THE MENSTRUAL PATTERN OF AUB IN PERIMENOPAUSE

Background: The Menstrual pattern of AUB in perimenopause. Methods: Prospective interventional study conducted at Kamla Nehru Hospital for State Mother and Child, IGMC Shimla. Results: Menorrhagia was the most common presentation of AUB patients accounting for 65.5% of cases with confidence interval of 58.96-71.64% followed by continuous bleeding per vagina(BPV) accounting for 17.9% with confidence interval of 13.17-23.49% with the least being oligomenorrhea 0.87% with confidence interval of 0.11-3.12%. Conclusion: Abnormal uterine bleeding in perimenopausal patients is a common and important part of clinical practice for health-care providers of women. Keywords: AUB, Menstrual pattern, Bleeding

Hemostasis Surgery of Spontaneous Hemothorax Complicating Neurofibromatosis Type 1

Vascular lesions in Von Recklinghausen’s disease also known as Neurofibromatosis type 1 (NF1), are rare but have a fatal and potentially life threatening complications such as spontaneous hemothorax. An emergent thoracotomy is indicated when there is an active bleeding associated unstable hemodynamic status. Despites surgery is laborious and unpredictable but it have a merit to stop hemorrhage. A conservative management with endovascular embolization or non-operative approach have also been reported in case of hemodynamic stability. We report two case report of spontaneous hemothorax in patient with Recklinghausen disease. A chest tube was immediately inserted for two patients. Due to continuous bleeding and hemodynamic instability (Patient 1), and the increase of pleural effusion volume (Patients 1 & 2), emergent surgery of thorax was done with favourable post-operative follow up.

Dührssen. - About the extirpation of the vagina. - (Centr. F. Gynaec., No. 9, 1895)

D. reports a case of extirpation of the vagina together with a high amputation of the cervix in a 50-year-old woman who suffered from cancer of the vagina and vaginal part and was extremely exhausted from continuous bleeding.

Transarterial Embolization in the Management of Intractable Haemorrhage

<b><i>Introduction:</i></b> The purpose of this study was to evaluate the effectiveness and long-term results of selective transarterial iliac embolization (STIE) in patients with intractable bladder haemorrhage (IBH). <b><i>Methods:</i></b> Twenty-five patients with a median age of 84 (range 65–94) years underwent STIE because of IBH between 2002 and 2020. The median follow-up time was 3 (mean 13.9) months. Patients were treated because of bleeding bladder or prostate cancer, radiation-induced haemorrhagic cystitis, and other conditions. Success was defined as technical success (feasibility to embolize bilateral hypogastric arteries or neoplastic arteries) and as clinical success (absence of further or additional therapy). <b><i>Results:</i></b> Twenty-five patients with a median age of 84 years with a median hospital stay of 7 days were embolized at our institution. In total, 60% required additional therapy. Only 20% had minor complications, but no complication major was seen; 60% needed an additional therapy because of continuous bleeding. Our 30-day, 90-day, 6-month, and 12-month mortality rates were 28, 44, 64, and 76%, respectively. <b><i>Conclusions:</i></b> STIE in IBH is a safe, well-tolerated, and feasible procedure for palliating haematuria patients in poor general condition. Major complications are very rarely seen. However, patients often need additional therapy after STIE.

Awareness on the Management of Bleeding Disorders among Dental Students

Continuous bleeding in the surgical site can be associated with an increased risk of morbidity and mortality across all surgical areas. To avoid complications related to excessive bleeding, numerous products have been developed to achieve hemostasis. It is of utmost importance to know the use of each and every product and effective method on how to manage excessive bleeding. The study aims at assessing the awareness on management of bleeding disorders. An awareness based survey was conducted in January 2020 among dental students (Third years, Final years, Interns). The questionnaire consisted of 10 awareness based questions and were equally distributed among Third years, Final years, Interns. The total sample size was 150 dental students. The data collected was entered in an Excel sheet and subjected to statistical analysis using SPSS version 20. From the results obtained it was seen that 33.33% of third years, 30% of final years and 22.67% of interns had never come across a patient with bleeding disorders. 33.33% of interns, 31.33% of final years, 28.67% of third years said that they collect a detailed history on the past medical problems of the patients. 33.33% of interns, 30.67% of final years, 20.67% of third years were aware of the possible bleeding disorders that might occur in a patient. 33.33% of interns and final years and only 4% of third years knew about hemostatic therapies. 30% of interns, 28% of final years and 16.67% of third years were aware of prophylactic transfusion of FFP. Chi square test shows p<0.05, significant. Thus it was seen that Interns had a good awareness on management of bleeding disorders when compared to the final and third years.

Complications following use of single rod etonogestrel implant (Implanon).

Objectives: To determine the frequency of complications and side effects of single rod etonogestrel implant (implanon). Study Design: Descriptive case series. Setting: At Contraceptive clinic, (Reproductive Health Clinic (Contraception), antenatal clinic of the Department of Obstetrics & Gynaecology, Nishtar Hospital Multan. Period: From November 2014 to November 2016. Material & Methods: The sample included 72 healthy active women. The final outcome in this study was efficacy. Results: Client mean age was 28.07±4.88 years. Usually clients 57 (79.2%) were 1-4 para. 5 (6.9%) clients complain of pain, out of which only 4 had pain at insertion site and 1 had pain at insertion site and also in stomach. No side effects were observed 55 clients (67.4%) main complains about menstrual disturbance like 26 (36.1%) having amenorrhea. Continuous bleeding was the main complain in 9 clients (12.5%), heavy menstruation was found in 7 (9.7%), 10 (13.9%) had irregular bleeding. Prolonged bleeding was present in 2 clients (2.8%), 7 (9.7%) complain of spotting, 10 (13.9%) had no menstruation problem. Conclusion: The results of this study showed that majority of the clients had amenorrhea.

Young Nulliparous Female with Continous Vaginal Bleeding: A Case of Atypical Endometrial Hyperplasia

Mrs. XYZ 32 years of age, nulliparous presented in the OPD with complaint of continuous vaginal bleeding for 1 month. She had had Dx D & C twice previously for the same complaint one year ago. The two H/P reports showed Adenocarcinoma of the Uterus and repeat D & C one month later showed Secretory endometrium. Dilatation and curettage was done again on19. 03 2018 which showed Atypical Endometrial Hyperplasia (AEH). The couple was counseled and they opted for definitive treatment. TAH & BSO was done on 03.04 2018. Cut section showed thickened endometrium with no myometrium invasion. Conclusion: In patients with irregular or continuous bleeding P/V should be evaluated for AEH or Endometrial carcinoma.

Glanzmann’s Thrombastenia: The Role of Tranexamic Acid in Oral Surgery

Glanzmann’s thrombastenia (GT) is the most frequent inherited condition. GT is a genetic autosomal recessive disease caused by the alteration of the genes ITGA2B and ITGB3, located on the chromosome 17. The incidence of GT is calculated in 1 on 1000000. The patients, during their life, show episodes of mucocutaneous bleeding, epistaxis, and gingival bleeding. Some subjects required continuous bleeding transfusion. The aim of this case report is to demonstrate that oral assumption of tranexamic acid is a gold standard to prevent excessive bleeding. The patient GM of 36 years old with GT type 1 needs dental extractions of the teeth 4.7 and 4.8 at the “Tor Vergata” University Hospital in Rome. The specialist suggests that 3 days before surgery, the patient must take 6 vials every day of tranexamic acid that is used in obstetrics and gynecology. The teeth were extracted and applied suture. The patient is observed and is recommended mouth rinse with tranexamic acid. No bleeding complications were observed.