Activity

To compare between oral diclofenac potassium alone versus a combination of it with hyoscine-

-butyl bromide (HBB) in reduction of pain in women undergoing office hysteroscopy.

Randomized, double-blind controlled trial.

Kasralainy hospital (atertiary hospital).

Sixty-Four patients undergoing office hysteroscopy were randomly divided into 2 groups (study group and placebo group) in the ratio of 11. Group 1 (study group = 32 participants) received two oral HBB tablets and one tablet of diclofenac potassium and group 2 (placebo group = 32 participants) received two oral placebo tablet similar in size, structure and color to buscopan in addition to the diclofenac tablet. The patient was given the drugs 30-60min before the procedure.

There was statistically significant difference between the two groups in the pain score immediately during entry (

value = 0.001) and after 30min of the procedure (

value =  < 0.001). And there was a statistically significant difference as regards the side effects (gastric irritation) of the medications (

value = 0.04) between the women participating in the two groups.

The combination of diclofenac potassium and HBB helps a lot in decreasing the pain and discomfort during and after performing office hysteroscopy but with more gastric side effects.

The combination of diclofenac potassium and HBB helps a lot in decreasing the pain and discomfort during and after performing office hysteroscopy but with more gastric side effects.

To correlate the clinical, hormonal, biochemical and ultrasound parameters in adolescent patients with polycystic ovarian syndrome (PCOS) and to compare them with adult patients.

This was a prospective, correlational study. 50 adult (20-35years) and 50 adolescent patients (15-19years) who had features of PCOS (Rotterdam Criteria, 2003) were selected. The control group comprised of 50 women of same age in each group with normal parameters. Pelvic ultrasound was done in early follicular phase (3-5th day of menstrual cycle). Assessment of hormonal and biochemical parameters (LH/FSH ratio, free testosterone level, lipid profile and fasting glucose/insulin ratio) and grey-scale ultrasound was done.

No significant difference was observed in menstrual pattern in adults and adolescents with PCOS. The mean values of serum LH/FSH ratio and free testosterone were significantly higher in both adult and adolescent PCOS patients as compared to their controls (

 < 0.001). The mean value of serum insulin was significantly higher (

 < 0.001) with positive correlation (adult

= 0.655,

 < 0.01; adolescent

 = 0.451,

 < 0.01) of serum insulin with free testosterone. Hyperandrogenemia without hyperinsulinemia was found in 56% adolescent and 60% adult PCOS patients. 82% adolescent and 88% adult PCOS patients showed multiple follicles (> 5) on ultrasound. The ovarian morphology had positive correlation with serum LH and free testosterone. The mean ovarian volume was significantly higher in adult (10.48 ± 4.38 vs. 4.17 ± 0.91) and adolescent (11.08 ± 5.82 vs. 4.23 ± 0.89) PCOS patients, when compared with controls, respectively.

No statistically significant difference was noted in PCOS between adults and adolescents.

No statistically significant difference was noted in PCOS between adults and adolescents.

To evaluate the resident learning curve, demographic and comparative analysis of total laparoscopic hysterectomy.

This retrospective observational study was conducted in a high-volume resident training setup.

Tertiary care center is used in the study.

Eight hundred and one total laparoscopic hysterectomy patients operated by the residents between July 2013 and June 2019 were evaluated with respect to the learning curve, duplication of the steps, the results in terms of intra- and postoperative complications and the time taken for the surgery. Surgeries were assigned as per the institutional inclusion criteria for the residents. The fellowship program enrolled six residents per year for training period of 1year. The residents initially performed ten simple cases under the supervision of the director followed by ten cases which were performed independently, and based on their learning curve, they then performed advanced cases independently.

TLH was successfully performed in all women by surgical residents in training. The surgical time was 61-120min in majority (49.3%). 2.99% had intra-operative complications while 7.61% had postoperative complications which were identified and managed. Selleck Saracatinib All women recovered uneventfully.

Dedicated teaching staff, uniform surgical protocols and high-volume centers contribute to the safety of TLH.

Dedicated teaching staff, uniform surgical protocols and high-volume centers contribute to the safety of TLH.

Early detection of adverse pregnancy outcomes is an important topic in prenatal care. This study aimed to evaluate the association between maternal serum markers and pregnancy outcomes.

This hospital-based cohort study was performed according to the national Down syndrome screening protocol on 2923 eligible pregnant women. Pregnancies were classified into three groups of based on each biomarker. Theparticipantswere followed up until delivery, and the pregnancy outcomes were identified by hospital discharge records.

High levels of free BHCG were significantly associated with an increased risk of preterm birth (

 = -0.31, SE = 0.158, OR = 0.730;

= 0.046). Based on multivariate analysis the high levels of MSAFP had a direct relationship with premature birth (

= -0.84, SE = 0.361, OR = 0.431,

= 0.020), gestational hypertension (

= -0.59, SE = 0.354, OR = 0.549.

= 0.091), IUGR (

= -1.46, SE = 0.433, OR = 0.231,

= 0.001), and fetal death (

= -1.50, SE = 0.533, OR = 0.223,

= 0.005). Furthermore, an increase in the levels of Inhibin-A could more likely lead to gestational hypertension (

= -0.63, SE = 0.235, OR = 0.533).

According to the result, maternal biomarkers, especially MSAFP, can be beneficial in identifying high-risk cases, in addition to examining the possibility of Down syndrome, facilitating achievement of the desired pregnancy outcomes.

According to the result, maternal biomarkers, especially MSAFP, can be beneficial in identifying high-risk cases, in addition to examining the possibility of Down syndrome, facilitating achievement of the desired pregnancy outcomes.

Antenatal diagnosis of placenta accreta spectrum (PAS) can ensure multidisciplinary management at center of excellence which can reduce maternal and fetal complications. This can be established by a scoring system which provides a standardized criterion for the diagnosis and management. The objective of our study was to assess the placenta accreta index (PAI) and its individual parameters for diagnosis of PAS in high-risk patients.

A prospective study was conducted on 71 pregnant women with placenta previa and previous cesarean section. After informed consent, history was taken and ultrasonography was used to calculate the PAI for each patient. Definitive diagnosis was made clinically during cesarean section or by histopathology for those requiring hysterectomy. The data were evaluated using the latest version of Statistical Package for the Social Sciences software.

All ultrasound parameters of placenta accreta index were statistically significant for predicting PAS (

value < 0.001). ROC curve with AUC of 0.87 95% CI of 0.77-0.94 showed that a score of 4.75 was the best cutoff value to diagnose PAS. Out of the 30 patients found to have placental invasion, 22 had a PAI score of more than 4.75. The score was found to have a sensitivity of 73.3%, specificity 95.1%, positive predictive value 91.7%, negative predictive value 83% and diagnostic accuracy 85.9%.

Women with placenta previa and history of previous CS should undergo screening by PAI, and a cutoff value of ≥ 4.75 should be viewed with high index of suspicion for the presence of PAS.

Women with placenta previa and history of previous CS should undergo screening by PAI, and a cutoff value of ≥ 4.75 should be viewed with high index of suspicion for the presence of PAS.

Gynecological cancers are common neoplasms in clinical settings with a high impact on the economy of communities. The medical literature is an essential resource to guide clinical decision-making, and misconduct in researches undermines the credibility and integrity of research in general. We aimed to evaluate the quality of Cochrane gynecological cancers reviews and their understudies RCTS among the different biases dimensions.

This cross-sectional analytical study was performed on 118 systematic reviews published by the Cochrane gynecological cancers Group up to June 2021. The risk of bias was assessed in each Cochrane survey using the Joanna Bridges Institute (JBI) critical assessment tool consisting of 11 questions. The JBI checklist for systematic reviews and research syntheses is available at https//jbi.global/critical-appraisal-tools. After a systematic critical evaluation of the reviews and meta-analysis, we extracted a different bias from all of their understudied RCTs examined in these systematierial available at 10.1007/s13224-022-01655-6.

The online version contains supplementary material available at 10.1007/s13224-022-01655-6.

The risk factors for ectopic pregnancy are on the rise. Despite the progress (availability of serum

hCG, USG and MRI), there are diagnostic and therapeutic challenges in the management. Up to 50% of ectopic pregnancies go undetected. Furthermore, cases seen as emergency with hemodynamic instability need urgent intervention with simultaneous arrangement of transport, blood transfusion and at times multidisciplinary team involvement. This is more challenging in a setting where resources are limited.

To evaluate the outcome of women presenting with uncommon ectopic pregnancies as life-threatening emergency. Challenges encountered in diagnosis, pre-operative evaluation, decision for surgery and the procedure are presented.

This is a series of twelve cases of uncommon ectopic pregnancies belonging to eight different types. These were managed under the first author during the period 2001 to 2019. Subjects were analyzed retrospectively.

Diagnostic dilemma was faced in majority of the cases even with the use of ultrasonography. All the conceptions were spontaneous. Emergency surgical interventions were made on the basis of clinical evaluation. Five cases presented with massive hemoperitoneum. Blood transfusion was needed in nine cases. There was no mortality. One woman (case 4), with abdominal pregnancy, went home with a live baby, after the second laparotomy.

Uncommon ectopic pregnancies are life-threatening conditions. Clinical acumen and an alert mind are of superior value in diagnosis. Investigations are supportive. Early diagnosis and intervention are lifesaving.

Uncommon ectopic pregnancies are life-threatening conditions. Clinical acumen and an alert mind are of superior value in diagnosis. Investigations are supportive. Early diagnosis and intervention are lifesaving.