Menstrual History Research Articles

Osteoporosis Risk Analysis in Women Residing in Selected Urban Areas

Osteoporosis is a bone disorder with significant changes in bone biologic material and consequent bonestructural disruption, affecting millions of people around the world from diverse ethnic groups. The numberof osteoporotic fractures increases in both men and women (by more than 3-fold over the next 50 years) asa result of the ageing population particularly in Asia and Latin America.Methodology: Results: Majority of the women are in the age group of 40 to 50 years. Majority of thewomen around 38% doesn’t have any formal education. Majority of the women (20%) were home makers.Very few women completed post-graduation. Around 36% working in private institution. Around 40 %women monthly family income is 60,000-80,000. Around 40% women were in moderate risk of gettingosteoporosis and 2 women has a high risk and 29% doesn’t have any risk towards osteoporosis. None ofthe variables are associated with the risk analysis of the women anyhow age of the women is near by theassociation as the value is 0.05.Conclusion: Previous studies suggested that osteoporosis is related to age, weight, intake of corticosteroidtablets, history of fracture, history of thyroid diseases, menstrual history and Vitamin D deficiency7. The toolis prepared to assess the risk factors. And it found that majority of the women are in moderate risk

English

BACKGROUND Haemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) i.e., HELLP syndrome is a vaguely understood condition of pregnancy which can present with rapid onset. It is commonly associated with pre - eclampsia. HELLP is also known to manifest itself without the clinical features of pre - eclampsia. The present study aims to assess the maternal and foetal complications associated with HELLP syndrome. METHODS This retrospective study included all the pregnant women who developed HELLP / partial HELLP with gestational age of ≥ 28 weeks. The variables analyzed were obstetric history, menstrual history, antenatal complications, laboratory investigations (haemolysis, ALT / AST, LDH, CBC), mode of delivery, postnatal complications, maternal outcomes and perinatal outcomes. RESULTS 72 patients were included in the present study. The mean age of pregnant women with HELLP syndrome was 23.6 ± 4.15 years. The average age of gestation was 33.17 ± 4.02 weeks. 58 % patients were primigravida. As per Mississippi triple-class system 82 % patients had partial HELLP, 18 % had complete HELLP. 4 %, 4 % & 10 % patients had HELLP class I, II & III respectively. Among the total cases, 74 % patients had antepartum onset, 10 % had intrapartum & 17 % postpartum onset of HELLP syndrome respectively. 65 % patients delivered vaginally & rest 35 % underwent caesarean section. High risk factors such as pre - eclampsia (65 %), eclampsia (3 %) & previous history of HELLP (8 %) were noted in study cases. Abruptio placentae (18 %), postpartum haemorrhage (17 %), pulmonary oedema (14 %), renal failure (14 %) & DIC (7 %) were the maternal complications noted. Maternal mortality was 7 %. The major perinatal morbidities noted were prematurity (67 %) & FGR (42 %). Intrauterine death was noted in 19 % babies. Neonatal intensive care (NICU) was required for 58 % babies, of which 42 % had respiratory distress. Neonatal death was noted in 17 %. CONCLUSIONS HELLP syndrome is a life threatening condition of pregnancy which has serious maternal and perinatal morbidities. Prompt referral, timely and appropriate interventions can save lives. Availability of Intensive Care Units (ICU) facilities, dialysis units and blood and its components along with Neonatal Intensive Care Unit (NICU) facilities can remarkably reduce the maternal and neonatal complications. KEY WORDS HELLP Syndrome, Preeclampsia, Maternal Mortality, Neonatal Mortality, Mississippi Triple - Class System

Prevalence of Female Athlete Triad Risk Factors and Iron Supplementation Among High School Distance Runners: Results From a Triad Risk Screening Tool.

Background:Investigations of the female athlete triad (Triad) in high school athletes have found that 36% had low energy availability, 54% had menstrual abnormalities, and 16% had low bone mineral density (BMD). Limited data are available showing the prevalence of these risk factors in high school distance runners or regarding best practice on screening for the Triad in the adolescent population.Purpose:To (1) evaluate the prevalence of Triad risk factors and iron supplementation in high school distance runners and (2) pilot a screening tool for Triad risk score.Study Design:Descriptive epidemiology study.Methods:The study population included female high school athletes who participated in cross-country/track. Participants completed a survey including questions regarding dietary habits, menstrual history, and bone stress injury (BSI) history. They then underwent evaluation of 25-hydroxyvitamin D, free triiodothyronine (T3), and dual-energy x-ray absorptiometry scan to measure body fat and BMD through use of age-, sex-, and ethnicity-matched Z scores. Triad scores were calculated. Relationships were analyzed using Spearman correlation coefficient.Results:There were 38 study participants (mean age, 16.9 years). Average body mass index was 19.8 kg/m2. Disordered eating or eating disorders were reported in 76.3% of runners; in addition, 23.7% reported delayed menarche, 45.9% had a history of amenorrhea or oligomenorrhea, 42.1% had low BMD (Z score < –1.0), and 15.8% reported prior BSI. Low free T3 was significantly associated with higher Triad risk scores (r S = –0.36; P = .028). More than 42% of athletes were supplementing iron.Conclusion:The prevalence of Triad risk factors in high school distance runners was high. Free T3 was inversely associated with Triad score, which may serve as an indicator of low energy availability. Nearly half of the athletes were using iron supplementation.

S3588 Chronic Lymphocytic Gastritis

INTRODUCTION: Lymphocytic gastritis (LG) is an uncommon cause of chronic gastritis, accounting for only 5% of cases. The pathology has no clear etiology, however, it is frequently associated with Celiac disease, found in approximately 40% of the patients. H. pylori infection, Crohn’s disease, HIV infection and lymphoma have also been associated in patients with LG. CASE DESCRIPTION/METHODS: A 37-year-old woman with no relevant past medical history who presented to the GI clinic for evaluation of iron deficiency anemia, change in bowel habits, chronic tenesmus and dyspepsia. Menstrual history was unremarkable and anemia did not improved with oral iron supplementation. Laboratory studies showed microcytic normochromic anemia, with an RDW of 15%. Iron profile was consistent with iron deficiency (serum iron of 25 µg/dL and ferritin of 14 ng/mL). Further work up included thyroid studies, vitamin B12 level and testing for celiac disease, which all resulted negative. Subsequent endoscopy and colonoscopy evaluation were unremarkable for macroscopic abnormalities, however, gastric biopsies revealed increased intraepithelial lymphocytosis suggesting a diagnosis of lymphocytic gastritis confirmed via CD3 stain. Colonic biopsies revealed chronic inflammation of lamina propia with intraepithelial lymphocytosis and positive CD3 stain. The patient was started on esomeprazole for lymphocytic gastritis and budesonide for lymphocytic colitis with improvement of symptoms. DISCUSSION: LG is commonly present in middle aged adults, affecting both male and females equally. Initial symptoms are usually non-specific and vary from dyspepsia, nausea, vomiting, diarrhea, anorexia and weight loss. Up to 20% of the cases are labeled as idiopathic, but commonly associated conditions thought to contribute to LG development include autoimmune diseases, infection or environmental influences. Upper endoscopy findings can show nodules, erosions, large gastric folds, or no abnormalities. Diagnosis is achieved by means of histopathological findings, with >25 lymphocytes per 100 epithelial cells. The treatment consists of symptomatic relief, with PPIs or with H. pylori eradication; however, some patients exhibit spontaneous remission. We present this case of refractory iron deficit anemia due LG in a rare location outside the colon resulting in malabsorption.Figure A.: H&E stain of biopsy from nodular gastric mucosa demonstrating increased intraepithelial lymphocytes and expanded lamina propria. Figure B: CD3 stain demonstrated predominant CD3 positive T cells with CD8 co-expression.

Effect of Age at Menarche on Anterior Cruciate Ligament Injury Incidence and Anterior Knee Laxity in Collegiate Athletes

Female athletes suffer painful, costly, and career-limiting non-contact anterior cruciate ligament (ACL) injuries more often than males. Previous research suggests that pubertal neuromusculoskeletal development contributes to this sex-bias, but the manner in which variation in pubertal development affects injury risk within females is poorly understood. Age at menarche is a variable, significant pubertal developmental event, signaling the onset of estrogen cycling and affecting musculoskeletal development. Earlier menarche may increase injury risk, possibly by increasing anterior knee laxity through prolonged estrogen exposure. The purpose of this case-control study was to test the primary hypothesis that collegiate athletes with previous ACL injuries have earlier age at menarche than their uninjured peers, and to test the secondary hypothesis that earlier menarche is related to greater anterior knee laxity in injured and uninjured athletes. The study sample consisted of female NCAA Division-I varsity athletes (N=14 injured, N=120 uninjured). Outcome measures included: menstrual history and ACL injury details (injury age, activity at time of injury, contact vs. non-contact), assessed by questionnaire; and anterior knee laxity assessed by KT-1000 arthrometer. Correlation, t-tests, and regression analysis were used to test for associations between age at menarche, injury incidence, and knee laxity. Fourteen athletes reported ≥1 non-contact ACL injury, and had significantly earlier menarche than uninjured athletes (12.6±1.3 y vs. 13.4±1.4 y; P=0.05). Earlier menarche also significantly predicted injury status (Wald c2=7.43; Pb=-1.02±0.37; OR=0.36; 95% CI:0.17-0.75), but was not correlated with anterior knee laxity. Within injured athletes, however, laxity in the unaffected knee was significantly related to time since menarche (r2=0.79, Pr2=0.72, P

Hormonal Contraceptive Use, Menstrual Dysfunctions, and Self-Reported Side Effects in Elite Athletes in Denmark.

To identify the prevalence of hormonal contraceptive (HC) use, menstrual cycle disturbances, and self-perceived physical and emotional symptoms related to the menstrual cycle/pill cycle in elite female athletes. One hundred eighty-six Danish elite female athletes completed an online questionnaire to assess menstrual status and history, use of HCs, and self-perceived physical and emotional symptoms related to the menstrual cycle or HC use. Fifty-seven percent of elite female athletes in Denmark use HC, with 74% using combined HCs and 26% using progestin only. Sixty percent of oral contraceptive users reported having manipulated their menstrual cycle by continuous oral contraceptive use. Forty-nine percent of non-HC users had a regular menstrual cycle, while 51% experienced menstrual disturbances, with 1 athlete being primary amenorrheic and 13 athletes having secondary amenorrhea. Menstrual disturbances were experienced by a larger proportion of endurance athletes (69%) compared with athletes performing power and technical disciplines. In endurance athletes amenorrhea was associated with a higher cardiovascular training volume (P < .001). Negative symptoms related to the menstrual/pill cycle were reported by both HC and non-HC users, whereas positive physical symptoms were experienced more often among the non-HC (14%) versus HC users (2%) (P < .01). Notably, 13% of the athletes reported that negative symptoms sometimes/always caused them to not participate in or complete the scheduled training. HC use is common among elite athletes, and continuation of HC is used to manipulate the menstrual cycle in relation to sport competitions. HC use does not abolish dysmenorrhea, but it may reduce emotional-related side effects. Menstrual disturbances are frequent in endurance athletes and are associated with cardiovascular training volume.

Anti-Mullerian Hormone as A Diagnostic Tool for PCOS Patient : Study in a Tertiary Level Hospital

Polycystic ovary syndrome (PCOS) is a frequently encountered problem affecting 6-11% women of reproductive age.1 Purpose of the study was to determine whether serum AMH level can be used to diagnose PCOS.&#x0D; Methods: It was a cross sectional study conducted among 55 sub-fertile women of reproductive age (18-35 year) in a tertiary level hospital during the period of January 2018 to December 2018. The study subjects were divided into group I (PCOS patient with subfertility by Rotterdam Criteria 2003) and group II (non PCOS subfertile patients of reproductive age). Menstrual history, obstetrical history, physical examination, clinical assessment of androgenesis, ovarian ultrasound assessment and level of AMH, FSH, LH were collected.&#x0D; Result: Twenty five PCOS &amp; 30 non PCOS sub-fertile patients were recruited. Mean age in PCOS &amp; non PCOS were 25.24±4.03 years and 27.8±5.01 years respectively. The mean serum AMH in PCOS was 11.03±3.78 ng/ml and in non PCOS was 3.93±1.92 ng/ml, their difference was statistically significant.&#x0D; Conclusion: AMH can be used as a diagnostic aid for PCOS.&#x0D; J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 142-146

Laparoscopic Salpingo-oophorectomy for Left-sided Primary Ovarian Hydatid Cyst

A 39-year-old woman presented with dull aching, continuous, left lower abdominal pain for the past 6 months. Her menstrual history was normal, and she had 2 cesarean sections in the past. Her medical history was unremarkable. A gynecologic examination revealed an acutely anteverted normal-sized uterus and fullness in the left posterior fornix. An ultrasound of the abdomen revealed a large multiseptated left ovarian cyst with normal findings in the upper abdomen. A computed tomography showed a well-defined multiloculated left complex ovarian cyst in the pelvis, situated in the midline toward the left side (12 × 11 × 10-cm) along with left hydrosalpinx (Fig.

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.

Comparative Study between Different Acupressure Points on Relieving severity of Primary Dysmenorrhea

Background: Dysmenorrhea constitutes one of the most frequent disorders in women of a fertile age. The objective of this research was to Comparative Study between Different Acupressure Points on Relieving severity of primary dysmenorrhea. Research Design : Prospective experimental design was utilized, Setting: at Faculty of Nursing, Benha University Sampling: convenience sample 120 females aged 18–25 years old who met the study criteria. were randomly assigned to one of two groups and evaluated during three menstrual cycles. Tools: four tools were used for data collection, first tool, was An interview questionnaire (a) Socio-demographic data (b)Menstrual history Second tool, Pain responses sheet, (a) Physiological responses to pain, (b) Behavioral responses to pain, Third tool, a modified version of Johansson pain-o-meter ,Fourth tool, a follow up chart. Results: main results of this study revealed that the severity of dysmenorrhea pain diminished significantly following treatment with acupressure at the SP6 and SP8 points (P < 0.001). Furthermore, Significant differences was observed between usage the SP6 and SP8 regarding the effect on physical condition and regarding the effective words (pain severity) which was reduced significantly further with SP6 point compared to SP8 point (*p<0.05).at the first day and second day Conclusion: Acupressure on SP6 had statistically significant effect than SP8 in female in age of 18-25 years old, suffered from primary dysmenorrhea. Recommendation: acupressure management especially on SP6 for dysmenorrea should be considered an integral part of nursing care, Mass media should be utilized for dissemination of simple, correct and relevant information about Acupressure management of dysmenorrhea, Studies to find out and assess effectiveness of acupressure on SP6 with another acupressure point..

Menstrual cycle phase, alcohol consumption, alcohol cravings, and mood among women in outpatient treatment for alcohol use disorder.

Research shows fluctuations in drinking across the menstrual cycle among women with alcohol use disorder (AUD), but little work has investigated moderators of these fluctuations. This study examined drinking and craving intensity across the menstrual cycle, and the moderating effect of baseline depression and emotional distress during the midlate luteal phase and/or menses, among women receiving AUD treatment. Fifty-nine regularly cycling women reported menstrual history and baseline depression. Over 3 months of treatment, they kept daily logs of drinks, alcohol cravings, and menstruation (yes/no). Emotional distress during the midlate luteal phase and/or menses of their most recent menstrual cycle was also assessed during treatment. Menstrual cycle phase was estimated for each within-treatment day. Mixed model analyses tested main and interactive effects of menstrual cycle phase, baseline depression, and emotional distress during the midlate luteal phase and/or menses on daily drinks and craving intensity. Women drank most during the midlate luteal phase and menses compared with other phases. Among women with lower baseline depression, those with lower distress during the midlate luteal phase and/or menses reported more intense cravings during the midlate luteal phase (ΔM = .77, p = .000) and menses (ΔM = .51, p = .012); those with higher distress reported more intense cravings during menses, compared with all other phases (p < .01). Among women with higher baseline depression, craving intensity remained consistently high. Results document more drinking during the midlate luteal phase and menses and suggest that cycle-related distress and depression moderate the alcohol-menstrual association among women in AUD treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prospective Longitudinal Assessment of Linear Growth and Adult Height in Female Adolescents With Anorexia Nervosa.

Growth retardation is an established complication of anorexia nervosa (AN); however, findings concerning the adult height of AN patients are inconsistent. The objective of this work was to assess linear growth and adult height in female adolescents with AN. A prospective observational study was conducted in a tertiary university hospital. Participants included all 255 female adolescent AN patients hospitalized in the pediatric psychosomatic department between January 1, 2000 and May 31, 2015. Height and weight were assessed at admission and during hospitalization. Patients were subsequently invited for measurement of adult height. Additional data collected included premorbid height data, menstrual history, skeletal age, pertinent laboratory studies, and parental heights. The main outcome measure of this study was adult height. Mean age at admission was 15.4 ± 1.75 years, mean body mass index (BMI) was 15.7 ± 1.8 kg/m2 (BMI SDS = -2.3 ± 1.45 kg/m2). Premorbid height SD scores (SDS) were not significantly different from those expected in normal adolescents (0.005 ± 0.96). However, height SDS at admission (-0.36 ± 0.99), discharge (-0.34 ± 0.96), and at adult height (-0.29 ± 0.95), were significantly (P < .001) lower than expected. Furthermore, adult height was significantly (P = .006) shorter compared to the midparental target height. Stepwise forward linear regression analysis identified age (r = 0.32, P = .002) and bone age (r = -0.29, P = .006) on admission, linear growth during hospitalization (r = 0.47, P < .001), and change in luteinizing hormone during hospitalization (r = -0.265, P = .021) as independent predictors of improvement in height SDS from the time of admission to adult height. Whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.

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.

Physiological Parameters of Bone Health in Elite Ballet Dancers

This study aimed to characterize bone health in relation to stress fracture history, body composition, eating disorder risk, and blood biomarkers in professional male and female ballet dancers. A single cohort of 112 dancers (male: 55, 25 ± 6 yr; female: 57, 24 ± 6 yr) was recruited. All participants underwent bone and body composition measures using dual-energy x-ray absorptiometry. In a subset of our cohort (male: 30, 24 ± 6 yr; female, 29, 23 ± 5 yr), a blood panel, disordered eating screen, menstrual history, and stress fracture history were also collected. Age-matched Z scores and young-adult T scores were calculated for bone mineral density (BMD) and body composition. Independent-samples t-tests and Fisher's exact tests were used to compare BMD, Z-scores, T scores, and those with and without history of stress fractures. A 1 × 3 ANOVA was used to compare BMD for those scoring 0-1, 2-6, and 7+ using the EAT26 questionnaire for eating disorder risk. Regression was used to predict BMD from demographic and body composition measures. Female dancers demonstrated reduced spinal (42nd percentile, 10%T < -1) and pelvic (16th percentile, 76%T < -1) BMD. Several anthropometric measures were predictive of BMD (P < 0.05, r = 0.65-0.81, standard error of estimate = 0.08-0.10 g·cm, percent error = 6.3-8.5). Those scoring >1 on EAT26 had lower BMD than did those with a score of 0-1 (P < 0.05). Professional female ballet dancers exhibit reduced BMD, fat mass, and lean mass compared with the general population whereby low BMD and stress fractures tend to be more prevalent in those with a higher risk of disordered eating. Anthropometric and demographic measures are predictive of BMD in this population.

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.

MATERNAL CRP AS A PREDICTOR OF CHORIOAMNIONITIS IN WOMEN WITH PPROM

Introduction: Preterm prelabor rupture of the membranes (PPROM) refers to spontaneous rupture of membranes in the absence of labor pains, before 37 completed weeks of gestation. Chorioamnionitis (CAM) affects many pregnancies complicated by PPROM. Finding a serum factor that could accurately predict the presence of CAM could potentially lead to more efficient management of PPROM and improved neonatal outcomes. It has been claimed that estimation of C-reactive proteins (CRP) is helpful in the diagnosis of chorioamnionitis, and this study aims to appraise such claimsObjective: To determine the diagnostic accuracy of C-reactive protein in the detection of chorioamnionitis in women with PPROM and to test sensitivity/specificity/positive predictive valve/negative predictive value of CRP in diagnosing chorioamnionitis against histopathological examination of placenta.Method: A study conducted on total 440 antenatal women, 220 cases of PROM and 220 cases with same gestation but without PPROM used as a control. A detailed obstetrical and menstrual history was taken and systemic and local examination was done. Subjects were managed expectantly with use of tocolytics, antibiotics and steroids. Frequent vital signs monitoring and hematological investigation were done. CRP levels were determined. After delivery placenta was sent for histopathological examination for the presence of chorioamnionitis.Results: CRP appears to be the most sensitive acute phase protein; rising of less than 24 hours makes it suitable to serve as a marker for diagnosing an infection. On comparing C-reactive protein levels with other laboratory tests and indicators of infection (e.g. total leucocyte count, maternal fever, maternal tachycardia, fetal tachycardia) we found CRP level to be more sensitive (100%) but less specific (45.45%) in identifying chorioamnionitis. The positive predictive value was 31.4% and negative predictive value was 100%.Conclusion: CRP is early and reliable indicator of histopathological and clinical chorioamnionitis in comparison of TLC and clinical parameter. Thus CRP can prove useful markers in identify early and subclinical infection which could lead to premature rupture of membrane.Key-words- Preterm birth, C-reactive protein, PPROM, Chorioamnionitis.

Incidence, Socio-demographic Characteristics and Predisposing Factors of Ectopic Pregnancy attended at a Private Tertiary Care Hospital in Dhaka City

Background: Ectopic pregnancy is frequently occurs among pregnant women.&#x0D; Objective: The purpose of the present study was to see the incidence and socio-demographic characteristics of ectopic pregnancy patients.&#x0D; Methodology: This cross-sectional study was carried out in the inpatient Department of Obstetrics and Gynaecology at Bangladesh Medical College Hospital, Dhaka, Bangladesh from January 2009 to December 2009 for a period of one (1) year. All clinically suspected cases of ectopic pregnancy within the reproductive age admitted in the department of Obstetrics and Gynaecology at Bangladesh Medical College Hospital, Dhaka were included in the present study. After taking detailed history with particular scrutinization of the menstrual, obstetric and contraceptive history, a thorough physical examination was performed. The ectopic pregnancy was confirmed by laboratory and imaging technique.&#x0D; Result: The incidence of ectopic pregnancy in BMCH was 2.16% cases.The mean age with SD of the study population was 24.0±2.87 years. The ectopic pregnancy was closely related with high parity and it had been found that para-2 was the most common which was 20(44%) cases.Pelvic infection (33.0%), past history of abortion or MR (28.0%), and history of infertility (25.0%) were constituted the main bulk of risk factors. Only 3.0% had history of tuberculosis.&#x0D; Conclusion: In conclusion young para 2 women with pelvic infection or past history of abortion or MR are most commonly suffering from ectopic pregnancy.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 59-63

HIP INJURY- CROSS COUNTRY

HISTORY 18-year-old high school female cross-country runner presented with one week of left anterior hip pain. Denied a specific injury. Pain started during a late season meet causing her to finish at a slower pace. Pain progressively worsened requiring crutches to ambulate, despite no further activity. Max mileage was 40 miles/week, had tapered to 20 miles/week prior to injury. History of stress fracture 4 years prior. Initial x-ray of left hip revealed open epiphyseal plates, no other osseous abnormalities. Inquiring about menstrual history, she had yet to reach menarche. Per the patient’s mother, she had been trialed on growth hormone and is currently on estradiol patches. She has a known eating disorder for which she is not actively receiving help, despite multiple hospitalizations. PMHX Primary amenorrhea, followed by endocrinology. Lab work revealed low estradiol, LH, FSH with high alkaline phosphatase. Normal labs were thyroid studies, BMP, LFT, vitamin D and prolactin. Genetics showed 46XX. Multiple XR for bone age showed that of an 11-year-old. Cardiac work up showed sinus bradycardia on EKG and normal echo. Brain/pituitary MRI revealed normal pituitary and mild enlargement of ventricles, sulci, cerebellar folia. PHYSICAL EXAMINATION Patient stands 55 inches tall, weighing 61 pounds with a BMI of 14. She appears much younger than stated age. Hair is full, though fine. Breast tissue is not appreciated. On left hip exam, there is TTP along flexor tendon, lateral hip, and piriformis. She has pain with external rotation, weakness and pain with hip flexion, abduction, and adduction against resistance. She is unable to do a single leg hop due to groin pain. She is neurovascularly intact. DIFFERENTIAL DIAGNOSIS 1. Femoral neck stress fracture 2. Primary amenorrhea 3. Hip flexor strain 4. Relative Energy Deficiency in Sports syndrome 5. ASIS avulsion fracture TESTS/RESULTS MRI left hip 1. Partial thickness tear at attachment of left iliopsoas tendon to lesser trochanter with intramuscular hematoma 2. Minimal partial thickness tear of the left common hamstring origin FINAL DIAGNOSIS 1. Partial tear of left iliopsoas tendon and hamstring 2. RED-S TREATMENT/OUTCOMES 1. Shut down from all activities 2. Weightbearing as tolerated 3. Referral to gynecology for transvaginal ultrasound 4. Referral to Eating Recovery Center

Predictors And Prevalence Of Low Bone Mineral Density And Bone Stress Injuries In Ultramarathon Runners

BACKGROUND: Low bone mineral density (BMD) and bone stress injuries (BSI) are highly prevalent among collegiate runners due to risk factors that have been well elucidated. Though initial data suggest ultramarathon runners are at high risk for low BMD and BSI, the prevalence of and risk factors for low BMD and BSI among this older population of long-distance runners has not been thoroughly investigated. PURPOSE: To determine the prevalence of and risk factors for low BMD and history of BSI in male and female ultramarathon runners METHODS: 123 ultramarathon runners who qualified for a 161km endurance race were recruited via pre-race email invitation in 2018 and 2019. Pre-race assessments included a survey on BSI history, dietary habits, body mass index and menstrual history in females; dual energy x-ray absorptiometry (DXA) scan; and, in 2019, serum evaluation for ferritin, total testosterone, free testosterone and estradiol. Poisson regression was used to evaluate risk factors for BSI; and linear regression or Pearson’s correlation coefficients when evaluating correlates of BMD. RESULTS: 40 women and 83 men (mean age 41.8 and 46.2 years, respectively) were enrolled and completed the survey with 36 women and 72 men completing DXA’s and 19 women and 32 men completing serum evaluation. 79.5% of men and 37.5% of women reported history of at least one BSI. 15% of women and 28.9% of men had low BMD (Z-score < -1.0). Low BMD was significantly or near-significantly associated with history of BSI: the age-adjusted risk ratio per BMD risk point was 1.86 (p=.036) for men and 2.03 (p=.056) for women. Oligomenorrhea was correlated with lower BMD values in women (beta coefficient=-.39 SD per risk point for total hip BMD, p=.038; and beta coefficient=-.35 SD per risk point for femoral BMD, p=.054). Of the blood markers, higher testosterone correlated with higher hip (r=.40, p=.022;) and femoral (r=.39; p=.027) BMD in males and higher estradiol correlated with higher spine BMD (r=0.47; p=.043) in females. CONCLUSIONS: BSI history and low BMD were highly prevalent among male ultramarathon runners and less so among females. Low BMD was associated with a history of BSI. Higher levels of sex hormones were correlated with higher BMD in both men and women. Oligomenorrhea was correlated with lower BMD in women.

Identifying Triad Risk Factors In Ultramarathon Runners

Ultramarathon running has gained popularity in the past decade, necessitating a better understanding of the health benefits and risks of this sport. The Female Athlete Triad (Triad) and a similar condition reported in males are common in endurance athletes, but the prevalence of triad risk factors in ultramarathon runners is unknown PURPOSE: To identify the prevalence of Triad risk in ultramarathon runners. METHODS: Runners who qualified to compete in a 100-mile endurance race were recruited pre-race to complete a survey assessing eating behaviors, menstrual history, training, and injury history; and dual-energy x-ray absorptiometry to assess bone mineral density (BMD). A cumulative Triad risk score was calculated using energy availability, body mass index (BMI), age of menarche and oligomenorrhea (for women), BMD, and history of bone stress injury. RESULTS: 123 runners (40 female and 83 male) participants had a mean age, respectively, of 41.8 and 46.2 years. 57.5% of females and 26.5% of males received moderate cumulative risk scores; 5.0% of females and 4.8% of males were classified as high risk. 62.5% of females and 39.7% of males scored moderate or high risk for low energy availability, with 13% reporting a history of clinical eating disorders. Mean female and male BMI was, respectively 21.2 kg/m2(SD=2.1) and 22.9 kg/m2 (SD=2.6). 15% of females and 0% of males scored moderate or high risk for low BMI, determined to be anything less than 18.5 kg/m2. 15% of females and 28.9% of males had BMD Z-score<-1.0, and 6.0% of males had a Z-score<-2.0. 37.5% of females and 79.5% of males reported at least one prior bone stress injury. CONCLUSIONS: Triad risk factors were common among ultramarathoners, particularly in men. ACKNOWLEDGEMENTS: Supported with grants from the Western States Endurance Run Foundation and the Napa Medical Research Foundation. Laboratory testing was done in partnership with InsideTracker