Gynecology OPD Research Articles

A Study of Urinary Disorders in Post-Menopausal Women in a Tertiary Institute in Western Maharashtra

Objective: To study the associated factors for the development of urinary problems in post-menopausal women and the appropriate investigations, management and regular follow up of such cases. Methods: A total 121 post-menopausal women with urinary symptoms attending the gynaecology OPD as well as in patients were enrolled in the study. These patients were studied and evaluated based on history, clinical examination, investigation and follow up. The data was then subjected to statistical analysis and conclusions were drawn. RESULTS: Burning micturition was the most common urinary symptom in the present study, seen in 85.12% post-menopausal women followed by urinary frequency (59.50%), urinary incontinence (28.92%), urinary urgency (27.27%) and mass per vaginum (25.61%). Escherichia Coli was the most common organism found in 45 post-menopausal women on urine culture and sensitivity. Local estrogen therapy provided relief of symptoms more than those who did not receive any local estrogen therapy. Conclusion: In modern era, a woman spends almost 1/3rd of her life is the in post-menopausal age group. Hence we need to concentrate on the various health aspects of menopause including urinary problems. As shown in this study, most of these problems can be treated medically, though few may require surgical treatment. Keywords: Menopause, Burning micturition, Incontinence, Estrogen therapy.

Contraceptive Acceptability of Female Condom: A Prospective Study

ABSTRACT Background Female condom is the only available method that women and girls can initiate and, in some ways, control, that protects against both unwanted pregnancy and sexually transmitted infections. In this regard, it is an important supplement to the male condom. Materials and methods One-hundred women between the age of 18 and 40 years attending the gynecology OPD and needing any temporary method of contrception were recruited into the study for 6 months. Only women willing to participate in the study were recruited. Results In the study, of the 100 women, only 17 women had heard about sexually transmitted diseases (STD) and/or human immunodeficiency virus (HIV) and that use of male or female condoms can prevent their transmission. Seventy-eight percent of women continued with the use of female condoms. Of them, 83% women reported that they were satisfied by the use of female condoms and they would continue to use them if they were easily available. The satisfaction of the male partners was observed in 79% of them. When both partners were taken together, female condoms were satisfying to 78% of both. Conclusion The female condom is an important temporary method of female contraception which also protects from and HIV. It is a method that empowers women; hence, it must be integrated in reproductive health programs to save the lives of millions of women and men now. How to cite this article Bharadwaj MK. Contraceptive Acceptability of Female Condom: A Prospective Study. J South Asian Feder Obst Gynae 2015;7(1):10-14.

Clinicopathological evaluation of abnormal uterine bleeding

Introduction: Historically our culture has traditionally viewed even the normal menustral cycle as an aberration, ostracizing the reproductive aged women. Aristotle quoted Hippocrates writings by describing the process of heavy uterine bleeding as In quantity, bleeding in excessive, saith Hippocrates, when they flow about eighteenth ounces. Aims and Objective: To study the various aetiopathological factors responsible for AUB in women ages 20-55 years, and to correlate the clinical presentation with ultrasonography, hysteroscopy, laparoscopy and histopathological finding. Sample: In this study, 140 cases of 15-55 years of age group were randomly selected after the exclusion criteria who were willing to get admitted as well as prepared for follow-up. Inclusion Criteria: The cases of abnormal uterine bleeding, attending the gynecology OPD with complaints of menorrhagia, metrorrhagia, polymenorrhoea, and polymenorrhagia in the age group 20-55 years, were selected. Exclusion Criteria: Pregnant patients and patients below 20 years and above 55 years are excluded from the study. Conclusion: It is seen that incidence of AUB is more common in 5 th decade of life and in multiparous women. Menorrhagia is the most common bleeding pattern followed by metrorrhagia. Histopathological examination of the endometrium revealed that whatever may be the pathology, proliferative endometrium is the most common pattern.

English

AIM: Aim of our study to analyze the prevalence of premalignant lesion based on Pap smear and liquid based cytology in patients of bad cervix. OBJECTIVE: To compare sensitivity and specificity of two methods for screening of bad cervix and to know IDR (increase detection rate) of cervical cancer by conventional Pap smear and liquid based cytology. MATERIAL AND METHOD: 200 women attending Gynaecology OPD were random selection on the basis of inclusion criteria. All 200 selected women were subjected for down staging through per speculum examination for identification of bad cervix. Pap smears of all 200 selected women were taken and ensured that no local douche, antiseptic cream and no local internal examination was done on the day of test. The prepared smears were then stained according to Papanicolaou's technique. Liquid based cytology smears preparing by using cervical brush 1-1.5cm were inserted into the cervical os until the large outer bristles of the brush touch ectocervix. Data collected for sociodemographic, parity, down staging clinical examination Pap smear and LBC was organised, interpreted and analysis on appropriate statistical software. P value < 0.05 is considered significant RESULT: Analysis revealed that the maximum number of women in our study are from middle age group(31-40yrs), low socioeconomic status, married before 18 yrs, multipara, do not use any contraceptive, uneducated, urban, Muslim population.in this study more abnormal smear is seen in LBC as compared to pap smear. Sensitivity and specificity for LBC is more as compare to pap smear. CONCLUSION: In low resource setting like ours were facilities for radiology, chemo- radiotherapy and supportive care are limited or unavailable. It is important to identify which resources fill healthcare need most effectively and to consider alternative approaches, LBC is strongly advocated in the best interest of public health, by improving the quality of the sample and reducing the likelihood of false negative cytology result. Thus it will significantly improve early detection and treatment of cervical lesions and

English

OBJECTIVES: To know the prevalence of premalignant lesions of cervix in this remote part of Andhra Pradesh, South India. MATERIAL AND METHODS: The study was conducted in Gynecology OP Dept. of Govt. General Hospital, Anantapur by screening the symptomatic women attending the Gynecology OPD of this hospital. They were examined by cervical Pap smear cytology to know the prevalence of premalignant lesions of cervix in this part of India. Total of 300 women were screened from April 2012 to March 2013 by the conventional Pap smear and the slides were reported according to the modified Bethesda system, by the Pathology dept. of Govt. Medical College, Anantapur. RESULTS: Out of the 300 cases studied, 20cases showed premalignant and malignant lesions, thus the ratio of inflammatory and other lesions to premalignant and malignant lesions was found to be 93.33% and 6.67% respectively. CONCLUSION: The premalignant epithelial abnormalities like ASCUS, LSIL and HSIL were found to be highest in the age group of 31-50 years in our study, which correlated well with other similar studies. Hence we should advocate pap smear study at least from 30 years onwards in our settings, by which we can prevent further advancement of the cervical cancer, if we detect them at the stage of ASCUS or LSIL etc.,

English

Introduction and Objectives: Dysfunctional uterine bleeding is an abnormal bleeding from the uterus in absence of organic disease of genital tract and demonstrable extragenital cause. Dysfunctional uterine bleeding is synonymous with anovulatory bleeding. Thyroid dysfunction is marked by large number of menstrual aberrations. This study aimed at detecting thyroid dysfunction in patients with a provisional diagnosis of DUB and refers positive cases to physician for further evaluation. METHODS: 100 cases of clinically diagnosed DUB were taken from gynecology OPD and inpatients of Calcutta National Medical College and Hospital. All patients from puberty to premenopausal age groups presenting as menorrhagia, acyclical metropathia, polymenorrhagia, metrorrhagia, oligomenorrhoea, polymenorrhoea and hypomenorrhoea were tested for their thyroid function by free thyroxine (fT4), TSH estimations in their serum. Patients who had clinical symptoms and signs of thyroid disease, already on hormonal treatment, IUCD users, or had bleeding disorders were excluded from the study. RESULTS: 23% of patients who were studied had thyroid dysfunction of which 13% of patients had subclinical hypothyroidism, 7% of patients had hypothyroidism and only 3% of patients had hyperthyroidism. The commonest bleeding abnormality in subclinical hypothyroid patients was polymenorrhoea and menorrhagia. All hyperthyroid cases were oligomenorrhoeic. CONCLUSION: Both subclinical hypothyroid and profoundly hypothyroid cases together were the commonest thyroid dysfunction and menorrhagia was their commonest menstrual abnormality. So this study concludes that biochemical evaluation of thyroid function should be made mandatory in all provisionally diagnosed cases of DUB to detect thyroid dysfunction.

A Study on Prevalence of Reproductive Tract Infections Amongst Women Attending in an Urban Clinic

Introduction: One element of reproductive health that directly concerns human well being is reproductive tract infections (RTI). The magnitude of the problem of RTIs is a growing public health concern in developing countries like Bangladesh. Aim: A study was carried out in the out patient department of a busy urban clinic with an attempt to study the Reproductive Tract Infections (RTIs).Materials and Methods: A descriptive type of cross sectional study was carried out in the Gynaecology OPD of an urban clinic at Dhaka, the capital of Bangladesh during the period from July 2007 to December 2007. The study population includes the women of reproductive age group (15-49 years). Among 1061 reported women 176 respondents were selected for the study with a systematic purposive sampling technique. Data were collected from prescription sheets of the concerned gynecologist, laboratory investigation reports and questionnaires used for interview.Results: Mean age of the respondents was 30.56+6.1. Among 176, 174 (98.86%) were married. Depending on clinical symptoms 32 (18.19%) were diagnosed as RTI, after clinical examinations 39 (22.16%) and while after laboratory investigations 42 (23.9%) were diagnosed as RTI. Among 39 provisionally diagnosed RTI cases 13 (33.33%) were diagnosed as PID, 10 (25.64%) as mixed infection and 05 (12.82%) as vulvovaginitis clinically. Among 42 confirmed RTI cases 16 (38.09%) were confirmed as bacterial vaginosis, 04 (9.52%) as trichomoniasis, 07 (16.66%) as candidiasis, 06 (14.28%) as mucopurulent cervicitis while 01 (2.38%) was diagnosed as syphilis. Among 28 abortion cases 10 (35.71%) developed RTI while among 38 MR cases 18 (46.36%) developed RTI. Among 34 IUD users 22 (64.7%) developed RTI while for other contraceptive method users only 19 (15.8%) developed RTI.Conclusion: Although the study was in a limited scale and the findings of it will not only serve as a guideline for taking preventive measures, but can be used as a basis for futureresearch and planning.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i1.19415

English

Bacterial vaginosis is the commonest cause of vaginal discharge in sexually active females. It is often associated with adverse pregnancy outcomes and increased susceptibility to other sexually transmitted diseases. In the present study, we evaluated efficacy of OSOM BV Blue test and compared it with conventional methods like Gram staining and Amsel’s criteria for diagnosing bacterial vaginosis. A total of 635 females attending gynaecology OPD and antenatal clinic with complaints of vaginal discharge were included in the study along with 50 healthy females as controls. Two vaginal swabs were collected aseptically from each patient. One swab was used for Gram staining and the other for OSOM BV Blue test. Amine test and vaginal pH test as defined in Amsel’s criteria were also performed. Bacterial vaginosis was detected in 60.8% of patients. OSOM BV Blue test detected maximum number of cases with sensitivity and specificity of 95.3 and 92.1%, respectively. Thus, it can be used as a point-of-care test useful in making rapid and accurate diagnosis of bacterial vaginosis in setups lacking microscopic facilities or technical expertise. Key words: OSOM BV Blue test, Gram staining, Amsel’s criteria, bacterial vaginosis.

Impact of Running a Behavior Therapy Room for Various Categories of Urinary Incontinence Cases in Different Age Groups in Obstetrics-Gynecology Outpatient Department of a Tertiary Care Hospital

ABSTRACT Introduction Urinary incontinence (UI) affects &gt; 60% women. Its management is simple with the use of Kegel exercises. However, very few studies have been done in India about this problem and its solution. Objective To assess the impact of running a behavior therapy room (BTR) for various categories of UI cases in different age groups in obstetrics gynecology outpatient department (OBG-OPD) of a tertiary care hospital. Materials and methods Patients of UI were referred from gynecology OPD to BTR. There was trained staff available in BTR to teach Kegel exercises and related behavior therapy to the patients. Records of the patients were maintained. Follow-up was done through phone calls and personal visits of UI patients. Results A total of 251 cases were registered in BTR over 2 years. Overall 126 patients got relief from urine incontinence and prolapse of pelvic floor organs after BT. Conclusion Establishment of a separate room (BTR) with trained staff can be done in OBG department to teach Kegel exercises and to provide relief to women suffering from UI and pelvic organ prolapse (POP). Recommendation Behavior therapy room should be established in gynecology OPDs of all hospitals. How to cite this article Kaur T, Dudeja P, Sharma M, Jain V, Singh A. Impact of Running a Behavior Therapy Room for Various Categories of Urinary Incontinence Cases in Different Age Groups in Obstetrics-Gynecology Outpatient Department of a Tertiary Care Hospital. J Postgrad Med Edu Res 2014;48(4):159-163.

Study on reproductive tract infection among the female patients attending the gynecology OPD in a teaching hospitals of Gujarat- India

Background: Reproductive tract infections (RTIs) often go unnoticed and sexually active young women are particularly susceptible to sexually transmitted Infections (STIs). STIs are among the top five disease categories and about one third of STIs globally occur among people younger than 25 years of age. Present study was carried out to know the socio demographic profile of women suffering from RTI/STI. Sensitivity and specificity of syndromic approach was also found. Aims & Objective: (1) To know the socio-demographic profile of female patients attending the gynecology OPD with complaints of RTIs. (2) To find out the sensitivity and specificity of various diagnostic tests used for diagnosing RTIs. Material and Methods: A cross sectional study was carried out among 150 female patients who have attended the Gynecology OPD with complains suggesting Reproductive Tract Infection (RTI) during March-September 2005. After taking Medical and Obstetric History, vaginal and cervical specimens were collected during pelvic examination for laboratory investigation to confirm the diagnosis of genital tract infection. 5 ml blood was drawn in sterile vacutainer for serology. Various laboratory tests were carried out to confirm the diagnosis of RTI. Results: Out of 150 females patients of reproductive tract infection, 68 (45.3%) were less than 25 yrs. Mean age of the study population was 27.37 ± 5.52 yrs. Majority (133, 88.7%) of the females were housewives. The most common symptom reported was vaginal discharge (147, 98%), followed by lower abdominal pain (114, 76%) Findings of present study revealed that sensitivity of Homogenous white discharge (compared with gram stain) to detect the Bacterial vaginosis was 69.4%. Similarly correlation of Green Yellow frothy (GYF) discharge with culture examination for detection of trichomoniasis revealed, sensitivity of 68.8% and specificity of 99%, which means that all the cases labelled as “not having GYF discharge” also tested negative for trichomoniasis by culture. Sensitivity of curdy white discharge in detecting candidiasis was 69.1% and specificity was 99.1%. Conclusion: Young married women are more prone to Reproductive Tract Infection (RTI). Abnormal vaginal discharge is the most common presenting feature among the sufferers of RTI/STI. Syndromic approach is highly specific in diagnosing RTI.

A double blinded randomized controlled trial to compare Ormeloxifene and Norethisterone in the treatment of Dysfunctional Uterine Bleeding

Aims: To compare the safety and efficacy of ormeloxifene and norethisterone in treatment of dysfunctional uterine bleeding as measured by decrease in menstrual blood loss using pictorial blood assessment chart. To assess the percentage change in haemoglobin and endometrial thickness before and after treatment. To assess the subjective improvement in life style as evaluated by a five point Likert scale. Methods: A double blinded randomized control trial was conducted on patients attending gynaecology OPD with complaints of menorrhagia with following inclusion criteria women between 18 and 51 years of age, absence of coagulopathies and any pelvic pathology, not taking any drug affecting menstruation, no hormonal therapy in previous three months and normal renal function. Findings and Interpretation: The menstrual blood loss was observed to decrease by 19.31% at end of two months, 30.74% at the end of four months and 43.25% at end of six months in case of norethisterone and 20.72% at the end of two months, 43.37% at end of four months and 59.50% at the end of six months in case of Ormeloxifene. There was an increase in haemoglobin percentage in both the groups and it was significantly better in case of Ormeloxifene. PBAC score and endometrial thickness improvement was better in case of ormeloxifene compared to norethisterone. The side effects were similar in both the cases except for follicular cyst which was seen in Ormeloxifene group. I. Introduction A woman can expect roughly 400 menstrual cycles during her reproductive lifespan, and it is estimated that up to 20% of women will have excessive menstrual blood loss. Although age of menopause has remained the same over this century, the magnitude of menstrual disorders has increased, likely because of shortened breast-feeding intervals, fewer pregnancies per woman, higher frequency of permanent sterilization, and later age of conception. Dysfunctional uterine bleeding is a diagnosis of exclusion when organic, systemic and pelvic pathology all have been ruled out. Once a diagnosis has been reached with the aid of history, examination, haematological and endocrine investigations, and dilatation and curettage when appropriate, medical treatment is the usual first line approach. The treatment options for dysfunctional uterine bleeding are diverse, which can be finally tailored to cater the needs of patients of different socioeconomic background, different age groups and different reproductive needs. Treatment options range from offering medical measures such as cyclooxygenase inhibitors, tranexamic acid, hormonal agents and in cases not managed by medical therapy offering surgical management. Trials comparing the various modalities have flooded the literature but ambiguity still exists. Norethisterone is still the most frequently prescribed drug for dysfunctional uterine bleeding serving 38% of the patient population the reason being cost effectiveness and absence of side effects. Ormeloxifene (also known as centchroman) is one of the selective estrogen receptor modulators used primarily as a contraceptive, but it is also effective in dysfunctional uterine bleeding. We undertook the study to compare the safety and efficacy of the two drugs in dysfunctional uterine bleeding.

Conceptual study on nidana and samprapti of Svetapradara with special reference to Leucorrhoea

The reputation of a physician depends upon his skill in diagnosing and treating the patients. Ayurveda has given much importance to nidana (etiology) and samprapti (pathogenesis) as these two are important components of nidana panchaka. Nidana is defined as the fundamental or root cause of a disease and samprapiti is defined as the evolution of an illness. Svetapradara is a condition characterized by white vaginal discharge which is not associated with foul smell, pain, itching, burning sensation etc. thus it can be correlated with Leucorrhoea. It is an annoying complaint of more than 60% of women seen in gynaecological OPD. The symptoms and treatment of Svetapradara is given in Ayurvedic texts but no where its nidana and samprapti is discussed. This study mainly deals with detailed discussion on nidana and samprapti of Svetapradara. Method - Classical Ayurvedic texts along with the commentaries were carefully studied to compile information about Svetapradara and to evaluate the nidana and samprapti of the disease. Observation - Ayurveda has given more emphasis to nidana and samprapti. It was observed that different ahara, vihara, agantuja, mansika etc karana influences the samprapti of the disease. Result -Vata prakopaka and kapha prakopaka karana are important nidana of Svetapradara and various nidana factors affects the samprapti in different process and accordingly treatment schedule must be adopted.

English

AIMS: This prospective study was done to evaluate the patients of Pelvic Organ Prolapse (POP) about the duration they are suffering from POP and also the symptoms, the main determinants, degree of prolapse, associated pathologies and the treatment they received. METHODS: This prospective study was done in the patients who reported in Gynecology OPD of our hospital with POP from November 2012 to April 2013. They were asked about the duration they are suffering from prolapse, their chief complaints in detail, the determinants of POP (occupation, BMI, Parity, menopausal status) and were then examined for the degree of prolapse and associated pathologies, complications and the treatment given was recorded. The results are expressed in descriptive statistics by simple percentages with frequency tables. RESULTS: The mean age of women suffering from prolapse was 52.2 years in our study whereas the mean age at which they developed the symptom of something coming out per vaginum was found to be 36.32 years.72.34% women were postmenopausal. Multiparity is major risk factor for prolapse which is proved by 97.88% women in our study being multiparous. Although obesity was not that major determinant in our study as 59.57% had normal BMI. The most common symptom was something coming out per vaginum (in 97.57%) followed by the disturbances in micturition found in 93.62% women. 80.85% women had third degree prolapse and cystocele was present in 95.74% women. Complications seen were decubitus ulcer, keratinization, elongated and congested cervix and hydronephrosis. Majority (74.4%) underwent vaginal hysterectomy with anterior colporrhaphy and posterior colpo- perineorrhaphy as the treatment of prolapse.

P2.049 NAATs For Gonorrhoea Diagnosis in Women: Experience of a Tertiary Care Hospital in North India

<h3>Background</h3> Gonorrhoea is among the most frequent of the estimated STIs and health implications related to morbidity and mortality especially in women and children are significant. The use of nucleic acid amplification tests (NAATS) has been shown to provide enhanced diagnosis of gonorrhoea in female patients &amp; are considered the standard for diagnostic purposes currently. However, it is recommended that an on-going assessment of the test assays should be performed to check for any probable sequence variation occurring in the targeted region. In the present study, an in-house PCR targeting <i>opa</i>-gene of <i>Neisseria gonorrhoeae</i> was used in conjunction with 16S ribosomal PCR to determine the prevalence of gonorrhoea in female patients attending the tertiary care hospitals <h3>Methods</h3> Endocervical samples collected from 250 female patients attending the Dermatology and Gynaecology OPD of AIIMS and STD clinic of Dr. R.M.L. Hospital, New Delhi, India were tested using <i>opa</i> and 16S ribosomal assay. Additionally, they were processed by conventional methods. True positives were defined as ones which were positive by culture and/or positive by both 16S ribosomal gene and <i>opa- </i>gene based PCR. <h3>Results</h3> Of the 250 female patients, only 1 was positive by conventional methods, i.e., microscopy and culture. Based on PCR results, <i>opa-</i>gene based PCR was positive in 17 patients who were also positive by 16S ribosomal PCR. However, 16S ribosomal gene based PCR picked up 8 extra positives. Overall, 17 patients were found to be true positives. <h3>Conclusion</h3> The clinical sensitivity of conventional methods for the detection of <i>N. gonorrhoeae</i> in female patients is low. The gonococcal detection rates increased significantly when molecular method was used giving a prevalence rate of 6.8%. However, it is pertinent to mention that the widespread use of NAATs might result in lack of isolates and ignorance of possible emergence of resistant organisms.

DETECTION OF HUMAN PAPILLOMA VIRUS DNA FROM DRY PAPER CERVICAL SMEAR- A HOSPITAL BASED STUDY

Background: Persistent infection of uterine cervix by human papilloma virus (HPV) among which high risk HPV (16, 18, 31, 33, 35, 52, and 58 collectively) are associated with cervical carcinogenesis. Cervical cancer precedes a precursor stage termed as cervical dysplasia or intraepithelial neoplasia which takes long years for development of invasive cancer. Aim: To studythe prevalence of HPV infection in uterine cervix and to correlate the HPV status of the cervical scrapping with the routine method of cervical cytology by Papanicolaou stain. Methodology: The studyincluded 226 no ofcervical scrapping from married non pregnant women attending gynecology OPD for both Pap smear and PCR testing to detect HPV DNA. The Nested PCR using primers for L1 consensus gene with My09/My11 & GP6+/GP5+ used for screening HPV followed by multiplex PCR which was carried out to detect HPV 16 & HPV18 by respective primers. Result: One hundred and ninety nine Papsmears were reported as NILM and 27 smears showed presence of SIL and invasive cervical carcinoma. PCR results detected9.7% of the patientsto be HPV positive out of which 5.3% cases were HR HPV 16 positive, 2.6 % cases were HPV 18 positive and 1.8% cases were HPV positive other than HPV 16 & 18.The sensitivity and specificity of the study were0.8182 (95%CI 0.5974-0.9481) and 0.9559 (95% CI 0.9178-0.9796) with positive predictive value being 0.6667(95% CI 0.4600-0.8349).

English

BACKGROUND : Utero-vaginal prolapse is a common condition in aged women and often they come to us with decubitus ulcer. Prolonged vaginal packing not only will heal the decubitus ulcer but also it may help in returning the normal rugosity of the vaginal skin. AIMS: To assess the role of prolonged moist vaginal packing in utero-vaginal prolpase. SETTINGS & DESIGN: It was an OPD based prospective study conducted at the gynecology OPD of College of Medicine & JNM Hospital, WBUHS, Kalyani, Nadia, West Bengal and Jawaharlal Nehru Institute of Medical Sciences, Porompat, Imphal, Manipur. METHODS & MATERIAL: Hundred (100) patients of utero-vaginal prolapse with decubitus ulcer were studied. After initial staging (POP- Q staging), daily moist (5% povidone-iodine solution soaked gauze) vaginal packing at home was advised. After 2 weeks, re-examination done for decubitus ulcer healing. Packing continued till operation (interval 1- 1½ month). Preoperative staging and modification of operation were noted. On follow up complication (mainly recurrence) was noted. RESULTS: Initial staging was stage 3 - 39%, stage 4 - 61%. Preoperative scoring revealed stage 3 became stage 2 in 54% cases and stage 4 became stage 3 in 49% cases. This improvement helped us to avoid excessive excision of vaginal mucosa. CONCLUSION: Prolonged pre-operative moist gauze vaginal packing may improve the outcome of the disease.

Drug utilization study of gynecology OPD: In a tertiary care hospital

Background: The treatment of diseases by use of essential medicines, prescribed by generic names, has been emphasized by WHO and National Health Policy of India. Drugs used in gynaecology are one of the top selling drugs in India; however they are least studied with respect to drug utilization. Thus present study was undertaken to analyze drug utilization pattern of gynecology OPD in a tertiary care hospital. Materials and Methods: A retrospective, cross sectional, observational study of prescriptions in Gynecology OPD. Data was obtained from an electronic medical record database of patients that attended Gynecology OPD during the study period. Prescription records of patients were screened as per inclusion and exclusion criteria and 300 prescriptions were randomly selected by Openepi software. Patient related and drug related information was collected on a customized data collection sheet. Results: The mean age of patients was 30.19+9.83 years and common age of presentation was >18-30 years. In infective cases, vaginal discharge (10.33%) was common, and in non-infective cases, menstrual disorders (24%) were common. The average number of drugs per prescription was 3.47+1.53. In drug category, minerals (30.94%) were most commonly prescribed, followed by antimicrobials (24.98%), and NSAIDs (13.37%). Polypharmacy was observed in 96.33% of the prescriptions. Conclusion: It is only by drug utilization studies that burden of diseases and corresponding utilization of drugs in gynecology can be measured. In our study majority of the drugs prescribed were generic which were from the essential medical list NLEM and WHO.

A Study on the Nucleolar Organizer Regions-As a Tumour Proliferative Marker in Cervical Smears

To study the Argyrophilic Nucleolar Organizer Regions (AgNOR) as a cell proliferative marker in cervical smears and to assess its counts with the severity of the lesions on Papanicolaou (PAP) stained cervical smears. The present study was a prospective experimental study which was carried out at Jawaharlal Nehru Medical College in a span of 2 years. 50 high risk cases were selected from the Gynaecological OPD. The cervical smears were collected in pairs, one for the conventional PAP staining and the other one for the specialized AgNOR staining. The Student's unpaired 't' test was used. There was a progressive rise in the AgNOR counts with the severity of the lesions [normal cervix< chronic cervicitis< low squamous intraepithelial lesion (LSIL)< High Squamouus Intraepithelial Lesion (HSIL) carcinoma cervix i.e. 1.75 < 2.09 < 2.81 < 4.17< 5.98 respectively]. Each lesion had a significant AgNOR value which helped in differentiating it from its precursor lesion. The AgNOR counts have been immensely helpful as they behave as a cell proliferative marker, aiding the diagnosis which is made through the cervical PAP stained smears and letting the cytopathologist understand the exact stage of the cervical lesion.

Effect of mifepristone (25 mg) in treatment of uterine myoma in perimenopausal woman

Objectives:To evaluate the effect of Mifepristone (25 mg) on symptomatic myoma in perimenopausal women.Study Design:Open label clinical trial.Materials and Methods:Ninety three perimenopausal women of age 35-50 years having symptomatic myoma were selected from Gynecology OPD and given 25 mg Mifepristone once daily continuously for three months. Variables as; baseline uterine size, uterine volume, myoma size, volume, their number, position, characteristics, hemoglobin and blood parameters, were taken and followed monthly for six months. Bleeding and pain scores were checked on monthly visits. Changes in above parameters were tabulated during the first three months treatment phase and then next three post-treatment phase for analysis.Statistical Analysis:Was done by calculating mean, standard deviation, standard error and percentage distribution of variables.Results:Menorrhagia was the most common symptom which led patients to report to hospital. Mean uterine volume reduced to 63.69% of baseline, Mean dominant Myoma volume reduced to 53.62% and hemoglobin level raised to 137% after complete three months of treatment. Changes persisted in next three months post-treatment follow-up, while hysterectomy was required in 10 (12.2%) cases.Conclusion:Three months treatment of 25 mg Mifepristone effectively controls bleeding, reduces the uterine and myoma volume and thus can avoid blood transfusion and hysterectomy in a lot of symptomatic myoma cases.

Prevalence of Carcinoma Cervix in Rural Punjab and Need to Create Awareness Regarding Cervical Cancer

Background: Carcinoma of the cervix is the second most common cancer amongst women and one of the leading cause of cancer death. Objectives: To study prevalence of cervical cancer in tertiary care centre and need to create awareness about it. Method: 300 subjects between the age group of 18-70 years visiting Gynecological OPD of tertiary care centre from December 2009 to February 2010 were enrolled. Results: The prevalence of cervical cancer was 7 cases in the study group of 300. The mean score of awareness regarding cervical cancer was 8.09 out of maximum score of 20. Only 37.7% had adequate knowledge whereas 187 (62.3%) had meagre knowledge. Conclusion: The percentage of cervical cancer was found to be 2.3% and all the patients had squamous cell carcinoma while large percentage of study subjects (62.3%) were unaware regarding cervical cancer.