Painful catamenial vulvar lesions misleading gynecologist

Endometriosis usually presents as cyclical pain in the pelvis but may also present as painful cutaneous lesions. Many diseases may mimic hidradenitis suppurativa (HS) since HS, a chronic inflammatory painful skin disease, is a clinical diagnosis. A 32-year-old woman presented with painful lumps on her vulva and groin accompanied with bloody discharge during menstruation. She was followed up with preliminary diagnosis of endometriosis. Previous excision without definitive diagnosis resulted in temporary relief. She was prescribed oral contraceptive pills that alleviated her symptoms but quitted due to headache. Surgical excision was performed for definitive diagnosis and therapeutic relief. Pathology report revealed HS. She was prescribed oral doxycycline. She responded well to the therapy and has symptom-free for the last 2 years. She delivered one healthy girl via cesarian section 2 years after the treatment. Endometriosis and HS should be included in the differential diagnosis when women present with menstrual painful lesions around external genitalia for diagnosis and treatment.

Opinions, Attitudes, and Prescribing Practices of Oral Contraceptive Pills of General Practitioners and Gynecologists in India

Background Prescribing behavior of oral contraceptive pills (OCPs) by physicians, gynecologists, and alternative medicine practitioners (AMPs). Materials and Methods Close-ended questionnaire-based cross-section study was performed between 1st September 2012 and 28th February 2014 in three groups of responders, i.e., AMP, general medical practitioners (GMPs), and obstetricians and gynecologists (ObGy). A stratified random cluster sample was used. Data of 400 subjects in all three groups were obtained using both univariate and multi-variate sophisticated statistical analyses for analyzing attitude and practices and were recorded on an ordinal scale using appropriate non-parametric test. Results Of the 1,237 subjects surveyed, 400 completed questionnaires were received from each of the three groups viz; AMPs, GMPs, and ObGy. Remaining 37 incomplete questionnaires were not included in the final analysis. Conclusion There are equal misconceptions regarding OCPs among users and prescribing physicians. Preference for OCPs in married and unmarried women is also equally low. OCP usage and their prescription practices can be improved by removing potential barriers, developing public–private partnership, and training promoters.

A study of knowledge, awareness, and acceptance of contraception among reproductive age women at tertiary care hospital, Ahmedabad

Background: India is projected to be the most populous country according to United Nations’ report; therefore, the knowledge and awareness of contraceptive methods is of utmost important for small family norms and to increase inter-pregnancy interval, so that we can achieve optimum maternal and child outcomes. This study was conducted to assess knowledge, awareness, and acceptance of contraceptive methods among reproductive-age women during Corona pandemic.Methods: A prospective observational questionnaire-based study involving 513 women belonging to the 15-49 years of age group were interviewed with consent. This was a knowledge, attitude and practice (KAP) study regarding socio-demographic profile, knowledge, awareness, and acceptance of the contraceptive method.Results: Statistical analysis of data was done by using chi-square and percentage. Out of 513 participants, 63 participants were not using any method of contraception. Barrier method is the most commonly preferred method of contraception. There was significant association of education of women and husband, occupation with usage of contraception (p<0.001, p=0.016 and p<0.001). During corona pandemic acceptance of tubal ligation had taken a hit.Conclusions: During corona pandemic barrier method and oral contraceptive pills were preferred methods. In comparison with pre-COVID era data, tubal ligation was least preferred method. Acceptance of IUCD and Injectable contraception remained same. Higher education level and better financial status had correlation with increased awareness and acceptance of contraceptive methods.

Acute Nonatherosclerotic Coronary Thromboembolism Presenting with an Inferior STEMI in a Patient on Oral Contraception

Background. Direct coronary embolism in the setting of oral contraceptive pill (OCP) use is a rare adverse effect. It is known for OCP to increase the risk of thrombosis; however, leading to an inferior ST elevated myocardial infarction (STEMI) due to an acute occlusive embolism is a rare entity. Coronary embolism occurs in about 3% of patients with acute coronary syndrome. Case Report. We present a case of a young 41-year-old female with a past medical history significant for dysfunctional uterine bleeding on oral contraceptive pills, who presented to the hospital with chest pain. Her workup was significant for troponin elevation and an electrocardiogram showing inferior ST elevations. The patient was taken emergently to the cardiac catheterization lab. A coronary angiogram revealed a coronary thrombus involving the distal left main and proximal left anterior descending (LAD) with no evidence of atherosclerotic disease. The patient subsequently received anticoagulation therapy leading to complete resolution of symptoms and ST elevations. Conclusion. Coronary embolism is rare and often not considered in the differential of acute coronary syndrome. It is of utmost importance for clinicians to keep a wide differential of nonatherosclerotic causes of STEMI especially when the patient is young, without significant cardiac risk factors.

Use and Acceptability of Birth Spacing Contraceptive Among Multiparae in Bangladesh

Background: Contraception is one of the critical components of reproductive health, enabling women to control their fertility according to their desires and circumstances. This study aimed to determine the prevalence and acceptability of contraceptives among sexually active multiparous women for birth spacing. Methods: This is a cross-sectional study among married women aged 15-40 years having at least one child from January to June 2013 in the Department of Obstetrics and Gynecology, ICMH (Institute of Child and Mother Health), Matuail, Dhaka. Findings: A total of 433 women participated in this study. A majority of the respondents were in the mid-thirty (73.9%) and housewives (94.7%). Almost half (49.0%) of the respondents had primary education. Surprisingly, close to half of the respondents married before 18 years (42.7%). Almost two-thirds (64.4%) of the respondents received oral contraceptive pills previously, followed by condoms (17.1%) and injectable contraception (14.5%). More than half (51.6%) of the participants were motivated by health workers to use a contraceptive method. In terms of reasons for using the family planning methods, convenience to use (38.1%), being safe (31.9%), and accessibility (23.1%) were the most common reasons. Whereas side effects (49.9%), shifting to other forms (43.9%), and wanting more children (6.2%) were the most common reason for changing family planning methods. The respondents mostly used the oral pill at any education level. However, injectable contraception was higher within higher education levels, and IUD was higher within the illiterate group.

Hubungan Antara Penggunaan Pil Keluarga Berencana Dengan Kejadian Hipertensi Pada Pasangan Usia Subur : Literature Review

Indonesia is a country that ranks 5th with the highest incidence of hypertension. Hypertension is the leading cause of death in the world (52%). There are two factors that can trigger hypertension: controlled and controlled factors. One of the trigger factors that can be controlled is the use of hormonal contraception (KB Pills). To determine the correlation between the use of oral contraceptive pills and the incidence of hypertension in couples of childbearing age through a literature review. This study used a literature review method by searching for articles through the Google Scholar database. The search for articles was carried out using the keywords: '-Hypertension", '-Contraception Pill". "Couples of Childbearing Age" then the researcher used the STROBE instrument with the limitation of articles in 2011-2021. Participants in this study were couples of childbearing age who used oral contraceptive pills. The results of this literature review of 5 articles showed that 3 articles which stated that there was correlation between the use of birth control pil.ls with the incidence of hypertension in couples of childbearing age with a result of p less than 0.05. The other 2 stated that there was no correlation between the use of oral contraceptive pills with the incidence of hypertension in couples of childbearing age. The use of contraceptive pills is one of the factors that can lead to an increase in blood pressure.Keywords: Hypertension; Contraceptive Pills; Couples' of Childheclring Age AbstrakIndonesia merupakan negara yang menduduki peringkat ke 5 dengan kejadian hipertensi terbanyak. Hipertensi merupakan pencetus kematian terbanyak didunia yaitu sebanyak 52%, terdapat dua faktor yang pemicu hipertensi yaitu faktor pemicu yang dapat dikontrol dan faktor pemicu tidak dapat dikontrol. Faktor pemicu yang dapat dikontrol salah satunya yaitu penggunaan kontrasepsi hormonal (Pil KB). Mengetahui Hubungan Antara Penggunaan Pil Keluarga Berencana Dengan Kejadian Hipertensi Pada Pasangan Usia Subur melalui Literature Review. Penelitian ini menggunakan metode literature review. Untuk pencarian artikel dengan mengakses database Google Schoolar. Pencarian artikel dilakukan dengan menggunakan kata kunci: “Hipertensi”, “Kontrasepsi Pil”, “Pasangan Usia Subur” kemudian peneliti telaah menggunakan instrumen STROBE dengan batasan artikel tahun 2011-2021. Partisipan pada studi ini adalah pasangan usia subur yang menggunakan kontrasepsi pil. Hasil penelitian literature review dari 5 artikel menunjukan bahwa 3 artikel ada hubungan antara pengggunaan pil KB dengan kejadian hipertensi pada pasangan usia subur dengan hasil p<0,05, sedangkan untuk 2 artikel menunjukan tidak ada hubungan antara penggunaan pil keluarga berencana dengan kejadian hipertensipada pasangan usia subur. Penggunaan kontrasepsi pil merupakan salah satu faktor yang dapat mengakibatkan terjadinya peningkatan tekanan darah.Kata kunci: Hipertensi; Kontrasepsi Pil; Pasangan Usia Subur.

Effect of the Monthly Injectable Combined Contraceptives versus Oral Contraceptive Pills on Mood

Background: Contraceptive agents are widely used by women of reproductive age, and resulting depression is the most common side effect of this usage. This study aimed to study the effect of monthly injectable combined contraceptives versus that of combined oral contraceptive pills (COC) on patients’ mood.Methods: A prospective cohort study was conducted on 124 females aged 18–45 years attending the Kom-Ashfeen Family Medicine Unit, El-Kalyubia, Egypt. Participants were divided into three groups according to their choice: group A included 44 participants who received monthly combined injectable contraceptives (CIC); group B included 40 participants who took COC; and group C included 40 participants who used the copper intrauterine device (IUD). The Patient Health Questionnaire-9 (PHQ-9) score was assessed at the beginning of the study and after 6 months of follow-up.Results: After 6 months of follow-up, there were mild but statistically significant increases in the PHQ-9 score in groups A and B, with group A (CIC users) showing the highest increase. Approximately 34.1%, 27.5%, and 15% of CIC, COC, and IUD users, respectively, moved from the non-depression stage to mild depression after 6 months; this change was statistically significant in groups A and B only.Conclusion: Monthly injectable combined contraceptives and oral contraceptive pills were associated with an increased risk of developing mild depression; this risk was higher in users of CICs, although the difference was not statistically significant. Thus, it is crucial to counsel patients about this possible risk and to follow them up. However, further studies are required to confirm our results.

Decoding enigma: Turner syndrome with ring chromosome

ABSTRACT Ring chromosome X is one of the rarest with some unique phenotypical features in Turner syndrome. A young female presented to us with anasarca developed over the past 2 months due to congestive cardiac failure along with jaundice and orthopnea. She had growth retardation, intellectual disability, primary amenorrhea, lack of secondary sexual character development and dysmorphic features like low posterior hairline, shield chest and cubitus valgus. She had dilated cardiomyopathy (DCM) with intracardiac thrombus on echocardiography. Skeletal survey revealed short fourth metacarpal/tarsal on limbs. Karyotyping showed a mosaic pattern, with 45, X/46, X,r(X)(p22.3q28), i.e. Turner syndrome karyotype with ring chromosome. Her heart failure with reduced ejection fraction was managed with vasopressor along with anticoagulant and given oral contraceptive pills for hormone replacement therapy. The ring chromosomal pattern of karyotype in this patient and DCM is a rare cardiological phenomenon that can be associated with Turner syndrome, making this case a unique one.