Pelvic Inflammatory Disease Research Articles

DESCRIPTION OF RISK FACTORS IN OCCURRENCE OF PIDIC INFLAMMARY DISEASE IN WOMEN OF REPRODUCTIVE AGE

Pelvic inflammatory disease is a reproductive system disorder in women that can be caused by viruses or bacteria. Pelvic inflammatory disease is an inflammatory process of the female genital organs in the pelvic cavity, namely the genital tract consisting of the uterus, fallopian tubes and surrounding areas including the peritoneum. It is caused by Neisseria gonorrhoeeae or Chlamidia trachomatis and may be the organism involved in bacterial vaginosis. Objective: This study aims to describe the risk factors for pelvic inflammatory disease experienced by women of childbearing age. Research methods; This study uses an analytical survey. The population in this study were all cases of GSR who were treated in hospitals. Andi Makkasau, Parepare City with a total of 247 people. The sampling technique was purposive sampling. The method of data collection in this study is secondary data, namely if the desired data collection is obtained from other people or other places and is not carried out by the researcher himself where in this study the researcher records the register number of patients with pelvic inflammation (PRP) obtained from the register book at the GSR treatment room or medical record. Then take the patient's status on the medical record at Andi Makkasau Hospital. After that, take the data and select the complete data based on the specified criteria. The data were analyzed using chi-square. namely if the desired data collection is obtained from other people or other places and is not carried out by the himself where in this study the researcher records the register number of patients with pelvic inflammation (PRP) obtained from the register book at GSR treatment room or medical records. Then take the patient's status on the medical record at Andi Makkasau Hospital. After that, take the data and select the complete data based on the specified criteria. The data were analyzed using chi-square. namely if the desired data collection is obtained from other people or other places and is not carried out by the himself where in this study the researcher records the register number of patients with pelvic inflammation (PRP) obtained from the register book at GSR treatment room or medical records. Then take the patient's status on the medical record at Andi Makkasau Hospital. After that, take the data and select the complete data based on the specified criteria. The data were analyzed using chi-square.

Menstrual Disorders and its Effects on Academic Performance among the Nursing Students of PUSHS, Gothgaun

Introduction: Menstrual cycle is a periodic physiological process in women of childbearing age. Menstrual disorders may affect the daily activities and quality of life among reproductive age group women worldwide.
 Objective: The objective of this study was to find out the menstrual disorders and its effects on academic performance among the nursing students of Purbanchal University School of Health Sciences.
 Methodology: It was a descriptive, cross-sectional study conducted among 170 undergraduate nursing students of Purbanchal University School of Health Sciences, Gothgaun. Proportionate followed by simple random sampling (lottery method) was adopted. Data was collected through self administered method using semi structured questionnaire. Statistical analysis was done by descriptive and inferential statistics using SPSS version 16.0. Female with systemic health problems, any diagnosed pelvic pathology (fibroids, pelvic inflammatory disease), positive pregnancy test, and lactating mothers were excluded from the study.
 Results: Among 170 respondents, most of them (87.1%) had some form of premenstrual symptoms. Majority of them (77.6%) had dysmenorrhea. There was statistically significant association between dysmenorrhea and academic performance with class absenteeism (p=0.009), lack of concentration in class (p<0.001), not able to prepare for exam (p=0.014), mood swings (p=0.043), difficulty in participating in extracurricular activities and difficulty in public speaking (p=0.007). Premenstrual syndrome was also significantly associated with class absenteeism (p=0.012), sleeping desire during lectures (p=0.031) and mood swings (p=0.001).
 Conclusion: Menstrual disorders were significantly high among the nursing students and most of them were suffering from premenstrual syndrome and dysmenorrhea. It had significant impact on academic performance of nursing students.

Coexistence of tubo-ovarian abscess and carcinoid tumor of the appendix in a sexually inactive girl: a case report

BackgroundTubo-ovarian abscess (TOA) is mostly a sequela of pelvic inflammatory disease (PID) which is seen in sexually active women. Although very rare, TOA could be seen in virgin adolescent girls. Fifteen cases of TOA were reported in virgin girls in English literature. Only one of these cases was suspected to be due to appendicitis. Herein, we present the first case of coexistence of tubo-ovarian abscess and carcinoid tumor of the appendix in a sexually inactive girl.Case presentationA 13-year-old girl presented with abdominal pain and fever. Ultrasonography reported that there was a 63×48 mm sized, heterogeneous, thick-walled, dense-content complicated cyst in the right ovary which was thought to be a hemorrhagic cyst and a tubular structure, measuring 12 mm in its thickest part which was thought to be the appendix. During the operation, a TOA was observed in the right adnexal region. The thick, edematous appendix which was lying separately was excised. The TOA was evacuated; a drain was placed. The appendix pathology was reported as “carcinoid tumor.”ConclusionWe present the first case of TAO with carcinoid tumor of appendix and the second case of TAO that was suspected to be due to appendicitis. When the sexually inactive TOA cases including our case were reviewed, we found that the median age was 15 years (12–47 years) and 11 of 16 cases (69%) were under 18 years of age. The presenting symptoms were abdominal or pelvic pain in all cases, fever in 11 cases (69%), vomiting in 6 cases (38%), dysuria in 5 cases (31%), and diarrhea in 3 cases (19%). Both perforated appendicitis and TOA patients have the same clinic presentation such as fever, abdominal tenderness, increased leukocyte count, increased inflammatory markers. The differential diagnosis can be achieved by radiological examinations such as ultrasonography, computerized tomography or magnetic resonance imaging.

Retrospective analysis of short-term curative effect of total laparoscopic loop ileostomy reversal after radical resection of rectal cancer

Objective: To investigate the safety, feasibility and short-term efficacy of total laparoscopic loop ileostomy reversal in patients after resection of rectal cancer. Methods: The clinical data of 20 patients who underwent total laparoscopic loop ileoscopic loop ileostomy after radical resection of rectal cancer at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, or Beijing Chaoyang District Sanhuan Cancer Hospital from October 2019 to June 2020 were collected and retrospectively analyzed. Results: All patients had successfully underwent total laparoscopic ileostomy reversal without conversion to open surgery or discontinued operation. No perioperative related death cases were found. In the whole group, the median operation time was 97 (60-145) minutes and the median intraoperative blood loss was 20 (10-100) milliliters. The median Visual Analogue Scale (VAS) score was 1.9 (1-5) one day after the operation. Nobody needed to use additional analgesic drugs. The median time to grand activities was 25 (16-42) hours, the median time to flatus was 44 (19-51) hours, and the median hospitalization after operation was 6.9 (5-9) days. No patients underwent operation related complications such as operative incision infection, abdominal and pelvic infection, intestinal obstruction, anastomotic leakage, bleeding and so on. Conclusions: Total laparoscopic loop ileostomy reversal appears to be safe, feasible and with promising efficacy for selected patients.

Five critically ill pregnant women/parturients treated with extracorporeal membrane oxygenation

BackgroundMaternal mortality has always been a major medical concern. Recently, the successful application of extracorporeal membrane oxygenation (ECMO) technology in the rescue of near-death patients has been reported.Case presentationThis study retrospectively analyzed 5 cases of critically ill pregnant women/parturients treated with ECMO for respiratory and circulatory failure in the Wuxi People’s Hospital from 2018 to 2020. The mean age of the 5 cases was 30.2 years. Among them, Cases 1 and 5 were treated with Venoarterial (VA) ECMO. Case 1 was diagnosed with congenital heart disease, atrial septal defect, and severe pulmonary hypertension. VA ECMO was applied before cesarean section and was successfully removed after double lung transplantation, but the patient died 10 months after delivery from lung infection. While Case 5 was diagnosed with systemic lupus erythematosus, lupus nephritis, thrombotic vascular disease, HELLP syndrome, and cerebral hemorrhage. VA ECMO was applied 39 days after cesarean section, and the patient died 40 days after delivery due to multiple organ failure. Cases 3 and 4 were treated with Venovenous (VV) ECMO. Case 3 was diagnosed with refractory postpartum hemorrhage, and Case 4 was diagnosed with postpartum hypoglycemic coma, aspiration pneumonia, and shock. They were treated with VV ECMO after delivery, and all survived after successful evacuation. Another Case (Case 2) was diagnosed with postpartum pelvic infection, sepsis and septic shock, and was treated with VA ECMO at 15 days after delivery. The patient changed to VV ECMO at 30 days after delivery due to significant improvement in heart function and poor lung function, but eventually died of multiple organ failure. For the 5 cases, the mean duration of ECMO was 8.7 days, the mean duration of intensive care was 22.0 days, and the mean length of hospital stay was 57.6 days. As a result, 3 patients gradually returned to normal with significant improvement in ventilation and oxygenation after ECMO treatment.ConclusionsECMO technology can be used to treat some of the critical obstetric patients with respiratory and circulatory failure that is ineffective to conventional treatment, but it has no therapeutic effect on the primary disease.

Correlation of Socio Cultural Factors in Patients of Pelvic Inflammatory Diseases

Majority of the patients of PID are from low socio economic status. Unhygienic delivery, post partum infection,unsafe abortion procedures are observed to be linked to pelvic infection.The sequele to PID include chronicabdominal pain, infertility, ectopic pregnancy, etc. PID is the most serious complication of Sexually TransmittedDiseases. It is also related to the number of sexual partners. Social factors are very important in PID like age,educational status, marital status,socio economic status, religion, type of family etc. The present cross-sectionalstudy was conducted in Gynaecological OPDs of the Department of Obstetrics and Gynaecology, Rural and UrbanHealth Training Centres (R.H.T.C & U.H.T.C) of the Department of Community Medicine in JN Medical College,AMU, Aligarh.The study was carried out for a period of one year, from 1st August 2001 to 31st July 2002. A totalof 350 ever married females were selected on the basis of history of PID elicited. The aim of this study was to findthe correlation of socio cultural factors in patients of PID. This study reported that unhygienic deliveries may giverise to more chances of pelvic infection. It also reported that abortion rate is more in lower social classes(III-V). Themaximum cases of infertility were seen in the age group 25-29 years (37 cases).There were 51 cases presenting withprimary infertility and 9 cases of secondary infertility. Damage to the female reproductive tract from PID is usuallyirreversible; therefore, prompt antibiotic treatment is necessary to prevent any scarring of the reproductive tract.

Potential therapeutic targets for combating Mycoplasma genitalium.

Mycoplasma genitalium (M. genitalium) has emerged as a sexually transmitted infection (STI) all over the world in the last three decades. It has been identified as a cause of male urethritis, and there is now evidence that it also causes cervicitis and pelvic inflammatory disease in women. However, the precise role of M. genitalium in diseases such as pelvic inflammatory disease, and infertility is unknown, and more research is required. It is a slow-growing organism, and with the advent of the nucleic acid amplification test (NAAT), more studies are being conducted and knowledge about the pathogenicity of this organism is being elucidated. The accumulation of data has improved our understanding of the pathogen and its role in disease transmission. Despite the widespread use of single-dose azithromycin in the sexual health field, M. genitalium is known to rapidly develop antibiotic resistance. As a result, the media frequently refer to this pathogen as the "new STI superbug." Despite their rarity, antibiotics available today have serious side effects. As the cure rates for first-line antimicrobials have decreased, it is now a challenge to determine the effective antimicrobial therapy. In this review, we summarise recent M. genitalium research and investigate potential therapeutic targets for combating this pathogen.

718: UNITED STATES TRENDS FOR AZITHROMYCIN USE IN PEDIATRIC CRITICAL ASTHMA: A MULTICENTER COHORT STUDY

Introduction: Observation reports have suggested macrolides, such as azithromycin (AZI), may be used as immunomodulation for pediatric acute asthma exacerbations. To date, few studies have described AZI use for critical asthma (CA). We sought to estimate prescribing rates of AZI for CA and identify regional and chronologic trends using a large administrative registry. Methods: We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry of children 3-17 years of age with CA in the pediatric intensive care units (PICUs) of 47 United States (US) children’s hospitals from Jan 2011-Dec 2020. We excluded for alternative indications for AZI (e.g., B. pertussis infection, urethritis, pelvic inflammatory disease, and atypical pneumonia). The primary outcome was prescribing rates of AZI by hospital center and calendar year (via Joinpoint regression). Cohorts with and without AZI exposure were characterized by demographics, applied CA therapies, and routine clinical outcomes using descriptive and comparative (Chi-square and Wilcoxon rank-sum) statistics. Results: Of the 32,225 children studied, 6,641 (20.6%) were prescribed AZI with a downward trend from 31.3% in 2011 to 14.7% in 2020. A Joinpoint regression indicated a linear model was ideal (-1.7% annual slope, R2 = 0.857). Regional AZI prescribing rates by hospital center varied widely with a median of 19%, interquartile range (IQR) of 13.1% to 29.5%, and total range of 4.4% to 74.5%. Compared to children without exposure, those prescribed AZI were older (median 8.3 [IQR:5.8,11.6] vs 7.4 [5,10.9] years, P< 0.001) and more severely ill with a greater rates of bilevel positive airway pressure ventilation (13.1% vs 7.3% P< 0.001), invasive ventilation (18.8% vs 11.5%, P< 0.001), extracorporeal life support (0.5% vs 0.1%, P< 0.001), and longer median length of stay (4 [IQR:3,6] vs 3 [IQR:2,4] days, P< 0.001). Conclusions: In this multicenter study assessing children hospitalized for CA in the PICU from 47 U.S. Children’s hospitals, we observed a downward AZI prescribing trend (-1.7% annually from 31.3% in 2011 to 14.7% in 2020) and wide regional variation (range: 4.4% to 74.5% by center). Prospective clinical trials are needed to assess clinical and molecular efficacy endpoints of AZI immunomodulation in pediatric CA.

Gracilis muscle interposition for complex perineal fistulas: A systematic review and meta-analysis of the literature.

Complex perineal fistulas (CPFs) are among the most challenging problems in colorectal practice. Various procedures have been used to treat CPFs, with none being a panacea. Our study aimed to assess the overall success and complication rates after gracilis muscle interposition in patients with CPF. PubMed, Scopus and Google Scholar databases were systematically searched until January 2022 according to PRISMA 2020 guidelines. Studies including children <18 years or <10 patients were excluded, as well as reviews, duplicate or animal studies, studies with poor documentation (no report of success rate) and non-English text. An open-source, cross-platform software for advanced meta-analysis openMeta [Analyst]™ version 12.11.14 and Cochrane Review Manager 5.4® were used to conduct the meta-analysis of data. Twenty-five studies published between 2002 and 2021 were identified. The studies included 658 patients (409 women). Most patients had rectovaginal (50.7%) or rectourethral fistulas (33.7%). The most common causes of CPF were pelvic surgery (29.4%) and inflammatory bowel disease (25.2%). A history of radiotherapy was reported in approximately 18% of the patients. 498 (75.7%) patients with CPF achieved complete healing after gracilis muscle interposition. The weighted mean rate of success of the gracilis interposition procedure was 79.4% (95% CI 73.8%-85%, I2 = 75.3%), the weighted mean short-term complication rate was 25.7% (95% CI 18.1-33.2, I2 = 84.1%) and the weighted mean rate for 30-day reoperation was 3.6% (95% CI 1.6-5.6, I2 = 42%). The weighted mean rate of fistula recurrence was 16.7% (95% CI 11%-22.3%, I2 =61%). The gracilis muscle interposition technique is a viable treatment option for CPF. Surgeons should be familiar with indications and techniques to offer it as an option for patients. Given the relatively infrequent use of the operation, referral rather than performance of graciloplasty is an acceptable option.

Prevalence of Chlamydia trachomatis infection and evaluation of its genotypes among pregnant women in Tehran, Iran.

Chlamydia trachomatis is an obligate intracellular pathogen. Infection with C. trachomatis in pregnant women can result in maternal and fetal death, due to pelvic inflammatory disease. Therefore, we aimed to evaluate this infection in pregnant women and identify circulating genotypes of C. trachomatis in Tehran, Iran. Endocervical swabs were obtained from 101 pregnant women and tested by PCR assay to detect cryptic plasmid gene. Positive isolates were analyzed for C. trachomatis genotypes through amplification and sequencing of the omp1 gene and alignment with deposited sequences in Gene Bank. Infection with C. trachomatis was observed in 11 cases, yielding an overall prevalence of 10.8% in total. The majority of infected women were asymptomatic and the rate of infection was found more in women at the age of ≥30 years. However, no statistical association was found between C. trachomatis infection and risk factors in pregnant women. Analysis of isolated sequences revealed genotypes E (44.4%), D and F (both 22.2%), and K (11.2%) as main genotypes of C. trachomatis in this region. Results of this study showed the prevalence of C. trachomatis infections among pregnant women is relatively high. Identifying the precise rate of infection and associated genotypes in other regions is suggested.

Pharmacokinetics and pharmacodynamics of bioactive compounds in Penyanqing preparation in THP-1 inflammatory cells induced by Lipopolysaccharide

BackgroundPenyanqing (PYQ), a traditional Chinese medicine (TCM), has a good clinical efficacy for the treatment of pelvic inflammatory disease (PID). Previously, researches on its anti-inflammatory effect and mechanism in vitro, in silico, and in vivo have been reported by our team. However, the interrelationship between the anti-inflammatory activity and the active compounds in PYQ are not clear. Here, the pharmacokinetics-pharmacodynamics (PK-PD) study was carried out for more proper clinical use.MethodsThe plasma concentrations of salvianolic acid B (SAB), protocatechualdehyde (PRO), paeoniflorin (PE), astilbin (AST), ferulic acid (FE), and chlorogenic acid (CH) in SD rats after PYQ administration were determined by a selective and rapid HPLC–MS/MS method. In addition, the PK-PD on cell model was used to explore the relationship between the plasma concentration and inflammatory biomarkers (TNF-α, IL-1β).ResultsThe results of this study showed that the six components could reach the peak blood concentration within 0.29 h, indicating the rapid absorption of it. The eliminations of AST, CH, FE, PE, and PRO were relatively fast due to their mean residence times (MRTs) within 3 h, while the elimination of SAB was slower (MRT 5.67 ± 0.66 h). Combined with a THP-1 cell model, there was a significant correlation between inflammatory factors and component plasma concentrations with correlation coefficients in the range of -0.9—-0.746. Correspondingly, the drug-containing plasma obtained at 0.25 h point exhibited the best inhibition effect on production of IL-1β and TNF-α in LPS-induced THP-1 cells.ConclusionThe six main components in PYQ could be quickly absorbed, and there was a potential good correlation between their pharmacokinetics and the pharmacodynamics of PYQ.

Chlamydia trachomatis Coinfection Does Not Influence Mycoplasma genitalium Bacterial Load in Urogenital Samples.

Mycoplasma genitalium (MG) is associated with urethritis in men and weakly associated with pelvic inflammatory disease in women. Mycoplasma genitalium coinfections with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are commonly reported; however, little is known about their interaction. One study suggested that MG/NG coinfections might increase the bacterial load of NG, which has been shown to have a higher transmission potential. As even less is known about the impact of a simultaneous MG/CT infection, we assessed whether patients with urogenital MG/CT coinfections have a higher bacterial load than patients with a single infection. There were 1673 urogenital samples from patients from a population-based chlamydia study, and our sexually transmitted infection clinic tested for both CT and MG. When positive, the load was quantified. Nonparametric tests compared the CT and MG load, and linear regression analyses tested the association of the CT and MG load within a patient. In 60 MG-positive patients, MG load ranged from 1.7 to 6.0 log10 copies/ml, similar to the CT load distribution. Only 6 patients were MG-positive and CT-negative, but the MG load distribution was similar to that of CT-positive patients (n.s.). The MG and CT load was unrelated in coinfected persons (n.s.). We found no correlation between the CT and MG load in urogenital samples, and the MG load distribution was similar in CT-positive and CT-negative patients. These results could have implications for the transmission risk of these infections.

A Baseline Microbial Stability Study of Panchavalkaladi Taila and Dashamoola Taila-An Ayurvedic Formulation for Pelvic Inflammatory Disease

Pelvic inflammatory disease is an upper genital tract infection and inflammation. Panchavalkaladi Taila and Dashamoola Taila is having anti-inflammatory and analgesic property. Aim and Objectives: Present study was carried out for stability study of Panchavalkaladi Taila and Dashamoola Taila with respect to microbial diagnostic procedure. Materials and Methods: Sample of Panchavalkaladi Taila and Dashamoola Taila were prepared and studied at regular time intervals from the date of the preparation to the date of completion of clinic study to analysis mycological findings by Wet mount preparation and presence of bacteriological findings by Gram stain test. Result: Both samples were subjected to the microbiological study from date of preparation to the date of completion of clinical study. No any contaminations were found in microbiological study in both samples. Discussion and Conclusion: The baseline microbial profile was studied at regular interval of one month for total 15 month (between October 2020 to January 2022). At the end of every month study, samples were not showed presence of any microbes even in different temperature and humidity of this sea sore region. Conclusion: Obtained data of Panchavalkaladi Taila and Dashamoola Taila were concluded that both samples were showed good shelf life.

Aortic laceration during veress needle insertion: a laparoscopic disaster

Introduction: More than 50% of all complications associated with laparoscopy occur during the entry phase for pneumoperitoneum and insertion of trocars. Major vascular injuries related to blind entry technique are infrequent, occurring in 0.04–0.1% of laparoscopic procedures. Nevertheless, 13%–50% of all vascular injuries are not detected immediately during the operation, resulting in correspondingly high morbidity and mortality rates. Major vascular injuries are the second most common cause of death during laparoscopy, after death from anesthesia, with a mortality rate of 6.37 %. The first reaction after vascular injury should not be conversion to laparotomy, but instead assessment and possible control of the injury. Obesity, previous abdominal surgeries, surgical experience, inflammatory bowel disease and pelvic inflammatory disease are known risk factors to injuries during the entry phase in laparoscopy. Clinical case: A 47 years old woman, BMI 42.2 kg/m2, without any previous abdominal surgery, was proposed to an elective left hemicolectomy after 2 diverticulitis episodes in a 6 months period, at a secondary hospital. As soon as the Veress needle was inserted, blood was seen. After the first trocar was placed, an median retroperitoneal inframesogastric hematoma was seen and the surgeon did an unsuccessful attempt to control the bleeding. Since there was hemodynamic instability, a conversion was made. An infrarrenal aortic laceration was seen and clamps were put in place to stop the bleeding. The patient was then transferred to a tertiary hospital to be intervened by vascular surgery. An aortoplasty with patch of the great safenous vein and trombectomy of the ilio-distal arteries was performed. The time occurred between the injury and the beginning of the vascular surgery was 2hours. The patient went to an Intensive Care Unit. A total of 15 red blood cells pool (first 2 without compatibility test), 12 plasma units, 3grams of fibrinogen and 1 pool of plaquelets were transfused. During the intensive care stay, the patient developed leg compartment syndrome, with the need of fasciectomy and a moderate ARDS, making it harder to manage the disease. Conclusion: Major Vascular lesions in laparoscopy surgery are rare but are associated with great morbidity and mortality. A close cooperation between laparoscopic surgeons, anesthesiologists, vascular surgeons and intensivists is needed to minimize the damage and the improve the result of the vascular repair. The existence of strict action protocols is necessary to minimize morbidity and mortality.

RUPTURED TUBO-OVARIAN ABSCESS: RARE PRESENTATION OF PELVIC INFLAMMATORY DISEASE - A CASE REPORT

Background: Infection of the endometrium, fallopian tubes, ovaries, pelvic peritoneam, and adjacent structures is known as Pelvic Inflammatory Disease (PID). Pelvic inflammatory disease and its consequences are still at epidemic levels, Despite the availability of effective broad-spectrum antibiotics. Tubo-ovarian abscess (TAO) may be difficult to identify since the clinical signs are comparable to those of other pelvic and abdominal illnesses. Case Description: Here we are reporting a case, 34 years nulligravida came to emergency department with acute abdomen, she was a known case of chronic PID, Emergency laparotomy was performed, per operatively ruptured tubo-ovarian abscess was present. Conclusion: The clinical diagnosis of PID and TAO is similar, imaging evidence from ultrasonography (US) or magnetic resonance (MR) should be used to supplement the clinical diagnosis. Clinical Significance: To avoid complications and resultant emergency surgeries and their consequences, a vigilant eye must be kept to promptly diagnose, and manage PID at the earliest.

A comparison of treatment outcomes for levofloxacin versus doxycycline plus metronidazole for first-line treatment of uncomplicated pelvic inflammatory disease

Background: Pelvic inflammatory disease (PID), a common condition among women of reproductive age caused by various aerobic and anaerobic organisms, may sometimes lead to complications such as infertility, ectopic pregnancy, and chronic pelvic pain. Moxifloxacin is a broad-spectrum bactericidal acting against many Gram-positive, Gram-negative aerobic organisms and anaerobes. Rapid absorption and high bioavailability allow single daily dosing and improves compliance. Aims and Objectives: The present study was done to compare the treatment outcomes for levofloxacin versus doxycycline plus metronidazole for first-line treatment of uncomplicated in PID patients. Materials and Methods: This was hospital-based prospective, randomized, double-blind study conducted at gynecology outpatient department of Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, West Bengal, from January 2019 to December 2019. The study group was divided into Group A 50 cases (receiving levofloxacin) and Group B 50 cases (receiving doxycycline plus metronidazole) were included in the study. Template was generated and analysis was done on SPSS software. Results: Among 50 patients of each group, mean age of the patients of Group A was 27.80 (±3.58) and mean age of Group B was 27.57 (±4.51). Mean parity of the patients of Group A was 1.93 (±1.11) and mean parity of Group B was 2.07 (±1.11). Past H/O PID in Group A was 17 and in Group B was 19. Visual analog scale (VAS) pain score of Group A was 3.80 (±1.827) and VAS pain score of Group B was 3.97 (±1.671). VAS pain score was 1.10 (±0.960) in Group A and 2.63 (±1.426) in Group B. VAS vaginal discharge was 1.40 (±1.276) in Group A and 3.00 (±1.619) in Group B. Conclusion: The management of uncomplicated PID requires broad-spectrum antibiotic regimens to cover all potential pathogens. This study confirmed that fluoroquinolones, specifically levofloxacin, are effective and well tolerated in the treatment of uncomplicated PID.

Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial

IntroductionThe sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting...

Extreme thrombocytosis with severe anemia and infection in a Sudanese patient: A case report

Secondary thrombocytosis, also known as reactive thrombocytosis, is defined as an abnormal increase in platelet count as a result of another underlying medical or surgical condition. Once the medical cause of reactive thrombocytosis was determined, it could be treated. In this case, supportive treatment with no iron supplements for anemia and infection improved the case condition rapidly. we report a 20 years old Sudanese female who presented with high-grade fever, right iliac fossa pain, hyper pigmented macules on the tongue and a past history of undiagnosed anemia. Laboratory results showed platelets=1007×10^3/μl, hemoglobin=3.5 g/dl with low MCV, total WBC was also high=14.9×10^3/μl. Peripheral blood picture showed anisocytosis and poikilocytosis, microcytic hypochromic RBCs associated with target cells, pencil cells, teardrops cells and polychromies cells and with leukocytosis and very high platelets in the film. Abdominal ultrasound showed evidence of pelvic inflammatory disease. After receiving supportive treatment, antibiotics and 3 units of blood the patient showed remarkable improvement and reduction in platelet count. We discuss the mechanism of the reactive thrombocytosis state and the variable treatment options when accompanied with iron deficiency anemia. Reactive thrombocytosis with extreme platelet count should always be considered in patients presented with severe iron deficiency anemia and infection. In this case report the high platelet count was reversed successfully after commencing antibiotics and blood transfusion although of the poor patient compliance and the poor investigations were obtained from the patient.

Pathogenetic correlation of severe sepsis and multiple organ dysfunction syndrome provoked by multiple infections in perinatal period of women

Introduction. Despite significant advances in diagnosis, medical management and antimicrobial therapy, sepsis in the puerperium remains an important cause of maternal morbidity and mortality. The abnormalities associated with the clinical syndrome of sepsis result from a nonspecific innate inflammatory response. This is due to the fact that sepsis represents a systemic inflammatory response syndrome (SIRS) to infection or injury; therefore, it can rapidly progress to septic shock and death despite aggressive treatment. Severe sepsis with MODS has a mortality rate of 20– 40%, rising to around 60% if septicemic shock develops. Symptoms of sepsis may be less distinctive than in the non-pregnant population and are not necessarily present in all cases; therefore, a high index of suspicion is necessary. The major pathogens causing sepsis in the puerperium are: group A streptococcus (GAS), also known as Streptococcus pyogenes, Escherichia coli, Staphylococcus aureus, Streptococcus pneumonia, methicillin-resistant S. aureus (MRSA), Clostridium septicum, Morganella morganii and antibiotic-resistant Stenotrophomonas Moltrophilia. Multiple risk factors for maternal sepsis have been identified: obesity, impaired glucose tolerance/diabetes, impaired immunity/immunosuppressant medication, anemia, vaginal discharge, history of pelvic infection, amniocentesis and other invasive procedures, cervical cerclage, prolonged spontaneous rupture of membranes, caesarean section, wound hematomas, retained products of conception, GAS infection, vaginal trauma. Material and methods. Presentation of case report using the following key-words: „infection”, „systemic inflammatory response syndrome (SIRS)”, „severe sepsis”, „septic shock”, „multiorgan dysfunction syndrome (MODS)”. Results. We present a case of perinatal infections complicated with MODS. Conclusions. The presence of pelvic hematomas triggers the sepsis caused by multiple infections in perinatal period and can significantly increase the morbidity related to bleeding, infection, surgery and blood product transfusion. The clinical situation may worsen in the presence of pre-existing pathological conditions before pregnancy.

Usefulness of Antibiotic Prophylaxis in Miscarriage Surgery for Induced Abortion and Retained Products of Conception: a Narrative Review

Background: Miscarriage surgery is one of the most performed surgeries worldwide. Prophylactic antibiotics aim to avoid postoperative pelvic infection. Its use and benefit are well-known in induced surgical abortion, but far more ambiguous for miscarriage surgery for retained products of conception. Objective: To investigate the usefulness of prophylactic antibiotics in miscarriage surgery for retained products of conception and induced abortion and evaluate the antibiotic regimen of preference. Material and Methods: A comprehensive electronic literature search was conducted using PubMed, MEDLINE and Google Scholar. There were no specific inclusion criteria concerning study design, publication year, language, or study population. Results: When evaluating the effectiveness of antibiotic prophylaxis for surgical intervention in induced abortion, 12 out of 19 studies showed a significant reduction on pelvic infection compared to the control group. There was no consensus regarding type and regimen of antibiotics. Five studies investigated prophylaxis in interventions for retained products of conception, of which 2 could show a significant effect. Conclusion: There is evidence that antibiotic prophylaxis reduces the risk of pelvic infection. Single dose preoperatively is favoured, for its effectiveness and patient compliance. Doxycycline and metronidazole are preferred, as for the type of antibiotics. There is limited evidence that antibiotic prophylaxis for surgical removal of retained products of conception or non-viable pregnancies might reduce the risk of pelvic infection.