EFFECT OF COMBINATION OF FRUIT OF BADARA [Ziziphus jujuba (L). Lam] AND PALM JAGGERY IN DYSFUNCTIONAL UTERINE BLEEDING

Dysfunctional uterine bleeding (DUB) is a state of abnormal uterine bleeding. It is a diagnosis of excluding any clinically detectable organic, systemic and iatrogenic cause. Current treatments available have many side effects, including hormonal imbalance. So there exists a lacuna for a safe and effective treatment without side effects for this condition. The present study is an effort to evaluate the combined effect of fruit of Badara [Ziziphus jujuba(L). Lam] with Palm jaggery in Dysfunctional uterine bleeding. The study design is interventional with a sample size of 15 subjects within the age group of 16-50 years. The study drug was administered in 6gm in the morning and the evening before food for 90 days. The following 30 days was follow up period without medication. The effect was assessed on subjective and objective parameters before treatment and on the 31st, 61st, 91st and 121st days. The results were statistically analyzed using Paired t-test and Wilcoxon Signed Rank test. The study drug showed the statistically significant result in DUB as reducing the amount and duration of bleeding, an interval of menstruation, number of clots, pain, fatigue, and increasing the Haemoglobin percentage.

Endometrial Cut Off Thickness as Predictor of Endometrial Pathology in Perimenopausal Women with Abnormal Uterine Bleeding: A Cross-Sectional Study

Purpose. We aim to determine the predictive value of endometrial thickness by transvaginal ultrasonography (TVS) in diagnosing endometrial pathology and to evaluate whether Doppler complements its diagnostic efficacy in perimenopausal women with abnormal uterine bleeding. Methods. This cross-sectional observational study was conducted among 70 perimenopausal women with AUB who underwent TVS measurement of endometrial thickness (ET) and Doppler flow indices followed by endometrial sampling and histopathological examination (HPE). Results. In HPE, 51 (73%) women had normal diagnosis while 19 (27%) women had neoplastic histology either benign or malignant. They were categorised into group I and group II, respectively. There was a significant difference in age ( P = 0.001 ) and incidence of obesity ( P = 0.01 ) between the two groups. The ETs measured in group I and group II were 7.89 ± 2.62 mm and 14.07 ± 3.96 mm, respectively, with significant difference ( P < 0.001 ). A TVS-ET of 10.5 mm had the highest sensitivity and specificity of 89.5% and 86.3%, respectively, PPV of 70.68%, NPV of 95.68%, LR+ of 6.52, and LR− of 0.12. Doppler flow velocimetric study of endometrial and uterine vessels did not demonstrate a significant difference. Conclusions. Women in perimenopause with AUB should be offered to undergo endometrial sampling for histopathological examination if TVS ET ≥10.5 mm. The coexisting risk factors especially higher age (>45 years) and obesity (BMI>30) significantly escalate the chances of developing endometrial pathology.

Imaging spectrum of acquired uterine vascular abnormalities with angiographic correlates, a pictorial review

Background Acquired uterine arterial anomalies, including uterine artery pseudoaneurysms (UAP), arteriovenous malformations (AVMs) and arteriovenous fistulae (AFVs), are rare presenting causes of abnormal uterine bleeding. Timely diagnosis is essential for safe and effective treatment, avoiding life-threatening haemorrhage resulting from erroneous uterine curettage due to misdiagnosing these as other more common differentials. Main text This pictorial review discusses the ultrasound (USG), CT and MRI features of various acquired uterine vascular abnormalities with angiographic correlates. Conclusion Acquired uterine arteriovenous injuries are a fundamental cause of dysfunctional intractable bleeding recalcitrant to traditional conservative management. Endovascular transcatheter uterine artery embolisation is an increasingly popular and safe mode of treatment, especially in young patients desiring to have the option of future pregnancies, with lesser morbidity and in-hospital stay duration.

Complete Response of a Mutated BRCA2 Metastatic Clear Cell Endometrial Adenocarcinoma to the Poly (ADP ribose) Polymerase (PARP) Inhibitor Olaparib

Background: Cancer of the endometrium is the most common gynecologic malignancy in developed countries and the second most common in developing countries. Endometrioid tumors tend to have a favorable prognosis and typically present at an early stage with abnormal uterine bleeding. Clear cell carcinoma as well as serous endometrial carcinoma are associated with a poorer prognosis. Patients with metastatic endometrial cancer are treated with systemic therapy either following surgery or as primary therapy. As far as second-line chemotherapy is concerned, there are no general agreements on the chemotherapy to be used. Furthermore, to the best of knowledge, there are no studies on the use of poly (ADP ribose) polymerase (PARP) inhibitors in endometrial cancer even in BRCA mutated tumors. Case Report: We here present the case report of an 81-year-old woman with a mutated BRCA2 metastatic clear cell endometrial adenocarcinoma that showed an excellent clinical and radiological response to the PARP inhibitor olaparib. Conclusion: Olaparib could be successfully used in this patient setting.