Deeksha Pandey

Awareness and Attitude towards Human Papillomavirus (HPV) Vaccine among Medical Students in a Premier Medical School in India

Background As preventing cancer with the help of a vaccine is a comparatively new concept, awareness and education about it will have important implication in the implementation of this strategy. Materials and Methods Present explorative questionnaire based survey included 618 MBBS students for final analysis. Results Majority of participants (89.6%) were well aware of the preventable nature of cervical cancer. Most of them (89.2%) knew that necessary factor responsible for cervical cancer is infection with high risk HPV. Awareness regarding the availability of vaccine against cervical cancer was 75.6%. Females had a better awareness regarding availability of vaccine, target population for vaccination and about the catch up program. Overall acceptance of HPV vaccine among the population studied was 67.8%. Medical teaching had a definitive impact on the understanding of this important public health issue. Females seemed to be more ready to accept the vaccine and recommend it to others. For our study population the most common source of information was medical school teaching. Majority of participants agreed that the most important obstacle in implementation of HPV vaccination program in our country is inadequate information and 86.2% wanted to be educated by experts in this regard. Conclusion HPV vaccine for primary prevention of cervical cancer is a relatively new concept. Health professional will be able to play a pivotal role in popularizing this strategy.

Pattern Recognition to Prognosticate Endometrial Cancer: The Science Behind the Art of Office Hysteroscopy-A Retrospective Study.

Objective This study aimed to evaluate a specific glomerular pattern for prognostication of endometrial cancer (EC). Materials and Methods The office hysteroscopy’s picture and video of 4197 women were reviewed, 48 women who were suspected of type I EC were analyzed: 26 have glomerular pattern (group 1) and 22 without it (group 2). Results The histopathological grading after hysterectomy with glomerular pattern had grade 2 or grade 3 disease on final histology (n = 25; 96%). The sensitivity and specificity of this test were 84.6% and 81.8%, respectively, with a likelihood ratio of 4:6 in predicting and prognosticating those women who have high-grade tumor or invasive disease. Conclusions This hysteroscopic picture might be used as a novel marker for risk stratification of EC.

Awareness and Attitude towards Breastfeeding among Two Generations of Indian Women: A Comparative Study.

Introduction Present study was aimed to analyze the impact of education, employment and financial independence in breastfeeding practices among Indian women. Methodology Present explorative questionnaire based survey included 256 women (128 pairs) in the final analysis. A pair means – a) pregnant lady (in her third trimester) representing younger generation and b) her mother/mother in law representing the elder generation. Results We found that the overall awareness regarding ‘breast milk’ being the best food for baby was excellent (overall 97.3%; younger generation: 96.9%; elder generation: 97.7%). Overall knowledge regarding the correct technique (28.9% younger generation and 21.9% elder generation) and frequency of breastfeeding (20.3% of younger generation and 34.4% of elder generation) was very poor. Less than 60% (younger generation: 57.8%; elder generation: 58.6%) were aware that the only major contraindication for breastfeeding is a mother infected with human immunodeficiency virus (HIV). On comparing responses obtained from the two generations of women, difference was not statistically significant among most of the issues related to breastfeeding. With regards to the attitude, despite better awareness, only 94.5% women in younger generation and 89.1% women in elder generation were planning to give mother’s milk as the first feed to the newborn. Similarly, less than 75% of women were ready to breast-feed the newborn immediately after birth. This was contradictory to the fact that 86% of pregnant women were aware that the baby should be breast-fed within an hour of birth. Conclusion Awareness with regards to breastfeeding issues had not changed significantly with the educational progress of Indian women. Despite the good level of awareness in the society regarding breastfeeding, attitude to practice the same is lacking.

Feasibility and Compatibility of Minilaparotomy Hysterectomy in a Low-Resource Setting

Introduction Minilaparotomy hysterectomy (MLH) relies on the simplicity of the traditional open technique of abdominal hysterectomy, imparts cosmesis and faster recovery of laparoscopic hysterectomy yet avoids the long learning curve and cost of expensive setup and instrumentation associated with the minimally invasive approaches, namely, laparoscopy and robotics. In the present study, we tried to ascertain whether the results obtained with MLH can be compared to LAVH in terms of its feasibility, intraoperative variables, and complications. The null hypothesis was that both MLH and LAVH are comparable techniques; thus, where cost and surgeons experience are the confining issues, patients can be reassured that MLH gives comparable results. Materials and Methods This was a prospective observational study done over a period of two years at a university teaching hospital. A total of 65 patients were recruited, but only 52 (MLH: 27; LAVH: 25) could be included in final analysis. All surgeries were performed by one of the two gynecologists with almost equal surgical competence, and outcomes were compared. Results MLH is a feasible option for benign gynecological pathologies as none of the patients required increase in the initial incision (4–6 cm). MLH could be done for larger uteri (MLH: 501.30 ± 327.96 g versus LAVH: 216.60 ± 160.01 g; p < 0.001), in shorter duration (MLH: 115.00 ± 21.43 min versus LAVH 172.00 ± 27.91 min; p < 0.001), with comparable blood loss (MLH: 354.63 ±227.96 ml; LAVH: 402.40 ± 224.02 ml; p=0.334), without serious complications when compared to LAVH. Conclusion The technique of MLH should be mastered and encouraged to be used in low-resource setting to get results comparable to laparoscopic surgery. This trial is registered with NCT03548831.

Subclinical anal sphincter injuries following instrumental delivery-a physiological analysis: A pilot study

Introduction: Obstetric Anal Sphincter Injuries (OASIS) has been reported in up to 25% patients and occult OASIS has been reported in up to 1.2%. Instrumental delivery has been considered a risk factor for OASIS. Aim: To compare the anal sphincter functions as assessed by Anorectal Manometry (ARM) in asymptomatic patients following instrument delivery with those of patients who underwent Lower Segment Caesarian Section (LSCS) after six months of delivery. Materials and Methods: Seventeen women who had instrumental delivery and thirteen who underwent elective cesarean section were recruited. Evaluation included a detailed history and physical examination, administration of the Cleveland Clinic Questionnaire and ARM to record the basal pressure, squeeze pressure, anorectal sensation and balloon expulsion time. Categorical variables were compared using the Chi-square test. All calculations were done using the software SPSS 21.0. Results: We found statistically significant lower basal (34 ± 3.4 vs 60±2.3 mm hg, p<0.05) and squeeze pressures (56±4.1 vs 76±5.2 mm hg, p<0.05), and higher balloon expulsion time (58±2.9 s vs 19±1.8 seconds, p<0.05) in women with instrument delivery compared to LSCS. The rectal sensation was comparable in both the groups. Conclusion: Persistent subtle anal sphincter dysfunctions are common following instrument delivery compared to LSCS. The role of identifying these and preventing future incontinence in such women needs to be assessed in future studies.

Establishing patterns on hysteroscopy in abnormal uterine bleeding (AUB)

Introduction: Pattern recognition of various phases of normal endometrium and endometrial pathologies during hysteroscopy has many advantages. It would help to triage women with AUB, so as to be selective with biopsies and curettages. Recognition of normal variant or benign lesion would reduce burden to the pathologist by decreasing the number of unnecessary sampling. It will also decreases anxiety of the patient as the report/prognostication can be instant in many cases. Material and methods: This prospective, double blind, correlation study was carried out in the teaching hospital with a sample population of 70 women presenting with AUB who underwent hysteroscopy and endometrial sampling. We identified patterns of endometrium which can used to predict six endometrial pathologies which were later correlated with the final histological diagnosis. Results: There was good correlation between hysteroscopic patterns and histopathology report, 33% of starry sky appearance correlated with atrophic endometrium, 87% of tongue shaped projections correlated with endometrial polyp, 44.4% of pebble stone appearance correlated with myomatous polyp, 50% of polypoidal pattern correlated with endometrial hyperplasia. 100% correlation was seen in strawberry appearance, pattern for secretory endometrium and cerebroid appearance which was pattern designated to endometrial carcinoma. Conclusion: Hysteroscopic pattern recognition is a useful concept to triage women who require sampling for histopathological diagnosis.

Correlation between clinical presentation and urodynamic findings in women attending urogynecology clinic

Introduction: Urodynamic studies objectively observe lower urinary tract function and dysfunction so that an appropriate treatment can be planned. In the present study, we tried to evaluate the role of urodynamic studies in the final diagnosis and management plan in patients attending an urogynecology clinic. Materials and Methods: This observational study was conducted in an urogynecology clinic. 202 women were included. After detailed history, pelvic examination and introital sonography these women were subjected to urodynamic study. During the filling cystometry detrusor activity, first desire to void and bladder capacity was recorded. This was followed by urethral pressure measurements, when functional urethral length, maximum urethral closure pressure and stress urethral pressure profile was recorded. Results: Most prevalent complaint was mixed urinary incontinence (33.17%), followed by stress incontinence (31.68%) and urge incontinence (13.37%). According to the standard urodynamic definition 66.33% were normal in the population studied. None of the urodynamic parameters individually or in combination were found to be very useful for establishing a diagnosis. Conclusion: Establishment of the final diagnosis of urinary incontinence and planning of management should be based on detailed history, physical examination, bladder diaries, and careful interpretation of urodynamic data. Urodynamic study; however, doesn’t seem to be imperative to establish a diagnosis in uncomplicated cases where symptoms and signs are reliable and correlating.