1
|
Rathod S, Acharya N, Shanoo A, Mishra P, Dande A. Hyperreactio Luteinalis: A Rare Phenomenon Complicating Gestational Trophoblastic Disease Presenting as Acute Abdomen in the Convalescence Period. Cureus 2024; 16:e55382. [PMID: 38562358 PMCID: PMC10984135 DOI: 10.7759/cureus.55382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
The hydatidiform mole is a rare gynaecological condition originating from trophoblastic cells, with an incidence of 1-3 per 1000 pregnancies. Theca lutein cysts (TLCs) and an invasive mole are rarely observed in association with a partial mole. This case describes an unusual case involving a 17-year-old primigravida at 11 weeks of gestation. She presented with abdominal pain and was diagnosed with a molar pregnancy with post-evacuation rupture of TLC, presenting as an acute abdomen, subsequently undergoing laparoscopy. Post-molar pregnancies exhibit a highly variable course, ranging from recurrent pregnancy loss and stillbirths to preterm deliveries and recurrent molar pregnancies. Few studies are available on obstetric outcomes after a molar pregnancy; most available data originate from national databases and monocentric research.
Collapse
Affiliation(s)
- Sachin Rathod
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amardeep Shanoo
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Preeti Mishra
- Department of Pathology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anubha Dande
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
2
|
Dahiphale SM, Potdar J, Acharya N, Jyotsna G, Saloni, Desale R. Congenital Anomalies of the Female Genital Tract: A Comprehensive Review. Cureus 2024; 16:e56753. [PMID: 38654788 PMCID: PMC11037924 DOI: 10.7759/cureus.56753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
This comprehensive review provides an in-depth examination of congenital anomalies of the female genital tract, explicitly focusing on the American Society for Reproductive Medicine (ASRM) Müllerian Anomalies Classification. The classification system is crucial for standardizing communication and guiding accurate diagnoses in clinical practice. The review explores the diverse clinical presentations, etiological factors, and diagnostic modalities associated with these anomalies. Management strategies, ranging from conservative approaches to advanced reproductive technologies, are discussed in the context of individualized treatment plans based on the ASRM classification. The psychosocial impact of female genital tract anomalies is thoroughly examined, emphasizing the importance of holistic care and patient-centered approaches. Looking toward the future, the review outlines emerging research areas, including advances in diagnosis techniques, innovative treatment modalities, and genetic studies. It ultimately underscores the need for a comprehensive understanding of physical and psychosocial dimensions, offering insights for healthcare professionals to navigate this complex landscape and improve the lives of affected individuals.
Collapse
Affiliation(s)
- Swati M Dahiphale
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jyotsana Potdar
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Garapati Jyotsna
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Saloni
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Rahul Desale
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
3
|
Ulhe SC, Acharya N, Vats A, Singh A. Study of Vulvovaginal Atrophy and Genitourinary Syndrome of Menopause and Its Impact on the Quality of Life of Postmenopausal Women in Central India. Cureus 2024; 16:e54802. [PMID: 38529421 PMCID: PMC10961929 DOI: 10.7759/cureus.54802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
Background Urogenital health is a necessary part of health for all women, especially in the postmenopausal age group. We suspected that the increased incidence of vulvovaginal atrophy (VVA) had some or other effects on the quality of life of older women. So, we aimed to study VVA/genitourinary syndrome of menopause (GSM) and its impact on the quality of life of postmenopausal women in Central India. Despite its significant prevalence and detrimental impact on women's health, VVA/GSM is underdiagnosed and undertreated. In view of the feminization of aging, VVA management is becoming increasingly crucial. This study contributes to postmenopausal women's understanding that keeping their urogenital and sexual longevity is a critical step toward healthy living and gender equality. Given its relationship with urogynecological conditions, this study will help to evaluate both subjectively and objectively the incidence of symptoms related to VVA and its effects on the quality of life of postmenopausal women. This will eventually help to understand the need to address this issue while making postmenopausal women health-related policies. Potential remedies to overcome the obstacles currently preventing patient-HCP interactions addressing sexual health include providing communication tools to facilitate the "uncomfortable" conversation, educating women, and providing enough training for healthcare professionals. Methods The current study was conducted at a rural tertiary healthcare center in Central India and is a cross-sectional study. The study population taken into consideration were all the postmenopausal women between the age group 45 and 75 years with at least one vulvovaginal symptom attending the Outpatient Department (OPD). The total study sample size was 100 women. Further study was conducted by interview method using a questionnaire by the principal investigator. Data was gathered with the help of a pretested questionnaire in the patient's language. Symptoms related to GSM were studied by the vaginal symptom Bothersomeness Scale. Further, a gynecological clinical examination for the confirmation of VVA was carried out, which included a gynecological physical examination. The Vaginal Health Index (VHI) was calculated for each female using the score scale. Assessment of the quality of life of postmenopausal females using the Day-to-Day Impact of Vaginal Aging (DIVA) Questionnaire was performed. Results The majority of females (34%) who presented with the symptoms were in the category of 55-60 years followed by 22% in the age group of 61-65 years. The most common symptoms experienced by females were vaginal dryness (77%) followed by vaginal discharge (74%). Our study confirmed that 79% of the total females included in the study have a VHI score of less than 15, i.e., they suffer from VVA, thus presenting our incidence at 79%. Conclusion According to the surveys discussed in this research, a significant portion of postmenopausal women have symptoms linked to VVA that have a negative impact on their quality of life, including their sexual relationships and self-esteem.
Collapse
Affiliation(s)
- Samiksha C Ulhe
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aarav Vats
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Awantika Singh
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
Nagaria TD, Shinde RK, Shukla S, Acharya S, Acharya N, Dighe SP. A Rare Case of Obstructed Recurrent Incisional Hernia With Incidentalomas. Cureus 2024; 16:e53473. [PMID: 38440004 PMCID: PMC10910421 DOI: 10.7759/cureus.53473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Incisional hernias (IHs) are the most common postoperative complication of incisions during laparotomy and contribute to a significant burden. The aetiology of IHs varies depending on the surgical technique, patient's condition, and surgeon's experience. Many patients present with abdominal swelling and some degree of discomfort, and in an emergency, the presentation is usually as bowel obstruction or strangulation, necessitating immediate exploration. Hernias can be repaired by closing the defect with a nonabsorbable suture or using mesh. Amidst the use of invasive techniques and mesh, the rate of recurrence remains high for IHs, with pain and infection being the most common symptoms. The consequence of IH repair is affected by comorbid conditions such as chronic cough, constipation, urethral stricture, benign prostate hyperplasia, ascites, and obesity. We present a case of a 63-year-old male with an IH, adrenal adenoma, and adrenal cyst, which was an incidental finding.
Collapse
Affiliation(s)
- Tapesh D Nagaria
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sajika P Dighe
- General Surgery, Lokmanya Tilak Municipal Medical College, Mumbai, IND
| |
Collapse
|
5
|
Shaikh M, Acharya N. Hospital-based interventional two-arm parallel comparative study on dydrogesterone vs combined oral contraceptive pills for functional ovarian cysts. F1000Res 2024; 13:84. [PMID: 38450050 PMCID: PMC10912786 DOI: 10.12688/f1000research.142012.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 03/08/2024] Open
Abstract
Background Functional ovarian cysts are common among women of reproductive age, often necessitating medical intervention. This hospital-based interventional study compares the efficacy and safety of combined oral contraceptive pills (COC) and dydrogesterone in managing functional ovarian cysts. Methods This randomized controlled trial will be conducted over two years at the Department of Obstetrics & Gynecology, AVBRH, Datta Meghe Institute of Medical Sciences. The study population consists of reproductive-age women seeking care at the outpatient unit of Obstetrics and Gynecology at AVBRH hospital. The sample size of 46 participants per group has been calculated based on a 95% confidence interval and the estimated prevalence of functional ovarian cysts. Group A will receive low-dose COC for three menstrual cycles. At the same time, Group B will be administered dydrogesterone (10 mg twice daily) for ten days during the luteal phase, repeated across three cycles. Expected outcomes The primary outcomes include evaluating the recession of cysts within three months, monitoring alterations in menstrual patterns (frequency, regularity, duration, and volume), assessing the necessary treatment duration, and observing potential side effects (e.g., nausea, vomiting, weight gain, and acne) and complications (e.g., thromboembolism, delayed menstrual cycles post-treatment, and interactions with other drugs). Data analysis will encompass descriptive statistics, comparative tests, and regression models to assess the primary outcomes. The significance level for hypothesis testing will be 0.05 with a two-tailed approach. Registration CTRI/2023/04/051811.
Collapse
Affiliation(s)
- Muneeba Shaikh
- Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, 442001, India
| | - Neema Acharya
- Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, 442001, India
| |
Collapse
|
6
|
Gupta A, Acharya N, Pajai S, Mishra P, Joshi JS. Unveiling the Enigma: A Rare Case of a Massive Gartner's Cyst Inducing Acute Urinary Retention. Cureus 2024; 16:e52476. [PMID: 38371111 PMCID: PMC10873763 DOI: 10.7759/cureus.52476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Vaginal cysts can occur due to embryonic remnants, misplaced tissue, or an abnormality in the urinary system. They are a common occurrence and usually indicate non-cancerous conditions. A case is presented here of a 35-year-old female para three living three who reported to the emergency room with complaints of acute retention of urine with something coming out of her vagina over the last two years. She was managed operatively by vaginal cystectomy, which led to the resolution of the symptoms.
Collapse
Affiliation(s)
- Aishwarya Gupta
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandhya Pajai
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Preeti Mishra
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jalormy S Joshi
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
7
|
Waghe T, Acharya N, Karnik M, Mohammad S, Patel NA, Gemnani R. Role of Platelet-Rich Plasma in Genitourinary Syndrome of Menopause. Cureus 2024; 16:e53316. [PMID: 38435897 PMCID: PMC10906939 DOI: 10.7759/cureus.53316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
The genitourinary syndrome of menopause (GSM) encompasses a range of symptoms linked to the genitourinary tract stemming from the reduction in estrogen levels following menopause. These symptoms may endure throughout a woman's lifetime. Platelet-rich plasma (PRP), known for its capacity to induce angiogenesis and the restoration effects of growth factors, has been widely employed in various disorders, including GSM. This article aims to comprehensively review the existing literature on the utilization of PRP for managing GSM. The search was executed in electronic databases, specifically PubMed, Scopus, and Google Scholar, up until April 2023. Eligible studies were meticulously chosen for inclusion in this systematic review. PRP emerges as a viable alternative for addressing vaginal atrophy, exhibiting favorable outcomes. Notably, it can be considered for patients with contraindications to hormonal therapy. However, the available body of evidence supporting the use of PRP for GSM remains limited. PRP presents itself as a promising agent, offering a patient-friendly, cost-effective alternative modality. To establish the efficacy of PRP in treating GSM definitively, future randomized trials are imperative.
Collapse
Affiliation(s)
- Tejal Waghe
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Megha Karnik
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nidhi A Patel
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rinkle Gemnani
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
8
|
Pantbalekundri N, Mathurkar S, Acharya N, Kumar S, Acharya S. Choroidopathy and Retinal Detachment: A Rare Sighting in a Case of Postpartum Hemorrhage Presenting With Posterior Reversible Encephalopathy Syndrome. Cureus 2023; 15:e50731. [PMID: 38234958 PMCID: PMC10792348 DOI: 10.7759/cureus.50731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome characterized by convulsions, headache, fatigue, impaired mental status, and decreased vision. It is mainly accompanied by hypertension. Although the pathophysiology of PRES is unknown, some theories revolve around cerebral autoregulation, the ability to maintain cerebral blood flow, or the brain's ability to maintain steady cerebral blood flow over a varying range of blood pressures by cerebral vaso-constriction or dilation. The presence of subcortical vasogenic edema in the posterior brain and hyperintensity lesions in the occipital and parietal lobes on magnetic resonance imaging (MRI) of the brain is diagnostic. We present the case of a woman who acquired PRES after a postpartum hemorrhage with no underlying disease, eventually leading to a choroidopathy and sudden onset diminution of vision, early diagnosis of which saved the patient from the catastrophic complication of permanent blindness.
Collapse
Affiliation(s)
- Nikhil Pantbalekundri
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Swapneel Mathurkar
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| |
Collapse
|
9
|
Motlani V, Motlani G, Pamnani S, Sahu A, Acharya N. Endocrine Changes in Postmenopausal Women: A Comprehensive View. Cureus 2023; 15:e51287. [PMID: 38288203 PMCID: PMC10823308 DOI: 10.7759/cureus.51287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Menopause, when menstrual cycles stop, is brought on by a decline in the level of the hormones progesterone and oestrogen synthesised by the ovaries. Menopause is an unavoidable stage of a female's lifecycle, but because experiences differ for every woman, several women require health care aid to manage their health problems. The physiological variations that take place at various periods of the reproducing age, along with the kind and timing of menopause, are components that are frequently associated with a greater threat of cardiometabolic illness. The most researched associations between menopause and cardiometabolic health are reduced levels of ovarian estrogen synthesis and excessive amounts of androgen during the onset of menopause. Although testosterone and oestrogens have differing effects on adipocyte physiology, it is debatable how important oestrogens are for the emergence of metabolic disorders following menopause. The control of adipocyte differentiation by the brain as well as potential roles of oestrogen and endocrine disruptors chemicals are reviewed in this systematic review of the subject. In general, women had a greater frequency of metabolic syndrome compared to men. Female metabolism was significantly impacted by overt hyperthyroidism and subclinical hypothyroidism. Osteoporosis is another medical condition that menopausal women may experience. Estrogen deprivation is the main contributor to osteoporosis in menopausal women. The regular cycle of bone turnover is disrupted by the decrease in estrogen secretion, which boosts osteoclastic resorption activity while decreasing osteoblastic activity. The entire article assesses and provides information on all the changes in a woman's life after menopause.
Collapse
Affiliation(s)
- Vidhi Motlani
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gunjan Motlani
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Soumya Pamnani
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Akshat Sahu
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
10
|
Motlani G, Motlani V, Acharya N, Dave A, Pamnani S, Somyani D, Agrawal S. Novel Advances in the Role of Selective Estrogen Receptor Modulators in Hormonal Replacement Therapy: A Paradigm Shift. Cureus 2023; 15:e49079. [PMID: 38125238 PMCID: PMC10730982 DOI: 10.7759/cureus.49079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
Estrogen is a key regulatory hormone in the functioning of a female reproductive system. Estrogen hormone regulates many complex physiological processes, which has its role in reproduction and skeletal and cardiovascular systems by acting on estrogen receptors alpha (ERα) and beta (ERβ), which are nuclear transcription factors. Selective estrogen receptor modulators (SERMs) are now being used to treat bone loss, breast carcinoma, and menopausal symptoms, metabolic neurodegenerative because of their characteristics that allow them to function as both estrogen agonists and antagonists, depending on the target tissue. First-generation SERMs, such as Tamoxifen, are used in the management protocol for breast cancer, which is estrogen receptor (ER-positive). Raloxifene is a second-generation SERM that is a valuable adjunct used to treat and prevent osteoporosis in postmenopausal women and prevent compression fractures of the vertebral column. Novel SERM molecules are on the horizon, proven more potent and efficacious in preventing and treating osteoporosis. These include Ospemifene, lasofoxifene, bazedoxifene and arzoxifene. The benefits of Raloxifene versus that of Bazedoxifene are under trial. Despite their therapeutic benefits and actions, these medications are not without adverse effects, such as thromboembolic disorders. Increased risk of uterine cancer has been linked to Tamoxifen. This article delves into the world of SERMs, including their development and discovery. The newer SERMs in late development, ospemifene, lasofoxifene, bazedoxifene, and arzoxifene, are described in detail.
Collapse
Affiliation(s)
- Gunjan Motlani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vidhi Motlani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Apoorva Dave
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Soumya Pamnani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Drishti Somyani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruti Agrawal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
11
|
Wasnik VB, Acharya N, Mohammad S. Genitourinary Syndrome of Menopause: A Narrative Review Focusing on Its Effects on the Sexual Health and Quality of Life of Women. Cureus 2023; 15:e48143. [PMID: 38046779 PMCID: PMC10692865 DOI: 10.7759/cureus.48143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Genitourinary syndrome of menopause (GSM) is a progressive condition due to a hypoestrogenic state affecting perimenopausal and menopausal women. GSM was previously known as urogenital syndrome, vulvovaginal atrophy, or atrophic vaginitis. The term vulvovaginal atrophy did not encompass the symptoms of the urinary tract like incontinence, urgency, and discomfort, or allude that it is due to a hypoestrogenic state. Although a significant segment of the population is affected by GSM, it is very sparsely studied, detected, and treated. GSM affects the quality of life and sexual health of most menopausal women suffering from it. Only a few healthcare providers ask about the symptoms of GSM and a tiny percentage of women seek consultation for it. This may be because they are either embarrassed or believe it to be a part of the natural process of aging. As the life expectancy of women has increased in general, the prevalence of GSM has also risen, while it still remains underdiagnosed and untreated. Properly educating women so that they can seek consultation regarding symptoms of GSM, and training healthcare professionals about communicating with the patient, as well as correctly identifying, diagnosing, and managing the patient are all important to overcome this communication barrier. Once we cross the barrier of diagnosing patients with GSM, we still have to manage the patients with tailor-made prescriptions according to the severity of the symptoms and their preferences. While there are various treatment options, the most effective one is low-dose topical estrogen therapy. In this review, we intend to explore the existing knowledge about GSM and its effect on the quality of life and sexual health of women along with the treatment options for managing and reversing the effects of GSM.
Collapse
Affiliation(s)
- Vaibhavi B Wasnik
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Shazia Mohammad
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| |
Collapse
|
12
|
Muneeba S, Acharya N, Mohammad S. The Role of Dydrogesterone in the Management of Luteal Phase Defect: A Comprehensive Review. Cureus 2023; 15:e48194. [PMID: 38050524 PMCID: PMC10693668 DOI: 10.7759/cureus.48194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
The luteal phase of the menstrual cycle is a pivotal period characterized by hormonal intricacies that lay the foundation for successful embryo implantation and early pregnancy development. Luteal phase defect (LPD), marked by abnormalities in luteal function, presents challenges that can impede reproductive outcomes. This comprehensive review article explores the role of dydrogesterone in LPD management, elucidating its mechanisms of action, evidence of efficacy, safety profile, and potential in combination therapies. Dydrogesterone, a synthetic progestogen, closely mirrors natural progesterone's actions, effectively supplementing the luteal phase and enhancing endometrial receptivity. Clinical studies demonstrate improved pregnancy rates, extended luteal phase support, and enhanced reproductive outcomes with dydrogesterone supplementation. Its favorable safety profile, minimal side effects, and reduced risk of unwanted hormonal effects contribute to its appeal. Furthermore, dydrogesterone's inclusion in international guidelines solidifies its importance in LPD management. Combination therapies, leveraging synergistic effects, offer a comprehensive approach. As gaps in knowledge persist, future research directions and personalized treatment strategies pave the way for a future where dydrogesterone stands as a beacon of hope in conquering the challenges of LPD and achieving successful reproductive outcomes.
Collapse
Affiliation(s)
- Shaikh Muneeba
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
13
|
Joshi KS, Mohammad S, Acharya N, Joshi S. Impetigo Herpetiformis Complicating Pregnancy: A Case Report on a Rare Gestational Dermatosis With Constitutional Symptoms. Cureus 2023; 15:e47898. [PMID: 38034246 PMCID: PMC10683327 DOI: 10.7759/cureus.47898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Impetigo herpetiformis (IH) is a rare dermatosis that can manifest during the last trimester of pregnancy. It has the potential to cause fatality to both the mother and the fetus. After birth, it often vanishes spontaneously and rapidly. Clinically and histologically, it resembles pustular psoriasis, leading some authors to call it "the pustular psoriasis of pregnancy." Steroids were previously the treatment of choice, but treatment remains challenging. A dermatologist with experience in skin conditions during pregnancy should assess any generalized pustular psoriasis instances. There is a danger of stillbirth when a systemic sickness develops, so both the mother and fetus should be properly watched. A well-known side effect of pregnancy-related generalized pustular psoriasis is maternal sepsis. We report our own experience with a case of a 26-year-old pregnant woman who presented with IH that resolved postpartum.
Collapse
Affiliation(s)
- Ketav S Joshi
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samir Joshi
- Obstetrics and Gynecology, Dr. Vinod Joshi Maternity Nursing Home, Mumbai, IND
| |
Collapse
|
14
|
Agrawal LS, Mohammad S, Acharya N, Huse S. Cervical Intraepithelial Neoplasia Grade 3 in the Third Trimester of Pregnancy: A Case Report. Cureus 2023; 15:e46703. [PMID: 38022072 PMCID: PMC10630653 DOI: 10.7759/cureus.46703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
The incidence of malignancies during pregnancy has been on the rise in the recent years, primarily due to an increase in older age pregnancies. This poses a significant risk to both the mother and the developing fetus. We present the case of a 29-year-old woman who experienced intermittent vaginal bleeding during her pregnancy. In the last trimester, the patient presented with abnormal vaginal bleeding and abdominal pain. The gestational age was 37.6 weeks. Notably, to our knowledge, there have been no reported cases of grade 3 cervical intraepithelial neoplasia in the third trimester.
Collapse
Affiliation(s)
- Laksh S Agrawal
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreyash Huse
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
15
|
Raj A, Deshpande KP, Acharya N. Endometriosis Grade 4 in In Vitro Fertilisation and Its Management: A Case Report. Cureus 2023; 15:e47455. [PMID: 38021867 PMCID: PMC10660601 DOI: 10.7759/cureus.47455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Endometriosis is a condition in which tissue that lines the uterus grows outside the uterus. Patients with endometriosis often experience pelvic pain with menstrual periods and sometimes also infertility. Sometimes it is mistaken for pelvic inflammatory disease or ovarian cysts. This condition is a contraindication for pregnancy. This is a case report of a 37-year-old female who came to in vitro fertilisation (IVF) with a history of infertility of 14 years and was diagnosed with Grade 4 endometriosis on diagnostic ultrasonography-guided hysterolaparoscopy. After many trials of intrauterine insemination she was advised to go for IVF, and that not by obtaining her own ovum. The donor's egg and male partner's sperm were used for the IVF. The fertilised zygote was then implanted in the patient's uterus.
Collapse
Affiliation(s)
- Abhijeet Raj
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kshiti P Deshpande
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
16
|
Bewtra C, Acharya N. Preservation of Fertility in Cancer Patients: A Narrative Review. Cureus 2023; 15:e47910. [PMID: 38034134 PMCID: PMC10684029 DOI: 10.7759/cureus.47910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
The survival rates for cancer patients have been steadily improving in recent years due to the improved efficacy of contemporary oncological care, including radiotherapy and chemotherapy. Modern technology makes it feasible to maintain fertility in cancer patients, and this practice needs to be included in oncological care. In many instances, it is impossible to avoid the harm that cancer treatments can cause to a patient's fertility; hence, research in fertility preservation techniques is being conducted to allow cancer patients to have future children biologically related to them. The development of fertility preservation approaches has grown in importance in the field of research over the past few years to increase patient's quality of life and survival. Oncologists must be aware of circumstances in which cancer patients' fertility will be impacted by their therapy and the avenues open for procedures like cryopreservation of the gametes or embryos. When cancer therapy is scheduled, all patients should receive prompt and thorough information on the fertility-related side effects of treatment and the prospects for fertility preservation. The article analyzes the literature, enlisting the factors that contribute to cancer and their effects on fertility, followed by a list of available and newly developed strategies for maintaining fertility in patients. The efficiency of the various fertility preservation techniques following cancer therapy is also discussed.
Collapse
Affiliation(s)
- Chehak Bewtra
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| |
Collapse
|
17
|
Nagaria TD, Shinde RK, Shukla S, Acharya S, Acharya N, Jogdand SD. The Sunlight-Vitamin D Connection: Implications for Patient Outcomes in the Surgical Intensive Care Unit. Cureus 2023; 15:e46819. [PMID: 37954702 PMCID: PMC10636290 DOI: 10.7759/cureus.46819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
This review delves into the intricate relationship between Vitamin D and patient outcomes in the Surgical Intensive Care Unit (SICU). Vitamin D, known for its multifaceted roles in immune modulation, inflammation regulation, and maintenance of calcium homeostasis, emerges as a pivotal factor in the care of critically ill patients. Our exploration reveals a high prevalence of Vitamin D deficiency in the SICU, primarily attributable to limited sunlight exposure, comorbidities, and medication use. Importantly, Vitamin D status impacts infection rates, mortality, and length of stay in the SICU, making it a clinically relevant consideration. Mechanistic insights into the immunomodulatory and anti-inflammatory effects of Vitamin D shed light on its potential benefits in critical care. However, challenges, including accurate assessment, individualised supplementation, and ethical considerations regarding sunlight exposure, are evident. The prospect of personalised Vitamin D supplementation strategies offers promise for optimising patient care. In conclusion, the Sunlight-Vitamin D Connection holds significant potential to improve outcomes in the SICU, emphasising the importance of further research and tailored approaches for the well-being of critically ill individuals.
Collapse
Affiliation(s)
- Tapesh D Nagaria
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sangita D Jogdand
- Pharmacology and Therapeutics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
18
|
Acharya N, Mishra P, Mohammad S, Karnik M, Muneeba S, Gemnani R, Saboo K, Shukla S, Acharya S. Hysteroscopy as a Therapeutic Tool: A Vision to Spare the Uterus in Premenopausal Abnormal Uterine Bleeding (AUB)/Heavy Menstrual Bleeding (HMB), an Update. Cureus 2023; 15:e47877. [PMID: 38021492 PMCID: PMC10681274 DOI: 10.7759/cureus.47877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB) is a common cause of gynecological complaints in perimenopausal women. The treatment chosen by most of the women having HMB/AUB in the perimenopausal age group when medical therapy fails is hysterectomy, which unfortunately has significant issues related to safety and long-term quality of life apart from being a burden on the health care system and cost to patients. Minimal access surgical techniques like hysteroscopic targeted therapies are available which are conservative and spare the uterus and major surgery and its complications and sequelae. Hysteroscopic management of HMB is a minimally invasive and targeted approach in diagnosing and treating the pathological lesions causing the symptoms and not radical like hysterectomy which has more chances of occurrence of adverse events both intra and postoperatively. In terms of health-related quality of life, women suffering from HMB who underwent a hysteroscopic conservative approach had better scores when compared to those with hysterectomy. The present review aims to review the evidence generated to compare the two surgical modalities, hysteroscopic targeted therapy and hysterectomy, in terms of their effectiveness, safety, and effect on the quality of life of these perimenopausal women having HMB/AUB.
Collapse
Affiliation(s)
- Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Preeti Mishra
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Megha Karnik
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shaikh Muneeba
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rinkle Gemnani
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keyur Saboo
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
19
|
Belapurkar P, Acharya S, Shukla S, Kumar S, Khurana K, Acharya N. Prevalence of Anxiety, Depression, and Perceived Stress Among Family Caregivers of Patients Diagnosed With Oral Cancer in a Tertiary Care Hospital in Central India: A Cross-Sectional Study. Cureus 2023; 15:e47100. [PMID: 38021994 PMCID: PMC10646617 DOI: 10.7759/cureus.47100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objectives Oral cancer is a significant health issue in India, with one of the highest incidence rates globally. Family caregivers play a crucial role in the care of oral cancer patients, but their mental health often faces challenges. This study aimed to assess the prevalence of anxiety, depression, and perceived stress among family caregivers of oral cancer patients in a tertiary care hospital in central India and explore the associated psychosocial factors. Population and method The study was carried out between March 2023 and August 2023 in a tertiary care hospital in Wardha, Maharashtra. Family caregivers (N=82, mean age = 36.1 (SD 10.5) years) of patients with clinically diagnosed oral cancer were subjected first to structured psychiatric clinical interviews to screen for psychiatric diagnoses and then were given self-reporting questionnaires for socio-demographic data, Beck Depression Inventory (BDI-II) for measuring the emotional, cognitive, and motivational symptoms of depression, Manifest Anxiety Scale (MAS) to assess the degree of anxiety and Perceived Stress Scale-10 (PSS-10) to assess stress level. Data was analysed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Chi-square test and logistic regression analyses were conducted wherever appropriate in order to explore predictive factors of depressive, anxious, or stress symptoms. Result In the studied population, the majority experienced symptoms of depression (65.1%), anxiety (69.5%), and perceived stress (74.7%). Caregivers of patients with advanced oral cancer were found to have a higher likelihood of experiencing depression (χ2 (1) = 16.76, p < .001) and anxiety related to unemployment (χ2 (1) = 10.12, p = .001) or insufficient earnings (χ2 (1) = 28.63, p < .001). Additionally, participants with no or little formal education (χ2 (1) = 4.63, p = 0.031) and lower income (χ2 (1) = 28.63, p < .0001) were significantly more likely to experience distress compared to those with higher levels of education. Conclusion This study highlights the need for comprehensive support systems for family caregivers of oral cancer patients. Educational programs, financial assistance, and mental health services should be tailored to caregivers' specific needs. Early identification and intervention strategies can help mitigate the psychological impact of caregiving. Further research is essential to develop targeted interventions that enhance the well-being of caregivers and improve the quality of life for both patients and caregivers.
Collapse
Affiliation(s)
- Parth Belapurkar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Kashish Khurana
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| |
Collapse
|
20
|
Muneeba S, Acharya N, Mohammad S, Reddy LS, Gupta A. Unicornuate Uterus and Rudimentary Horn: An Unusual Cause of Recurrent Fetal Malpresentation Identified During a Scheduled Cesarean Delivery. Cureus 2023; 15:e46277. [PMID: 37908913 PMCID: PMC10615386 DOI: 10.7759/cureus.46277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
This case report presents a unique clinical scenario involving a 32-year-old woman with a unicornuate uterus and a rudimentary horn, leading to recurrent fetal malpresentation. The patient, gravida 3, para 1, presented at 36 weeks of gestational age with contractions and vaginal bleeding. Clinical evaluation revealed a breech presentation and nonreassuring fetal heart tracings. An emergency cesarean section was performed, during which a unicornuate uterus with a rudimentary horn was identified and fused to the main uterine cavity on the left posterior aspect. The rudimentary horn bore a functional left tube and ovary. The surgical procedure was successful, resulting in the delivery of a healthy baby girl. This case underscores the importance of meticulous preoperative assessment, multidisciplinary collaboration, and informed consent in managing complex uterine anomalies to ensure optimal maternal and fetal outcomes.
Collapse
Affiliation(s)
- Shaikh Muneeba
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky S Reddy
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
21
|
Mohammad S, Joshi KS, Muneeba S, Acharya N, Jajoo SS. Echinococcal Disease of the Fallopian Tube as a Rare Cause of Primary Subfertility. Cureus 2023; 15:e46198. [PMID: 37905297 PMCID: PMC10613431 DOI: 10.7759/cureus.46198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Echinococcosis is a significant zoonotic infection caused by Echinococcus granulosus, which has a worldwide distribution. In India, the annual incidence varies from one to 200 in 100,000 people. The liver and lungs are often affected, making diagnosis difficult when infections occur in uncommon areas. We report a case of a hydatid cyst in the fallopian tube, which presented as subfertility and was confirmed by radiological imaging.
Collapse
Affiliation(s)
- Shazia Mohammad
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ketav S Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shaikh Muneeba
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubhada S Jajoo
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
22
|
Karnik M, Acharya N, Potdar J, Muneeba S, Mishra P, Shukla S. Pseudo Broad Ligament Fibroid Posing a Clinical Dilemma: A Case Report. Cureus 2023; 15:e43272. [PMID: 37692590 PMCID: PMC10492518 DOI: 10.7759/cureus.43272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Pseudo broad ligament fibroids originate in the uterus but grow into the broad ligament while retaining their attachment to the uterus. We report a case of a right-sided pseudo broad ligament fibroid mimicking an adnexal mass in a 40-year-old woman presenting with dysmenorrhoea and heavy menstrual bleeding. She had a uterine mass corresponding to an 18-week pregnant uterus size, which clinically and radiologically posed a diagnostic dilemma between an ovarian cyst, a bicornuate uterus with multiple fibroids, and a broad ligament fibroid. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, which revealed a pseudo broad ligament fibroid of 12x10x6 centimeters, weighing 1.2 kg. The histopathology report confirmed the diagnosis of a leiomyoma with normal ovaries.
Collapse
Affiliation(s)
- Megha Karnik
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jyotsna Potdar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shaikh Muneeba
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Preeti Mishra
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
23
|
Mohammad S, Joshi KS, Mohammad S, Acharya N. Aesthetic Gynaecology: What Women Want? Cureus 2023; 15:e44251. [PMID: 37772220 PMCID: PMC10523831 DOI: 10.7759/cureus.44251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
The demand for aesthetic gynecology is growing among patients and medical professionals. It is becoming a field of increasing interest. In obstetrics and gynecology, there are currently few superspecialization or fellowship training programs that teach this subject; nevertheless, improvements have been made in aesthetic and plastic surgery training that foresee the need to add specialized training in this sector. In the US and the UK, numerous reputable certification and preceptorship programs are now where many surgeons start their careers. To give physicians interested in surgical and non-surgical therapies certification training, new programs were introduced globally in 2016-2017. We provide an overview of both surgical and non-surgical "aesthetic gynecology" treatments, as well as the opinions of the top gynecologic associations on this new field of study.
Collapse
Affiliation(s)
- Shazia Mohammad
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ketav S Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shirin Mohammad
- Otolaryngology - Head and Neck Surgery, NKP Salve Institute of Medical Sciences, Nagpur, IND
| | - Neema Acharya
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
24
|
Dahiphale SM, Potdar J, Dave A, Acharya N, Memon SI. Deep Vein Thrombosis as a Rare Post-procedural Complication After Uterine Artery Embolization: A Case Report. Cureus 2023; 15:e39716. [PMID: 37398716 PMCID: PMC10309658 DOI: 10.7759/cureus.39716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
When a patient is undergoing uterine artery embolization (UAE) which is considered a modality that is safer than surgical management for abnormal uterine bleeding (AUB), one must acknowledge as a surgeon the existence of rare but serious complications such as deep vein thrombosis (DVT). We encountered such a case where a 34-year-old female (para-3 living-3) with AUB and severe anemia because of heavy bleeding required multiple blood transfusions and was treated with UAE. The procedure was uneventful and the patient was discharged. However, later she presented with DVT of the right lower limb which was promptly managed with an inferior vena cava filter implant and thrombolysis, which prevented life-threatening sequelae such as pulmonary embolism and, potentially, death. Therefore, one must be vigilant about such complications despite UAE being a safer alternative to surgical management for gynecological complaints.
Collapse
Affiliation(s)
- Swati M Dahiphale
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jyotsana Potdar
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Apoorva Dave
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sharmeen I Memon
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
25
|
Bajpai K, Acharya N, Prasad R, Wanjari MB. Endometrial Receptivity During the Preimplantation Period: A Narrative Review. Cureus 2023; 15:e37753. [PMID: 37214054 PMCID: PMC10198587 DOI: 10.7759/cureus.37753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Endometrial receptivity is a complex and critical process fundamental to achieving a successful pregnancy. While researchers have made significant strides in understanding the underlying mechanisms governing endometrial receptivity, effective diagnostic and therapeutic strategies remain scarce. This review article aims to elucidate the various factors that contribute to endometrial receptivity, including the hormonal regulation and molecular mechanisms that govern this process, as well as potential biomarkers for assessing endometrial receptivity. One of the major challenges in identifying reliable biomarkers for endometrial receptivity is the intricate nature of the process itself. Nonetheless, recent advances in transcriptomic and proteomic technologies have identified several candidate biomarkers that could potentially enhance our ability to predict endometrial receptivity. Furthermore, emerging technologies such as single-cell RNA sequencing and mass spectrometry-based proteomics hold great promise for providing novel insights into the molecular mechanisms underlying endometrial receptivity. Despite the lack of reliable biomarkers, various therapeutic strategies have been proposed to improve endometrial receptivity. One promising approach involves the transplantation of mesenchymal stem cells (MSCs), which have been shown to increase endometrial thickness and receptivity in both animal models and clinical trials. Growth factors, cytokines, and exosomes derived from MSCs and other cell types may also have therapeutic potential for addressing endometrial dysfunction.
Collapse
Affiliation(s)
- Kshitij Bajpai
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
26
|
Deeksha HS, Pajai S, Acharya N, Mohammad S. Pregnancy in Women With Cerebral Palsy. Cureus 2023; 15:e36502. [PMID: 37090316 PMCID: PMC10119739 DOI: 10.7759/cureus.36502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Cerebral palsy is a permanent, non-progressive, irreversible, non-curable condition with high co-morbidities and lifelong complications. Brain lesions may be present at birth or shortly after that. It may be congenital or acquired, prenatal, or abnormal brain development. The damage to the brain is non-progressive. It mainly affects movement, coordination, strength, and posture. Cerebral palsy is believed to increase women's chance of unfavorable pregnancy outcomes. According to studies, the main outcome of cerebral palsy in pregnant women is premature birth. Secondary outcomes like LSCS, labor induction, low 5-minute APGAR, small for gestational age (SGA), large for gestational age (LGA), and stillbirth point to the necessity for increased surveillance during prenatal treatment. A 27-year-old primigravida with a known case of dystonic Cerebral palsy since childhood presented with a history of nine months of amenorrhea, pain in the abdomen, and backache for one day. Per abdominal examination, the uterus was 34 weeks in size with Breech presentation, mild contractions were present, and a fetal heart rate of 146 beats per minute, which was regular. On per-vaginal examination cervical os was one finger loose, the show was present. The patient underwent a planned Lower segment caesarean section after neuro physician and anesthesiologist clearance and delivered a healthy female baby of 2.4 kg. Both mother and baby were stable.
Collapse
Affiliation(s)
- H S Deeksha
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Sandhya Pajai
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Shazia Mohammad
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| |
Collapse
|
27
|
Acharya N, Acharya S, Shukla S, Potdar J, Waghe T, Kabra R. Acute Onset Postpartum Pleural Effusion: A Near-Miss Maternal Case Due to Scrub Typhus Infection. Cureus 2023; 15:e35142. [PMID: 36949983 PMCID: PMC10027019 DOI: 10.7759/cureus.35142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
A 32-year-old puerperal patient developed acute onset breathlessness and fever on the third postoperative day. On evaluation, the patient was diagnosed to have scrub typhus pneumonia without any characteristic eschar. The condition was associated with pleural effusion, and it was drained. Azithromycin was used as the drug of choice due to the peripartum status of this patient. The patient improved due to early detection and multidisciplinary timely care. The safe outcome of this near-miss case suggests that fever profile workup, especially in scrub typhus endemic areas, should include scrub typhus testing even if classical signs are absent in the peripartum period.
Collapse
Affiliation(s)
- Neema Acharya
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Jyotsana Potdar
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Tejal Waghe
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Ruchita Kabra
- Department of Medicine, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| |
Collapse
|
28
|
Memon SI, Acharya N. A Rare Case of Posterior Vaginal Wall Gartner's Duct Cyst Mimicking as Genital Prolapse. Cureus 2022; 14:e31507. [DOI: 10.7759/cureus.31507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
|
29
|
Chauhan S, Shrivastava D, Acharya N, Chaudhari K. A Rare Case of Granulosa Cell Tumor Associated With Endometrial Carcinoma - A Case Report. Cureus 2022; 14:e31122. [DOI: 10.7759/cureus.31122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/05/2022] [Indexed: 11/07/2022] Open
|
30
|
Patel NA, Acharya N, Borkar K. Transcatheter Uterine Artery Embolisation in Treating Secondary Haemorrhage Post Hysterectomy: A Life-Saving Approach. Cureus 2022; 14:e30249. [PMID: 36381840 PMCID: PMC9652743 DOI: 10.7759/cureus.30249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Hysterectomy, which is a surgical procedure to remove all or a part of the uterus, is one of the most commonly done procedures by a gynaecologist. However, it may be associated with a number of complications. Haemorrhage following hysterectomy is a life-threatening complication. One of the most common complications is haemorrhage, whether primary or secondary. The various options to treat secondary haemorrhage post hysterectomy are uterine artery embolization (UAE) or surgical re-exploration. Here, we present a case of secondary haemorrhage post hysterectomy treated with uterine artery embolization and describe the numerous advantages of UAE as a novel approach to stop bleeding post hysterectomy over the traditional surgical re-exploration method.
Collapse
|
31
|
Kesharwani DK, Mohammad S, Acharya N, Joshi KS. Fertility With Early Reduction of Ovarian Reserve. Cureus 2022; 14:e30326. [PMID: 36407155 PMCID: PMC9662254 DOI: 10.7759/cureus.30326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023] Open
Abstract
Female infertility is defined as the failure to conceive after a year of frequent, unprotected sexual activity. Infertility affects 8-10% of females worldwide. There are many causes of infertility. One of them is diminished ovarian reserve (DOR). In this condition, the ovary loses its reproductive potential, which affects fertility. This condition may be caused due to injury, but it usually results from aging. DOR is one of the main reasons for infertility in women worldwide. A woman with DOR has fewer eggs in her ovaries than usual. The quality of the remaining eggs may not be bad. This condition impairs the development of existing eggs. Patients with DOR may be able to get pregnant if they are properly treated according to their profile. Their treatments are individually tailored according to their needs. These patients should be recommended a robust approach toward treatment and increasing fertility. The chances of pregnancy increase if the treatment is started early.
Collapse
Affiliation(s)
- Dipanshu K Kesharwani
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Ketav S Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| |
Collapse
|
32
|
Sinha P, Acharya N, Banode P. Repeat Uterine Artery Embolization for Obstetric Hemorrhages: A Rare Event in a Single Patient. Cureus 2022; 14:e29729. [PMID: 36324353 PMCID: PMC9617221 DOI: 10.7759/cureus.29729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
This is a case report of a single patient who had two episodes of obstetric hemorrhages, first in the puerperium and second one post medical termination of pregnancy for which the patient had to be managed by uterine artery embolization (UAE). This is a rare case in which this interventional radiological procedure proved life-saving twice in her obstetric history. A 29-year-old woman with an obstetric history of para two and living two (P2L2), presented with a complaint of per-vaginum (p/v) spotting with a history of recent intake of pills for medical termination of pregnancy (MTP). Retained products of conception (RPOC) were ruled out radiologically and she was managed conservatively. She subsequently presented with acute uterine bleed with severe anemia and lethargy. After initial resuscitation and failing of conservative therapy, she was promptly taken up for bilateral UAE. She had also undergone UAE 5 years ago during her puerperal period. Uterine artery embolization is a safe and effective life-saving procedure to control torrential uterine bleed and should be considered when the conservative approach has failed.
Collapse
|
33
|
Jain S, Acharya N. Fetal Wellbeing Monitoring – A Review Article. Cureus 2022; 14:e29039. [PMID: 36249607 PMCID: PMC9550204 DOI: 10.7759/cureus.29039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/11/2022] [Indexed: 11/15/2022] Open
Abstract
While assessing maternal health is relatively easy, assessing fetal well-being has always been tricky. This has led to tremendous technological development in fetal well-being assessment, thus bridging the gap between biotechnology and antenatal medicine. It is broadly divided into early pregnancy, late pregnancy, and during labour assessment. While the early assessment involves genetic check-ups and malformations, the late pregnancy check-ups aim at delivering a healthy fetus at term by normal vaginal delivery. The early tests can be invasive or non-invasive. Non-invasive include cell-free fetal DNA assessment and fetal cell-based assessment. Invasive tests include amniocentesis and chorionic villous sampling. These are followed by chromosomal microarray and next-generation sequencing. Under this procedure, exome sequencing is done, which is either clinical or whole. Sequencing of the whole genome can also be done. A recent advancement is pre-implantation genetic testing. These are mainly useful in identifying monogenic disorders for which the locus causing disease is identified beyond any doubt. In late pregnancy, the most commonly used test is biophysical. It works on the principle that an increase in the fetal heart rate occurs in conjugation with fetal movements. The next widely employed technology is Doppler, which is used to know fetal heart rates, valve timing intervals, and umbilical artery waveforms. Cardiotocography is also widely used both during pregnancy and during labour. It measures the fetal heart rate while correlating it with uterine contractions. Wireless fetal and maternal heart monitoring and telemonitoring are recent upcoming fields.
Collapse
|
34
|
Varghese J, Acharya N. Platelet-Rich Plasma: A Promising Regenerative Therapy in Gynecological Disorders. Cureus 2022; 14:e28998. [PMID: 36249659 PMCID: PMC9549690 DOI: 10.7759/cureus.28998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/10/2022] [Indexed: 11/24/2022] Open
Abstract
Platelet-rich plasma (PRP) could be understood as a special preparation of plasma in which the concentration of platelet is immensely high. This rationale for plasma use has been in the medical science for many years with plenty of success in various fields where it was inculcated, bringing dramatically favorable and better outcomes in terms of disease management and prognosis. PRP has been widely used in orthopedics from the very beginning, but in the past few years its use has been extended to other fields too, such as obstetrics and gynecology. From the very onset of the introduction of platelet-rich plasma in gynecology, there had been constant research being carried out all around the globe in order to scientifically prove and confirm its exact role in the management of gynecological problems. Regenerative medicine in gynecology was among the first areas where the platelet-rich plasma was implemented and has substantially given great results, which encouraged further extensive research to be carried out in other spectrums of gynecology. The implications of such great struggles ultimately gave way to evidence suggesting the importance of platelet-rich plasma in managing gynecological disorders like Asherman’s syndrome, urinary incontinence, genital fistulas, thin endometrium, etc. This review article collectively summarizes the various use of platelet-rich plasma in gynecology.
Collapse
|
35
|
Acharya N, Humagain R, Dahal S, Kafle D. The Need of Endodontic Therapy among Patients Attending Tertiary Care Center in Central Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:264-267. [PMID: 37042363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background Dental caries is considered as the most prevalent oral disease in Nepalese population that frequently needs endodontic therapy or root canal treatment (RCT). Pulp infection is one of the most common sequels of dental caries which when left untreated leads to pulpal necrosis and peri-radicular diseases. Patients usually reports to the dental hospital after there is pain, sensitivity, swelling or fracture of the tooth structure which usually impedes their normal routine of daily life. RCT is one of the efficacious therapeutic procedures that can save the teeth retaining its aesthetics and function. Objective To determine the need of RCT among patients attending Tertiary Care Hospital. Method A cross-sectional epidemiological study was conducted in the Department of Conservative Dentistry and Endodontics over the period of one year from April 2019 to April 2020. Ethical approval was taken from the Institutional Review Committee Kathmandu University School of Medical Sciences. In total, 7566 records of the patients that needed endodontic therapy and other treatments were collected and the need of endodontic therapy versus other treatments were assessed. The data obtained were analyzed using the SPSS version 20. The association between various patient-related variables were calculated by chi square test and mean, standard deviation, frequency and percentage were calculated using descriptive statistics. P value was set at < 0.05 for statistical significance. Result Among the total study population, (n=7566), the mean age was 34.97±14.34 years among which 4387 (58%) were females and 3179 (42%) were males. The type of treatment required by the study participants were significantly associated with age and sex (p < 0.001) and p < 0.001, respectively). Conclusion The findings of this study concluded that there was an increased need for endodontic therapy among patients visiting the department compared to other treatments. There was a significant association between gender and age showing females and elderly patients in greater need for endodontic therapy.
Collapse
Affiliation(s)
- N Acharya
- Department of Conservative Dentistry and Endodontics, Institute of Medicine, Maharajgung Medical Campus, Dental Teaching Hospital, Kathmandu, Nepal
| | | | - S Dahal
- Department of Community Dentistry, Institute of Medicine, Maharajgung Medical Campus, Dental Teaching Hospital, Kathmandu, Nepal
| | - D Kafle
- Department of Orthodontics, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kavre, Nepal
| |
Collapse
|
36
|
Madaan S, Talwar D, Jaiswal A, Kumar S, Acharya N, Acharya S, Dewani D. Post-COVID-19 menstrual abnormalities and infertility: Repercussions of the pandemic. J Educ Health Promot 2022; 11:170. [PMID: 35847136 PMCID: PMC9277727 DOI: 10.4103/jehp.jehp_1200_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/19/2021] [Indexed: 05/31/2023]
Abstract
While battling the life-threatening complications of COVID-19, its effect on the menstrual cycle and infertility has been somewhat ignored. This brief review aims on highlighting the importance of menstrual abnormalities being experienced during the post-COVID period and to make the clinicians aware about what to expect in regard of menstrual abnormalities by learning from various studies that have been conducted worldwide. This review article was written with systematic literature review with the help of data search machine such as PubMed, Scopus, Web of Sciences, and Google Scholar. A search strategy leads to the extraction of 160 related articles that after the removal of inappropriate and duplicate articles, 33 articles were selected for the review. To find other potentially relevant articles, the references of the extracted articles were thoroughly examined. The search was carried out using keywords including "COVID-19," "Menstrual abnormalities," and "Infertility." Using OR and AND, the keywords mentioned above were combined and then utilized in the search box of the databases. Articles published from January 2020 to September 2021 were included in this study. It includes worldwide data ranging from studies done in China, India, Ireland, Turkey, Jordan, and Germany. During the post-COVID period, there is a significant alteration in the sex hormones of females infected by COVID-19 which may manifest as menstrual cycle abnormalities such as decreased cycle length or prolonged menstrual cycle bleeding. It may also manifest as infertility due to ovarian failure due to suppression of ovarian function COVID-19 a novel coronavirus which is presently a pandemic has affected the world in manner reminding the world of 1918 Spanish flu. However, while battling the deadly pandemic, the clinicians should also be aware of the repercussions of the effect this infection has on multiple organs such as ovarian suppression leading to infertility, oligomenorrhea, or menorrhagia.
Collapse
Affiliation(s)
- Sparsh Madaan
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Dhruv Talwar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Arpita Jaiswal
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Deepika Dewani
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| |
Collapse
|
37
|
Joshi K, Acharya N, Acharya S, Joshi S. Maternal Serum High-Sensitivity C-Reactive Protein (hsCRP) as a Prognostic Marker of Fetomaternal Outcome in Hypertensive Disorders of Pregnancy: A Novel Study. Cureus 2022; 14:e24327. [PMID: 35607538 PMCID: PMC9123406 DOI: 10.7759/cureus.24327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Hypertensive disorders of pregnancy (HDP) are a group of obstetric disorders causing profound fetomaternal compromise, leading to adverse obstetric outcomes. High-sensitivity c-reactive protein (hsCRP), an inflammatory marker of systemic inflammation, is elevated in HDP and correlates with the severity of the disease. However, prediction and prevention of HDP and its associated fetomaternal complications remain elusive to most obstetricians. The present study aimed to evaluate the use of hsCRP as a prognostic marker of adverse fetomaternal outcome in HDP. Methods: The study included 132 third-trimester pregnancies with HDP who underwent hsCRP quantification at the time of presentation to the out-patient department and followed up till delivery. HsCRP quantification was done using immunoturbidimetry method. Results: Of the 132 cases studied, 72 had normal hsCRP levels while the remaining 60 had raised hsCRP levels. It was observed that patients with raised hsCRP levels had poorer fetomaternal outcomes at delivery as compared to those with normal hsCRP levels. Conclusion: The obstetric outcomes of patients with HDP worsened with increasing levels of hsCRP, as shown in our study, when compared to normotensive patients. Thus, hsCRP delivers promising results as a prognostic marker of adverse fetomaternal outcomes in patients of HDP.
Collapse
|
38
|
Talwar D, Kumar S, Acharya S, Talwar D, Jain S, Acharya N, Chaudhari K, Madaan S, Hulkoti V, Annadatha A, Pawar T, Patel M, Shah D. Implication of chronic obstructive pulmonary disease on the severity and outcome of covid-19 in rural India; Is COPD the hidden culprit amongst the havoc: A cross sectional study. Medical Science 2022. [DOI: 10.54905/disssi/v26i122/ms131e2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
39
|
Madaan S, Talwar D, Kumar S, Jaiswal A, Acharya N, Acharya S. HELLP Syndrome and COVID-19; association or accident: A case series. J Family Med Prim Care 2022; 11:802-806. [PMID: 35360752 PMCID: PMC8963628 DOI: 10.4103/jfmpc.jfmpc_1136_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022] Open
Abstract
Partial Hemolysis, elevation of liver enzymes and low platelet count (HELLP) syndrome is a leading cause of maternal mortality. With the exceeding spread of COVID-19, leading to increasing number of COVID-19 infected cases there has been a emergence of an overlap of COVID-19 with HELLP Syndrome. Multiple factors are associated with the thrombocytopenia witnessed in COVID-19 somewhat similar to what is witnessed in preeclampsia and HELLP Syndrome. We Describe a case series of two ante natal cases who presented with a picture of HELLP syndrome and upon investigations turned out to be COVID-19 thus trying to establish an association between the two.
Collapse
Affiliation(s)
- Sparsh Madaan
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences and Research (Deemed to be University), Maharashtra, India
| | - Dhruv Talwar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences and Research (Deemed to be University), Maharashtra, India
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences and Research (Deemed to be University), Maharashtra, India
| | - Arpita Jaiswal
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences and Research (Deemed to be University), Maharashtra, India
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences and Research (Deemed to be University), Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences and Research (Deemed to be University), Maharashtra, India
| |
Collapse
|
40
|
Madaan S, Jaiswal A, Acharya N, Tayade S, Dhok A, Kumar S, Acharya S, Dewani D, Talwar D, Halani D, Reddy Eleti M. Role of Salivary Uric Acid Versus Serum Uric Acid in Predicting Maternal Complications of Pre-Eclampsia in a Rural Hospital in Central India: A Two-Year, Cross-Sectional Study. Cureus 2022; 14:e23360. [PMID: 35475103 PMCID: PMC9020463 DOI: 10.7759/cureus.23360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Hypertensive disorders during pregnancy are an important topic of concern, specifically in rural and remote areas of India where there is a lack of awareness and it is difficult to maintain proper follow-up of pregnant females to screen them for complications developed during pregnancy. Gestational hypertension and pre-eclampsia result in the abruption of the placenta, hemolysis, elevated liver enzymes, low platelet count syndrome, eclampsia, and disseminated intravascular coagulation, which can be a serious threat to the health of the mother and the fetus. Therefore, it is important to identify biomarkers for diagnosing and predicting the complications of pre-eclampsia that may aid the obstetric high-dependency units based in rural areas to tackle this important health hazard during pregnancy. Methodology A total of 180 singleton pregnant women of more than 34 weeks of gestational age were enrolled in this study. All women were divided into three groups (control group, severe pre-eclampsia, and non-severe pre-eclampsia) based on the severity of blood pressure and the presence of proteinuria (≥+1 by the dipstick method). Salivary and serum uric acid levels were measured through morning samples, and all patients were monitored for the development of complications and outcomes. Salivary uric acid and serum uric acid levels were correlated with each other and with maternal complications of pre-eclampsia. Results Mean salivary uric acid (mg/dL) in severe pre-eclampsia was (6.72 ± 0.49) significantly higher compared to non-severe pre-eclampsia (4.75 ± 0.94) and control (3.13 ± 0.43). Mean serum uric acid (mg/dL) in severe pre-eclampsia was (8.13 ± 0.87) significantly higher compared to non-severe pre-eclampsia (6.23 ± 0.76) and control (3.85 ± 0.46).The lowest best cut-off value of maternal salivary uric acid was 5.06 mg/dL, above which one can predict maternal complications with a diagnostic accuracy of 78.33%. Conclusions Salivary uric acid and serum uric acid levels are significantly raised in cases of pre-eclampsia in comparison to normal pregnancy. Salivary uric acid and serum uric acid are correlated significantly indicating that salivary uric acid can function as a cost-effective, novel marker to provide an idea about serum uric acid levels. The prognostic accuracy of salivary uric acid was good in predicting maternal complications among cases of pre-eclampsia (severe and non-servere) and early-onset maternal complications. Therefore, it may be utilized as a helpful marker to identify high-risk patients.
Collapse
|
41
|
Acharya N, Singhal S, Madaan S, Mohammad S, Acharya S. Use of the modified early obstetric warning system chart as a predictor of peri-partum obstetric morbidity in a rural teaching institute: A two-year cross-sectional study. J Family Med Prim Care 2022; 11:7644-7651. [PMID: 36994023 PMCID: PMC10040990 DOI: 10.4103/jfmpc.jfmpc_320_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/16/2022] [Accepted: 07/11/2022] [Indexed: 01/31/2023] Open
Abstract
Background and Objectives The occurrence of obstetric morbidity is on the rise in developing countries. The peri-partum period is very crucial as most of the deaths occur during labour or in the first 24 hours of the post-partum period. Early recognition and treatment of disease entities leading to obstetric morbidity can be performed by the "track and trigger" system of parameters on a chart, thus preventing the obstetric morbidity and mortality. Therefore, the MEOWS chart (Modified Early Obstetric Warning System chart) was recommended by the Confidential Enquiry into Maternal and Child Health report in order to evaluate the patient at an urgent basis with timely diagnosis and treatment. Material and Methods We conducted an observational study in a rural tertiary care centre based in central India over the span of 2 years from September 2017 till August 2019. Physiological parameters of 1000 patients which included pregnant women in labour >28 weeks of gestation were recorded on the MEOWS chart. Trigger was defined as either one red zone (any one parameter that was markedly abnormal, with values in the red zone) or two yellow zones (when simultaneously any two parameters were moderately de-ranged with values in yellow zones). Based on trigger, patients were categorised as triggered and non-triggered groups. Further based on the obstetric morbidity during hospital stay, triggered and non-triggered groups were divided into category 1 (patients who did not have any obstetric morbidity during hospital stay) and category 2 (patients who had any obstetric morbidity during hospital stay). Results Out of the total 1000 patients, 24.8% patients had an abnormal MEOWS chart and were categorised into the triggered group. Out of a total of 248 patients in the triggered group, 47.5% (118) patients had obstetric morbidity during hospital stay (category 2). The MEOWS chart was found to be 85.51% sensitive and 84.92% specific with a positive predictive value of 47.58% and a negative predictive value of 97.34%. The accuracy of the MEOWS chart was 85%. Conclusion and Interpretation It was concluded that there was a significant difference between obstetric morbidity in normal (non-triggered) and abnormal (triggered) MEOWS chart findings. The sensitivity and specificity of the MEOWS chart were high. The negative predictive value of the chart was very high. Thus, the MEOWS chart can be used as a bedside screening tool for predicting obstetric morbidity.
Collapse
|
42
|
Agarwal H, Godhiwala P, Acharya S, Acharya N, Lahane V. An unusual presentation of a corpus luteum rupture. Gynecol Minim Invasive Ther 2022; 11:57-60. [PMID: 35310112 PMCID: PMC8926042 DOI: 10.4103/gmit.gmit_135_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 03/25/2021] [Indexed: 11/04/2022] Open
Abstract
Rheumatic heart disease (RHD) is one of the most common cardiac conditions seen in India with mitral stenosis as the most prevalent cause affecting females more than males. With the increasing number of patients undergoing mitral valve replacement (MVR) and mandatory use of anticoagulants post-MVR, the patients presenting with drug-induced coagulopathy have increased. One of the rare complications of coagulopathy-related hemorrhage may be associated with a gynecological cause with maximum risk in women of reproductive age group. This chance of hemorrhage has increased due to various events that occur in reproductive organs, namely, ovulation, menstruation, trauma due to sexual intercourse, or pregnancy-related bleeding. Such bleeding is evident as external vaginal bleeding or hemoperitoneum. Hereby, we present a rare case of a 30-year-old woman, on anticoagulant therapy for MVR who presented with congestive cardiac failure associated with massive hemoperitoneum. On ultrasound-guided paracentesis, the cause of mild-to-moderate ascites was normal ovulatory bleed evident by the bleeding from the corpus luteal cyst.
Collapse
|
43
|
Mohammad S, Acharya N, Acharya S, Jajoo S, Joshi K. Peripartum dilated cardiomyopathy complicated by miliary tuberculosis—a maternal near miss (MNM): Case report. J Family Med Prim Care 2022; 11:4010-4015. [DOI: 10.4103/jfmpc.jfmpc_1623_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/21/2021] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
|
44
|
Shukla S, Acharya S, Acharya N, Singh S, Dolas P. Inculcating research methodology related skills and aptitude amongst medical undergraduates- An interventional study. J Family Med Prim Care 2022; 11:3648-3653. [PMID: 36387717 PMCID: PMC9648304 DOI: 10.4103/jfmpc.jfmpc_1812_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/16/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: The present project was carried out at Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences (DMIMS, deemed to be University), Wardha, Maharashtra, as part of the training programme as per the advanced course in medical educational research, the theme of the project was based on skill training. The project was titled “Inculcating research methodology related skill and aptitude amongst medical undergraduates”. Aim: The basic aim of the study was to make the medical undergraduates competent and apprised with certain basic research skills in research methodology and to develop aptitude amongst the undergraduates for research. Material and Methods: The present research project took Bachelor of Medicine and Bachelor of Surgery (MBBS) students from the 2016 batch, from the sixth and seventh term of their professionals and the project was conducted for 6 months duration from October 2018 to March 2019. From the batch of 200, a randomised selection of students was carried out and 57 students in total were selected. The study was carried out in three phases as follows: Phase one (assessment and sensitization); phase two (skill training/mentoring); phase three (research outcome/culmination). Results: In the primary endpoint, the assessment of pretest and posttest were tabulated as well as feedback was taken; in the secondary endpoint the research projects conducted were translated into publications and the student’s response were applied for funded research projects like the Indian Council of Medial Research (ICMR) that was evaluated. Pretest score of 1 out of 10 (average score of 57 responses), that is, 10% and a posttest score of 6.9 out of 10, that is, 69.1%, the absolute learning gain was 59.1% and relative learning gain was 59.1%, the classroom averaged learning gain was 0.59. In the present study, the learning gain score was 0.59 which is in medium range according to Hake’s learning gain criteria. Conclusion: The present study concluded that there was a lack of understanding amongst medical undergraduates pertaining to the basic nuances of the research and how to go about carrying out the same. An ideal environment, mentorship is necessary for inculcating interest for research.
Collapse
|
45
|
Shaheed R, Acharya S, Shukla S, Kesarwani M, Acharya N. Psychological aspects of COVID-19 vaccine in Indian population. Are we still hesitant? J Family Med Prim Care 2022; 11:4280-4285. [PMID: 36353009 PMCID: PMC9638551 DOI: 10.4103/jfmpc.jfmpc_2328_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/14/2022] Open
Abstract
During the Coronavirus disease-19 (COVID-19) pandemic, with channelization of misinformation in several platforms that people can access, the world has witnessed a unique infodemic throughout the globe. Some knowledge helped people to alleviate not only the stigma and anxiety but also inclined them to take appropriate COVID-19 behavior; whereas, the some acted opposite and buildup an aura of negative thoughts in the community regarding the prevention and control and the efforts toward effective vaccine uptake contributing to psychological disbeliefs which in turn leading to vaccine hesitancy. In India, current vaccination program for COVID-19 needs to be communicated to not only promote vaccine acceptance but to also counter rumors related to COVID-19. The WHO has recommended all the individual governments to highlight the vaccine objection spots and that the governments, educate, and implement social awareness on the vaccination with the help of local organizations so that large proportion are covered with this safe immune program. With the emergence of new variants COVID-19 infection can be severe. “Earlier people get vaccinated the earlier people are protected”. Taking these concerns, our study will throw some light for primary care physicians on COVID-19 vaccine-related psychological attributes and hesitancy and will present pragmatic approaches to deal with scenarios related to it during the pandemic.
Collapse
|
46
|
Pandey G, Acharya N, Bhatt A. Choriocarcinoma: A Review. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i64a35914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Here in his article, we will learn about choriocarcinoma, a highly malignant tumor arising from the chorionic epithelium. Among 3-5% of all patients with molar pregnancies develop choriocarcinoma. All the types of choriocarcinomas and their defining features are discussed below in a view to you to understand better the basic pathogenesis, histology, etiological factors involved. The patient may present with persistent ill-health, irregular vaginal bleeding, continued amenorrhea, and when it is metastasized, it forms lesions which present in the lung as cough, breathlessness, hemoptysis whereas in the vagina as irregular and at times as brisk hemorrhage. It can also have lesions in the cerebral region presenting as headache, convulsions, paralysis. Signs include pallor of varying degrees, and in all, the patient looks ill. Various investigations necessary to identify this disease are chest x-ray, pelvic sonography, diagnostic uterine curettage, etc. also, excisional biopsy, the ratio of HCG levels, CT scan, ultrasonography, chest X-ray can also be done. We also talked about staging in the forthcoming article for gestational trophoblastic tumors. Management of the same has also been discussed below to treat the disease better and cure many patients. It can be preventive as well as curative. Here we have talked about treatment modalities for low-risk and high-risk patients. Also, add treatment for those resistant to the drugs used for low-risk and high-risk patients. Finally, prophylactic chemotherapy and follow-ups are given.
Collapse
|
47
|
Naik S, Mohammad S, Acharya S, Acharya N, Varma A. Chemotherapy Induced Secondary Spontaneous Pneumothorax in a Female with Endometrial Cancer- A Case Report. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i62b35168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Endometrial cancer is one of the leading causes of death in post- menopausal women. It has significant impact on mortality and morbidity of women in the post-menopausal age group often requiring Hysterectomy along with Chemotherapy. Chemotherapy can be used to treat endometrial cancer with hematogenous metastases. Chemotherapy induced secondary pneumothorax is a rare complication. We present a case of a 68-year-old female patient with endometrial cancer who had pulmonary metastasis and was subjected to carboplatin, paclitaxel-based chemotherapy. During the fourth cycle she developed tension pneumothorax. This case highlights the importance of knowledge of life-threatening complications of chemotherapy regimens, so that the treating of physician/oncologists are ready to tackle these anticipated conditions.
Collapse
|
48
|
Acharya N, Mohammad S, Mohammad S, Acharya S, Shukla S. Neutrophil-lymphocyte Ratio as a Bio- Inflammatory Prognostic Marker of Fetomaternal Outcomes of Preeclampsia: A Narrative Review. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i62a35142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Preeclampsia & its related problems have potential contribution to maternal mortality & morbidity. Early diagnosis & appropriate management of preeclampsia can prevent antenatal, intranatal & postnatal complications associated with preeclampsia. The neutrophil to lymphocyte ratio (NLR) which is derived from a complete blood count & dedifferentiation, is a straightforward inflammatory index (1). Pre-existing studies have shown that NLR is indicator of Preeclampsia.
Objective of this Narrative Review: In this we summarized the evidence regarding the clinical utility of NLR in preeclampsia & its related complications.
Methods: A comprehensive systematic search from PubMed, Embase, Cochrane Library, VIP database for relevant literature. Sensitivity, specificity & other measures of accuracy of NLR for the diagnosis of PE were pooled.
Collapse
|
49
|
Tiwari M, Acharya N, Shukla S, Mahakarkar M. Comparative Evaluation for the Efficacy of Collecting Sample by using Vaginal Atrophy Screening Combistick (VAS Combistick) as against the Traditional Method of Collecting Sample for Screening of Vaginal Atrophy in Perimenopausal Women. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i60b35050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Genitals and sexuality is an essential element of healthy and happily aging perimenopausal women with their partners. Vaginal atrophy (VA) of menopause is a condition associated to physiological, histological and anatomical changes noticed in the genital and urinary tracts in peri and postmenopausal women. Vaginal atrophy is the sequel of the decrease levels of estrogens in plasma, which are symptoms of menopause.
Objectives: 1. To evaluate the baseline data for vaginal maturation index (VMI) & pH in perimenopausal women. 2. To evaluate and compare the method of collecting sample by using VAS combistick & traditional method. 3. To evaluate and compare the accuracy of VMI score & pH using VAS combistick & traditional method. 4. To evaluate and compare the feasibility & acceptability using survey based analysis in VAS combistick method and traditional method.
Methodology: This will be an interventional-cross sectional comparative study. This study will include women who will come to Acharya Vinobha Bhave Rural Hospital (Obstetric and Gynaecology) OPD with at least one symptoms of vaginal atrophy. These women will take self sampling by using VAS combistick will be included in ‘sampling A’ (self sampling group) while, samples of the same group of patients taken by the traditional method will be included in ‘sampling B’ (clinician sampling group).
Results: In this study we have hypothesized that vaginal sampling by vaginal atrophy screening (VAS) combistick may be better when compared to traditional method of sampling for screening of vaginal atrophy in terms of adequacy, feasibility and acceptability.
Conclusion: VAS combistick may be considered as an alternative and better examining strategy which may give a reproducible and equivalent result to screening of vaginal atrophy in comparison to that of traditional sampling methods.
Collapse
|
50
|
Acharya N, Singh P, Singh M, Sinha P. Oxytocin Regimens for Labour Augmentation and Its Effect on Perinatal Outcomes: A Narrative Review. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i60a34533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: The issue of childbirth, stimulation of labor is very important for successful childbirth and the birth of healthy babies. Obstetricians play main role in providing and rising Maternal and Child Health (MCH) care facilities. One amongst the goal of MCH care is safe delivery with smart feto-maternal outcome. The hormone plays vital role to cut back rates of caesarean birth once used for management of dystocia. Interventions with oxytocin particularly at high doses would lead to adverse effects on fetal heart rate and uterine tachsystole which occurs due to reduction in blood flow during contraction in intervillousspaces. The purpose of use of oxytocin is for physiological birth and for successful delivery practices. For augmentation of labour hormone regimens are low-dose (1-3 milli units/min) and high dose (4-7 milli units/min). Studies have shown high-dose of hormone causes hyperstimulation to womb. It's been mentioned that there's decrease in induction to delivery time at meta-analysis.
Augmentation of labour is that the method of accelerating the frequency of contractions to facilitate a labour. The principal methodology for achieving augmentation of labour varies in the use and approach. Oxytocin is widely used for each induction and augmentation of labour. Interventions with oxytocin particularly at high doses would lead to adverse effects on fetal heart rate and uterine tachsystole which occurs due to reduction in blood flow during contraction in intervillous spaces. The purpose of use of oxytocin is for physiological birth and for successful delivery practices. These results reinforce the need to reflect on a change in care during delivery. Thus,this will help health care professional for better understanding on use and its effect during labour which will help in proper decision making for augmentation of labour.
Collapse
|