reported in the English-language PubMed database. This report adds to the medical literature as a rare instance of prenatally diagnosed lymphangioma-associated hydrops fetalis.

Analysis of Cesarean Section Rates Using Robson Ten Group Classification System in A Tertiary Care Hospital of Peshawar: A Cross-Sectional Study

Objective: To observe CS rates and assess them using Robson's Ten Groups Categorization System in a government tertiary medical facility in Peshawar, Pakistan Study Design and Setting: From 1st March to 31st August 2023, a cross-sectional study was carried out at the Khyber Teaching Hospital’s department of obstetrics and gynecology in Peshawar, Pakistan Methodology:. The research cohort consisted of 1250 women with CS who were hospitalized throughout the specified study period. Information on maternal features and pregnancy-related details was collected for every patient. Results: 4227 women sought labor and delivery services during the course of the research. It was discovered that the CS rate was 29.5%. Most common were Groups 1 (7.57%), 3 (8.65%), and 5 (54.66%), which together accounted for around 69% of all CS occurrences. Group 5's CS rate was 80.7%, but subgroup 5.1's (previous CS) women experienced repeat CS at a rate of 65.14%. 95% babies were alive and 5% were stillborns. Conclusion: Noticeable raise in the caesarean deliveries rate, leading to substantial worse influence in terms of health, finances, and society. Previous CS is the most prevalent sign of CS.CS if performed on primigravidae with a valid indication, the rate of CS may be managed.

Study on Misoprostol in Case of Missed Abortion

Background: Misoprostol and manual vacuum aspiration (MVA) are both effective treatments for incomplete abortion. Misoprostol, a medication that induces uterine contractions, is often preferred for its non-invasive nature and ease of administration. MVA, a surgical method, involves removing retained products of conception using suction. Studies suggest that while MVA has a higher success rate and faster recovery, misoprostol is a cost-effective, accessible option with fewer complications, though it may require follow-up treatment in some cases. Objective: In this our main goal is to assess the efficiency of misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion. Method: This hospital based randomized controlled trial study was conducted in in-patient patient Department of Obstetrics and Gynaecology, Chittagong Medical College and Hospital from October 2007 to September 2008. A total of 128 women between the age of 15 to 40 years with diagnosis of first trimester uncomplicated spontaneous incomplete abortion was included in this study. Among them 64 patients were randomized in group ‘A’ as case who were treated with Misoprostol and 64 patients were in group ‘B’ as control who were treated with Manual Vacuum Aspiration. Results: During the study, where the mean gestational size of uterus was 9.52 weeks at the time of initial examination. The mean size of uterus in misoprostol group was 9.07(SD ±1.93) and that of MVA group was 9.87 (SD± 1.35). More women in case group had no child of viable age on the other hand increased number of women in control group had at least one viable birth. 36 (60%) out of 60 women in misoprostol group 26 (41.93%) out of 62 reported pain and 36 (58.07%) out of 62 women in MVA and 24 (40%) patients in misoprostol arm said bleeding as the worst feature. Thirty six percent women in misoprostol group and 16% women in MVA group reported that the adverse effects were easily tolerable. Thirty percent women ...