Gynecology Unit Research Articles

Knowledge, Attitudes, and Practices of Gynecologic Cancer Patients at Maharaj Nakorn Chiang Mai Hospital Toward COVID-19: A Cross-Sectional Survey

Background and Aim: During the Covid-19 pandemic, the knowledge, attitudes, and practices about COVID-19 infection in gynecologic cancer patients were still limited. This study aimed to explore these issues.Methods: Gynecologic cancer patients who attended our gynecologic oncology unit between February and June 2022 were invited to a cross-sectional survey using a WHO survey tool. Results: 363 patients participated with 20.9% undergoing treatment and receiving the COVID-19 vaccine significantly less than the surveillance participants (85.4% vs.57.9%, P < 0.01). Forty-eight participants developed a COVID-19 infection. The most common vaccine used for the two first doses was AstraZeneca. Regarding attitudes issues, most participants felt health literacy was obtained easily. They considered that they had a moderate probability to have severe symptoms of COVID-19 infection and almost all knew the proper behavior for prevention. The participant reported little stress and most trusted healthcare workers and family doctors. They agreed with lifting regular rules to control the COVID-19 pandemic. The other opinions that were significantly higher in participants who did not receive the vaccine versus those who received the vaccine, were as follows: “If everyone is vaccinated, no need for me to vaccinate”, “the stress made me not want to vaccinate”, “no need to vaccine due to rare disease” and “the vaccine is unsafe”. Conclusion: Gynecologic cancer patients who were under treatment received the COVID-19 vaccine less than those under surveillance. Most participants revealed a good attitude toward this pandemic. However, unvaccinated participants were concerned about the severe side effects of the vaccine.

Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program.

Introduction Gynecologic dysplasia units and dysplasia consultations are obliged to offer diagnosis and treatment in accordance with the guidelines. The organization of the consultation process, management of patient appointments, diagnosis, and treatment algorithms are heterogeneous. The legislation arising from the new Federal Joint Committee decision, dated 22 November 2018, concerning the organized cervical cancer screening program has been in force since 1 January 2020. In this article we provide an overview of the existing structures and interdisciplinary cooperation of specialized dysplasia units incorporated in certified gynecologic cancer center. Materials and Methods We carried out a retrospective database search of data collected prospectively from 1 July 2014 to 31 December 2019 at the dysplasia unit at the Department of Gynecology and Obstetrics, Erlangen University Hospital, which was the first dysplasia unit to be certified in 2014. Results A total of 5594 patients presented at the unit, and 16061 colposcopic, vulvoscopic, and anoscopic examinations were performed. Approximately 4100 examinations of the cervix, vagina, vulva, and anus are carried out each year, 1600 of these were exclusively cervix colposcopies. A total of 12197 cytology results were assessed, as well as 4850 histology results, and 8193 high-risk HPV tests. The quality indicators required by the dysplasia unit for annual recertification were met each year. Conclusion Certified dysplasia units and consultations form the central component in the algorithm for further investigating abnormal screening results; but they are also the first point of contact for a large number of patients with acute or chronic complaints in the genital region.

Oral Tetrahydrocannabinol (THC):Cannabinoid (CBD) Cannabis Extract Adjuvant for Reducing Chemotherapy-Induced Nausea and Vomiting (CINV): A Randomized, Double-Blinded, Placebo-Controlled, Crossover Trial.

To evaluate the effects of tetrahydrocannabinol (THC):cannabinoid (CBD) (1:1) oil in reducing chemotherapy-induced nausea and vomiting (CINV) in gynecologic cancer patients who received moderate-to-high emetogenic chemotherapy. This was a randomized, double-blinded, crossover and placebo-controlled trial. The study was conducted at the Gynecologic Oncology Units, Bhumibol Adulyadej Hospital (BAH), Royal Thai Air Force, Bangkok, Thailand, between August and November 2022. Participants had gynecologic cancer and received moderate-to-high emetogenic chemotherapy. Subjects were randomized and divided into two groups (A and B) based on the block of four randomization method. In the first cycle, groups A and B received THC:CBD extract oil 1:1 (TCEO) and placebo before chemotherapy administration. In the second cycle, groups A and B received placebo and TCEO before chemotherapy administration. Both groups received per protocol antiemetic medication during chemotherapy. Nausea score and side effects were recorded. A total of 60 cases were recruited. After exclusion, 54 cases were included in the study. The mean age of participants was 54.4 years. The mean body mass index (BMI) was 26.5 kg/m2. Fifty-nine (21/54) percent cases were the advanced stages of cancer. The nausea score of TCEO and placebo groups were 2.11 and 2.99, respectively (P < 0.05). More than half of the participants (36/54) reported dizziness and sedation side effects. Dry mouth, confusion, anxiety, and palpitation of both groups were comparable. The cannabinoid extract (THC:CBD) was an appropriate adjuvant agent to reduce CINV in patients with gynecologic cancer who received high-emetogenic chemotherapy. Dizziness and sedation were the major side effects.

Impact of minimally invasive surgery on surgical outcomes for obese women with endometrial cancer following robotic surgery introduction; a single centre study.

The aim was to assess the surgical outcomes in obese women with endometrial cancer following robotic surgery introduction in a London tertiary gynaecological cancer unit. Data was prospectively collected for 281 women undergoing endometrial cancer surgery in 2016, 2018 and 2019 (robotic surgery was introduced in November 2017). The proportion of obese and morbidly obese patients undergoing minimally invasive surgery (MIS) significantly increased following robotic surgery introduction from 43.8% to 69.6% (p<0.001). Overall robotic surgery operating time was not affected by higher body mass index (r=0.177, 95% CI -0.068-0.402). There was no difference in the length of stay or in the frequency and severity of complication rates between obese, morbidly obese and non-obese populations undergoing MIS. Robotic surgery led to a significant rise in MIS and improved surgical outcomes for obese and morbidly obese women with endometrial cancer within 12months of its introduction.

Dysregulation of IL-6 and Iron Biomarkers as Potential Diagnostic Markers for Polycystic Ovary Syndrome

Polycystic Ovary Syndrome is one of the most common endocrinopathies in women of reproductive age group. A Case-control study is carried out in Kirkuk city from 10th of November 2022 to 10th of March 2023 for determination the relationship of ferritin, serum iron and interleukin-6 among PCOS women. The number of PCOS women under study were 60 women whose ages were between 15-45 years old. These patients admitted to obstetrics and gynecology unit at Gynecological and Pediatric Hospital in Kirkuk city. In addition, the control group consisted of 30 healthy volunteer females with regular menstrual cycles aged between 15 to 45 years. All PCOS patients and healthy control underwent full physical examination and anthropometric measurements including weight, height, and were asked to complete a general questionnaire. Body Mass Index (BMI) was calculated by using the formula: weight (Kg)/height (meters2). Blood samples collected from each women for measurement of interleukin-6 by Enzyme linked immunosorbent assay (ELISA), and serum ferritin, by immunofluorescence and serum iron by manual biochemistry procedures. The average IL-6 level in PCOS women was (279.8±77.8 pg/ml), whereas the control group had a level of( 92.5±11.54 pg/ml). Based on the study findings, women with PCOS had significantly higher average serum iron levels compared to the control group (223.5±57.3 and 129.144.9 g/dl), serum ferritin levels were significantly elevated in women with PCOS (279.9±44.9 and 189.5 57.3 ng/ml), The Mean of IL-6 in PCOS women with BMI&gt;25 (kg/m2) was (293.1± 81.8pg/ml) which is significantly higher than in PCOS women with normal BMI (231.9±18.9 pg/ml). The study showed that the serum iron and ferritin were elevated significantly in obese PCOS women (151.72±44.85 g/dl and 247.4±147.4 ng/ml) respectively as compared with non-obese PCOS women (140.61±35.08 g/dl and 228.7±38.2 ng/ml). High levels of iron, ferritin and IL-6 were observed in PCOS women as compared with healthy women specialty obese women with PCOS which highlight the importance of inflammation in PCOS and suggest that IL-6 levels could potentially serve as a biomarker for the condition. Additionally, exploring the relationship between IL-6 and other factors, such as hormonal imbalances and metabolic abnormalities, can provide a more comprehensive understanding of the pathophysiology of PCOS.

Maternal and Neonatal Outcomes in Intrahepatic Cholestasis of Pregnancy.

The aims of our study were to evaluate the maternal and fetal outcomes of intrahepatic cholestasis of pregnancy (ICP). In this observational, retrospective case-control study, we included all pregnant women who gave birth with a diagnosis of ICP between January 2010 and December 2020 at the Unit of Obstetrics and Gynecology, University Hospital of Messina. The data were compared with those from a control group of pregnant women who did not have ICP. One hundred twenty-nine and eighty-five patients were included, respectively, in the study and in the control group. There was a significant difference between the two groups in the incidence of hypothyroidism, thrombophilia, gestational diabetes, gestational hypertension, postpartum hemorrhage, and preterm delivery, which were more frequent in the ICP patients. No neonatal adverse events were recorded, although a significant difference in the meconium-stained amniotic fluid condition was noted. After a 24-month follow-up, 48/129 patients with ICP accepted to be reassessed by liver ultrasound, elastographic examination, and liver function blood tests. No patient showed signs of chronic liver disease. This study confirmed a higher probability of adverse short-term maternal outcomes in ICP pregnant patients, but a lower probability of adverse short-term fetal outcomes and the absence of a long-term maternal risk of chronic liver disease.

Prevalence of Antepartum Hemorrhage in Two Referral Hospitals in Douala-Cameroon

A few years after the implementation of policies to combat maternal mortality, antepartum hemorrhage, which is one of the main causes, is not systematically documented to the point where we are left to wonder what it is prevalence in the major cities of Cameroon. This study was conducted in the Gynecological and Obstetric units of the Laquintinie hospital and the General hospital of the city of Douala, from May 01, 2020, to April 30, 2022, has been to determine the prevalence of antepartum hemorrhage in Douala. It included 166 women who had had antepartum hemorrhage. The data collected with an indirect self-administered questionnaire was processed by SPSS 23. Following this treatment, participants had an average age of 31.28 ± 6.33 years. The prevalence of antepartum hemorrhage in the two hospitals was 3.47% and of 166 cases, 51.80% had placenta abruption. Keywords: Antepartum Hemorrhage, Prevalence, Pregnancy.

Socio-Demographics and Contraceptive Acceptance of Women of Reproductive Age in Peshawar Pakistan: A Cross-sectional Study

Background: Delaying in the initiation of effective contraception in postpartum period and during lactation puts a woman at risk of rapid, repeat, and unintended pregnancy. Postpartum Intrauterine Contraceptive Device (PPIUD) insertion during a Caesarean section allows obstetrician to insert it under vision thus excluding any fear of perforating the uterus with major side effects that is bleeding and abdominal cramps being masked in the puerperium. The aim of the currents study was to investigate knowledge, attitude, and acceptance trends of contraception practices among women from Peshawar Pakistan. Methods: Current six-month duration (January 1,2019 to June 30, 2019) based cross-sectional study was conducted at Obstetrics and Gynecology Unit B, Lady Reading Hospital, Peshawar by following non-probability purposive sampling approach. Detailed socio-demographic and obstetric history was obtained from 316 women who were admitted for elective lower segment Caesarean section by informed ethical concern. The major socio-demographic details collected from the study participants may include age, education level and number of total pregnancies conceived. Further, profession and duration from last childbirth related factor were compared with the knowledge and acceptance rates of intra-uterine postpartum contraception by using Chi-Square test. Further data analysis was made by using SPSS v. 20 and Microsoft office 2010 different tools. Results: Out of 316 participants, only 22 (6.96%) women accepted PPIUCD during Caesarean section. The mean age of participants was 33.26 ± 5.1 SD. About 243 (76.89%) cases had no normal schooling, 15 (4.7%) had primary education, 57 (18%) had secondary and only 1 (0.3%) had higher education. Similarly, 294 (93%) were housewives while only 22 (7%) were employed at work., no significant difference was noted among the acceptance of the different age groups. Conclusion: The uptake of PPIUCD is very low as observed in this study. To improve the situation, health authorities should be encouraged to provide counseling on postpartum contraceptive methods during ante- and post-partum care visits.

Constipation After Elective Laparoscopy for Benign Gynecological Indications–A Prospective Observational Study

Discover the rate of post-operative constipation in participants undergoing elective laparoscopy for benign gynecological indications DESIGN: Prospective observational study SETTING: Single site, tertiary level gynecology unit with a focus on pelvic pain and endometriosis. Recruited participants were patients of the institution over the age of 18 who had planned to undergo an elective laparoscopy for benign gynecological indications prior to enrolment in the study. Participants were excluded if they were not English speaking, had a chronic bowel condition (with the exception of irritable bowel syndrome), were planned to have bowel surgery, hysterectomy, or converted to laparotomy. In this prospective study, participants completed 3 consecutive surveys. One prior to surgery, one a week post-surgery, and a third 3 months post-surgery. The surveys collected data regarding the participant's bowel habits, pain relief used, laxatives used, and the distress or bother caused by their bowels. Constipation was defined by a modified ROME IV criteria. Opiate use and laxative use were defined by patient-reported tablet counts. The level of distress was measured as a continuously variable scale from 0 to 100. Variables adjusted for included subject's demographics, pre-operative constipation, indication for surgery, duration of surgery, estimated blood loss, opiate use (preoperative, peri-operative, and post-operative), laxative use, and length of stay. A total of 153 participants were recruited, of which 103 completed both the pre-operative and post-operative survey. Post-operative constipation was present in 70% of participants. The mean length of time to first bowel motion was 3 days, with 32% of participants having their first bowel motion after the third post-operative day. The level of bother caused by their bowel habit was higher in the constipation group compared to those without constipation. Post-operatively opiates were used in 84.9% of participants, and laxatives were used in 47.1%. Visits to the general practitioner for constipation occurred in 5.8% of participants. Post-operative constipation is common and bothersome in participants who undergo elective laparoscopy for benign gynecological indications. Analysis of individual variables failed to identify any factors that influenced the rate of constipation.

Cross-sectional investigation of mycological diagnosis challenges in Saudi Arabia.

The global incidence of fungal infection has increased dramatically over the last two decades. Fungal diseases threaten both immunocompetent, and immunocompromised patients. The current fungal diagnostics status in Saudi Arabia needs to be evaluated, especially with the increase of the immunosuppressed population. This cross-sectional study investigated the gaps in mycological diagnosis on a national level. The call interview questionnaire responses were collected to evaluate the demand for fungal assays, diagnostic methods' quality, and mycological expertise of laboratory technologists in both public and private medical intuitions. The data were analyzed using (IBM SPSS ® software version 22.0). A total of 57 hospitals from all Saudi regions participated in the questionnaire; however, only 32% received or processed mycological samples. Most participants were from the Mecca region (25%), Riyadh region (19%), and Eastern region (14%). The top fungal isolates identified were Candida spp., Aspergillus spp., and dermatophyte. Fungal investigation is highly requested by intensive care, dermatology, and obstetrics and gynecology units. Most laboratories rely on fungal culture and microscopic examination, which mostly identify Candida to the genus level, and use 37°C incubators for culture (67%). Antifungal susceptibility testing (AST) and serological and molecular methods are rarely performed and mostly outsourced. Using accurate identification and AST are the primary factors to improve fungal diagnosis in respect to turnaround time and cost. The three major obstacles identified were availability of facility (47%), reagents and kits (32%), and good training (21%). The results indicated that fungal diagnosis demand was relatively higher in high-population regions. This study highlighted the gaps in fungal diagnostics reference laboratories to encourage their improvement in Saudi hospitals.

The importance of the regularity of preventive examinations in the early diagnosis of ovarian cancer

Objective. To show the importance of regularity of preventive examinations in early diagnostics of ovarian cancer. Malignant ovarian tumors occupy the third place in the frequency of occurrence among the gynecological tumors after cancer of the uterine body and cervix but they leave them behind with regard to the mortality rate. Detection of the disease at late stages leads to only 17 % five-year survival rate in Europe and Russia.&#x0D; Materials and methods. A prospective study was conducted on the basis of the Gynecological Unit of Perm Regional Oncological Dispensary. It enclosed 50 patients aged 45 to 77 years, operated for ovarian cancer with various stages of the disease. The following methods were used: collection of complaints and anamnesis, study of outpatient cards and medical histories, assessment of morphological conclusions.&#x0D; Results. According to the anamnesis, all patients represented a risk group for ovarian cancer. The annual gynecological preventive examination was carried out in 40 % of patients, ultrasound examination of the pelvic organs was performed in 28 % of cases. The smallest group,10 % of patients, was a group of patients with stage I of the disease and asymptomatic course of pathology, who underwent preventive examinations and ultrasound in 100 % of cases. The largest number of patients had stage III 40 %, annual preventive examinations were carried out in 20 % of women of this group without ultrasound examination of the pelvic organs. In 64 % of cases, a late examination by a doctor was detected a year or more after the symptoms of the disease occurred. Patients with stages III and IV of the disease were postmenopausal, were unemployed and lived in rural areas.&#x0D; Conclusions. The absence of symptoms at an early stage of ovarian cancer and late onset of treatment with the complaints available actualizes the need for annual preventive gynecological examinations with mandatory ultrasound verification of the diagnosis to identify the disease in time.

Bilateral posterior Richter sacrospinous fixation with native tissue: anatomical and functional results and quality of life assessment over 10 years.

Pelvic organ prolapse (POP) is a common condition that affects 50% of women who have given birth in their lifetime. With stop of vaginal mesh sale in 2019, the sacrospinous fixation technique according to Richter with native tissue has seen its incidence tripled in 15 years. Classically, sacrospinous fixation according to Richter is performed unilaterally, however its unilateral or bilateral character is controversial. Objective of this work is to evaluate the efficacy and safety of bilateral sacrospinous fixation according to Richter by the posterior approach with native tissue (SSB). We performed a retrospective single-center study. From March 12, 2010 to March 23, 2020, all first-time operated patients who underwent SSB in CHU Strasbourg gynecological surgery unit for symptomatic POP management were included. The main endpoint of our work is the anatomical and functional success rate at 12 and 24 months. The secondary judgment criteria of our work were based on the postoperative evaluation of patient's quality of life according to the PFDI-20 score as well as the rate of postoperative complications. 77 patients were included in our work. The anatomical success rate at 12 months is 94% and 81% at 24 months regardless of the compartment affected. The functional success rate is 94% at 12 months and 82% at 24 months. Quality of life evaluation through the PFDI-20 scale revealed a clear improvement in the symptomatology related to POP: 127/300 +/- 27.3. preoperatively and 59.8 ± 14.7 postoperatively. Bilateral sacrospinous fixation according to Richter by posterior approach with native tissue is a safe and effective surgical technique allowing a clear improvement in patients quality of life.

TRIAL OF LABOR AT THE MATERNITY DEPARTMENT OF THE SOUROSANOU UNIVERSITY HOSPITAL (CHUSS): CLINICAL ASPECTS, THE MATERNAL AND PERINATAL PROGNOSTICS

Aims : We aimed at studying the clinical aspects and the maternal and perinatal prognostics during trial of labor at the Gynecology and Obstetrics Unit. Patients and Methods : This is a transversal and Descriptive study over a period of 06 months from 1 st May to 30 th October 2016 in the Gynecology and Obstetrics Unit of the SourôSanou University Hospital (CHUSS). The data were collected and analyzed by the software Epi info version 3.4.5. Results : During the period of study, 109 cases of trial of labor for a total of 2124 births were registered, with an overall frequency of 5.13%. The average age of the patients was 26.6 years. In 42.2% of cases, the patients were primiparious . Admission was direct in 85.5% of cases. The coverage rate for prenatal consultation was 100%. There was vaginal delivery for 108 patients, ie a success rate of 99.08% for trial of labor. An episiotomy was performed in 18.34% of those who delivered vaginally with a labor time less than 3 hours in 65.13% of cases. The indication of the cesarean section during the failure of the trial of labor was dominated by acute fetal distress in 0.91% of cases. Among the 14 patients who had complications during the postpartum period, 06 cases of postpartum hemorrhage of 22.85%, were noted, but did not occasion any maternal death. We registered 109 newborns including 106 alive (97.2%), 10 fresh stillborn, 02 perinatal deaths and 01 macerated stillborn. Among the 13 cases of perinatal morbidity, infections, neonatal suffering and hypotrophy were largely dominant with 5.5%, 38, and 5.34% of the cases. Conclusion : The results of our study (99.08% of success) argue in favor of vaginal delivery after uterine scar, with little risk related to this scar when the pregnancies are followed closely. Indeed, with a normal and careful obstetric monitoring, a scarred uterus after one segmental cesarean section must be considered as a normal uterus that can allow the woman to deliver simply without her being exposed to any particular risk of uterine rupture.

The Frequency of Maternal Complications after Home Delivered

Objective: To determine the frequency of maternal complications among women delivered at home by Traditional Birth Attended (TBA) Dais presenting at the emergency department of tertiary care hospital. Study Design: Descriptive case series Study setting: The study was conducted at the Emergency Department of Gynecology Unit –III of Liaquat University Hospital, Hyderabad. Study Duration: Six months from 1st May 2018 to 30th November 2018. Methods and Material: A sample of 140 was obtained, participants were selected by using the Non-probability sampling technique and all the women from 20 to 45 years of age either primipara or multiparous who delivered at home by traditional birth attendant (TBA) Dais and presented within 12 hours up to 10 days after delivery at emergency department of Gynecology Unit –III of Liaquat University Hospital, Hyderabad included, after getting informed and written consent from their family members, a questionnaire was used to collect information from the women or her relatives. Data was collected for the complications like post-partum hemorrhage, a retained product of conceptus, perpural sepsis perineal tears injuries. We have used SPSS version 20.0 software for both data entering and analysis. Frequencies and standard deviations were calculated and the chi-square test was used to analyse categorical variables. P values less than 0.05 were considered statistically significant. Result: The total number of women who delivered at home by (TBA’s)/ Dia’s and developed maternal complications presented in the emergency department within 12 hours up to 10 days during the study period was 140. The average age of the patients was SD 29.27±5.21 years. Regarding parity, 58(41.43%) were primigravida and 82(58.57%) multigravida. The postpartum hemorrhage was the commonest maternal complication observed in 62.14% (87/140) cases, retained placental products 27.14% (38/140), purpureal sepsis 7.86% (11/140) and perineal tear injuries 17.14% (24/140). Retained placental product, perianal tear injury and PPH were not statistically significant among different ethnicity while the rate of puerperal sepsis was statistically significant among different ethnicity groups. The frequency of PPH and perianal tear injury was significantly high among those women who had primigravida while the rate of Retained placental products and Puerperal sepsis was high in multigravida but it was not statistically significant. Conclusion: This study concluded that home deliveries conducted by untrained birth attendants were associated with increased maternal morbidity and a high risk of maternal mortality. The postpartum hemorrhage was the most common maternal complication observed in women after home delivery by a Traditional Birth Attended (TBA) Dais.

The relationship between personality traits and individual factors with perinatal depressive symptoms: a cross-sectional study

BackgroundPregnancy is a crucial transition moment exposing women to potential mental health problems, especially depressive disturbances. Sociodemographic, pregnancy-related, and psychological factors have been related to depressive symptoms in the perinatal period. This study aims at (1) exploring personality and individual factors related with perinatal depressive symptoms, and (2) testing the mediating role of personality in the relation between characteristics of the woman’s family of origin and depressive symptoms.MethodsWomen in the perinatal period admitted to the gynecology unit for motherhood-related routine assessments (n = 241) were included in the study. A survey on individual sociodemographic, clinical, and pregnancy-related factors was administered, also including the Edinburgh Postnatal Depression Scale (EPDS) and the BIG-5 personality test.ResultsCouple conflict and neuroticism were independent and directly correlated with EPDS total score (respectively: B = 2.337; p = .017; B = 0.303; p < .001). Neuroticism was a significant mediator of the relation between the presence of a psychiatric disorder diagnosis in participant’s parents and the EPDS total score (indirect b = 0.969; BCCI95%=0.366—1.607).ConclusionsCouple relation and neuroticism traits are individual factors related to depressive symptoms in the perinatal period. The family of origin also plays an indirect role on perinatal depressive symptoms. Screening of these factors could lead to early recognition and more tailored treatments, ultimately leading to better outcome for the entire family.

Effect of Amino Acid Infusion on Amniotic Fluid Index in Pregnancies Associated With Oligohydramnios and Fetal Growth Restriction.

Background Oligohydramnios and fetal growth restriction have been known for ages, with increased risk of disease and death during antenatal, neonatal, and adult life leading to operative interventions and perinatal mortality and morbidity. The amniotic fluid index varies with gestational age and is used to detect fetal well-being. Various oral and IV hydration and amino acid infusion therapies are studied to improve amniotic fluid index (AFI) and fetal weight. Objective To study the effect of intravenous amino acid infusion on AFI in pregnancies associated with oligohydramnios and fetal growth restriction (FGR). Material and methods A semi-experimental study done in Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi Meghe, Wardha enrolled pregnant women in the in-patient department (IPD) unit of Obstetrics & Gynecology and divided them into two groups of 52 each, which met inclusion and exclusion criteria. Group A received IV amino acid infusion on an alternate day, whereas group B received IV hydration, and serial monitoring was done till delivery. Results The mean gestational age at admission was 32.73 ± 2.21 in the IV amino acid group and 32.25 ± 2.27 in the IV hydration group. In both groups, the mean AFI at admission was observed at 4.93±2.03 cm and 4.22 ± 2.00 cm, respectively. The mean AFI on the 14th day in the IV amino acid group was 7.52 ± 2.04, and in the IV hydration group, 5.89± 2.20 with a significant p-value of <0.0001.

Variables related to health-related quality of life among breast cancer survivors after participation in an interdisciplinary treatment combining mindfulness and physiotherapy.

Breast cancer diagnosis and treatment increase the potential psychological impact on breast cancer survivors (BCS). The objective of this study was to assess the effects of an interdisciplinary intervention during follow-up in BCS and identify variables related to improvements in HRQoL. In a non-randomised quasi-experimental design performed on an outpatient basis in a hospital gynaecology and oncology unit, 60 BCS were assigned to an interdisciplinary experimental group (EG) or a usual care group (CG). The EG underwent 12 sessions of an interdisciplinary program which included Mindfulness and physiotherapy, for 120 min per day, once a week for 6 weeks. At baseline, at 6 weeks and at 3 months after the intervention, participants of EG and CG completed an assessment of HRQoL (EuroQol and EORTC-QLQ-C30) and symptomatology of anxiety and depression. Additionally, EG completed an assessment of satisfaction with the treatment. For data analysis, we used descriptive statistics, Wilcoxon test, Kruskal-Wallis test, Chi-square and Fisher tests and generalised linear models. After 6 weeks, statistically significant differences were apparent in global and cancer-related health symptoms such as fatigue and pain in the EORTC QLQ-C30 and in anxiety and depression, among the EG (n = 30) compared with the CG (n = 30). Patients receiving the intervention reported a high degree of satisfaction with the treatment. Three months after the intervention, patients in the EG continued to show statistically significant improvements compared with the CG. In addition, allocation to the EG was identified as a variable related to improvement of HRQoL (EORTC QLQ-C30) in the multivariable model. The results of our study suggest that a 6-week interdisciplinary intervention may improve HRQoL and symptomatology of anxiety and depression in BCS patients at 3 months. The study presents data that the intervention for BCS appears promising and warrants further study in a randomised controlled trial.

Evaluation of the medically necessary, time sensitive triage score during and beyond the local COVID-19 pandemic in the Gynaecologic Oncology Unit of a tertiary hospital in South Africa.

The main objective of this study was to evaluate the Medically Necessary Time Sensitive (MeNTS) scoring system in triaging gynaecologic oncologic surgery during and beyond the COVID-19 pandemic. This was a retrospective cross-sectional study including 209 patients who either had surgery (151) or surgery postponed (58) between the 26th March and 30th September 2020 in an academic hospital in South Africa. The MeNTS score was used to independently score each patient three times by two observers. The mean age of the participants was 46.6 ± 15 years and the cumulative mean MeNTS score was 51.0 ± 5.1. Over two-thirds of the cases had surgery. There was no significant difference between the first and second observers' cumulative scores, 51.0 vs 51.1 (p 0.77). The cumulative score among those who had surgery was significantly lower than that for those whose surgeries were postponed, 49.8 vs 54.1 (p <0.0001). The intra-observer and inter-observer reliability were 0.78 and 0.74 respectively. After adjusting for confounding variables, those with low cumulative MeNTS scores were about 5 times more likely to have surgery than those with high scores (Adj. OR = 4.67, 95% CI: 1.92-11.4, p <0.001. Patients with malignant diagnosis were also 5 times more likely to be operated than those with benign diagnosis (Adj. OR = 5.03, 95% CI: 1.73-14.6, p <0.001. The area under the curve (AUC) was 0.85 suggesting an excellent discriminatory power between those who were operated and those who were postponed. The study provided some insight into the potential usefulness of MeNTS score in prioritizing patients for surgery in gynaecologic oncologic sub-specialty. The score performed well across a range of gynaecologic conditions and procedures with good intra-observer and inter-observer consistency and reliability. This is a prioritization tool that is dynamically adaptable to accommodate changes in resources availability and operating theatre capacity.

Teratoma nasofaríngeo inmaduro con diagnóstico prenatal: reporte de un caso y revisión de la literatura

To report the case of a pregnant woman with prenatal diagnosis of fetal immature nasopharyngeal teratoma, and to conduct a review of the literature describing the prognosis of this condition. We report the case of a 27-year-old pregnant woman who received care at the Obstetrics and Gynecology Unit of a reference hospital in Bogotá (Colombia) because of a finding during a prenatal visit of evidence of polyhydramnios, secondary to a nasopharyngeal teratoma. A literature search was conducted in the Medline vía PubMed, Scopus, SciELO and ScienceDirect databases, restricted by language (English and Spanish) and date of publication (January 2001 to January 2021). Case reports and case series covering the prognosis of this condition were included. Overall, 168 titles were retrieved, 55 of which met the inclusion criteria. Perinatal outcomes for a total of 58 fetuses with a diagnosis of immature nasopharyngeal teratoma detected during the prenatal stage were reported. In the identified cases, perinatal mortality was 25.4 % and the percentage of fetal demise was close to 3.6 %. Immature nasopharyngeal teratoma is an infrequent condition. The available literature suggests that fetal prognosis depends on the degree of compromise of intracranial structures and the possibility of resecting the lesion. Further studies are needed to assess the prognosis of fetuses with immature nasopharyngeal teratoma.

Comparison in Mean Amniotic Fluid Index with Omega-3 Fatty Acids vs Placebo in Cases of Unexplained Oligohydramnios

Background: Oligohydramnios is hazardous for fetal health for which new treatment modalities are being sought out. The fetus floats in amniotic fluid which takes care of its proper development. Omega-3 Fatty acids protect against inflammation and raised blood pressure. With omega-3, AFI can be improved and the complication scan be reduced leading to an overall better fetal outcome. Aim: To compare the mean amniotic fluid index with omega-3 polyunsaturated fatty acids supplementation versus placebo for management of cases of unexplained oligohydramnios Methods: A randomized control trial was held at Gynecology Unit 2, Lady Willingdon Hospital, Lahore from 21-12-2020 to 21-06-2022. 60 females were recruited to the study and randomly divided into two groups. Group 1 treated with omega-3 once capsule daily contained 1000 mg. of fish oil and group 2 treated with placebo. After 4 weeks, females were subjected to ultrasonography by a single senior sonologist with assistance of researcher. All the collected data was analyzed on SPSS version 21. Mean AFI was compared in both groups by use of independent sample t-test taking p-value&lt;0.05 as significant. Results: Mean age in omega-3 group was 25.63±3.57 years, and in placebo group was 25±2.704 years. 22(36.67%) females were nulliparous. The mean change of AFI with omega-3 was 4.90±1.185 and with placebo group was 2.93±0.944 (p-value=&lt;0.001). Conclusion: it was inferred that by supplementingomega-3 polyunsaturated fatty acids showed better results in terms of mean AFI than placebo for management of cases of unexplained Oligohydramnios. Keywords: Omega-3 Polyunsaturated, Amniotic Fluid Index, Unexplained Oligohydramnios