Postcoital Bleeding Research Articles

Evaluation of tumor size in cervix cancer patients treated with surgery: ultrasonography or MRI?

Objective: This study aims to compare tumor diameters measured by transvaginal ultrasonography and MRI in cervical cancer. Materials and methods: The study includes 127 cervical cancer patients diagnosed and treated at Akdeniz University Faculty of Medicine between January 2002 and December 2019. Data were collected retrospectively using the electronic archive system of the hospital. Patients with pathologically unknown tumor diameters were excluded from the study. Data were tested for normal distribution, and the mean, standard deviation, median, min-max values, and frequencies were used as descriptive statistics. Categorical data were expressed as numbers and percentages (%). The Student’s t-test, one of the parametric tests, was used to compare tumor diameters. Statistical Package for the Social Sciences (SPSS) 23 software (IBM Corp., Chicago, IL, USA) was used for data analysis. A p-value less than 0.05 was considered statistically significant in all tests. Results: The mean age of patients included in the study was 49.55 ± 11.67 years. Of all patients, 79.5% had a normal delivery. 87 (68%) of the patients were not using any contraceptive method, with 0.7%, condom protection was the least. Among the complaints of patients at admission, postcoital vaginal bleeding was the most common complaint with 42.5%, and asymptomatic patients were the second most common with 22%. Human papillomavirus (HPV) status was unknown in the vast majority of patients (91.3%). Regarding the stage status, stage 1b2 was the most frequently seen stage with 29 patients. Tumor histology revealed SCC in 80.3% and adenocarcinoma in 18.1%. The mean tumor diameter measured by transvaginal ultrasonography (TVS) was 3.30 ± 1.95, by magnetic resonance imaging (MRI) was 3.37 ± 2.03, and the pathologically measured tumor diameter was 3.17 ± 1.86. There was no statistically significant difference between the mean tumor diameter measured by TVS and MRI, MRI and pathology, and TVS and pathology (p: 0.769, p: 0.589, p: 0.891, respectively). Conclusion: When used by specialists experienced in the field of gynecological oncology, ultrasonography can be considered as effective as MRI, especially in tumor size measurement in cervical cancer, due to its ease of use, cheapness, and easy accessibility in regions with low socioeconomic status.

Modern investigation of cervico-vaginal infections (from microbiome disorders to pelvic inflammatory disease)

Vaginitis is the general term for disorders of the vagina caused by infection, inflammation, or changes in the normal vaginal flora, while cervicitis refers to inflammation of the uterine cervix. Symptoms of vaginitis include vaginal discharge, pruritus, odor, and/or discomfort. Women with cervicitis may have presenting symptoms such as purulent or mucopurulent (yellow) vaginal discharge, intermenstrual or postcoital bleeding, dysuria, vulvovaginal irritation and dyspareunia. The initial evaluation typically consists of a medical history, physical examination, microscopy examination of vaginal swab, and cervical tests for sexually transmitted infections. Evaluation of patient risk factors is important and should include a detailed discussion about the sexual history (number of partners, type of sexual activity, condom use, new sex partner, sex partner with a diagnosed sexually transmitted infection, sex partner with concurrent sex partners), vaginal hygiene (douching), and age (< 25). All women with symptoms suggestive of cervicitis or vaginitis undergo a physical examination that includes pelvic and vaginal evaluations. Vaginitis is often the result of the presence of infectious agents. The most common infections, such as bacterial vaginosis, Candida vulvovaginitis and trichomoniasis, account for over 90 percent of the vaginal infections. Cervicitis, typically acquired from sexually transmitted infections such as gonorrhea, chlamydia, and mycoplasma, can present with nonspecific vaginal symptoms.

A STUDY OF CORRELATION OF PAP SMEAR AND COLOPOSCOPY WITH HISTOPATHOLOGICAL FINDINGS IN CASES OF UNHEALTHY CERVIX

BACKGROUND: Cervical malignancy is the second most common among the malignancies in females, with breast carcinoma the first. Screening of unhealthy cervix by pap smear and supported by colposcopy and histopathology can easily identify the premalignant lesions and also other non-invasive inflammatory lesions of the cervix. OBJECTIVES: To correlate Pap smear and Colposcopy findings with histopathological findings in detecting premalignant lesions in the unhealthy cervix. MATERIALS AND METHODS:A prospective observational study was conducted on 100 symptomatic, sexually active women of 20-60 years. Pap smears and colposcopy was done for all 100 women who came with complaints of white discharge per vagina, intermenstrual, postcoital, or postmenopausal bleeding. The final correlation of the Pap smear and colposcopy was based on histopathology reports. RESULTS: In the present study, the sensitivity of Pap smear for detecting lesions above LSIL was 82.3%, specificity 96.9%, PPV was 93.3%, negative predictive value 91.4% and accuracy of Pap smear was 92%. The sensitivity of colposcopy in the detection of low-grade lesions and above came out to be 94.1%,specificity 87.8%,positive predictive value 80%,negative predictive value 96% and accuracy of colposcopy was 90%. CONCLUSION: This study suggests that the accuracy of detection of cervical abnormalities is higher when cytology, colposcopic guided cervical biopsy and colposcopy are used complimentarily in the diagnosis of cervical lesions. Colposcopy abolishes the need for repeated follow-up as in Pap smear and helps to reduce false-negative cases.

UTERUS DIDELPHYS IN NULLIPAROUS AND MULTIPAROUS WOMEN – A RARE ENTITY

Uterus didelphys is a rare congenital uterine abnormality in which the embryogenetic fusion of the Mullerian ducts fails to occur. It will lead to the formation of a double uterus with two separate cervices and most often a double vagina with a longitudinal septum as well. Here, we present two different cases of uterus didelphys with varied presentations. The first case is a nulliparous woman presented with post-coital bleeding. On examination, two cervical openings with a longitudinal complete vaginal septum were found, conservative management was done. Findings of didelphys uterus were confirmed on USG. The patient was counseled and discharged. The second case is a multiparous woman with previous cesarean delivery, rupture of membranes, and meconium in this pregnancy with term pregnancy taken up for emergency cesarean section. Dense adhesions and a mass on the right side of uterus were found intraoperatively, which on further inspection confirmed to be patent right horn of uterus. Diagnosis of uterus didelphys was made after doing per speculum and per vaginal examination post-cesarean.

A retrospective analysis of clinical profile of patients with cancer cervix in a rural medical college in Karnataka

Cancer cervix is most common cause of cancerous deaths in females especially in developing countries. The pre-invasive stage of cervical cancer lasts for a long period and a small proportion progresses to an invasive lesion. In Indian set up, majority of the patients are presenting with an invasive lesion. To describe the clinical profile of patients presented with cervical cancer and to describe various treatments received by those patients.: The present study is a retrospective observational study done on confirmed cases of carcinoma cervix who attended rural medical college in Karnataka. Clinical records of the patients, who presented between November 2019 and November 2020 and were diagnosed with cervical cancer, were retrieved. The data related to demographic and clinical variables like age, socioeconomic status, education, symptoms, clinical staging, treatment and histopathology report were recorded. Data collected were entered in Microsoft Excel Office 2007and data analysed. Data were presented using descriptive statistics. The data was expressed in the form of frequencies and percentagesA total of 30 patients with the median age of 46 years were studied. Most common presentation was post coital bleeding (40%) followed by white discharge per vagina in 33%. Majority were under low socioeconomic status (70%). 60% presented in stage II and 30% in stage I. Chemoradiation was treatment of choice in 60% followed by surgery in 33% and 7% were lost to follow up. On histopathology, majority had squamous cell carcinoma (70%).The appropriate management of Cervical intraepithelial neoplasia(CIN) can prevent invasive cervical cancer. In this study most of them presented in advanced stage which could have been prevented with the regular screening and awareness among women in the reproductive age group. : Detection of pre invasive lesions or in situ cases remains important key to decreasing cervical cancer morbidity and mortality.

Frequency of Cervical Cancer in Women Attending Gynae OPD with Complaint of Abnormal Vaginal Bleeding

Aim: Frequency of cervical cancer in women of reproductive age presenting with abnormal vaginal bleeding. Methodology: Descriptive cross sectional study, done at Department of Obs &Gynae, JPMC, Karachi Duration of study: Six months from 01-11-2014 to 30-04-2015 Total 73 patients of age 18-45 years, having history of abnormal vaginal bleeding > 3 menstrual cycles were selected. Pregnant woman, abortion within last 6 months, age >45 years, fibroid/ tumors/ polyps, PID, gonorrhea, or Chlamydia patients were excluded. Chi-square was used as test of significance with a P value <0.05 taken as significant. Results: Mean ± SD age was 38.12 ± 4.33 years. Mean ± SD parity was 2.21 ± 1.67 children (Range: 0-5). Mean ± SD duration of presenting symptoms was 7.45 ± 2.81 months (Range 3-11). About one fifth of patients (i.e. 19.2%) were of age between 18-25 years. a vast majority (i-e; 43.8%) were in 26-35 years age category while remaining (36.99%) patients were of age between 36-45 years. 12.3% women had no children, 35.6% had 1-2 children, 28.8% had 3-4 children while remaining 23.3% women had 5 children. 12 out of 73 (16.4%) women had cervical cancer confirmed through biopsy and histopathology of cervical tissue. Age was significant (P value = 0.003) while parity & duration of presenting symptoms were non-significant (P values = 0.110 & 0.405 respectively). Conclusion: The study found that almost every 6th women with abnormal vaginal bleeding is suffering from cervical cancer. Younger age women and those having lesser parity are less prone to this condition. Keywords: Abnormal vaginal bleeding, Cervical cancer, Postcoital bleeding

STUDY OF DIAGNOSTIC HYSTEROSCOPY IN PERI AND POSTMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING

Background:Abnormal uterine bleeding is dened as bleeding from uterus that differs from that of usual normal menstrual bleeding, in frequency of occurrence or in amount or in alteration of ow. The advantages of hysteroscopy as an accurate diagnostic technique are that it not only allows direct visual observation of pathology but also provides a means to sample the site, most likely to yield positive results. The present study was conducted to study the role of Hysteroscopy in abnormal uterine bleeding in Peri and Post-menopausal women at a tertiary care hospital. Material And Methods: Present study was single-center, prospective, Cross sectional study, conducted in women age ≥40years with heavy menstrual bleeding, prolonged bleeding, frequent menstruation, intermenstrual bleeding and post coital bleeding, Post-menopausal bleeding. Hysteroscopy was performed preferably in post-menstrual phase or post bleeding phase with a standard 4mm hysteroscope(Stryker) with a 30 degree fore-oblique lens. Procedure was performed under IV sedation with normal saline as distention media. Results: In present study, majority of the subjects (n=28) i.e. 36.8% presented with heavy menstrual bleeding followed by prolonged bleeding (32.8%), post- menopausal bleeding (21%), frequent menstruation (7.89%) and inter-menstrual bleeding (1.3%). On hysteroscopy normal ndings were present in 32 subjects (42%) followed by hyperplasia (17.1%), atrophic endometrium (13.1%), submucous broid (14.4%), endometrial growth (2.96%) & broid polyp (1.36%). Histopathology examination noted Proliferative endometrium (31.5%), secretory (10.5%), disordered proliferative phase (1.3%), simple hyperplasia (18.4%), complex hyperplasia with atypia (1.3%), submucous broid (14.4%), endometrial polyp (34.2%), atrophy (13.1%), broid polyp (1.34%) and malignancy (3.96%). Sensitivity, Specicity, PPV, NPV values were 100 % except for sensitivity for endometrial growth (66.7 %). p Value was highly signicant for all parameters (p <0.0001) Conclusion: Hysteroscopy has a better diagnostic accuracy as it provides the option of see and treat which is recommended for peri and post-menopausal women with AUB.. The intracavitary lesions (submucous leiomyomas, polyps, endometrial growth are) better diagnosed on hysteroscopy

A Case Report: Conservative Treatment Modalities as Loop Electrosurgical Excision Procedure (LEEP) Can Be Used to Treat Precancer Cervix Lesion High Grade Squamous Intraepithelial Lesion (HSIL) or Moderate and Severe Dysplasia (CIN II and III) with Post Coital Bleeding Disorders

Precancer cervix lesion High Grade Squamous Intraepithelial Lesion (HSIL) or moderate and severe Dysplasia (CIN II and III) is cervical Intraepithelial Neoplasia (CIN) which changes cervix epithelial cells without invasive to basalis membrane cells. This change step cervical epithelial cells through high-risk Human Papilloma Virus (HPV) infection such are HPV 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70. Precancer cervix lesion HSIL could cause erosion of the cervix and cause post coital bleeding disorders. Loop Electrosurgical Excision Procedure (LEEP) treatment could cure HSIL or moderate and severe dysplasia (CIN II and III). Therefore, it relieves post coital bleeding disorders to the patients. Cervical precancerous lesions High Grade Squamous Intraepithelial Lesion (HSIL) or moderate and severe dysplasia (CIN II and III) are Cervical Intraepithelial Neoplasia (NIS) or Cervical Intraepithelial Neoplasia (CIN) where changes in cervical epithelial cells occur without penetrating the basement membrane. The stages of normal cervical epithelial changes begin with high-risk Human Papilloma Virus (HPV) infection, namely HPV 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70 The HSIL cervical precancerous lesion could cause erosion of the cervix and cause complaints of post-coital bleeding disorders. Loop Electrosurgical Excision Procedure (LEEP) therapy could cure HSIL or moderate and severe dysplasia (CIN II and III) which could eliminate post-coitus bleeding disorders that suffered by patients.

INCIDENCE OF CERVICAL ADENOCARCINOMA: A RETROSPECTIVE CASE STUDY AT RIMS RANCHI

BACKGROUND:Cervical cancer remains one of the most common causes of death for women globally and ranks 4th of all cancers.Currently,every 2 minutes a life is lost to this disease.Endocervical adenocarcinomas are a heterogeneous group of neoplasms. Screening strategies designed for and effective in detecting squamous cell carcinoma precursors are less effective in detecting endocervical glandular precursor lesions.Because of this and possible other reasons,the real and relative incidence of endocervical adenocarcinoma has increased in recent years from 5% to up to 20-25%, particularly in patients 30yr of age or older.MATERIAL AND METHOD: It was a retrospective record based study, performed in the Department of pathology, RIMS Ranchi. Study population included all cases who were clinically suspected of any cervical pathology, with common clinical presentation of abnormal vaginal bleeding, intermenstrual heavy bleeding,postmenopausal bleeding,postcoital bleeding,whitish discharge per vagina,pain in lower abdomen, from January 2020- july 2021.RESULT:In our study incidence of SCC of cervix is 91.97% and second most common type is adenocarcinoma of cervix with incidence of 8.02%.Striking feature of adenocarcinoma of cervix is its preponderance in younger female as compared to SCC

V10-04 A BUCCAL MUCOSAL GRAFT SUB-CORONAL RESURFACING FOR TREATMENT OF RECURRENT PENILE ADHESIONS: THE BUCCAL BELT

You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-04 A BUCCAL MUCOSAL GRAFT SUB-CORONAL RESURFACING FOR TREATMENT OF RECURRENT PENILE ADHESIONS: THE BUCCAL BELT Matthew Beamer, Javier Angulo, Leandro Capiel, Damian López-Alvarado, Erick Ramirez-Perez, Paksi Satyagraha, Daniel Zaccarini, and Dmitriy Nikolavsky Matthew BeamerMatthew Beamer More articles by this author , Javier AnguloJavier Angulo More articles by this author , Leandro CapielLeandro Capiel More articles by this author , Damian López-AlvaradoDamian López-Alvarado More articles by this author , Erick Ramirez-PerezErick Ramirez-Perez More articles by this author , Paksi SatyagrahaPaksi Satyagraha More articles by this author , Daniel ZaccariniDaniel Zaccarini More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent penile adhesions often cause pain, post-coital bleeding, disfigurement and patient distress. Treatment options are limited and include topical steroids, lysis of adhesions and repeat circumcisions. Furthermore, adhesions are often associated with Lichen Sclerosus (LS) limiting the use of skin in any reconstruction. We present a novel surgical procedure using a sub-coronal buccal mucosal graft (BMG) resurfacing technique. METHODS: To perform the buccal belt procedure a sub-coronal segment of affected skin, approximately 1.5 cm in width, was circumferential excised. The circumference of the penile shaft was measured and an appropriately size buccal mucosal graft was harvested. The graft was placed sub-coronally and secured circumferentially with a proximal and distal anastomosis. Buck’s fascia was included in both the anastomosis and quilting sutures to allow for appropriate spread fixation of the graft. A vaseline gauze bolster was secured as a tie-over dressing. Patients were discharged with the bolster dressing and foley catheter. They were seen 7 days postoperatively for removal and then at 4-6 month intervals for follow-up. A retrospective, international multi-institutional review was conducted to include all patients treated with this technique. Surgical complications and evidence of recurrence were recorded. Patient-reported outcome measures including visual analog scale (VAS) and Global Response Assessment (GRA) questionnaires administered to measure functional and esthetic outcomes were also reviewed. RESULTS: Thirty-one men underwent the procedure across six institutions between 3/2014 and 9/2020. Mean age was 56.3 (32-77) and prior treatments included: topical agents 14 (45%) and circumcision 25 (81%). LS was seen in 23(74%) patients. Mean surgical time was 59 (25-95) minutes and mean hospital stay was 0.65(0-2) days. At the mean follow-up of 27 (4-79) months no patients developed recurrence. No patients reported painful erections. Mean VAS was 8.9 and 9.0 for esthetics and functional outcomes respectively. On GRA overall improvement was reported by all patients (61% +3; 25% +2; 14% +1). The majority saw improvement in esthetic appearance (46% +3; 39% +2; 7% +1; 4% 0; 4% -1) and improvement with post-coital bleeding (43% +3; 43% +2; 4% +1; 11% 0). Ninety-six percent would recommend the procedure to a friend. CONCLUSIONS: There are limited options for the treatment of recurrent penile adhesions, particularly in the setting of LS. A sub-coronal BMG resurfacing is feasible, with no recurrence and overall high satisfaction seen on an initial patient cohort. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e756-e756 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Beamer More articles by this author Javier Angulo More articles by this author Leandro Capiel More articles by this author Damian López-Alvarado More articles by this author Erick Ramirez-Perez More articles by this author Paksi Satyagraha More articles by this author Daniel Zaccarini More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement Loading ...

Effectiveness of cryotherapy in VIA positive women

Introduction: In this study we studied the effectiveness of Cryotherapy in cases with abnormal squamous intraepithelial lesions detected only by VIA.
 Method: In our study, 64 patients in reproductive age group attending gynecology OPD, with complaints of discharge per vaginum, lower abdominal pain, and post coital bleeding were screened with VIA and positive women had cryotherapy and they were followed up by same after six months.
 Result: A total of 64 VIA positive women had cryotherapy. Most of the women were of age group 31-40 years (40.6%). Majority of the women were of parity 2 or more (89.1%). The most common complaint was discharge (46.9%) followed by pelvic pain (32.8%). VIA was negative among most of the women (87.5%) after cryotherapy. The outcome of cryotherapy was not associated with age and parity rather presence of symptoms was statistically associated (p=0.034).
 Conclusion: We concluded that in low resource settings, simple and safe diagnostic test VIA and therapeutic procedure cryotherapy are safe and effective method to combat the killer disease of cervical cancer.
 Keywords: Cryotherapy, Visual inspection with acetic acid (VIA), cervix

Small cell neuroendocrine carcinoma of the uterine cervix (SCNEC): a case report and review

Objective: Improving skill and knowledge to diagnose and manage a rare case of small cell neuroendocrine uterine cervical cancer
 Method: a Case report
 Result: A 51 years old, para 2, Indonesian woman with chief complaint post-coital vaginal bleeding. Gynecology examination revealed cervical exophytic fragile mass size 3x3x3,5 cm, easily bleeding, with a necrotic part, infiltrated both parametria but not reach the pelvic wall correspond to stage IIB. Initially, the histopathology result from punch biopsy was an adenocarcinoma well-differentiated, with no lymph vascular invasion, DD/ adenosquamous, neuroendocrine tumor. We did the histopathology review continued with immunohistochemistry examination. Immunohistochemistry result showed that although all the sample was not typical, immunohistochemical outward patterns can support morphological features of high-grade neuroendocrine carcinoma, small cell type. We proceed here for chemoradiation therapy.
 Conclusion: Small cell neuroendocrine carcinoma of the uterine cervix is a rare case. Histopathology and immunohistochemistry examination has an important role to develop the diagnosis. Although the prognosis is poor, adjuvant chemotherapy or chemoradiation was associated with improved survival in patients with advance staged.
 Keywords: SCNEC, immunohistochemistry, chemoradiation

Cervical glandular neoplasia referrals and the diagnosis of adenocarcinoma in situ: Correlating cytology, colposcopy findings, and clinical outcomes.

To determine the clinical outcomes of women with possible glandular neoplasia of endocervical type on cervical cytology, and review all diagnoses of cervical adenocarcinoma in situ (AIS) over a 5year period at our institution. A retrospective case-note review was conducted of all women referred to colposcopy with possible glandular neoplasia of endocervical type on cervical cytology or diagnosed with cervical AIS after biopsy or excision, from January 2014 until December 2018 in a London district hospital. Of 55 women referred with possible glandular neoplasia of endocervical type, 47 (85.4%) had a significant pathology on histopathological analysis: AIS (n=22); invasive cancer (n=7); high-grade cervical intraepithelial neoplasia (n=18). Women with a history of borderline abnormality on cervical cytology within the last 5years were significantly more likely to be diagnosed with AIS or invasive cancer (P<.05). For the same period 49 women had histologically proven AIS. Among these 22 (44.8%) were referred as possible cervical glandular intraepithelial neoplasia. Other reasons for referral were the following indications: borderline dyskaryosis (n=13); high-grade dyskaryosis (n=8); low-grade dyskaryosis (n=4); postcoital bleeding (n=2). Due to the raised risk of significant gynaecological pathology in women with possible glandular neoplasia of endocervical type on cervical cytology, excisional biopsy is essential. Colposcopic impression varies significantly and complete excision of the abnormal lesions should be achieved. AIS is a histological diagnosis and should always be considered during colposcopical and cytopathological assessment.

Fallopian Tube Prolapse Through the Internal Cervical os: A Rare Complication of Uterine Perforation

Fallopian tube prolapse (FTP) is a rare complication described after hysterectomy without salpingectomy [1,2]. Symptoms reported by patients with FTP include abdominal/pelvic pain, postcoital bleeding, and vaginal discharge [3]. Uterine perforation is the most common complication in patients undergoing dilation and curettage (D&C) [4]. We report a rare case of fallopian tube prolapsed through the internal cervical os into the endocervical canal presenting as a late complication in a patient with undiagnosed uterine perforation.

A study on microbiological profile in women with symptomatic vaginal discharge

Background and Objective: Abnormal vaginal discharge is characterized by change of colour, consistency, volume, or odour, and may be associated with symptoms such as itch, soreness, dysuria, pelvic pain, or intermenstrual or post-coital bleeding. Main objective of the study is to know the incidence of symptomatic vaginal discharge in various age groups and to know the microbiological profile in women presenting with symptomatic vaginal discharge. Methods: The study was conducted in the department of OBG, EPIONE Hera Hospitals over a period of 20 months Aug 2018- Apr 2020 among women complaining of vaginal discharge of various degrees who fulfilling the inclusion and exclusion criteria were included in the study. A detailed clinical history and examination of all cases were done, a speculum was inserted into the vagina, to visualize cervix and vagina, any pathology in the cervix and vagina noted, swabs were collected from the posterior fornix of vagina and sent for microbiological examination. Following tests were done a) Gram staining and Nugent scoring system used, based on the morphology of the bacteria, score 0 to 7 is considered positive for bacterial vaginosis, b) Wet mount preparation done to look for motility of Trichomonas, c) KOH preparation, d) Swabs are inoculated in Blood agar, Mac Conkey’s agar and Sabouraud’s dextrose agar. Results: Out of 260 cases, majority of the patients 145 (55.76%) were in the age group of 19-28 years, followed by 91 (35%) cases in the age group 29-38 years, 21 (8.07%) cases in age Group 39-48 and 3 (1.15%) were below 19 years. Maximum 128 (49.23%) were illiterate, followed by 82 (31.53%) were with primary schooling educational status. Most of the women 160 (61.53%) were in the lower socioeconomic status followed by 62 (23.84%) upper lower class. Majority patients 161 (61.92%) had associated combined symptoms of foul smell and itching, others like only vaginal discharge 51 (19.61%) abdominal pain 18 (6.92%), burning micturition 13 (5%), heavy menstrual bleeding (3.46%) and lower backache 8 (3.07%) were noted. Large part 98 (37.69%) showed mucopurculent discharge, followed by 89 (34.23%) yellowish and fothy discharge, curdy white 46 (17.69%) and homogenous discharge 27 (10.38%). Prevalence of bacterial vaginosis is maximum 122 (46.92%), followed by Trichomonas vaginalis 99 (38.07%), vaginal candidiasis 18 (6.92%), other nonspecific 9 (3.46%). In around 10 (3.84%) of cases no cause was identified. Conclusion: White discharge is one of the major women public health problem, principle morbidity to the women in terms of loss of self-esteem, reduction in work time, increased hospital visits and their expenses and also vulnerable to pelvic inflammatory diseases, infertility, endometriosis, cuff cellulitis, urethral syndrome, spontaneous abortions, preterm labor etc. So, it is very important for microbiological diagnosis of abnormal vaginal discharge especially, when a patient is having recurrence or not responding to standard therapy. Increase of educational status in urban and rural areas is considered one of the greatest way to reduce the genital health problems.

Histomorphological spectrum of small cervical biopsies with p16 staining in pre invasive lesions: A seven year retrospective analysis

I ntroduction: Uterine cervix is a common site for many neoplastic and non-neoplastic lesions. Nonneoplastic lesions include acute and chronic cervicitis, hyperplasia, polyps and cysts. Neoplastic lesions include pre invasive lesions and cervical cancer. Cervical cancer is the second most common cancer in Indian women after breast cancer. Histo pathological studies of cervical lesions helps in early diagnosis and proper management of patients. Various biomarkers are available for diagnosis of HPV in pre invasive lesions of cervix. Aims : To analyse the histo pathological spectrum of cervical lesions and their relation with demographics and clinical presentation in small cervical biopsies. Our aim was also to study the role of p16 immunohistochemistry on a small subset of pre invasive lesions of cervix. Materials and Methods : This is a hospital based seven year retrospective study of 279 cervical punch biopsies performed on patients from January 2013 to December 2019. Clinical history, demographic details, histopathology (H&E) slides and reports of cervical punch biopsies of the patients were retrieved from past records and analyzed. Six cases of pre invasive lesions of cervix were studied using p16 immunohistochemistry. Results : The age range of various cervical lesions was 21 to 70 years with a mean age of 45.5 years. The most common age group affected in non- neoplastic lesions was 30-40 years and among neoplastic lesions it was found to be in 40 to 50 years. White discharge per vaginum was the most common complaint seen in122 (43.7%) cases, followed by backache in 50 (17.9%), abdominal pain in 37 (13.2%). Bleeding per vaginum was noted in 60 (21.5%) cases and post coital bleeding was reported in 10 cases (3.5%) On histopathological examination, 163 cases (58.4%) were non-neoplastic, 68 (24.37%) were pre-invasive and 48 (17.2%) cases were malignant. The most common non-neoplastic lesion was endocervical polyp reported in 90 biopsies. Among neoplastic cases, LSIL was seen in 30 (12.1%) HSIL in 37 (13.5%) and condyloma in 1 case (0.35%). Squamous cell carcinoma was diagnosed in 44 cases (15.2%). Adenocarcinoma was seen only in 4 cases (1.4%). The percentage positivity of p16 staining on six biopsies, was 33.3% in LSIL and 66.6% in cases of HSIL. Invasive squamous cell carcinoma was taken as a positive control. Conclusion : Histopathological diagnosis of cervical punch biopsy is a valuable tool in early diagnosis of neoplastic, pre-invasive and non-neoplastic lesions of cervix.Immunostaining with p16 can be a useful adjunct to routine histopathology in diagnosis of preinvasive lesions of cervix. Keywords: Cervical biopsy, Cervicitis, Koiliocytosis, Preinvasive lesions, Carcinoma cervix, p16, HPV.

Cervical Cancer: Assessment of Its Knowledge, Utilization of Services and Its Determinant Among Female Undergraduate Students in a Low Resource Setting.

Cervical cancer is a preventable disease that contributes significantly to the death of women. This study is aimed at determining the level of knowledge and utilization of cervical cancer screening and its determinants among female undergraduates of Ebonyi State University. A structured questionnaire was used for a cross-sectional survey of the study population between January 1 and March 3, 2018. The data were analyzed using IBM SPSS Statistics version 20. Data were represented with frequency table, simple percentage, mode, range, Chi square and pie chart. The level of significance is at P-value < 0.05. Majority (74.8%) of the respondents were aware of cervical cancer and it could be prevented (70.8%). More than three-fifths (68.30%) were informed via health workers, and 86.8% were aware that post-coital vaginal bleeding is a symptom. Less than half (49.8%) knew that HPV is the primary cause, and only 32.9% were aware of the HPV vaccine. One-quarter of the respondent were aware that early coitarche is a risk factor for cervical cancer. Only 41.8% of the women were aware of Pap smear, 9.2% had undergone screening, and 97.6% were willing to be screened. Marital status was the significant determinant of being screened while class level did not significantly influence uptake of cervical cancer screening. The most common reason (20.6%) for not being screened was lack of awareness of the test. Our study population had a good knowledge of cervical cancer, but utilization of cervical cancer screening was poor. Awareness creation through the mass media and provision of affordable screening services can promote the use of cervical cancer screening in the study area.

Evaluation of autologus platelet-rich plasma versus silver nitrate in the treatment of cervical erosion

Background Cervical erosion is identified by the existence of columnar cells on the ectocervix rather than on the squamous epithelium. Adolescent age, pregnancy, and hormonal contraception are all causes of erosion. Some doctors think erosion is a typical asymptomatic variation, while others believe it is caused by persistent cervicitis. Metaplastic columnar epithelium may cause a variety of symptoms such as vaginal discharge, leukorrhea, postcoital bleeding, pelvic discomfort, and dyspareunia. Laser ablation, microwave ablation, platelet-rich plasma (PRP) injections, herbal treatments, and cryosurgery have all been reported as therapeutic options. Aim Evaluating the therapeutic effect of applying an autologous PRP in cervical erosion versus chemical cautery with silver nitrate. Patients and methods Randomized controlled clinical study on 100 patients at the outpatient clinic of the Obstetrics and Gynecology Department, Faculty of Medicine, Tanta University Hospitals. A total of 50 patients was assigned as the PRP group), the study group, while the other was the silver nitrate group. Follow-up visits occurred on the 1st, 2nd, 4th, 6th, 8th, 10tht, and 12th week posttreatment for the lesion size changes, symptom relief, postprocedure discomfort, pain, and long-term complications. Results PRP and silver nitrate are now being used to treat symptomatic patients with cervical erosion. Because it resulted in a faster tissue healing time and fewer complications, autologous PRP has the potential to replace alternative unpleasant treatment options such as cautery, with promising results for inflamed and injured cervical tissue with erosion repair. Conclusion PRP shows no immunogenic difficulty or ethical matters as autologous. It stops damage to the cervix and hence prevention from cervical cancer.

An Unusual Finding of 2 Cesarean Scar Defects in a Patient with History of Multiple Cesarean Sections

A healthy, 27-year-old woman with a history of 4 previous cesarean sections (CS) was referred for evaluation of pelvic pain accompanied by intermenstrual and postcoital bleeding. Initial transvaginal ultrasound suggested the presence of a uterine polyp. This was further investigated by a saline-infused sonogram, which demonstrated a retroflexed uterus and 2 discrete fluid-filled cesarean scar defects (CSDs) (Fig. 1). The first CSD was noted in the lower uterine segment measuring 8 mm in length and 6 mm in height, with an overlying myometrial thickness of 4 mm.

Primary vaginal sarcoma treated with upfront fertility-sparing surgery

A 31-year-old nulliparous woman was referred for a 5 cm vaginal tumor diagnosed by physical examnation. She complained of post-coital bleeding in the prior 2 months. Pelvic examination showed a...