Comparing effectiveness of COBAS HPV test with VIA/VILI, pap smear and colposcopy for screening of cancer cervix

Cancer cervix is the second leading cancer causing 21% of all cancer deaths. Cervical cancer can be prevented if detected by premalignant changes and is curable in its earliest stage. Various procedures including VIA/VILI, pap smear have been routinely used for the purpose of screening cervical cancers. Infection with Human Papilloma virus is the principal cause of cancer cervix. Roche COBAS HPV test was approved by US FDA on April 24, 2014 as one of the first line primary screening method for cancer cervix based on the presence of high risk HPV DNA. The FOGSI guidelines in January 2018 has suggested cobas HPV test for cancer cervix screening. This study was conducted on 100 women with high risk cervical lesions during the period of 18 months. Women attending the NCD clinic of Government Thoothukudi Medical college hospital were taken for the study. The women were to undergo VIA/VILI, Pap smear study and subjected to COBAS HR HPV Test after their consent. Cervical specimens collected in PreservCyt solution using an endocervical brush/ spatula or collected in SurePath preservative fluid using a cervical broom were sent for COBAS HR HPV test. Collected sample kits were recruited in Department of Radiation oncology, Government Thoothukudi medical college for storage at low temperature for a short period, after pooling of samples, these were sent through the Department of radiation oncology to Adayar cancer institute, Chennai, with which the department has treated with for COBAS HPV test. The results were analysed and proceeded.This study has proven that screening for high risk HPV test in cervical specimen can easily pickup the premalignant lesion with high sensitivity, specificity when compared with other screening tests. Hence, this study emphasizes the importance of implementing HPV tests that can provide a 3-year screening free interval, compared to yearly pap screening. The other advantage is that the results are available immediately reducing the frequency of visits to hospital for further follow up on colposcopy/biopsy.

Knowledge, attitude and practices about coronavirus disease (COVID-19) and its spread among pregnant females in rural West Bengal, India

In view of the prevailing COVID-19 pandemic, people should have adequate knowledge about cause of the disease, mode of spread and the protective measures against it. Basic protective measures against the Coronavirus disease have been laid out by WHO for the public which are practicing hand hygiene, social distancing and wearing a mask. Good knowledge status when coupled with optimistic attitude will lead to effective practice of the protective measures.: This study will assess the knowledge, attitude and practices about Coronavirus disease among pregnant females of rural West Bengal. It will help in finding the limiting factors and assess the association between knowledge and attitude, practices of the respondents. It is a hospital based cross-sectional study carried out in antenatal out patient department from 18 October, 2020 to 5 December, 2020. 500 pregnant women were enrolled through simple random sampling after proper informed consent. Significant association between knowledge score and age group (p -0.0457) and literacy status (p -0.0105) was found. The mean COVID-19 knowledge score was 10.70 (SD:2.18, range :1-12) with an overall correct rate of 89.17% (10.70/12* 100). Significant practice of wearing a mask was 6.5625 [OR -6.5625(3.1603, 13.6385; p <0.0001] times more in good knowledge score group. Practice of preventive measures reduces the chances of contacting the infection, thus reducing maternal mortality and morbidity. Practices of preventive measures can be further strengthened by improving the knowledge of the people thorough awareness at grassroot level.

Adult onset stills disease: Newly diagnosed in pregnancy with rare clinical presentation as pleural effusion

Adult onset Still’ disease (AOSD) is a rare inflammatory disease which involves multiple systems and is of unknown etiology first described in 1971.It has more prevalence among young females and few studies show the exacerbation of symptoms during pregnancy. Patients usually presents with high grade fever, arthritis, arthralgia, salmon pink rash, organomegaly, lymphadenopathy but rarely can present with pleural symptoms, cardiac symptoms. Several criteria’s are used for diagnosis but Yamaguchi’s has the highest sensitivity of 93.5%. Yamaguchi’s classification criteria includes major and minor criteria’s and exclusion criteria’s. Although diagnostic criteria are there but AOSD till date is a diagnosis of exclusion. All the causes of clinical symptoms should be excluded which involves malignancies, infections, inflammatory conditions, autoimmune diseases before the diagnosis of AOSD is made. A 26-year-old female with G2P0010 and POG 6 weeks presented to medicine OPD with high grade fever associated with chills and rigors from 1 week. She was also complaining of stiffness and pain in multiple joints with chest pain, easy fatigability. She was having rashes on upper back below nape of neck. All the necessary investigations were carried out. It was found that she was also having right sided pleural effusion and severe microcytic hypochromic anemia. After batteries of investigations and consultation by obstetrician, rheumatologist, dermatologist diagnosis of Adult Onset Still’s disease was made. It was a diagnosis of exclusion. Patient was started on steroids and she responded well. All the symptoms including pleural effusion was subsided. Adult onset still’s disease is a form of still’s disease. It is a rare systemic auto-inflammatory disease. Yamaguchi is the most sensitive criteria but till date it is diagnosed after excluding possible causes of malignancies, infections and autoimmune conditions. Sometimes patients do present with rare symptoms like pleural effusion, pericarditis some may present as acute respiratory distress syndrome or mild symptoms like cough, pleuritic chest pain. In our case also all the possible causes were excluded as patient presented with pleural effusion for the first time during pregnancy, so the impact of the disease on the fetal outcome was also considered. AOSD has always been a diagnosis of exclusion but as in our case and cases with similar presentation AOSD should be consider as a differential diagnosis. Although there are only few studies which shows that there is fatal outcome of pregnancy in AOSD however there are studies showing exacerbation of symptoms of AOSD during pregnancy. Its early diagnosis and prompt treatment can be helpful in the better outcome of pregnancy as well as better prognosis of disease.

Compare safety and efficacy of intramuscular progesterone versus vaginal progesterone in prevention of preterm labour

Currently preterm labour is one of the most challenging problem faced by both obstetricians and perinatologists, this episode in the course of woman’s pregnancy takes a heavy tool for perinatal mortality which accounts for approximately 50-75%. The incidence of preterm labour is estimated to be 5-10% of all pregnancies. It was a prospective randomize control study. All the cases with inclusion and exclusion criteria were selected during the study period. The subjects were randomized into two groups with group A received vaginal micronized progesteron and group B intramuscular 17a hydroxyprogesteron caproate. Total of 100 cases were included in this study. All preterm pregnancy of more than 20 weeks were considered in this study. Initial nefidipine 10 mg, 4 tablets 15 min apart was given for tocolytic activity for 48 hours. Injection bethamethasone 12 mg I.M 2 doses in a duration of 24 hours apart is given for fetal lung maturity. One group will receive weekly intramuscular 17a hydroxyprogesteron (250 mg) injection while other group will receive daily micronized vaginal progesteron suppository (200mg). Subsequently compare the safety and efficacy of intramuscular progesterone versus micronized progesterone as a maintenance therapy in preventing preterm labour and analyse maternal and fetal factors.Subsequently compared the safety and efficacy of intramuscular progesterone versus micronized progesterone as a maintenance therapy in preventing preterm labour.This analysis showed that women who randomized to progesterone prophylaxis had a significantly increase in duration of pregnancy. The mean ± SD of birthweight in Group A and Group B was 2784.2 ± 490.7 gm and 2813.9 ± 363.3 gm respectively which confirmed the positive effects of progesterone on increasing infants’ weights at birth. Authors concluded that progesterone therapy had acceptable efficacy in the prevention of preterm labor in terms of prolongation of delivery and by increasing gestational age at delivery.

Knowledge, awareness and practices regarding menses and its hygiene among adolescent girls

Menstruation is a physiological process which starts around 11-16 yrs of age in most girls andcontinues throughout the reproductive life until menopause. During these years females spend one-sixth of their time menstruating and in discomfort. It is of utmost importance that hygienic practices are followed for a healthy and safe life. Various social and cultural taboos and habits have clouded the situation along with restricted facilities creating a disease burden such as genital infections and menstrual problems, including missed days at schools and work. It is the responsibility of the policy makers and also the health care workers to help in bridging the gap of lack of knowledge and availability of resources in creating a female hygiene friendly infrastructure in all the places. The study was conducted to assess the knowledge and awareness about menarche and menstrual cycle in school going girls. Also it was carried to study the prevailing practices of menstrual hygiene among the adolescent girls. The various sociocultural restrictions and taboos under practice in relation to menstruation and were analysed the reasons alongwith their solutions to improve the present situation of female hygiene practices were tabulated. A semi structured, question answer style written survey was conducted among adolescentgirls aged 11-18 yrs from nearby schools of Index Medical College, with help of PG resident doctors and medical interns. The survey was followed by educational and awareness talk on female hygiene practices that need to be followed.The result of the study were as follows-56.4%% were aware about menstruation before attaining menarche, and 88.20% had attained menarche at the time of study. 68.5% had mother as first informant, 40.3% knew about menstruation only after getting their 1 period. 28.5% felt insecure, 18.4% had anxiety, 30.5% were worried about menstruation. 95.5% perceived menstruation as a natural process, 98.6% used sanitary pads for bleeding, 1.4% used old cloth. 98.6% cleaned private parts during menses of which 75.3% used only water. Only 78.1% had the facility to change pads in school, of which only 58.9% changed pads in school. 90.4% had a daily bath during menses. 38.6% were not allowed to pray. 5% were not allowed to attend school, 8.3% were not allowed to sleep on their regular bed, and 11% were asked not to touch family members. 5% were restricted from playing outside and were not even allowed to go out of their home. 81.3% shared their menstrual health problems with mother. This study provided an understanding of perception of menstruation amongschool going girls. It also deals with the understanding of the society that still menstruation is not taken as a natural process, but rather as a curse and menstruating girls and women are being put under a lot of restrictions due to such practices. Lack of proper infrastructural facilities are a reason why so many girls drop out and restrict their attendance at school after menarche and much still needs to be done in this field to ensure smooth and healthy transition of adolescent girls into adulthood.

Catastrophe at menarche

Menarche, the beginning of menstrual function occurs as a result of complex interaction between the hypothalamus, pituitary and ovarian hormones and is an important event in any girl’s life as it signifies the beginning of fertility. Rarely some diseases like migraine, epilepsy, inherited bleeding disorders can manifest at menarche and cause significant anxiety to the parents and the adolescent girl. A 13-year-old girl presented with convulsions following 8 days of excessive bleeding at the time of menarche. She had altered sensorium, severe anaemia with Respiratory alkalosis and needed ICU Care. She needed multiple transfusions of blood and blood products. She showed features of sepsis on haemogram at admission later manifested respiratory findings. Her bleeding per vaginum did not respond to antifibrinolytics and progesterones and stopped only after evacuation of contents on day 5 under GA. No organism could be isolated and she recovered on Day 6 of higher broad spectrum antibiotics. Her parents were counselled to watch for occurrence of seizures in later life as this catastrophe may signify onset of epilepsy in later life.

Study of bad obstetric history cases attending tertiary care centre, Tirupati

To assess the obstetric and medical risk factors in patients with bad obstetric history (BOH) and outcome of pregnancy in case of BOH. A prospective cross-sectional study was conducted in Government maternity hospital, Tirupati for a period of 1 year from December 2017 to November 2018. All pregnant women who were fulfilling inclusion criteria of BOH, as study group and all possible variable were compared with control group, who got selected randomly from the rest of deliveries. And analysed the results in terms of sociodemographic factors, risk factors, pregnancy complications, mode of delivery, maternal and foetal outcome. Of 102 pregnant women in BOH, 76.5% were in age group between 21-30yrs, and 14.7% in age group >30yrs. Primary Recurrent pregnancy loss (RPL) was 51% and that of secondary recurrent pregnancy loss was 49%.History of hypertensive disorders including preeclampsia, eclampsia and chronic hypertension, noted in 11.8% cases, which was higher than previous studies, indicating changing trends in incidence.In foetal complications IUGR (0% vs 9.8%, p=0.026) and IUFD (0% Vs 7.8%, p=0.05) were more in BOH group and statistically significant also. Even though the maternal complications were more in BOH group, there was no statistical significance (P=0.075).Among the various causes of RPL found in the present study, endocrine causes were seen in 12.7%, Anatomical causes were found in 11.8% and in about 63.7% cases no definite cause was found and aetiology was unexplained. Present study, supporting the change in definition of recurrent pregnancy loss from 3 consecutive losses to 2. So early evaluation and with appropriate interventions in most of couples outcomes were fruitful.

A retrospective analysis of clinical profile of patients with cancer cervix in a rural medical college in Karnataka

Cancer cervix is most common cause of cancerous deaths in females especially in developing countries. The pre-invasive stage of cervical cancer lasts for a long period and a small proportion progresses to an invasive lesion. In Indian set up, majority of the patients are presenting with an invasive lesion. To describe the clinical profile of patients presented with cervical cancer and to describe various treatments received by those patients.: The present study is a retrospective observational study done on confirmed cases of carcinoma cervix who attended rural medical college in Karnataka. Clinical records of the patients, who presented between November 2019 and November 2020 and were diagnosed with cervical cancer, were retrieved. The data related to demographic and clinical variables like age, socioeconomic status, education, symptoms, clinical staging, treatment and histopathology report were recorded. Data collected were entered in Microsoft Excel Office 2007and data analysed. Data were presented using descriptive statistics. The data was expressed in the form of frequencies and percentagesA total of 30 patients with the median age of 46 years were studied. Most common presentation was post coital bleeding (40%) followed by white discharge per vagina in 33%. Majority were under low socioeconomic status (70%). 60% presented in stage II and 30% in stage I. Chemoradiation was treatment of choice in 60% followed by surgery in 33% and 7% were lost to follow up. On histopathology, majority had squamous cell carcinoma (70%).The appropriate management of Cervical intraepithelial neoplasia(CIN) can prevent invasive cervical cancer. In this study most of them presented in advanced stage which could have been prevented with the regular screening and awareness among women in the reproductive age group. : Detection of pre invasive lesions or in situ cases remains important key to decreasing cervical cancer morbidity and mortality.

Resurgence of classical caesarean section in current obstetric practice- A case series

Although, the incidence of placenta accreta spectrum (PAS) and large fibroids is rare but still these cases contributes to a large number of maternal morbidity and mortality. Major obstetric hemorrhage is one the dreadful complication of these types of cases and thus early diagnosis and intervention in such cases helps the physician to minimize the risk to mother and the fetus. Also, current widespread use of ultrasound has helped us to manage these cases judiciously, predict and prevent life threatening obstetric hemorrhage. Here we present three complicated obstetric cases of placenta accreta, large lower segment uterine fibroid and large cervical fibroid which necessitated classical cesarean sections (CCS) thus emphasizing prowess in CCS in modern obstetric era. High index of suspicion, Multidisciplinary approach alongwith expert surgical personnel should be available in high risks cases like placenta accreta syndrome and large fibroids in pregnancy.

Effect of traditional versus site specific anterior repair in reduction of urinary symptoms in women with pelvic organ prolapse

The present study was undertaken to evaluate effect of traditional anterior repair versus site specific anterior repair in reduction of urinary symptoms in women with Pelvic organ Prolapse. During the study period of 2 years 140 women belonging to reproductive, peri-menopausal and postmenopausal age groups were included in the study. Employing past literature, the sample size calculated was 140. All women were assessed pre-operatively by the assessment method – Pelvic organ prolapse quantification (POP-Q) system. 70 women belonging to Group A were treated according to vaginal hysterectomy with traditional anterior repair and 70 women belonged to Group B who were treated according to vaginal hysterectomy with site specific anterior repair.Post-operatively, all women were followed up till 7th post-operative day and were assessed for anatomical and functional improvement to determine a better method for repair in reduction of urinary symptoms in women with pelvic organ prolapse.Our study shows functional and anatomical outcomes of traditional anterior repair and site specific anterior repair. 48 of 70 women (68.2%) who were subjected to traditional anterior repair and 52 of 70 women (73.4%) who were subjected to site specific anterior repair had marked functional improvement after surgery. 58 of 70 women (83.2%) belonging to traditional anterior repair group and 67 of 70women (95.3%) belonging to Site specific anterior repair group had considerable anatomical improvement post-operatively. This impresses the role of site specific anterior repair in women with pelvic organ prolapse for attaining better functional and anatomical outcome.