Review of PPIUCD at tertiary care centre in Southern Rajasthan

Background: This study was conducted to observe the acceptance rate and safety for PPIUCD as PPIUCD was used as contraceptive method under family welfare program in this institute. Aims and Objectives: To see pattern of acceptance and safety of PPIUCD among women admitted for childbirth. Materials and Methods: A prospective, preformed semi-structured questionnaire-based observational study was conducted between September 2012 and August 2020 in the Government Medical College Kota. CuT380A was used as PPIUCD for insertion. WHO medical eligibility criteria were met along with inclusion and exclusion criteria. After counseling and consent, PPIUCD was inserted post-placentaly and during LSCS. Acceptance rate was calculated along with safety profile. Results: In the present study majority of patients were in the age group of 21–30 years. 44.26% women were second para. 96.35% insertions were uneventful during the study. The most common reason for acceptance and refusal of PPIUCD was reversibility and for refusal was fear of complications, respectively. The acceptance was increasing over the years. On follow-up majority of clients had no complaints. Among those who had complaints, irregular bleeding was most common. Major cause of requesting for removal was irregular bleeding. Continuation rate was found to be 91.91% and 85.30% at 6 weeks and 6 months, respectively. Conclusion: PPIUCD is a safe and effective method of contraception. Acceptance rate is increasing over the years and which can further increase with antenatal, intra natal and postnatal counseling along with counseling of husband/family attendants and management of side effects.

AN UNUSUAL CASE OF POSTPARTUM CHORIOCARCINOMA WITH VAGINAL METASTASIS AND UTERINE PERFORATION

Gestational trophoblastic disease is a heterogenous group of interrelated lesions that arise from abnormal proliferation of placental 1 trophoblasts . Choriocarcinoma differs from any type of villous trophoblast and is the most aggressive GTN and is highly chemosensitive. When a patient reports with irregular bleeding during her postpartum or postabortion, pregnancy related causes should be ruled out. We describe a patient who presented to us after a term pregnancy and was diagnosed to have stage III choriocarcinoma.

Tamoxifen for Five Years

Tamoxifen is an effective anti-cancer drug in breast cancer treatment. However, very few women could do the complete 5-year treatment due to the side effects of the medication. The irregular bleeding, osteoporosis, and hormonal imbalance symptoms always cut the time short. Since every woman is different in body weight, genetic compose, reproductive history, and personal habits, the treatment with tamoxifen should also be different. Moreover, since estrogen has the similar positive effects as Vitamin K2 in bone formation tamoxifen, as a estrogen blocker, should be used with proper vitamin K2 supplement, to which, current medical world has not paid enough attention.

Polypoid Endometriosis of Cervix: A Case Report

Polypoid endometriosis is an uncommon and distinctive variant of endometriosis with histologic features simulating those of an endometrial polyp which is found most often in the colon and ovary. The cervix is an infrequent site for polypoid endometriosis. We report a 40-year-old female presented with irregular bleeding and on examination detected to have an endocervical polyp. She underwent polypectomy and histopathological examination suggested polypoid endometriosis. She remained asymptomatic during two years of follow-up.Polypoid endometriosis is a variant of endometriosis that may be mistaken for a neoplasm on clinical and pathologic examination. There is often a delay in diagnosis resulting in unnecessary suffering and reduced quality of life. Though a rare entity, it should be considered in the differential diagnosis of all cervical polyp.

Tamoxifen for Five Years

Tamoxifen is an effective anti-cancer drug in breast cancer treatment. However, very few women could do the complete 5-year treatment due to the side effects of the medication. The irregular bleeding, osteoporosis, and hormonal imbalance symptoms always cut the time short. Since every woman is different in body weight, genetic compose, reproductive history, and personal habits, the treatment with tamoxifen should also be different. Moreover, since estrogen has the similar positive effects as Vitamin K2 in bone formation tamoxifen, as a estrogen blocker, should be used with proper vitamin K2 supplement, to which, current medical world has not paid enough attention.

Metode Pengukuran Volume Perdarahan Pemeriksaan MSCT Kepala pada Kasus Intraserebral Hemmorhage

Background: Intracerebral hemorrhage is bleeding in the brain parenchyma. An accurate measurement of bleeding volume to determine the appropriate medical action. This study to determine the method of measuring the volume of intracerebral hemorrhage in MSCT examination of the head and determine the advantages and disadvantages between the manual method (Broderick, ABC's, Ellipsoid) and the software method (automatic volume, otsu).Methods: This type of descriptive qualitative research with the Literature Review. Data obtained by identifying problems then searching for keywords, looking for several journals sourced from databases such as Google Scholar, Science Direct, Springer. Data analysis by studying theoretically the method of measuring the volume of bleeding methods manually (Broderick, ABC’s, ellipsoid) and using software methods (automatic volume, otsu).Results: The results of measuring the volume of bleeding in the same patient with the manual method (Broderick) produce more bleeding volume (overestimate) that is 8750 mm3 from the 7960 mm3 automatic volume method. The manual method (Broderick, ABC’s, Ellipsoid) uses the ABC / 2 formula and uses 5 mm slice thickness, the automatic volume software method uses 1 mm slice thickness segmentation and technique, while the otsu software method uses 2.5 mm segmentation and slice thickness techniques.Conclusion: The advantages of the manual method (Broderick, ABC’s, ellipsoid) take approximately 1 minute to determine the estimated outcome of the bleeding volume, the weakness is higher in irregular bleeding. The advantages of the software method (automatic volume, otsu) in the use of precise segmentation techniques for accurate volume results, weaknesses are too long in determining the estimated bleeding volume results.

MANAGEMENT OF ASRIGDARA THROUGH VIRECHANA KARMA

Dysfunctional uterine bleeding is a state of Abnormal uterine bleeding (AUB) without any clinically detectable organic, systemic & iatrogenic cause (pelvic pathology like tumor, inflammations excluded). DUB represents a particular type of AUB and is defined as excessive, prolonged and irregular bleeding of endometrium with frequency less than 21 days, duration more than seven days that does not cause pain and does not involve any organic lesion. Based on the clinical features it can be compared with Asrigdara mentioned in Ayurvedic classics. Asrigdara is one of the commonly met problems in Gynae OPD among peri menopausal women. One half of women among the AUB will have DUB. 10 – 15% of women experience episodes of DUB at some time during their reproductive age. This study was conducted in a single patient. A lady of age 41 years, having problem of prolonged bleeding since one and half years came to OPD of Prasuti and Stri roga, National Institute of Ayurveda, Jaipur. She had taken hormonal preparations and haemostatics for five continuous months along with D& C done for same problem, after wards bleeding increased even more and then doctors have given hysterectomy advice as the last resort. Patient was posted for Virechan Karma as classical schedule owing to her Agni and Vyayamshakti. Snehapan was done by plain Go Ghrita and Virechan was done by Trivritalehyam. Followed by few oral medicines after Samsarjana Karma. The patient was followed up for three months. There is significant reduction in amount of blood flow along with increased inter – menstrual period. Thus, we can conclude from the study that Ayurveda regimen plays an effective role in management of Asrigdara.

Catamenial pneumothorax due to pulmonary endometriosis

Endometriosis is a chronic condition causing menstrual pain, irregular bleeding and infertility among women. Although usually in the pelvis, it can manifest in atypical places. We describe a 39-year old woman with a previous endometriosis diagnosis who presented three times on the second menstrual day with dyspnea and chest pain. Imaging showed right-sided pneumothorax on all three occasions. Thoraco­scopy revealed endometriosis-like lesions. Histology was suggestive of endometriosis. After treatment with chemical pleurodesis and hormonal suppression she has remained symptom-free. Diagnosis should be obtained by concomitant thoraco- and laparoscopy with biopsies to verify the disease and give a basis for appropriate treatment.

Impact of experiencing specific side-effects on contraceptive switching and discontinuation in Uganda: Results from a longitudinal PMA Survey

There is substantial evidence that contraceptive side-effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role that specific side-effects, rather than “side-effects and health concerns”, have on contraceptive dynamics. This study used population-based, longitudinal data to explore the effect that specific side-effects had on contraceptive continuation, discontinuation, and switching in Uganda. Methods Data for this study come from two rounds of PMA2020 data collection in Uganda PMA2020 Uganda’s sixth cross-sectional survey and a follow-up survey conducted one year later. The main outcomes of interest were discontinuation and switching among modern users of hormonal contraceptive methods and the IUD at baseline (n=550). Multivariable multinomial logistic regressions assessed the association of reporting experiencing specific side-effects (more bleeding, less bleeding, irregular bleeding, increased dryness/reduced libido, and physical discomfort) with discontinuation and switching one year later, adjusting for socio-demographic characteristics, type of method, and length of use.ResultsOne-third of hormonal contraceptive users reported experiencing side-effects at baseline. Reporting more bleeding increased the risk of discontinuation by 2.39 times (95% CI: 0.01-4.72). Experiencing irregular bleeding decreased the risk of switching by a factor of 0.40 (95% CI: 0.17-0.93). Vaginal dryness/reduced libido and physical discomfort were both marginally associated with increased relative risk of switching, increasing the risk of switching by a factor of 3.10 (95% CI : 0.97-9.10) and 1.75 (95% CI: 0.95-3.24), respectively. Wealth was significantly negatively associated with discontinuation while education was marginally significantly and positively associated with switching. ConclusionsGreater attention should be paid to understanding the unique contributions of side-effects to contraceptive behavior using population-based data. Not all side-effects are associated with contraceptive discontinuation and switching, despite the experience of side-effects being common. The experience of physical discomfort and vaginal dryness/reduced libido, largely ignored in other research, were shown to affect use. Providing greater individualized care that includes information about common side-effects and how they may impact daily life is necessary.

OBSTETRIC GYNECOLOGICAL SOCIETY IN BERLIN. Meeting on January 8, 1892

Mackenrodt presented a case of a bilateral tubal pregnancy, which he operated on with good success in November 1891. A 32-year-old patient, 6 years ago, got married for the first time and in the course of three years of her marriage gave birth 2 times safely and once there was a miscarriage. Since then, she was no longer pregnant. After the death of her first husband, she remained a widow for 2 years, then remarried. In May 1890, the regulations were absent, in June there were irregular bleeding and severe pain on the right side, and the temperature rose to 40 . The doctor diagnosed a right-sided ectopic pregnancy.