History Of Menstrual Irregularity Research Articles

Frequency and pattern of female genital tract malignancies in patients presenting with gynecological problems

Introduction: Significant morbidity and mortality is caused by cancers in women all over the world. Cancers of the female reproductive organs are called genital tract cancers. They include cervical cancer, ovarian cancer, endometrial cancer, vaginal carcinoma, cancer of the fallopian tubes and gestational trophoblastic tumor. After breast carcinomas, they account for the second most common carcinomas in females. 
 Methodology: This cross-sectional study was conducted from 1 June 2018 to 31 May 2022. After taking written informed consent, 256 patients presenting to Gynae A Unit, Ayub Teaching Hospital, Abbottabad, were included in the study. Patients with a history of menstrual irregularities, vaginal bleeding, abdominopelvic pain or mass were included, while those presenting with other gynecological problems were excluded. The confirmed diagnosis was made based on histopathology reports by the consultant pathologist of the laboratory in the hospital after the patient's surgery.
 Results: Out of the 256 patients, 30 (11.71%) had female genital tract malignancies. The mean age was 48.79 years, and the standard deviation was 12.93 years. 17 patients (56.66%) had ovarian cancer, 5 (16.66%) had cervical cancer, 7 (23.33%) had endometrial cancer, and 1 (3.33%) had vaginal cancer. Ovarian cancer was the most common (56.66%), followed by endometrial cancer. Serous adenocarcinoma of the ovary was the most frequent type (26.66%). 
 Conclusion: The percentage of female genital tract malignancies in patients with gynecological problems is relatively high with serous adenocarcinoma of the ovary being the most common malignancy. Developing and implementing an effective policy regarding early cancer detection is necessary.

The Relationship Between Menstrual Cycle Irregularities and COVID-19 Vaccination.

Background After COVID-19 vaccination, females reported irregularities and changes in their menstrual cycle. We aimed to explore the menstrual irregularities following COVID-19 vaccination in Saudi women of childbearing age. Methodology The study was a cross-sectional study conducted among women in Riyadh, Saudi Arabia, who had no history of menstrual irregularities before receiving the first dose of the COVID-19 vaccine. The participants filled out an online self-administered questionnaire via Google Form about any menstrual irregularities they experienced after receiving the COVID-19 vaccine. Results A total of 535 participants completed the survey. The study found that 41.7% (223) of women experienced menstrual changes after the first dose of the COVID-19 vaccine, increasing to 44.1% (236) after the second dose. The incidence of these changes varied between the first and second doses. For example, the incidence of changes in period duration decreased from 51.6% to 48.3% after the first and second doses, respectively. Similarly, the incidence of delayed periods decreased from 48.4% to 47.9%, while dysmenorrhea increased slightly from 30.9% to 32.2% after the two doses. The incidence of heavier menstrual flow increased from 26.9% to 30.5%, while the incidence of lighter menstrual flow decreased from 26.9% to 24.6% after the first and second doses, respectively. Conclusions There is an increased incidence of changes in menstrual cycle after COVID-19 vaccination, particularly in menstrual cycle length, menstrual pain, and the flow of menstruation. Future studies are needed to investigate the potential underlying biological mechanisms.

Visceral Adiposity Index as an Indicator for Menstrual Disturbance, Hormonal and Metabolic Dysfunction in Polycystic Ovarian Syndrome.

Increase in visceral adiposity is characteristic of polycystic ovarian syndrome (PCOS) and is the main cause of insulin resistance and hyperandrogenism. This study tried to compare the visceral adiposity index (VAI) in PCOS women and control population, thereby exploring its correlation with ovarian morphology, hormonal and metabolic dysfunction. Reproductive-age women who fulfilled the Rotterdam criteria for PCOS constituted the cases. Control population consisted of the same number of non-PCOS women. History of menstrual irregularity and features of hyperandrogenism were noted. Overnight fasting serum hormonal profile on second day of the cycle, oral glucose tolerance test (OGTT) and serum fasting insulin and lipid profile were obtained. Ultrasound evaluation was done simultaneously. Free androgen index (FAI), homeostatic model assessment of insulin resistance (HOMA-IR) and VAI were calculated. Serum androgen levels and OGTT were greater in PCOS women. No significant difference was noted in serum fasting glucose, fasting insulin and lipid profile between cases and controls. Both systolic and diastolic blood pressures were significantly higher among women with PCOS. Mean ovarian volume, antral follicle count, FAI and HOMA-IR were higher in PCOS women. VAI was significantly higher in cases compared to controls. VAI demonstrated a strong negative correlation with number of menstrual cycles per year. Increasing VAI was associated with longer menstrual cycles and correlated positively with greater severity of anovulation. VAI also showed highly significant correlation with fasting blood glucose and statistically significant moderately strong positive correlation with OGTT values at two hours post glucose challenge, systolic blood pressure and mean ovarian volume.There was no demonstrable correlation between androgen levels or HOMA-IR values. VAI is higher in women with PCOS. It correlates positively with features of disease severity and ovarian morphology. An assessment of VAI in PCOS women could be predictive of a greater propensity for development of classical metabolic risk factors.

Cyclic Targetoid Rash With Menstruation

A 41-year-old woman had a 5-year history of targetoid purpuric-red plaques on the legs at a menstrual cycle interval. The eruption predictably started 5 to 7 days before menstruation and resolved within several days after cessation of menses. She had no history of menstrual irregularity or other comorbidities. There was no history of intake of exogenous progesterone. On physical examination, there were multiple targetoid plaques with purpuric-red color on the leg (Figure 1). Skin specimen showed parakeratosis, spongiotic microvesicle, upper dermal edema, and perivascular infiltration of inflammatory cells (Figure 2).

LAPAROSCOPIC MANAGEMENT OF A RARE CASE OF BILATERAL GIANT OVARIAN CYST IN A YOUNG UNMARRIED GIRL: AN INDEX CASE

Introduction: Nowadays it is rare to nd giant ovarian cysts as they are diagnosed and managed early due to easy access to the good imaging modalities. Traditionally the treatment modality is conventional midline laparotomy. Here we present a case of laparoscopic ovarian cystectomy with keeping the healthy ovarian stroma intact in a case of bilateral giant dermoid ovarian cyst. A 27-year-old unmarried womanCase Report: presented with the symptoms of progressive abdominal distension over 6 months and vague abdominal pain of 1week duration. There was no history of bowel/bladder disturbances, loss of weight/appetite, no history of menstrual irregularities. No relevant medical and surgical history but on Preoperative work up she was diagnosed with hypothyroidism. On per abdominal examination a 22 to 24-week size rm non-tender mass with smooth surface was palpable. Upper and lateral borders well dened. Lower border not felt. There was restricted transverse mobility and no bruit over mass with no ascites. On Ultrasonography revealed suspicion of Dermoid cyst with suspected torsion. Uterus—anteverted, normal size. No free uid seen. CECT of the abdomen and pelvis conrmed Multiple bilateral ovarian dermoids (Left> Right). She was then taken up for laparoscopic ovarian cystectomy. Left Ovarian mass around 24-week size and the right ovarian mass was 10X12 cm. in size. Her histopathology report revealed the presence of bilateral dermoid ovarian cyst. After exclusion of possibility of malignancy with normal tumor markerConclusion: prole and appearance on imaging modalities, it is possible to manage giant ovarian cyst laparoscopically.

Precancerous Lesion of the Cervix and Associated Factors Among Women of West Wollega, West Ethiopia, 2022.

BackgroundPrecancerous cervical lesion is an abnormality in the cells of the cervix that could eventually develop into cervical cancer. Cervical cancer is a public health problem that contributes to the death of women worldwide. In line with the high burden of the issue, the Ethiopian government had attempted to expand cervical cancer screening centers and recommendation of services to age-eligible as well as high-risk groups of women. Therefore, the study aimed to assess the prevalence of precancerous lesions of cervix cancer among women aged 30-49 years and associated factors in West Wollega.MethodFacility-based analytic cross-sectional study design was conducted in selected hospitals of West Wollega from January 1- February 20, 2022, among 339 women. A face-to-face interview was conducted and the presence or absence of precancerous cervical lesion was tested by visual inspection with acetic acid. Data were analyzed by SPSS version 25. Variable with P-value <.25 in the bi-variable analysis were entered into multivariable logistic regression. Results with a P-value ≤ .05 at 95% confidence level were considered for statistical significance.ResultThe prevalence of precancerous cervical lesions was 27.4% (95% CI: 22.7%32.1%). The mean standard deviation of participants was 35.22 +6.32 years. More than half (63.4%) and 67.6% of them were regarded as having good knowledge and a favorable attitude towards precancerous cervical lesions respectively. History of menstrual irregularity had two folds higher odds of being diagnosed with the precancerous cervical lesion when compared with counterparts at, [AOR = 2.29(95% CI:1.29-4.04]. Women with a history of STI had 3.5 times higher odds of developing precancerous cervical lesion compared to women with no history of STI [AOR)=3.46(95% CI:1.94-6.18)], history of bleeding after sexual intercourse was 2.88 times more likely to have precancerous cervical lesion compared to those without it at [AOR=2.88(95% CI:1.43-5.78)]. Parity greater than or equal to five had 2.4 times higher odds of developing precancerous cervical lesions compared to women with parity less than five at [AOR=2.41(95% CI: 1.23-4.75)]. History of steroid use had 3.5 times higher odds of developing precancerous cervical lesion compared with opponents at [AOR=3.5(95% CI: 1.32-9.34) and women with an Unfavorable attitude towards screening for Cervical cancer screening, prevention, and control methods had 2.2 times higher odds of developing precancerous cervical lesion compared their counterpart at [AOR=2.15(95% CI: 1.21-3.83)].ConclusionThe precancerous cervical lesions continue to be a significant public health concern in Ethiopia. It will remain a significant cause of death of women unless effective screening methods like VIA and vaccination against HPV are scaled up. Furthermore, having a history of menstrual irregularities, STI, bleeding after coitus, parity greater than ≥5, steroid use, and having an unfavorable attitude towards screening factors are significantly associated with the occurrence of the precancerous lesion. Therefore, effective prevention approaches have to consider these factors for the control of cervical cancer in the early phase of the lesion.

English

BACKGROUND Obesity has emerged as an important risk factor in modern obstetrics and poses a major threat to pregnancy by causing complications including gestational diabetes. It also increases the risk of cardiovascular diseases and diabetes mellitus in later life. Obesity creates major technical challenges in providing maternity services too. The objective of the study was to assess the prevalence of abnormal glucose tolerance in obese pregnant women in a Government Medical College over one year. METHODS A prospective observational study was conducted among obese pregnant women, registered at the Outpatient department of Obstetrics and Gynaecology at the Government Medical College, Kottayam from January 2017 to December 2017. 450 women were considered for the study after satisfying inclusion and exclusion criteria. BMI was calculated using pre-pregnant weight. An oral glucose test was performed with 75 gm glucose at 24 to 28 weeks of pregnancy after 8 hours of fasting. International Association of Diabetes and Pregnancy Study Group cut-offs i.e., fasting blood sugar values more than 92 mg/dl, 1hr value more than 180 mg/dl, 2 hr value more than 153 mg/dl were used as the criteria. Oral glucose tolerance was considered abnormal if any of the above values were impaired. RESULTS The prevalence of abnormal glucose tolerance among the 450 pregnant women was 35.6 %. The incidence of abnormal GTT increased with increasing age and in those with a history of menstrual irregularities and infertility treatment. No relation was found between economic status, family history of diabetes, preeclampsia and abnormal GTT. CONCLUSIONS Obesity turns to be a menace in the reproductive life of women that begins by affecting the fertility, continues to cause complications in pregnancy, increases morbidity in the long-term future and reduces the quality of life. Since more than one-third of the study population was affected by gestational diabetes, active intervention to reduce the weight preconceptionally is needed. KEY WORDS Obesity, Glucose Tolerance Test, Gestational Diabetes Mellitus, Body Mass Index, Pregnancy

A Rare Case of Broad Ligament Angioleiomyoma

Angioleiomyoma aka Vascular leiomyoma is a benign mesenchymal tumour originating from the smooth muscles and containing thick walled vessels. It is commonly seen in the subcutis of the lower extremities. Although a few cases of uterine angioleiomyoma have been reported, broad ligament angioleiomyoma is extremely rare. Case History: 45 year old multiparous women presented to the OPD with complains of pain and mass in abdomen since 4 months. No history of menstrual irregularities was noted. Ultrasonography revealed a homogenous solid mass in lower abdomen region. The mass was hypodense. A provisional clinical radiological diagnosis of Broad ligament fibroid was made. The patient underwent a surgery for removal of broad ligament mass with bilateral salpingo-oophorectomy and specimen was submitted for histopathological examination. Conclusion: Angioleiomyoma of broad ligament is an extremely rare diagnosis and should be diagnosed correctly with the help of IHC markers.It must be kept in mind as a differential diagnosis of abdominal mass associated with pain to be able to arrive at a correct diagnosis. Keywords: Angioleiomyoma, broad ligament, vascular leiomyoma, mesenchymal tumour, broad ligament fibroid.

Rate of Prophylaxis Oophorectomy and Associated Factors at the Time of Hysterectomy in Premenopausal Women with Benign Diseases

Objective: To determine the rate of oophorectomy and associated factors at the time of hysterectomy in premenopausal women with benign diseases. Materials and Methods: The medical records of the premenopausal women that underwent hysterectomy with or without oophorectomy due to benign gynecologic conditions between January 1, 2012 and December 31, 2017 at Khon Kaen University Hospital (Thailand) were retrospectively reviewed. The data collected included age, BMI, parity, indication for surgery, family history of carcinoma, route of hysterectomy, procedure, specialization of the surgeon, operative notes, and histopathological reports of the ovaries. Results: Six hundred thirty-eight subjects underwent hysterectomy due to benign gynecologic conditions. Bilateral salpingo-oophorectomy (BSO) was performed in 57.37% (366) of the cases. In 81.97% (300) of these cases, either one or both patient’s ovaries were grossly normal. The rate of prophylactic oophorectomy among all cases was 47.02% (300 in 638). The strongest associated factor with BSO was age (odds ratio 8.421, 95% CI 5.488 to 12.921). Other associated factors were irregular menstrual history, the surgeon being a gynecologic oncologist, and abdominal hysterectomy. No cases of ovarian cancer were found. Conclusion: Nearly half of premenopausal women that underwent hysterectomy due to benign conditions underwent prophylactic oophorectomy. Associated factors were age, irregular menstruation, the surgeon being a gynecologic oncologist, and abdominal hysterectomy. Keywords: Hysterectomy, Premenopausal women, Prophylactic oophorectomy

Variations in anthropometry and physical characteristics of staff with low back pain working in tertiary hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Several links were searched to know the variations in anthropometry and physical characteristics of staff with low back pain (LBP) working in tertiary hospital. Controversy exists between the association of these characteristics with LBP. The study was conducted to understand the relation between physical characteristics and LBP in the south Indian population.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Ethical approval was obtained from the institutional health research ethical committee. A survey was conducted using a proforma and it was circulated among the staff and doctors in the tertiary care hospital. The validated questionnaires were framed to collect all the physical characteristics and anthropometry of the respondents and history of LBP. The distribution of the parameters are calculated either as mean±two standard deviation, or as count and percentage. The tests used for comparison is the t test and for association is the chi square (𝛘2) test. A p value less than or equal to 0.5 is considered as statistically significant. The data was analysed using the microsoft excel and the minitab (17) software.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study showed significant positive association of back pain with increase in weight of the subjects, history of back trauma, spinal injections and lifting heavy weights (p value&amp;lt;0.01). There was no significant association of LBA with variables like history of menstrual irregularities and mode of transport.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There is a positive association between LBP with anthropometric features like weight of the patient and also physical characteristics like history of back trauma, spinal injections and lifting heavy weights.&lt;/p&gt;

“A CLINICAL STUDY ON ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION OF BREAST AND ITS MANAGEMENT IN UPPER ASSAM”

ANDI of breast is a common phenomenon. They are more common than breast malignancy. In this study an attempt was made to study the spectrum of diseases that come under ANDI of breast, their clinical presentation, treatment and also to nd out the clinical and cytohistological correlation. Study group includes 152 cases of Upper Assam who attended the Surgery OPD of AMCH during the study period and also all the patients who were admitted in the department of surgery under the clinical diagnosis of ANDI of breast. Conrmation of diagnosis was made on the basis of history, clinical examination, pathological and radiological investigations. Pathological investigations include FNAC and HPE. Radiological investigations include Ultrasonography and mammography. The following observations were made in the present study: Ÿ The commonest disease encountered was broadenoma of breast (14.47%) followed by mastalgia (23.68%) brocystic disease (14.47%) breast cyst (9.87%). The less common are duct ectasia, scleroding adenosus and phyllodes tumour, 9.87% each. Ÿ Majority are present in the second, third and fourth decades of life. All broadenoma, brocystic disease and phyllodes tumour are present in the third decade. Youngest patient was of 11 years and oldest was of 47 years. mean age of presentation was 27.45 years and the standard deviation was 7.13. Ÿ 86.84% had regular menstrual history and 13.16% had irregular menstrual history. Majority were nulliparous (46.05%). The highest parity was 4. Ÿ 94.08% did not give history of OCP use and 98.68% did not give history of lactation. Ÿ The commonest presentation was pain in the breast (76.32%) followed by lump (71.05%). Ÿ Majority cases presented to the hospital within 3-6 months of their onset of symptoms. The minimum duration of symptom was 1 month and the maximum was 12 months. Ÿ Right breast was involved more commonly 961.84%) than the left (38.16%). Ÿ Upper outer quadrant was involved most commonly involved (34.21%) and the least commonly involved was the central quadrant (1.32%). Ÿ The majority of the breast lumps (85.05%) had size less than 5cm in their greatest dimension. 14.95% had size more than 5cm. Ÿ 63.82% of the lumps had rm consistency whereas 6.58% had soft consistency. There was no positive family history in majority of the patients (89.47%). Ÿ The correlation between clinical diagnosis and histopathological diagnosis had the following ndings: For broadenoma the sensitivity of FNAC is 84.9% and HPE is 86.54% .Both have positive predictive value of 100%.For breast cyst the sensitivity of FNAC is 93.3%.For phyllodes tumour the sensitivity of FNAC is 85.7% and HPE is 75%.. Ÿ In the management, 41.45% cases underwent excision followed by aspioration of cyst in 7.89%, microdochectomy in 7.24%, wide local excision in 3.29% and simple mastectomy in 1.97%. Among conservative treatment 14.47%b were given evening primrose oil, 12.50% were given topical analgesic and breast support and danazol was given in 5.26%. The cases were followed up at three monthly interval for a period of one year and there was no recurrence during this period.

POLİKİSTİK OVER SENDROMUNDA (PKOS) ENDOTELYAL DİSFONKSİYONUN ERKEN SERUM BELİRTECİ: ENDOCAN

Objective: Polycystic ovary syndrome (PCOS) is a common endocrinological disease in women of reproductive age and has a wide range of metabolic effects. Chronic low-grade inflammation and endothelial dysfunction plays a key role in the pathogenesis of PCOS and they are associated with an increased risk of cardiovascular disease. Endocan, is an inflammatory marker showing endothelial dysfunction. The aim of our study, to compare serum endocan levels in PCOS and healthy control groups and to determine the relationship between some cardiovascular risk factors and serum endocan levels. Materials and Methods: This case-control study included 52 PCOS patients and 59 age-matched healthy controls. Patients were diagnosed as PCOS based on 2003 Rotterdam criteria. Demographic data, history of menstrual irregularity and infertility, polycystic ovary appearance in ultrasonography and hirsutism status were recorded. Endocan levels of PCOS patients and controls were compared. Data analysis was performed by using SPSS-22 for Windows (Statistical Package for Social Science, SPSS Inc. Chicago IL, USA®Z). Results: The median (IQR) value of serum endocan level was 420.7 ng/L (355.2-570.3) in the PCOS group and 320.0 ng/L (219.9-455.9) in the control group (p=0,003). While there was no significant correlation between serum endocan and some cardiovascular risk factors such as waist circumference, hip circumference, BMI, LDL, triglyceride, systolic and diastolic arterial tension but a positive correlation was found between homeostatic model assessment insulin resistance (HOMA-IR) (r= 0.276, p= 0,003). Conclusion: Serum endocan levels are higher in PCOS patients, in line with the literature. Endocan level shows a significant correlation with insulin resistance, one of the metabolic parameters. This may be a sign of early endothelial dysfunction in PCOS.

The burden of the probable polycystic ovarian syndrome and its associated factor among college going late adolescents and young adults: a cross sectional analytical study in urban Puducherry, South India.

Polycystic Ovarian Syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. In low income and developing countries like India, there are very high chances of developing PCOS due to marked variation between culture, ethnic groups, diet, lifestyle and genetic factors. This study aims to determine the burden of probable PCOS among college going students in Puducherry. A cross sectional study was carried out among students aged 18 years and above in a Government College for Women located in urban Puducherry. A total of 610 students were selected through a cluster random sampling technique. A pretested validated proforma was administered after obtaining informed consent. 25.1% (21.8-28.7) of women were having probable PCOS, 18.7% (15.8-22.0) had irregular menstrual history, 8.4% (6.4-10.8) had Hirsutism and 2% (1.8-3.3) had both the symptoms. Regarding food habits, 43.1% were vegetarians and were having probable PCOS and this association was found to be statistically significant. No significant association was found between prevalence of probable PCOS and factors such as higher age, parental income, higher BMI and physical inactivity. The present study found a high prevalence of probable PCOS among college going students, especially among study respondents who were obese, physically inactive and vegetarians compared to the counterpart. Earlier detection and proper management of the symptoms can avoid some major co-morbidity in the future. Therefore, screening is an important part in the diagnosis and management of PCOS among adolescent girls.

Identification of clinical and psychosocial characteristics associated with perinatal depression in the south Indian population

BackgroundLongitudinal perinatal depression (PND) data is sparsely available in the Indian population. We have employed Edinburgh Postnatal Depression Scale (EPDS) to assess the prevalence and identify characteristics associated with PND in the south Indian population. PND was assessed longitudinally using EPDS scores with traditional cut-off approach as well as a novel method of latent class mixture modeling (LCMM). The LCMM method, to the best of our knowledge, has been used for the first time in the Indian population. MethodsThree hundred and forty seven women, predominantly from economically-weaker sections of rural and urban South India were longitudinally assessed for antenatal depression (AD) and postnatal depression (PD) using EPDS cutoff-scores ≥13 and ≥10, respectively. Uni/multivariable analyses were used to identify PND associated characteristics. LCMM was then implemented, followed by risk characteristics identification. ResultsPND prevalence from traditional approach was 24.50 % (12.68 % AD; 18.16% PD). Characteristics associated with PND were urban-site and recent adverse life events. Irregular menstrual history and chronic health issues were associated with AD and PD, respectively. Three distinct PND trajectories were observed from LCMM-analysis: low-risk (76.08%), medium-risk (19.89%) and high-risk (4.04%). Urban-site, recent adverse life events, irregular menstrual history and pregnancy complications were associated with medium-risk/high-risk trajectories. LimitationsEPDS is a screening tool and not a diagnostic tool for depression. Since the study population included women from economically-weaker sections, the results need verification in other socio-economic groups. ConclusionsBoth the traditional cut-off-based approach and LCMM provided very similar conclusions regarding the prevalence of PND and characteristics associated with it. Higher PND prevalence was observed in urban women compared to rural women. In low-income countries, identifying risk characteristics associated with PND is a critical component in designing prevention strategies for PND related conditions because of the limited access to mental health resources.

Determinants of gestational diabetes mellitus: a hospital-based case–control study in coastal South India

A public health problem that has been on the rise in the twenty-first century is gestational diabetes mellitus (GDM). There are serious adverse effects on both maternal and fetal health following GDM. Potential complications can be reduced by early detection of risk factors, which predispose women to GDM. This study aims to identify the risk factors associated with GDM. A case–control study was carried out among antenatal women admitted to hospitals affiliated to Kasturba Medical College, Mangalore. The study population consisted of cases, who were GDM patients, and controls, who were age-matched, non-GDM patients. Statistical Package for Social Sciences (SPSS) version 25.0 was used for entering and analysing data. Both univariate and multivariate analysis was done for determining the factors responsible for GDM. The mean age of cases was 29.54 (± 4.3) years and of controls was also 29.54 (± 4.2). There was no significant difference while comparing the socioeconomic status across the study groups. Irregular menstrual cycle (OR = 2.78, CI = 0.94–08.4, P = 0.06) and history of type 2 diabetes mellitus in first-degree relatives (OR = 5.26, CI = 2.13–12.99, P ≤ 0.001) were found to be significant risk factors. It was found in our study that irregular menstrual history, history of GDM in previous pregnancy, history of type 2 diabetes mellitus in first-degree relative and history of GDM in first-degree relative are all independent risk factors of GDM.

Prevalence of hyperandrogenism in Iraqi women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a mainly common endocrine disorder. Hyperandrogenism is the major standard in the diagnosisof PCOS development.Eighty women diagnosed with PCOS and twenty healthy women(aged 20-40 years)were enrolled in this study which was conducted at the infertility clinic of Kamal AL-Samaraay Hospital/ Baghdad. The diagnosis of PCOS was made according to the Rotterdam criteria. Body mass index (BMI, Kg/m2)was calculated by a specific formula. History of menstrual irregularity, hirsutism, acne, and alopecia was taken. Hormone levels in serum, namely luteinizing hormone (LH), follicle stimulating hormone (FSH), and testosterone were measured in all patients and control subjects.There was a statistically significant difference (P &lt;0.05) in the BMI between the PCOS and control women.Also, the prevalence of overweight and obesity was much higher in PCOS women than in their matching control. The serum levels of LH, FSH, and testosterone were significantly different (P &lt;0.05) in PCOS as compared to healthy women. Clinical hyperandrogenism (hirsutism and alopecia) were present in most of PCOS women, while acne wasa less useful clinical sign of hyperandrogenism.Inaddition, the prevalence of hirsutism and alopecia was increased in obese when compared with overweight and lean PCOS women.

Risk factors for low bone mineral density in pediatric inflammatory bowel disease: the positive role of physical activity.

In pediatric inflammatory bowel disease (IBD), the prevalence of low bone mineral density (BMD) and bone fractures and the relationship between these are still debated. Our aim was to report data from a cohort of pediatric patients with IBD. Cross-sectional assessment of growth and BMD [(dual-energy x-ray absorptiometry (DXA)] and retrospective chart review were performed to report the lifetime prevalence of bone fractures and clinical associations with patients' data. We examined 216 patients with IBD, 8-25 years old (median: 14 years). Low BMD was found in 12.5% (spine) and 27% (total body). Multiple regression analysis showed that BMD was predicted by Z-scores for height and weight at DXA. History of menstrual irregularities and nasogastric tube feedings was associated with lower BMD, whereas physical activity and higher Z-score for height at DXA were associated with higher BMD.The prevalence of lifetime fractures was 11.8%. Patients with a history of fractures had lower Z-scores for spine BMD (-1.20 vs. -0.69, P=0.020) and total-body BMD (-1.30 vs. -0.75, P=0.014) compared with those without a history of fractures. Patients with spine BMD Z-score of up to -2 SD score had significantly increased prevalence of fractures compared with those with Z-score more than -2 SD score (28 vs. 10%, P=0.015). This study provides further insight into risk factors for low BMD in pediatric IBD. Novel findings were the association between low BMD and fractures, and the positive relationship between BMD and physical activity.

RARE-07RECURRING PITUITARY CYST WITH HISTOLOGY OF XANTHOMATOUS HYPOPHYSITIS: FIRST CASE REPORT OF SURGICALLY TREATED RECURRENCE AND LITERATURE REVIEW

INTRODUCTION: Xanthomatous hypophysitis (XH) is the rarest histological type of primary hypophysitis. It is non lymphocytic in nature, and is characterized by an infiltration of pituitary gland by lipid-laden histiocytes and macrophages. Consequent to a shared location, the clinical and radiological features of XH overlap heavily with pituitary adenomas and are prone to misdiagnosis. In this report we describe a case of newly diagnosed XH, which recurred after 1 year and was treated surgically. CASE: A 45-year-old female presented with history of menstrual irregularity for 9 months and a history of amenorrhea, galactorrhea and headache for 2 months duration. Preoperative endocrinologic studies showed increased prolactin. Magnetic resonance imaging (MRI) of the sella showed a cystic lesion with suprasellar extension suggestive of a pituitary adenoma. The patient underwent transsphenoidal resection that revealed a thick yellowish colloidal material. Histopathology demonstrated necrotic tissue with no definitive diagnosis and no identified microorganisms. The patient resumed her normal menstrual cycle with serum prolactin levels normalizing at 2-months post surgery. At 1-year post surgery her menstrual cycle again became irregular. A repeat MRI showed a recurrent mass and she underwent a second transsphenoidal resection. Repeat histopathology was consistent with XH. At present, the patient is at 5-years post initial surgery and is doing very well without evidence of recurrence. CONCLUSION: To the best of our knowledge, there are 18 prior reported cases in the literature of XH and two reported cases of recurrent disease. The clinical and radiological features of XH are undistinguished form pituitary adenoma. These lesions present similarly to nonfunctional adenomas and diagnosis is often difficult without surgical pathology, necessitating meticulous immunohistochemistry to prevent misdiagnosis. As such, XH should be considered as a rare etiology in the differential of both newly diagnosed and recurrent sellar-region lesions.

Isthmocele in a retroflexed uterus: a report of an unrecognized case

The term “isthmocele” refers to a niche on the anterior wall of the uterine isthmus or of the cervical canal at the site of a previous cesarean delivery scar. Such anatomic defect can cause many gynecologic sequelae that only recently have being identified and described. Hysteroscopy is commonly considered the gold standard for the diagnosis and also for the treatment, at least in the case of defects of small size. The authors described the case of a 37-year-old woman who underwent a cesarean section (CS) seven years before, with a long lasting history of menstrual irregularities, and pelvic pain increasing during menstruation at the hypogastric level. Magnetic resonance imaging (MRI) showed an exceptionally large isthmocele on the anterior wall of a retroflexed uterus which was otherwise misinterpreted as the uterine cavity filled with menstrual blood during a previous hysteroscopy (HSC). Although exceptional, this case highlights the possibility that a large sized isthmocele in a retroflexed uterus could be misinterpreted as the uterine cavity filled by menstrual blood at HSC. In this case MRI definitely clarified the diagnosis.

Prevalence and predictors of antenatal depressive symptoms among Chinese women in their third trimester: a cross-sectional survey.

BackgroundDepression during pregnancy can be detrimental to both maternal and fetal health outcomes. A cross-sectional study was undertaken, with the goal of determining the prevalence and predicting factors associated with antenatal depressive symptoms during late pregnancy among Chinese women.MethodsParticipants were recruited during bookings for antenatal care at a maternal and child health hospital’s outpatient care clinics. Measurements included the Chinese version of Self-rating Depression Scale, Eysenck Personality Questionnaire, Social Support Rating Scale, and Simplified Coping Strategies Questionnaire.ResultsA total of 292 women participated in this study, with 28.5% prevalence of depressive symptoms. Significant protective predictors were: a younger age (OR = 0.85; 95% Confidence Interval-CI 0.76-0.95), good partner relationship (OR = 0.40; 95% CI 0.17-0.93), preparedness for delivery (OR = 0.36; 95% CI 0.20-0.63), active coping (OR = 0.92; 95% CI 0.89-0.96), and social support (OR = 0.92; 95% CI 0.88-0.97). In contrast, significant risk factors were: a history of miscarriage (OR = 1.86; 95% CI 1.30-2.66), irregular menstrual history (OR = 2.98; 95% CI 1.64-5.40), and financial worries (OR = 2.33; 95% CI 1.27-4.30). Psychosocial risk factors include psychoticism and neuroticism personality traits (OR = 1.06; 95% CI 1.02-1.10 and OR = 1.07; 95% CI 1.04-1.10, respectively), and pregnancy pressures (OR = 1.04; 95% CI 1.02-1.07).ConclusionDepressive symptoms are common in third trimester antenatal clinic attendees. Interventions for early recognition of depression should target older women with a history of miscarriage and financial worries. Intervention strategies could be by providing more social support and promoting active coping strategies. Findings support a recommendation that antenatal services consider integrating screening for depression in routine antenatal care.