Current Practices for Treatment of Uterine Fibroids

The treatment of uterine fibroids depends on symptoms of patients, size of the fibroid, desire for future pregnancy, and preference of the treating gynecologist. The present study was undertaken to compare treatment preferences in women desirous and nondesirous of pregnancy by an experienced gynecologist in symptomatic uterine fibroids. Newer medical or minimally invasive treatment modalities are increasingly being used for the treatment of fibroids. However, conventional surgical treatment such as myomectomy and hysterectomy are still preferred by gynecologists.

Preventable risk factors for osteoporosis in postmenopausal women: Systematic review and meta-analysis

Background and Objective:

The osteoporosis is becoming public health problem in India and neighboring Asian countries. As the environmental risk factors for osteoporosis in women are similar in these countries, the study was planned to compare risk factors for osteoporosis in postmenopausal women in Asian countries.

Materials and Methods:

A systematic literature search was done in August 2015. The period included for this search was from January 2005 to December 2014. The search was done for India and neighboring countries. The final analysis was done on the studies from India, China, Korea, and Japan. The literature search was done in PubMed and Google Scholar using key words, “Osteoporosis” and “Menopause” and “Risk factor.”

Results:

The pooled prevalence for the osteoporosis in postmenopausal women is 41%, but in India alone, it is 53%. Various risk factors are studied in China as compared to other countries. Adequate calcium intake and various exercises were found to be useful modifiable factors. Other factors like age, height, and postmenopausal status cannot be modified.

Conclusion:

Adequate calcium and Vitamin D intake and combinations of various exercises can be considered as preventive measures for osteoporosis in postmenopausal women.

Overview of research studies on osteoporosis in menopausal women since the last decade

Purpose/Introduction:

Osteoporosis is a multifactorial and slowly emerging global health problem. The lifetime risk of dying from hip fracture is same as that from breast cancer. One out of three women between age group of 50-60 years in India suffers from osteoporosis. Indian women have an early age of onset of osteoporosis as compared to western counterparts. There is need for early diagnosis, identification of high-risk groups and prevention and treatment of osteoporosis in the Indian context. The aim of this study was to review the literature published in last decade and compare the research in India with that in rest of the world.

Materials and Methods:

Research articles with key words menopausal, osteoporosis and bone mineral density were searched in Pubmed from January 2004 to December 2013. Articles were categorized according to year, place and objective of the studies.

Results:

In India more articles were published in year 2010-11 (53.3%), while outside the country a uniform distribution of studies was observed throughout the last decade. Objective of research was screening and diagnosis (36.7%) and risk factor identification (40%) in most of the Indian studies as compared to rest of the world. Research publications on prevention and treatment of osteoporosis are less in India (20%).

Conclusion:

Research focusing on diagnosis, prognosis, prevention and treatment are needed in India.

Low dose mifepristone in medical management of uterine leiomyoma - an experience from a tertiary care hospital from north India

BACKGROUND & OBJECTIVES

Uterine myoma is a common indication for hysterectomy in India. An effective medical treatment option may reduce hysterectomy associated morbidity. This study was undertaken to evaluate efficacy and safety of low dose mifepristone in medical management of myoma and to compare two doses - 10 vs. 25 mg/day.

METHODS

In this randomized clinical trial, women with symptomatic myoma or myoma>5 cm were included. Uterine size >20 wk, fibroids >15 cm were excluded. Pictorial blood loss assessment chart (PBAC) score was used to assess menstrual-blood-loss and visual analog scale (VAS) for other symptoms. Haemogram, liver function test, ultrasound with doppler and endometrial histology was performed. Patients were randomized and were given oral mifepristone as 25 mg/day in group 1 and 10 mg/day in group 2 for 3 months. Patients were followed at 1, 3 and 6 months.

RESULTS

Seventy patients in group 1 and 73 in group 2 completed treatment. Mean PBAC score reduced from 253 to 19.8 and from 289.2 to 10.4 at 1 and 3 months in groups 1 and 2, respectively. At 3 months, 67 of 70 (95.7%) patients of group 1 and 66 of 73 (90.4%) of group 2 developed amenorrhoea which reverted after median 34 (range 4-85) days. Mean myoma volume decreased by 35.7 per cent (from 176.8 to 113.7 cm 3 ) and 22.5 per cent (from 147.6 to 114.4 cm 3 ) at 3 months in groups 1 and 2, respectively. Side effects seen were leg cramps in 7 of 70 (10%) and 5 of 73 (6.8%) and hot-flushes in 5 of 70 (7.1%) and 5 of 73 (6.8%) in groups 1 and 2, respectively. Repeat endometrial-histopathology did not reveal any complex hyperplasia or atypia in either group.

INTERPRETATION & CONCLUSIONS

Mifepristone (10 and 25 mg) caused symptomatic relief with more than 90 per cent reduction in menstrual blood. Greater myoma size reduction occured with 25 mg dose. Amenorrhoea was developed in 90-95 per cent patients which was reversible. It can be a reasonable choice for management of uterine leiomyoma as it is administered orally, cost-effective and has mild side effects.

A comparative study of oral single dose of metronidazole, tinidazole, secnidazole and ornidazole in bacterial vaginosis

Objective:

To compare the cure rates of oral single dose of metronidazole (2 g), tinidazole (2 g), secnidazole (2 g), and ornidazole (1.5 g) in cases of bacterial vaginosis.

Materials and Methods:

This was a prospective, comparative, randomized clinical trial on 344 Indian women (86 women in each group) who attended a gynecology outpatient department with complaint of abnormal vaginal discharge or who had abnormal vaginal discharge on Gynecological examination but they did not complaint of it. For diagnosis and cure rate of bacterial vaginosis, Amsel's criteria were used. Statistical analysis was done by Chi-square test of proportions. The cure rate was compared considering metronidazole cure rate as gold standard.

Results:

At 1 week, the cure rate of tinidazole and ornidazole was 100% and at 4 weeks, it was 97.7% for both drugs (P<0.001). Secnidazole had cure rate of 80.2% at 4 weeks (P=NS). Metronidazole showed a cure rate of 77.9% at 4 weeks, which is the lowest of all four drugs.

Conclusion:

Tinidazole and ornidazole have better cure rate as compared to metronidazole in cases of bacterial vaginosis.

Utility of pH test & Whiff test in syndromic approach of abnormal vaginal discharge

BACKGROUND & OBJECTIVE

In India, National AIDS Control Organization (NACO) introduced syndromic approach to treat patients with abnormal vaginal discharge without a need for laboratory tests. Simple tools like pH test and Whiff test can be done without high expertise, microscope and even speculum. This can improve diagnostic value of syndromic approach of abnormal vaginal discharge. The present study was conducted to evaluate sensitivity and specificity of pH test and Whiff test in diagnosis of abnormal vaginal discharge, considering microscopic diagnosis as gold standard.

METHODS

This prospective hospital-based study included 564 women with abnormal vaginal discharge. All women were subjected to gynaecological examination, pH test and Whiff test. The findings were compared with microscopic examination. Statistical analysis was done by calculating proportions, percentage, sensitivity and specificity.

RESULTS

Vaginitis was diagnosed in 301 (53.37%) women. Bacterial vaginosis (BV) was the commonest type of vaginitis (39.01%). Cervical erosion was the second most common cause (17.91%) and physiological discharge was the third (14.36%). pH >or= 4.5 and positive Whiff test had sensitivity of 94.09 per cent and specificity 87.5 per cent in diagnosing BV. Similarly pH < 4.5 and positive or negative Whiff test had sensitivity of 83.72 per cent in diagnosing candidiasis.

INTERPRETATION & CONCLUSION

pH test and Whiff test can improve diagnostic value of speculum examination where microscope facilities are not available.

Aetiology & risk factors of recurrent vaginitis & its association with various contraceptive methods

BACKGROUND & OBJECTIVES

Women who do not seek treatment for recurrent vaginitis have risk to acquire other sexually transmitted infections. Besides proper antibiotic treatment, male condom acts as a barrier to various infections. Present study was done to assess type of vaginitis, its association with various contraceptive methods and need of male condom in prevention of recurrent vaginitis.

METHODS

Prospective hospital based cohort study with a total of 400 women with recurrent vaginitis was done. Wet mount and Gram's staining examination were done to diagnose type of vaginitis. After treatment, proper counselling about good hygiene and use of male condom for 4 months in addition to their contraceptive method was advised. Patients were called after four months or when they developed symptoms of vaginitis.

RESULTS

Tubal ligation (38.8%) and non contraceptives (34.0%) were the most common methods used by recurrent vaginitis patients. Bacterial vaginosis (BV, 53.8%) and mixed infection (36.8%) were commonly seen infections. BV was not observed in OC pill users. Overall post-treatment cure was 89.1 per cent. INTERPRETATION CONCLUSIONS: Our findings showed that male condom use provided protection against recurrent vaginitis and its use should be promoted with other contraceptive methods in high risk cases. Female condom may be another option.

Metabolic properties of lactobacilli in women experiencing recurring episodes of bacterial vaginosis with vaginal pH >or= 5

While 60% of women experiencing recurring episodes of bacterial vaginosis (BV) with vaginal pH >or= 5 are depleted of resident probiotic lactobacilli, the remainder carry one or more strains of lactobacilli. Their ability to make D-lactic acid is, however, low (3.94 +/- 0.72 mM/L) compared to the D-lactic acid produced by strains from healthy vagina with vaginal pH approximately 4 (8.04 +/- 1.07 mM/L) culture supernatant of 0.5 McFarland concentration (P < 0.001).