Foul-smelling Vaginal Discharge Research Articles

Knowledge of Cervical Cancer and Attitudes Towards Its Prevention Among Women Attending Antenatal Clinics in Primary Health Centres in a Niger Delta Capital City

<i>Introduction </i>Cervical cancer is the fourth commonest cause of cancer and cancer-related deaths among women worldwide and commonest gynaecological cancer in Nigeria. This study sort to determine the awareness of cervical cancer, its prevention and determine the attitude and practice of these women towards screening. <i>Materials and methods: </i>This was a descriptive cross-sectional questionnaire-based study to assess the knowledge, attitude and utilisation of cervical cancer screening among pregnant women attending antenatal clinics in primary health centres in Uyo, South-south Nigeria. <i>Results: </i>The mean age of respondents was 34.7±8.9 years. The majority (76.7%) had post-secondary education, were married (69.6%), had 2 or more lifetime sexual partners (>60%) and had been pregnant twice (25%). Most (87.5%) have heard about cervical cancer, mainly from health workers, 116 (44.8%). The top 2 clinical features known were abnormal vaginal bleeding 177 (59.8%) and foul-smelling vaginal discharge 157 (53.0%) while the commonest risk factors mentioned were sex at early age 145 (49.0%) and multiple sexual partners 135 (45.6%). Preventive strategies known include quitting smoking (53.4%), avoiding early sexual intercourse (49%) and avoiding multiple sexual partners (48.3%). The majority, 186 (62.8%) knew about screening measures but less than a quarter knew that all sexually active women should be screened 46 (15.5%), while only 24.7% were aware of free services, 15.2% had ever been screened. The commonest reasons for non-screening were not feeling at risk 68 (27.1%) and being unaware of screening 57 (22.7%) while most had a positive attitude towards screening for cervical cancer. 167 (56.4%). <i>Conclusion: </i>The good knowledge of cervical cancer and attitude towards its screening was not matched by action as only a few had ever been screened despite their high lifetime risk for it. There is therefore the need for further awareness creation on cervical cancer prevention with the aim of increasing their uptake of available screening services in the state.

Genotypes Diversity and Virulence Factor screening of Trichomonas vaginalis Isolated from Pregnant Women in Mosul (North of Iraq)

Trichomonas vaginalis is a causative agent of trichomoniasis , one of the most common non-viral sexually transmitted disease (STD) over all the world, especially in immunocompromised women such as pregnant. Wet smear and Giemsa stain are the current methods used in hospital to diagnosis trichomoniasis. DNA based diagnosis is still to be validated to diagnose the local isolates, the objective of the present study was to compare the conventional methods of disease diagnosis with the DNA-based method to diagnose Trichomonas incidence in local isolates. In the present study, 105 samples were collected from outpatient women (18-45 years) of Maternity hospital in Mosul who showed a classical presentation of Trichomonas infection including foul-smelling vaginal discharge with a pH exceeding 4.5. Samples underwent microscopic examination and nucleic acid detection of AP65-1 gene, the wet smear test showed that 16.18% of the collected specimen were positive while the parasite appeared only in 8.9% of the samples stained with Giemsa dye, the molecular screening for AP65-1gene that encodes for the surface attachment protein showed high sensitivity level of 100 at 50 specificity level in compare with other routine methods, the algorithm was evaluated according to specificity, sensitivity, and predictive values. Random Amplification Polymorphic DNA (RAPD) was achieved to estimate genetic indices among isolated strains. Phylogenetic analysis was performed using PAST (Paleontological statistics software) and dendrogram with neighboring clusters was constructed. According to the outcomes of research, we recommended to utilize a probiotic vaccines and molecular silencing vaccine (like miRNA sense and antisense oligonucleotides) as a treatment in.

Management of Clinical Chorioamnionitis: An Evidence-based Approach

(Am J Obstet Gynecol. 2020;223:848–869) Clinical chorioamnionitis affects 1% to 6% of US pregnancies and is a risk factor for postpartum hemorrhage, neonatal sepsis, neonatal intensive care unit admission, neonatal death, and other adverse outcomes. Clinical chorioamnionitis has typically been diagnosed by maternal fever combined with at least 2 other symptoms: maternal tachycardia, fetal tachycardia, uterine tenderness, purulent or foul-smelling amniotic fluid or vaginal discharge, or maternal leukocytosis. This condition is usually treated with antibiotics and antipyretic agents, along with expedited delivery, though management regimens vary widely in terms of types of antibiotic and timing of treatment. This review aimed to examine evidence on the treatment of clinical chorioamnionitis to develop an evidence-based management approach. A literature search was conducted using MEDLINE, EMBASE, POPLINE, LILACS, CINAHL, the Cochrane Central Register of Controlled Trials, clinical trial registries, and Google Scholar.

STHANIK CHIKITSA (LOCAL THERAPIES) IN STRI ROGA: CRITICAL REVIEW

Ayurveda is one of the oldest systems of health gives a detail description of Stree Roga. Women combat with quite common gynecological problems like white discharge, itching at vulva, foul smelling vaginal discharge, burning micturition etc. Sthanik Chikitsa has given excellent results in these problems. Sthanik Chikitsa preferably includes Yonidhawan (Douching per vaginum), Yoni-Pichu (Tampooning per vaginum), Yoni Dhoopan (Fumigation of vagina), Yoni-Varti (Vaginal suppository), Yoni-Lepana (Vaginal painting), Uttarbasti (Medicated oil or decoction is pushed into the uterine cavity through vagina), Agnikarma (Cauterization) and Ksharakarma (Chemical cauterization) etc. In the present study all these local therapies are revised through ancient Samhitas, and these therapies are reviewed with their meanings, indications, procedures, application site and probable mode of actions. It is my sincere and optimistic effort to encourage most of the Ayurveda physician towards Sthanik Chikitsa in the management of Stree Rogas. Keywords: Sthanikchikitsa, Local therapies, Stree Roga.

CLINICOPATHOLOGIC FEATURES OF CERVICAL CANCER PATIENTS SEEN IN A COMPREHENSIVE CANCER CENTRE IN NORTH-WESTERN NIGERIA

The purpose of this study was to evaluate the socio-demographic and clinicopathological features of patients with cervical cancer seen in a comprehensive cancer center in North-western Nigeria. It was a six years retrospective study of patients with cervical cancer treated in the Department of Radiotherapy and Oncology, UDUTH, Sokoto. Data was obtained from the patients’ case notes using a semi-structured data extraction form. A total of 220 cases were reviewed for patients whose mean age was 49.9 years (SD ± 11.9); with the age range of 24-87 years. Results show that squamous cell carcinoma was the most common histological type seen in 182(82.7%) of the patients, followed by adenocarcinoma 22(10%) and clear cell carcinoma 9(4.1%). Vaginal bleeding 110(50%), foul-smelling vaginal discharge103 (46.8%), fatigue 67(30.5%), lower abdominal pain 65(20.5%) and weight loss 30(13.6%) were the commonest clinical features. 176(80%) patients presented late stages (IIB – IVB) of cervical cancer. Concluding, most of the women with cervical cancer presented with features of vaginal bleeding or foul-smelling vaginal discharge, weight loss, fatigue and lower abdominal pain, with commonest histological categorization being squamous cell carcinoma. Late presentation of the disease was obviously observed in most of the cases diagnosed. The clinical features of cervical cancer identified in the cases reviewed are indicators of advanced disease. Thus, it is imperative that advocacy for cervical cancer screening should be stepped up in order to ensure early detection and prevent the progression of the disease to advanced stages.

A case of fetal maceration in a dog

Fetal maceration is a process which is characterized by enzymatic autolysis of cells and degeneration of connective tissue. In this case, fetal maceration was described in a female dog. A 22 months old, 32 kg female Golden Retriever dog was brought to the Animal Hospital of Afyon Kocatepe University with the complaints of whitish and foul-smelling vaginal discharge, anorexia and weakness nearly two months. The body temperature, respiratory and pulse rates were at normal values. In the ultrasound examination, hyperechogenic areas were detected in the uterus. Before the ovariohysterectomy operation, an adhesion was determined between left uterine horn and the omentum. Furthermore, a huge solid and vascularized structure was detected in the left horn. After removal of the ovaries and the uterus, a foul-smelling mucous structure of brown-reddish fluid and fetal bone residues were found after incision and inspection to the uterus. Considering all findings, the patient was diagnosed with fetal maceration. In the postoperative period, the process was supported with systemic antibiotics and periodic wound care for the first seven days, recovery was achieved and no complications were encountered in the next six months. Since the case is rarely seen, veterinarians should not overlook this problem in bitches and they are recommended to use ultrasound in examinations.

Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: A randomized controlled trial.

Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities. This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections. Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P=.001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P<.05). Foul-smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30-64.55; P<.001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54±1.04days compared with 6.01±1.55days, P<0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species. Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post-cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.

Genitourinary Problems of Female Orphan Adolescents

Introduction: Genitourinary problems are major health problems affecting millions of people each year, especially among female adolescents. This problem often associated with significant morbidity and mortality.&#x0D; Objective: The study aimed to find out genitourinary problems of female orphan adolescents.&#x0D; Methodology: A cross sectional study was conducted from January to December 2017, among 308 female orphan adolescents, which was selected purposively. Data were collected by face to face interviewing by using pretesting questionnaire and checklist which covers demographic characteristics, genital and urinary problems along with menstrual hygiene practices. Data were analyzed by using SPSS 20.0 version.&#x0D; Results: The study found that mean± SD age of the respondent 11.89 ± .749 years, 62% has menstrual problems followed by 37.6% has painful menstruation, 17.4% has irregular menstrual cycle, 13.1% has headache/vertigo, 11.4% had generalized body ache/leg cramps, 7.4% has polymenorrhea , 4.8% has menorrhagia, 2.8% has oligomenorrhea and 23% has foul smelling vaginal discharge. There is an association between age group of the respondents and their pattern of menstrual cycle (p=0.005), association between foul smelling vaginal discharge and itching of the respondents (p=0.000), association between menstrual hygiene and ways of drying of used cloth, multivariate analysis shows the association between menstrual hygiene and perennial cleaning (p= 0.797), taking bath (p=0.000) and ways of drying of used cloth (0.029) during menstruation. And 40.9% has urinary problems followed by 33.6% has painful micturition, 28.3% has burning sensation during micturition and 4.1% has incomplete voiding of urine.&#x0D; Conclusion: The study concluded that significant number of respondents suffer from one or more genitourinary problems. Educational level does not comply the knowledge of these adolescents regarding menarche. Many of them are still used to use old cloth during menstruation. Study recommended the prevention of genitourinary problems by improving knowledge of genitourinary tract physiology, reasons, complication, drinking plenty of water, emptying bladder completely as soon as feel the urge and maintain proper perennial hygiene with changing absorbent frequently during menstruation.&#x0D; JOPSOM 2019; 38(2): 9-14

Knowledge of obstetric danger signs among Saudi Arabian women

BackgroundIn the Middle East, tremendous efforts have been made to promote both maternal and child health. However, there is little information in the literature about maternal knowledge of obstetric danger signs. Thus, this study aims to investigate Saudi Arabian women’s knowledge of obstetric danger signs and their determinant factors.MethodsA community-based, cross-sectional survey was conducted in primary health care centers (PHCCs) in Riyadh City. A proportionate random sample of women who have delivered during the past 2 years was selected from the PHCCs. Data were then collected through structured interviews; the questionnaire was developed based on the literature review.ResultsA random sample of 1397 women were included in the final analysis of this study. During pregnancy, 21.1% of the participants reported that they knew about swollen hands or faces. During labor, 23.1% of the participants reported that they knew about prolonged labor (> 12 h). At postpartum, 26.3% of the participants reported that they knew about foul-smelling vaginal discharge. In this study, women in the northern region of Riyadh who visited government hospitals had significantly higher odds of knowing at least one obstetric danger sign. A statistically significant difference was found between the participants’ knowledge of at least one obstetric danger sign and her 11–15 times of antenatal care visit.ConclusionsA dedicated health education guide, and a kingdom-wide maternal and child health preventive care promotion program could improve the health and wellbeing of expectant mothers. In these programs, it is essential to focus on birth preparedness, with danger signs recognition, and the integrate health-related data for the whole kingdom.

Rupture of an unscarred uterus - a case report

Introduction. Rupture of an unscarred uterus is extremely rare and associated with severe maternal and fetal morbidity. Risk factors are second-stage dystocia, grand multiparity, high parity, labor induction or augmentation with oxytocin or prostaglandins, delivery after the 42nd week of gestation, neglected labor, fetal malpresentation, breech extraction, and instrumental delivery. Case Report. A 44-year-old multipara (gravid3 para3) underwent induction of labour at 40 + 3 weeks of gestation. The patient?s medical history showed no uterine surgeries, but her first delivery was instrumental, with vacuum extractor. The induction of labour was initiated by oxytocin infusion of 6 mIU/min. Continuous fetal heart rate monitoring was performed and there were no signs of fetal distress. Fetal descent in the second stage of labor lasted an hour, which is slightly over than average duration for multiparas. A live female infant weighing 3380 g was born and the pediatrician started resuscitation of the baby. Apgar score was 1/3/3. Ten days following the delivery, the patient was admitted to Emergency Gynaecology Department of the Clinic of Gynecology and Obstetrics due to abdominal pain, left sided retrouterine hematoma, and foulsmelling vaginal discharge. Laparotomy was indicated due to suspected uterine rupture. The intraoperative findings showed subinvolution of the uterus with signs of panmetritis and on the left side below the round ligament there was a 2 cm long rupture, passing through and invading the lateral and posterior walls of the uterus. A total abdominal hysterectomy with bilateral salpingo-oophorectomy on the left side was performed. Conclusion. Although a reliable prediction and prevention do not exist, the obstetricians? awareness of this rare event in unscarred uterus may decrease maternal and neonatal morbidity. This case report is an example of a serious and difficult outcome after a seemingly low-risk situation.

Is Sinus Bradycardia a Side Effect of Clindamycin in Treatment of Septic Abortion? A Case Report

Introduction: Clindamycin is the preferred antimicrobial agent in the treatment of septic abortions. However, the administration of this medication may be associated with side effects. We describe the uncommon case of a patient who developed chest pain and sinus bradycardia following the administration of clindamycin. Case Presentation: A 19-year-old primigravid woman presented herself to Shahid Motaharri Hospital (Urmia, Iran) with high grade fever and severe pain in the hypogastrium. A physical examination established pyrexia, tachycardia. Vaginal examination revealed active bleeding accompanied by foul-smelling vaginal discharge. Ultrasonography revealed the presence of retained products of conception. Our main diagnosis was septic abortion. The patient was treated by volume replacement and administrating intravenous clindamycin and gentamicin. Following the intravenous infusion of clindamycin, an episode of chest pain and bradycardia occurred. Conclusions: Based on the clinical course of the current case, we conclude that the episode of bradycardia was induced by clindamycin administration. Therefore we advise physicians to exercise caution when administrating clindamycin due to its possible potential to induce bradycardia.

Short communication: Assessment of biomarkers of inflammation in the vaginal discharge of postpartum dairy cows diagnosed with clinical metritis

Clinical metritis, characterized by the presence of an enlarged uterus and abnormal red-brownish foul-smelling vaginal discharge (VD), is a prevalent condition that causes important economic losses to dairy operations. The accurate diagnosis and treatment of this disease can help decrease its negative effects on the well-being and performance of dairy cows. The objectives of this study were to assess (1) the concentration of haptoglobin (Hp) and neutrophil-derived haptoglobin-matrix metalloproteinase 9 (Hp-MMP 9) in the VD of postpartum cows; and (2) the correlation between Hp and Hp-MMP 9 concentrations in serum and VD. Fifty-three dairy cows from 4 farms in central Pennsylvania were enrolled in this observational study.. Postpartum cows (7 ± 3 DIM) were screened using a Metricheck device to assess VD score (VDS): 1, clear fluid (n = 4); 2, < 50% white purulent fluid (n = 14); 3, > 50% white purulent fluid (n = 8); 4, red-brownish watery fluid without fetid smell (n = 22); and 5, fetid red-brownish watery fluid (n = 5). Blood and VD samples were collected for assessment of Hp and Hp-MMP 9 concentrations. Cows with a VDS of 4 or 5 (VDS4/5) had higher serum Hp concentrations than cows with a VDS of 1, 2, or 3 (VDS1/3; 93 ± 187 µg/mL vs. 59 ± 106 µg/mL, respectively). Similarly, cows with VDS4/5 had higher VD Hp concentrations than cows with VDS1/3 (73 ± 56 µg/mL vs. 17 ± 16 µg/mL, respectively). We found a significant correlation (0.37) between Hp levels in serum and in VD. We found no difference in serum Hp-MMP 9 between VDS4/5 and VDS1/3 cows. The VD concentrations of Hp-MMP 9 were higher in VDS4/5 cows than in VDS1/3 cows (7,629 ± 9,847 ng/mL vs. 1,567 ± 2,165 ng/mL, respectively). The correlation between Hp-MMP 9 in serum and VD was 0.22; nevertheless, it was not statistically significant. Interestingly, Hp and Hp-MMP 9 concentrations were higher in VD samples than in serum, regardless of VDS. Results from this study suggest that inflammatory biomarkers may be increased in cows with a VDS of 4 or 5. Further research should be aimed at elucidating the processes involved in inflammatory biomarker production and transportation in the uterus, as well as the effect of these biomarkers on endometrial cells.

Knowledge, attitude, and practice regarding the screening of cervical cancer among women in New Delhi, India.

Objective:Cervical cancer is one of the major concerns of public health importance in today's world. It is a leading cause of mortality in women of reproductive age group worldwide, mainly in developing countries. Reduction in mortality and morbidity due to cervical cancer is possible through early detection and treatment. The major factors influencing the early detection of cervical cancer are knowledge regarding risk factors, screening, Pap smear, and symptoms among women.Materials and Methods:The present cross-sectional study was carried out to assess the knowledge, attitude, and practice of women about the risk factors, symptoms, and prevention of cervical cancer. Data were obtained from 220 women who visited international trade fair using a pretested self-administered questionnaire.Results:Only 75 study women (50.0%) had ever heard of cervical cancer. The knowledge regarding cervical cancer and its various domains was significantly higher in students and unmarried women. The foul-smelling vaginal discharge was the most common early symptom of cervical cancer according to most of the study women (26, 17.3%). Most of the study women (19, 12.7%) reported tobacco and smoking as the most common risk factor associated with cervical cancer. Only 39 women (26%) had ever heard of cervical cancer screening. Only 27 women (18.0%) ever had Pap smear done in the past and 87 women (58.0%) were willing to undergo cervical cancer screening is offered free of cost.Conclusion:The study demonstrates the lack of awareness in women regarding cervical cancer and its screening modalities. This necessitates spreading awareness regarding early symptoms and risk factors associated with cervical cancer for early detection and treatment initiation.

Mullerian adenosarcomas of the uterine cervix with sarcomatous overgrowth

Mullerian adenosarcoma with sarcomatous overgrowth (MASO) of the uterine cervix is an extremely rare variant of adenosarcoma of the genital tract associated with aggressive clinical course. We searched the PubMed and Medline databases for MASO of the cervix and we identified and reviewed eleven cases published between years 2004 and 2017. The most common clinical picture includes abnormal vaginal bleeding, postcoital bleeding, pelvic pain and foul-smelling vaginal discharge. Therapeutic options for MASO are still undefined. Radical hysterectomy with sufficient tumour-free margins combined with adjuvant chemotherapy and radiotherapy should serve as an effective treatment tool with favourable outcome.

Risk scoring and prediction of early onset septicaemia in neonates through study of perinatal factors

Background: Diagnosis of early onset septicaemia is often difficult due to lack of specificity of clinical manifestations. Being a common but neglected problem, the present study was undertaken to develop a scoring system which can predict early neonatal septicemia.Methods: 300 newborns born out of consecutive deliveries were assessed for the total score as combination of physical factors and neuromuscular factors. Information for perinatal factors was collected on a prepared pro forma by questionnaire method. Data was tabulated and subjected to statistical analysis.Results: Incidence of neonatal infection was higher in the presence of birth asphyxia, unclean vaginal examination, presence of foul smelling vaginal discharge, or when duration of labour exceeded 24 hours as compared to prolonged rupture of membranes. Incidence of infections among babies born before 37 weeks gestation or having a birth weight of 2 kg or less was nearly the same as in the cases of premature rupture of membranes (PROM). 224 cases got score 0-3 and only 0.6% got infected, whereas out of 62 cases with score 4-5, 51.6% were infected and 14 out of 14 having score of 6 or more had infection. The sensitivity of scoring system was 96%, specificity 90%, positive predictive value of 88% and negative predictive value of 60.5%.Conclusions: Besides PROM there are many other perinatal factors which are of significance in relation to early onset infections. This led to the formulation of the presenting scoring system. Validation of this scoring system through further studies can help in early diagnosis, administration of proper antibiotics and inhibition of the irrational use of antibiotics.

Assessment of daily activity patterns and biomarkers of pain, inflammation, and stress in lactating dairy cows diagnosed with clinical metritis

The objectives of the present case-control study were to assess (1) daily activity patterns (lying time, number of steps, number of lying bouts, and lying bout duration), and (2) circulating concentrations of biomarkers of pain (substance P), inflammation (haptoglobin), and stress (cortisol) in lactating dairy cows diagnosed with clinical metritis. Lactating dairy cows (n = 200) from 2 commercial dairy herds were enrolled in the present study. Cows diagnosed with clinical metritis (n = 100) at 7 ± 3 d in milk were matched according to lactation and days in milk to cows without clinical metritis (NO-CM; n = 100). On study d 1, clinical metritis was diagnosed (using a Metricheck device, Simcro Tech Ltd., Hamilton, New Zealand) by the presence of watery, reddish, or brownish foul-smelling vaginal discharge, and blood samples were collected for assessment of circulating concentration of substance P, haptoglobin, cortisol, total calcium, β-hydroxybutyrate, and blood cells. In addition, on study d 1 body condition of cows was visually assessed, and activity monitors were placed on the hind leg of a subset of cows (CM, n = 56; CON, n = 56) and were kept until study d 7. Cows showing any other signs of other diseases were not included in the study. Cows with clinical metritis tended to spend more time lying (CM = 628.92 min/d; NO-CM = 591.23 min/d) compared with NO-CM cows. Activity analysis by parity revealed that primiparous cows with clinical metritis spent more time lying compared with primiparous cows without clinical metritis. However, no differences in daily lying time were observed between multiparous cows with and without clinical metritis. Furthermore, cows in the CM group had a higher circulating concentration of substance P (CM = 47.15 pg/mL; NO-CM = 37.73 pg/mL) and haptoglobin (CM = 233.00 µg/mL; NO-CM = 99.98 µg/mL) when compared with NO-CM cows. Cows with clinical metritis had lower body condition score, and a greater proportion of cows in this group had hypocalcemia when compared with cows without clinical metritis. The circulating concentration of leukocytes and erythrocytes were decreased in cows with clinical metritis compared with cows without clinical metritis. Results from this study showed that concentrations of markers of inflammation, stress, pain, and activity were affected in cows diagnosed with clinical metritis; thus, strategies aimed to minimize the negative effects associated with clinical metritis may be required to improve the welfare of dairy cows.

Per-vaginal Findings among the Women with Pelvic Inflammatory Diseases at a Tertiary Care Hospital in Dhaka City

Background: Pelvic inflammatory disease (PID) is a major health problem for adult female. Women presented with pelvic inflammatory diseases give different per-vaginal findings. So we designed this study to assess the per-vaginal findings among the women presented with pelvic inflammatory diseases.Objective: The purpose of the present study was to measure the pervaginal findings among the women with PID.Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College &amp; Hospital, Dhaka during January to June 2007. Women in the age group of 15−45 years presented with lower abdominal pain, tenderness, per-vaginal discharge and cervical motion tenderness were included in this study. After taking verbal consent from the patients, a pre-designed data collection sheet was filled in after per-vaginal examination.Results: The study was done on 50 cases, of which 20% patients had 1st degree perineal tear, 6% had utero-vaginal prolapse and 24% had foul-smelling vaginal discharge. Majority (90%) patients had healthy vagina. Ninety percent patients had anteverted uterus; and uterus was mobile in 60% cases. Cervical motion tenderness was present in 44% cases, tenderness of fornix was found in 34% cases and thickening of fornix was found in 22%.Conclusion: In this study first degree perineal tear, foul smelling vaginal discharge and cervical motion tenderness are the commonest findings among the women presented with pelvic inflammatory diseases.J Enam Med Col 2018; 8(2): 90-93

Prevalence of reproductive tract infection symptoms and treatment-seeking behavior among women: A community-based study.

Introduction:Reproductive tract infection (RTI) is a public health problem affecting women's health, especially in developing country like India. The associated stigma with this reproductive morbidity is often a deterrent in seeking health care.Aims and Objectives:The aim was to study the prevalence of RTI symptoms and treatment-seeking behavior among married women of reproductive age group.Methodology:It was a community-based cross-sectional study. A total of 276 women were interviewed in the community by trained medical social workers. RTI symptoms were defined according to the syndromic case management guideline developed by the World Health Organization. Statistical analysis was performed using the Epi Info software for Windows (CDC Atlanta).Results:About one-third (98/276; 35.5%) of women reported symptoms suggestive of RTI. The most commonly experienced symptoms were foul-smelling vaginal discharge (68/98; 69.4%) followed by lower abdominal pain not associated with menstruation (51/98; 52.0%). Around half of those having RTI symptoms sought treatment for their problem (57.1%).Conclusion:Health-care professionals in India should focus on strengthening women knowledge of RTI symptoms and encouraging them to seek health care.

Primary Vaginal Carcinoma in a Long Standing Rectocele: A Case Report and Review of the Literature

Background: Primary vaginal cancer is rare, comprising 1%–2% of all gynecological malignancies. It is commonly seen in women aged 60–80. A primary vaginal carcinoma presenting in conjunction with pelvic organ prolapse is even more rare. This carcinoma usually involves the upper one-third of the anterior or posterior wall of the vagina. Primary vaginal carcinoma involving the lower one-third of the posterior vaginal wall and associated with uterovaginal prolapse is extremely rare and only 1 case has been reported in literature until now. This article reports a very rare case of a primary vaginal carcinoma in a long-standing isolated rectocele involving the posterior lower third of vaginal wall. Case: A 62-year old postmenopausal female presented with complaints of a mass protruding through her vagina for 22 years and bloodstained, foul-smelling vaginal discharge for 2 months. She had a history of chronic constipation for 12 years. Her vulva was healthy. A 4 × 4-cm exophytic growth, 1 cm from the fourchette and well away from the cervix, which bled on touch, was present over a grade 2 rectocele. Results: Histopathology of the vaginal biopsy demonstrated poorly differentiated squamous cell carcinoma. A diagnosis of International Federation of Gynecology and Obstetrics stage 1 primary carcinoma of the vagina with a rectocele was made. She was referred to the radiotherapy department for further treatment. Conclusions: In all patients with long-standing uterovaginal prolapse and postmenopausal bleeding, although the first differential diagnosis is a decubitus ulcer, the possibility of vaginal cancer should also be kept in mind. (J GYNECOL SURG 33:268)

Transvaginal Resection of an Infected Sacrocolpopexy Mesh by Single-Port Trocar

Study ObjectiveLaparoscopy using a single port improves morbidity while keeping the same level of requirement. This technique has been evaluated in gynecology for salpingectomy, ovarian surgery, and hysterectomy. Here, the authors illustrate a new use of a single port using the transvaginal approach. DesignCase report (Canadian Task Force classification III). SettingTertiary referral center in Strasbourg, France. PatientWoman age 59 years. InterventionSingle-port platform used in the transvaginal approach for resection of sacrocolpopexy mesh. The local institutional review board approved the video. Measurements and Main ResultsA 59-year-old woman suffering from insulin-dependent diabetes and a tobacco user had 2 laparoscopic sacrocolpopexies for recurrent rectocele, the first in 2007 and the second in 2012. The sequences were marked by mesh erosion and granuloma in the vagina, requiring its surgical excision in 2016. The patient was then symptomatic, with an increasingly foul-smelling vaginal discharge with recurrent mesh erosion. Magnetic resonance imaging showed an abscess formation along the length of the mesh to the promontory. The patient then underwent surgery, realized under probabilistic antibiotic therapy, consisting of complete excision of the sacrocolpopexy mesh by the transvaginal approach. After putting the single-port trocar (GelPoint; Applied Medical, Rancho Santa Margarita, CA) into the vagina and obtaining distension with the insufflator (AirSeal; Conmed, Utica, NY), classic laparoscopic instruments were introduced by the single-port trocar. The mesh was entirely resected in the retroperitoneal space. Mesh was again used because the exposed space is almost always surrounded by loose granulation tissue that facilitates dissection and also prevents injury to adjacent structures such as bladder, rectum, and peritoneum. Moreover, the opening of adjacent structures will manifest gas leaks and, consequently, loss of the pneumovagina. At the end of procedure, the vagina is not closed to permit optimal drainage with a multitubular drain in the dissection space. The surgery lasted 60 minutes. The mesh excision was completed with relative ease, and there was no blood loss. Bacteriologic examination revealed the presence of Streptococcus anginosus, Klebsiella pneumoniae, and Bacteroides fragili. The operating suites were simple with great cicatrization after 6 weeks. The principal difficulties of this surgery were obtaining a good seal by the creation of cutaneous sutures. Finally, there are less conflicts between the instruments inside the single-port trocar used in transvaginally because of a more limited dissection space. Indeed, the rate of mesh erosion reached 2.4% and, in case of infection, justifies this excision. ConclusionThe transvaginal use of a single-port trocar represents a good alternative, allowing easy resection of the sacrocolpopexy mesh while remaining in the retroperitoneal space.