scholarly journals Management of adnexal masses: save the ovaries

Author(s):  
Chitra Champawat ◽  
Reena Jatin Wani

Background: Adnexal mass is a common presenting complaint in gynaecology. Total 1318 cases were operated over two and a half years (January 2015-June 2017), out of which 195 (14.7%), were for adnexal mass.Methods: To review cases of adnexal masses who underwent surgery over the period of two and a half year in a tertiary care hospital with respect to presentation, aetiology, type of surgeries and fertility preservation.Results: There were totally 195 patients, mostly of age group 26-45 years affected by adnexal mass. Most common presentation was pain abdomen (70 cases i.e. 79.5%). Ectopic pregnancy (115 cases i.e. 58.9%) was the most common diagnosis, followed by ovarian cyst (71 cases i.e. 36.4%). Most cases were treated by open surgery. Laparoscopic management was done for 33 cases (17.9%). Except in unavoidable situations active effort were made to conserve ovaries. Oophorectomy was done in 22 cases (11.2%) and in 173 cases (i.e. 88.8%) fertility preservation was done. Malignancy was seen in 4 (2%), which were managed by open surgery.Conclusions: Ectopic pregnancy was the most common aetiology of adnexal mass, and laparoscopy and its known benefits to patients is the best approach if available. For cases with suspected malignancy, open surgery will remain a safer option.

2019 ◽  
Vol 08 (03) ◽  
pp. 168-172
Author(s):  
Rojna Rai ◽  
Pema Choden Bhutia ◽  
Ugyen Tshomo

Abstract Context: Adnexal masses of ovarian origin are of growing concern due to high fatality associated with ovarian malignancy because they are diagnosed at advanced stage due to vague symptoms and absence of recommended screening tests. Aims: The aim was to study the prevalence of histopathologic types of adnexal masses in different age groups and to analyze the accuracy of preoperative evaluation in diagnosing ovarian malignancy. Settings and Design: This was a cross-sectional study carried out in the Department of Obstetrics and Gynecology of a tertiary care hospital in Bhutan with gynecologic-oncology services, from January to December 2017. Subjects and Methods: Women presenting with adnexal mass were evaluated and those meeting criteria were enrolled. They were evaluated preoperatively with complete history, examination, ultrasound, and tumor markers. Risk of malignancy index (RMI) was calculated for all patients. Following surgery, histopathology results were compared with preoperative evaluation. Statistical Analysis Used: Chi-square test, t-test, Cohen's Kappa, and receiver operating characteristic curve analysis were used for statistical analysis. Results: Of 165 patients evaluated, 127 fulfilling criteria were enrolled. Adnexal masses of ovarian origin were most common (n = 102, 80.3%), of which 12.7% were malignant. Epithelial ovarian malignancy was the most common malignant ovarian tumor, serous cystadenocarcinoma being the most common. Malignancy was significantly more in older, postmenopausal women with high RMI. Seven out of 11 women with high RMI were diagnosed in Stage 3 or 4. RMI score at cutoff of 200 was 54.6% sensitive and 85.7% specific. Conclusions: Adnexal mass of ovarian origin was the most common. Malignancy was significantly more in older, postmenopausal women with high RMI. RMI showed moderate correlation in diagnosing epithelial ovarian malignancies.


2021 ◽  
Vol 10 (2) ◽  
pp. 58-62
Author(s):  
Farmud Ansari ◽  
Sushil Yadav ◽  
Ram Hari Ghimire

Background: One of the defining elements of Nepal's socioeconomic environment is labor migration. Migrant workers are more likely to develop occupational diseases because they do dangerous tasks and have limited access to occupational health care. The purpose of this paper is to produce clinical profile of migrant workers admitted in medical ward at tertiary care hospital. Materials and Methods: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital on migrant workers patients admitted in medical ward from October 2018 to September 2019. The sample enrollment process was consecutively who were admitted under medical ward. Pre-designed questionnaire was used to collect data for clinical profile of the patients. Data were entered in Microsoft Excel and analyzed. Results: The migrant workers in this study mainly came from Malaysia, United Arab Emirates, Saudi Arabia, Qatar and Kuwait. They are almost male (97.1%) in this study with mean age of 30.3±7 years in age. The commonest age group of migration was 20-29 year. The highest number of workers 22 (31.1%) had visited to Malaysia in the seek of work. The most common symptoms among them were weakness 15 (21.7%) and headache 13 (18.8%). The highest diagnosis among them was diabetes mellitus 13 (18.8%) and hypertension 11(15.9%). The highest number of workers was involved in their job at different foreign countries as a labor at factories or at construction site 32 (46.4%). Conclusion: Male from younger age group were mainly observed as migrant worker with their proclivity to work in Malaysia. The most common diagnosis among them was diabetes mellitus and hypertension. Most migrant workers worked as workers in factories and construction sites


Author(s):  
Anjani Teja Ch ◽  
Ramesh babu K ◽  
Leela subramanyam S ◽  
Janani Y ◽  
Eswar Sai Kiran K ◽  
...  

The descriptive observational study was conducted over six months among inpatients of the orthopaedics department. The aim is to observe the prescribing pattern of drugs, to find out the percentage of analgesics given and most commonly prescribed analgesic, to compare the prescribed drugs whether they are in NLEM, WHO list and calculate DDD/100 Bed-days and to analyze the drugs for WHO prescribing drugs. A total of 250 patients were included in the study. Out of this, 168 were male, and 82 were female. Most of the patients were in the age group of 31-40[45 in number with 18%]. The most common condition was found to fracture [113 in number with 95.2%]. Commonly prescribed drugs were analgesics 447 with 26.76%. Among all the NSAID's, PCM was most commonly prescribed analgesic with 34.4%. The highest no, of drugs was found to be 4drugs/prescription with 24%. Monthly one analgesic was prescribed per prescription with 38.8%. Utilization of analgesics in term of DDD/100 Bed-days was 55.26; Drugs will be evaluated per prescription as per prescribing indicators of WHO was done, the average no. of drugs per prescription was found to be 0.45, percentage of drugs prescribed by generic name was found to be 13.3%, percentage of encounters with antibiotics prescribed were found to be 94.4%, In ratio percentage of drugs prescribed from the national list of essential medicine was found to be 92.6%. This study would help to facilitate better health care delivery.


2021 ◽  
Vol 19 (3) ◽  
pp. 23-29
Author(s):  
Yogita G Bavaskar ◽  

Background: Most of the countries including India have witnessed two or more waves of Covid 19 pandemic. The present study was conducted to compare the differences in clinico-demographic characteristics and outcomes of Covid 19 patients admitted in first and second wave of Covid 19 pandemic in a tertiary care hospital at Jalgaon, Maharashtra. Methods: A retrospective observational study was conducted at a tertiary care Dedicated Covid hospital for Covid 19 at Jalgaon, Maharashtra. All microbiologically proven corona positive patients were included in the study. The demographic records and clinical history was extracted from the case history sheets of the patients from first as well as second wave using standardized data collection form. Clinical outcome of the patients, i.e., development of complications, death or discharge was also recorded for each enrolled subject. Results: 3845 patients of Covid-19 admitted in the hospital during the first wave of epidemic and 2956 patients during second wave of the epidemic were included in the study. The mean age of patients admitted in the second wave was significantly lower as compared to first [48.77(15.31) years vs 50.23 (14.33) years, P<0.005]. There is increase in proportion of patients in the age group of < 15 years in second wave as compared to first wave (74/2956, 2.5% vs 52/3845, 1.3%). The number of patients requiring admission in ICU at the time of admission increased by 13% in second wave as compared to first wave. [827/2956 (28%) vs 577/3845(15%), P<0.0001]. More than half of the patients who got admitted for Covid 19 in first as well as second wave were having one or more comorbidities.But the proportion of the patients with previous co-morbities was significantly higher in second wave (1684/2956, 57% vs 1960/ 3845, 51%, P= 0.0004). The mortality was also higher in second wave (533/2956, 18.03% vs 541/3845, 14%, P=0.0004). Conclusions: The demographic, clinical characteristics and outcome of Covid 19 patients was different in first and second wave of pandemic with involvement of younger patients, increased rates of admission to ICU and more mortality in the second wave as compared to first wave of the pandemic.


2021 ◽  
pp. 25-27
Author(s):  
P. Mohan ◽  
P. Revathi Guru ◽  
V. Sudha ◽  
L. Balamurugan ◽  
Pavithra Gunasekaran ◽  
...  

Paederus dermatitis is a form of irritant contact dermatitis due to contact with certain insects of the genus Paederus presenting with mostly erythematous linear lesions of sudden onset on exposed parts of the body. To study the clinico epi Aim: demiological features in patients with Paederus dermatitis. A retrospective analysis of clinicoepidemiological Materials & Methods: features of patients affected with Paederus dermatitis who had attended the Dermatology OPD, in a tertiary care hospital between January 2018 to December 2019 was done. All the required data had been collected from the OPD records and details were tabulated and analysed. A total of 56 patients had been affected with Result: Paederus dermatitis during the study period, of which 32 were males and 24 were females. 41out of 56 (73.21%) of patients presented between the months of August and December. Most common age group affected were between 11 to 30 yrs, with front and back of neck being the most common affected sites. In 42 out of the 56 patients the lesions resolved with post inammatory hyperpigmentation. Conclusion: Paederus dermatitis is a common condition that is often misdiagnosed and hence awareness is required for the clinicians and the general public to prevent it.


2015 ◽  
Vol 7 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Shib Shankar Kuiri ◽  
Bikash Chandra Ghosh ◽  
Nilay Mandal ◽  
Mintu Mohan Nandi ◽  
Tusar Kanti Saradar ◽  
...  

Aims and Objectives: We conducted a retrospective analysis among 1984 burn patients to study the incidence, prevalence of burn injury, its various types and modes (actual event behind the burn injury), risk factors and to find out the preventive measures.Materials and Methods: The retrospective study was carried out among 1984 patients having burn injuries, admitted in a tertiary care hospital of West Bengal, India over a period of nine years. The sources of information were the admission registers and the patients' folders from the medical records department. The Ethical clearance was taken from the Institutional Ethical Committee. The information obtained included age, sex, whether accidental or suicidal, etiology of burn injury and particularly the mechanism of injury. Results: Females were mostly affected (83%) in comparison to males. Among the study population, most of the burn patients were in the age group of 21-30yrs i.e. 35.3%. The number of burn patients were less in number in the age group of 11-20yrs i.e. 7.3%. Most of the burn injuries (87%) were accidental. Suicidal burns occurred in 10% cases. Of which about 1/3rd of the cases were due to dowry related issues.  A significant number of teenagers also attempted suicides due to trivial reasons (e.g. failure in examination, quarrelling with parents). Gas oven related injuries occurred in 2.7% cases. Oil lamps (‘kupi’), candles and hurricane-lanterns, diyas were also responsible to some extent in rural India for flame burns(5%). Smoking related burn injuries occurred in 1.7% cases. Scald injuries occurred in 14% cases. Chemical injuries (0.3%) were due to spillage of unlabelled bottles of acid/alkali. Electrical burn injury occurred in 4.9% cases. Conclusion: Burn injury prevention is not easy, but to avoid the significant morbidity and mortality following injury we have to prevent it by any means. A coordinated and dedicated approach among social workers , medical and paramedical personnel, administrators can only minimize the incidence of burn.Asian Journal of Medical Sciences Vol.7(1) 2015 70-75


Author(s):  
Mithilesh Kumar ◽  
Shipra Saini ◽  
Lokesh Parashar ◽  
Rajesh Chetiwal ◽  
Tanisha Kalra ◽  
...  

Background: CKD (chronic kidney disease) is one of the major complications of diabetes and hypertension. With increase in prevalence of non-communicable diseases, the patients presenting with the symptoms of CKD are also rising. Most of the patients suffering from CKD eventually land up on renal replacement therapy, putting extra burden economically as well as psychologically to the self and their family. The aim of the study is to find out the socio demographic and clinical profile of the patients suffering from CKD attending a tertiary care hospital in Delhi.Methods: It was a record based descriptive analysis, conducted between January 2019 and June 2019 in one of the ESIC (Employee State Insurance Corporation) hospital of Delhi. Medical Records of the only those patients were considered whose complete data were present in the record file. Data about Socio demographic profiles , clinical data, duration of CKD, duration of haemodialysis, viral markers, number of blood transfusions, vascular access, number of failed AV fistula etc. were entered in MS Excel and analysed through SPSS 11.Results: Hospital records of 473 CKD patients undergoing hemodialysis were analyzed. It was found that 315 (67%) were males and 158 (33%) were females. Majority of the patients i.e. 245 were in the age group of 41-60 years followed by 166 who were in the age group of 21 to 40. Out of total patients, 195 (41.2%) participants were undergoing hemodialysis twice a week, 276 (58.4%) thrice a week, 2 (0.4) patients were undergoing hemodialysis session four times a week. Majority of the participants i.e. 414 (88%) were Hindu. Out of total 473 participants, 439 (93%) participants had sero negative for viral marker (i.e. HbsAg, HCV, HIV I and II) and 33 (7%) participants were sero positive for viral marker. Most common etiology of CKD was found to be hypertension in our study followed by diabetes.Conclusions: Patients suffering from chronic kidney diseases are increasing day by day with increasing prevalence of hypertension. Most of the patients of CKD patients were middle aged males. Most of the patients have to visit 3 times a week to any health care institution for hemodialysis.  Many of the patients are getting infected with viral hepatitis during course of the illness.


Author(s):  
Mahima Jain ◽  
Bhargavkumar K. Nimavat

Background: India has an estimated 2.1 million persons living with HIV in 2011. The prevalence of HIV among adult population has consistently declined over the last one decade from 0.4% in 2000 to 0.27% in 2011.HIV transmission from infected mother to baby is known to occur. The effective use of Antiretroviral drugs is known to reduce the risk significantly.Methods: This is a retrospective data analysis to know the prevalence of HIV infection among antenatal women attending a tertiary care hospital. All antenatal females are offered pretest counseling, sample collected and tested as per NACO guidelines by Rapid test and ELISA. Results of the test are disclosed after posttest counseling and kept confidential.Results: The seroprevalence over five years in the present study ranges from 0.466% to 0.278%. Women in the age group 21-25 years shows high prevalence due to peak sexual activity in this age group. 56.66% Husbands of these females are reactive which shows the major source of infection.Conclusions: The present study stresses the need to target the population mainly between 21-30 years in various Government programmes, thereby to reduce the transmission from parent to child.


Author(s):  
Ayan Roy ◽  
Nayan Kumar Patel

Background: Cardiovascular morbidity plays a villainous role globally as well as countries like India. Additionally, irrational prescription incurs greater damage to health and wellbeing. Drug utilization studies scrutinize the appropriateness of treatment and provide favorable feedbacks to strengthen clinical practices. The objective of the study was to describe treatment practices in cardiology outpatient and drug utilization pattern using core prescribing indicators by World Health Organization (WHO).Methods: A cross-sectional, observational study of 4-month duration was undertaken for cardiology Outdoor patients at a tertiary care hospital. 615 prescriptions were screened and analyzed.Results: Males (59.84%) were more in number than females (40.16%). Average number of the prescribed drugs per patient were 4.32±2.7 and (3.73±1.1 for cardiovascular drugs). Generic prescription was 60.98%. Percentage encounters with antibiotics 4.11, injectables 2.92%, fixed-dose combinations (FDCs) (11.8%) were documented. Drugs from the National List of Essential Medicines were 75.89%. The most common diagnosis was ischemic heart disease (68.29%). Hypolipidemics (78.25%) followed by antiplatelets (71.14%) were toppers in cardiovascular drug. Antiulcer drugs (PPI/Antacids) comprised 58.54% of total prescriptions.Conclusions: Less adherence to EDL, less generic prescriptions, use of FDC are major shortcomings. Areas to further rationalization like optimal use of evidence based medication like beta-blockers, newer anticoagulants/anti-platelet agents and newer anti-anginal agents are identified.


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