scholarly journals Role of office hysteroscopy in gynecology: retrospective observational study at a tertiary care hospital

Author(s):  
Manoj Kumar Tangri ◽  
Prasad Lele ◽  
Krishan Kapur ◽  
Anupam Kapur ◽  
Neelam Chhabra ◽  
...  

Background: Hysteroscopy being the gold standard for evaluation of uterine cavity can be utilized for varied gynaecological indications. Conventionally, hysteroscopy is performed under general anaesthesia but with technical advances over years, it is now possible to do the procedure in ambulatory office setting with same diagnostic accuracy. Aim of this study was to assess the role of hysteroscopy as a diagnostic tool in office setting, to evaluate various gynaecological conditions.Methods: Study performed retrospective analysis on 1920 patients who underwent office hysteroscopy between Jan 2011 to Apr 2015, at outpatient department of a tertiary care centre at Maharashtra, India. The procedure was done in office setting without any sedation or anaesthesia. Approach used was vaginoscopic free hand technique with minimal instrumentation and the findings were documented after evaluation of uterine cavity, ostea and endocervical canal.Results: Office hysteroscopy could be successfully performed in 1920 out of 1938 patients. Most common indications were primary infertility (38.0%), secondary infertility (11.2%), abnormal uterine bleeding (36.6%) and postmenopausal bleeding (8.3%). The procedure done in office setting was tolerated well. The procedure was also used for evaluation in patients with breast and endometrial carcinoma.Conclusions: Office hysteroscopy by vaginoscopic approach is a simple and convenient method for evaluation of uterine cavity and cervical canal. It has the potential to come out from formal operation theatre to more patient friendly outpatient department.

Author(s):  
Apeksha M. Mohite ◽  
Deepali S. Kapote ◽  
Michelle Fonseca

Background: Abnormal uterine bleeding is one of the commonest conditions amongst patients attending gynaecology OPD which also leads to significant disruption in a normal lifestyle. The causes of abnormal uterine bleeding are heterogeneous and complex. A systematic evaluation with detailed history and physical examination is foremost important in reaching diagnosis. Hysteroscopy is not only safe, quick and observes entire uterine cavity but also helps in precision in sampling and increases accuracy of diagnosis. It is also curative in conditions such as polyps, fibroids, uterine synechiae, menorrhagia and lost intrauterine contraceptive device. The aim of the study is to evaluate the role of hysteroscopy as a screening method in patients with AUB & compare to their USG findings and to the histopathological reports of the endometrial biopsy.Methods: This is a prospective observational study conducted at a tertiary healthcare centre over a period of 18 months, in 50 females belonging to pre, peri and post-menopausal age group. Sampling was done based on selection criteria after obtaining valid consent from the study group.Results: Hysteroscopy has a definitive role in evaluation of patients presenting with abnormal uterine bleeding with high sensitivity, specificity, PPV and NPV with immediate results.Conclusions: The above study concludes that the accuracy of diagnosing the cause of abnormal uterine bleeding is more with hysteroscopy followed by D and C then USG combined with D and C.


Author(s):  
Ashis Samuel John ◽  
Kamaxi M. Bhate

Background: Inadequate understanding by patients of medical prescription given to them adversely affects treatment compliance; which can result in treatment failure and increase the incidence of adverse effects. The study site is a tertiary care hospital in a metropolitan city and the patients attending here are particularly vulnerable in this regard both due to the heavy patient load in the outpatient department and their low socioeconomic status.Methods: This was a cross sectional study conducted in the pharmacy of K.E.M. Hospital, Mumbai over a period of 1 month. Study population included general outpatient department patients of the hospital. Patients were interviewed using a pre validated questionnaire and their knowledge of the prescription analysed under five key aspects including dose, timing, duration, side effects and purpose of each drug. Data was entered using Microsoft Excel and analyzed using SPSS 22 software.Results: The mean age of the population was 37.6, with a standard deviation of 12.4. A good overall knowledge of the prescription was present only in 12.4% patients. In 52% of patients, the level of knowledge ranged from ‘no knowledge to little knowledge’. Age and literacy had statistically significant associations with overall knowledge of prescription.Conclusions: There is a significant gap in prescription knowledge in the study population. Age and literacy of the patient has an effect on prescription knowledge.


2021 ◽  
Vol 59 (238) ◽  
Author(s):  
Neelam Joshi ◽  
Asim Shrestha ◽  
Deepika Karki ◽  
Pradip Man Singh

Introduction: Adolescence is the time when most mental illness begins most of the time these problems are overlooked leading to increased morbidity and mortality. The study is undertaken to find out the prevalence of psychiatric disorders in adolescents attending psychiatry outpatient department in a tertiary hospital. Methods: A descriptive cross-sectional study was done from 1st December 2019 to 29th November 2020 at a tertiary care centre of Kathmandu. Ethical approval (Ref No.: 012-076/077) was taken from the Institution Review Committee. A semi-structured proforma was used for the socio-demographic profile of patients and International Classification of Diseases-10 was used to make the diagnosis. Data were analyzed using Statistical Package for the Social Sciences version 16. Results: A total of 174 adolescents were included in the study. Out of the total cases 141 (81.03%) (75.1-86.8 at 95% Confidence Interval) were diagnosed with psychiatric disorders, among them 73 (51.77%) were males and 68 (48.23%) were females. The common diagnoses were anxiety disorders 63 (36.20%), mood disorders 34 (19.54%), psychotic disorders 26 (14.94%), substance use disorders 8 (4.59%), non-organic sleep disorders 5 (2.87%), behavioral and emotional disorders 3 (1.72%) and mental retardation 2 (1.149%). Conclusions: Prevalence of psychiatric illnesses is high in the adolescent population compared to the similar studies.


Author(s):  
Anjaneya Prasad V. ◽  
Anjani Kumar C. ◽  
Neelima V. ◽  
Sai Prasanth R.

Background: Prevalence of anaemia is very high in rural tertiary care hospital O.P.D patients. Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. Anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this long-standing problem and to do whatever is needed to be done.Methods: In our study 200 people attending medical outpatient department at a tertiary care centre were enrolled. Assessment of the anaemic problem is worked out.Results: Out of 200 patients, 107 were females and 93 were males. 49 females out of 107 had haemoglobin less than 10 and 9 males out of 93 are having haemoglobin less than 10. Among people with hemoglobin less than 10, 84.5% are females. Significant p value was observed in females (<0.0001).Conclusions:Anemia continues to be a major health problem in developing countries like India, particularly rural India. Despite different strategies and programs have been taken by government of India the growing menace of anaemia is not solved. So newer strategies must be taken.Background: Prevalence of anaemia is very high in rural tertiary care hospital O.P.D patients. Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. Anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this long-standing problem and to do whatever is needed to be done.Methods: In our study 200 people attending medical outpatient department at a tertiary care centre were enrolled. Assessment of the anaemic problem is worked out.Results: Out of 200 patients, 107 were females and 93 were males. 49 females out of 107 had haemoglobin less than 10 and 9 males out of 93 are having haemoglobin less than 10. Among people with hemoglobin less than 10, 84.5% are females. Significant p value was observed in females (<0.0001).Conclusions: Anemia continues to be a major health problem in developing countries like India, particularly rural India. Despite different strategies and programs have been taken by government of India the growing menace of anaemia is not solved. So newer strategies must be taken.


Author(s):  
Ujwala P. Gawali ◽  
Harshad V. Kesari ◽  
Komal S. Gawand

Background: Monitoring adverse drug reactions (ADRs) helps in alerting physicians and developing strategies to prevent and minimize the risk of developing ADRs. Data regarding pattern of ADRs due to psychotropic medications is scanty. Hence, the study was planned to assess ADRs among psychiatry outpatients of a tertiary care hospital in Maharashtra.Methods: A prospective, observational study was conducted in psychiatry outpatient department of a tertiary care centre for 3 months. Cases were enrolled by active and passive surveillance after obtaining informed consent. Demographic details, adverse event details, history of medications were recorded. Pattern of ADRs was studied according to demographic parameters, drug class, organ system affected, causality (WHO - Uppsala Monitoring Centre Scale) and severity (modified Hartwig and Siegel Scale).Results: Out of total 1200 patients screened, 77 qualified the inclusion and exclusion criteria and 92 ADRs were reported; overall incidence rate of 6.41%. Maximum ADRs were reported in the age group of 31- 40 years. 63.63% subjects received more than 2 psychotropic drugs. Among 24 types of ADRs observed, tremor (13.04%) was the commonest, closely followed by somnolence. Antipsychotics (45.65%) were most frequently incriminated and central nervous system (46.73%) the most often affected. Trifluoperazine (11.96%) was the commonest drug, followed by olanzapine and haloperidol (10.53% each). Causality analysis yielded 66 ADRs as “probable” and on severity analysis 80.43% were mild.Conclusions: The study provides an insight into pattern of ADRs in psychiatry outpatients. It is prudent to communicate this to treating physicians as well as counsel patients (and caregivers). Initiatives and concerted efforts involving all stakeholders in healthcare can go a long way in decreasing drug-related morbidity and health costs.


Author(s):  
Rehana Tabassum ◽  
Syed Sajad Hussain ◽  
Sajad Hussain Arif ◽  
Altaf Ramzan ◽  
Samina Farhat

Background: The neurosurgical disorders are amongst the leading cause of global mortality and morbidity. Though surgical intervention is thought to be the main management protocol in the neurosurgical setup but drugs are being equally used especially in the outpatient setting. The present study was carried out in view of the sparse data available on prescribing pattern in neurosurgery.Methods: The present study was conducted by the department of pharmacology in outpatient department of neurosurgery in a tertiary care centre to look into the prescription pattern among these patients.Results: In 268 patients analyzed, mean age was 43.02±15.93 years and 52.23% were females. Majority of our participants (44%) were found to be of young to middle age group (21-40 years). The diagnosis among the study population was spread over large number of diseases. Lumbar Disc Prolapse (LDP) was found to be the leading cause of neurosurgical morbidity, amounting to 32%. As far as the prescription of various drugs in the outpatient of neurosurgery is concerned, Analgesics were the most common drugs prescribed constituting about 48% of the total drugs prescribed followed by GABA analogues and multivitamins which equally formed 41% of the total prescribed drugs.Conclusions: Although the prescription pattern studies among the outpatient neurosurgery patients are very scant, the analysis of prescription studies will be helpful to encourage the rational drug prescribing pattern.


Author(s):  
S.V. Nachiketha

Background: Hysteroscopy has been found useful to evaluate the problem of abnormal uterine bleeding. It helps to resolve this by direct view of uterus. It is useful in detecting endometrial hyperplasia. Objective of the study is to evaluate the role of Hysteroscopy in the diagnosis of patients with AUB and Correlate HPR findings.Methods: Total 50 woman who presented with complaints of abnormal uterine bleeding were studied for one year from December 2012 to November 2013. The observations obtained were analyzed.Results: Total of 50 women presenting with complaints of abnormal uterine bleeding were enrolled. Data obtained analyzed and final results and observations were tabulated pertaining to age, Chief complaints, Duration of symptoms, Menopause, Parity, Hysteroscopic/HPR findings, Accuracy obtained correlating with HPR.Conclusions: Hysteroscopy is highly sensitive diagnostic procedure which not only provides useful information of the uterine cavity but also an ideal method for the evaluation of patients with abnormal uterine bleeding.


Author(s):  
Gurram Swetha Reddy ◽  
Gandavaram Jyothi

Background: Infertility globally is a raising threat and problem associated with significant social and psychological problem. Infertility currently affects about 10 to 14 percent of the Indian population, with higher rates in urban areas where one out of six couples is impacted. Patency of the tubes, structure of uterus and cervix can be visualized by hysterosalpingogram which is a simple safer inexpensive investigation of choice in cases of infertility. Objective of this study was to study the role of hysterosalpingography (HSG) in cases of primary and secondary infertility and to observe the structural abnormalities of cervix, uterus and fallopian tubes.Methods: A two year prospective study was conducted on cases of primary and secondary infertility attending the OPD of infertility clinic. HSG was performed on the subjects included in study and findings were noted. Analysis was done by Microsoft excel spread sheet.Results: A total of 286 cases with 11.19% of primary infertility and 88.81% of secondary infertility evaluated by HSG. Mean age of the study group was 35.16±2.8 years. 74.83% had abnormal findings, with 20.28% having normal uterine cavity with uterine filling defect being the common abnormality. Two congenital anomalies of uterus were noted. Tubal occlusion was seen in 8.39% right and 9.09% left cases. Hydrosalpinx was observed in 7.69% of right and 9.79% of left cases.Conclusions: To conclude, women presenting with infertility should be evaluated for tubal pathology. The tubal pathologies like occlusion or hydrosalpinx may be due to infections or post surgical sequelae. HSG remains one of the diagnostic backbone in infertility even availability of new modalities.


Author(s):  
Atul Padmawar ◽  
Ankita Khande

Background: Abnormal uterine bleeding is defined as any type of bleeding in which the duration, frequency or amount is excessive for an individual patient. Hysteroscopy has ushered a new era in the evaluation of abnormal uterine bleeding. With this background, we conducted a study to find the role of hysteroscopy with dilation and curettage in post-menopausal bleeding.Methods: It was an observational study conducted in the department of obstetrics and gynecology of a tertiary care hospital in Maharashtra. Post-menopausal patients with abnormal uterine bleeding, admitted in the period of March 2018 to September 2019 were included in the study. A pretested and predesigned questionnaire was used to collect the data. Hysteroscopy with dilation and curettage was done and samples were sent for histopathology.Results: Bleeding was present in all the 30 cases. About 33.33% had pain abdomen, 56.67% had hot flushes, 10.00% had mass and 10% had other symptoms in the present study. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of hysteroscopy in diagnosing malignancy was 75%, 96.15%, 75%, 96.15% and 93.33% respectively.Conclusions: To conclude the most common cause of abnormal uterine bleeding in post-menopausal women in our study was polyp. The sensitivity and specificity of the hysteroscopy in diagnosing the malignant lesions is 75% and 96.15% respectively which corroborated with other study findings. Hysteroscopy with dilation and curettage is better alternative to hysterectomy and biopsy in most of the cases. 


2018 ◽  
Vol 9 (2) ◽  
pp. 36-41 ◽  
Author(s):  
G. M. Savelyeva ◽  
S. A. Mikhalev ◽  
A. G. Konoplyannikov ◽  
L. M. Mikhaleva ◽  
I. I. Babichenko ◽  
...  

The crucial role of chronic endometritis in the genesis of endometrial dysfunction has been currently established. The inflammatory process serves as a co-factor and leads to a decrease in the receptivity of the sex hormones of the endometrium due to impaired blood circulation of the tissue and fibrosis in the stroma of the endometrium. This article is devoted to the study of the morpho-functional state of the endometrium in women of the reproductive age with abnormal uterine bleeding, in whom endometritis was diagnosed pathomorphologically, which is important for clarifying indications for the pregravid preparation in the future. A comprehensive examination of patients with abnormal uterine bleeding includes: bacterial culture (PCR) of the cervical canal and uterine cavity, hormonal profile, ultrasound examination of the pelvic organs and a complex histological examination of the uterine biopsy at the 7–10th and 19–21st days of the menstrual cycle, followed by immunohistochemical examination with the use of antibodies to the receptors of estrogens and progesterone, glycodelin, CD138, CD4, CD8, CD20.


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