Gita Radhakrishnan

Comparison of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labor

To compare the efficacy and adverse effects of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labor (AMTSL).

Testicular Fine Needle Aspiration Cytology for the Diagnosis of Azoospermia and Oligospermia

OBJECTIVE To evaluate qualitative and quantitative cytologic features on testicular fine needle aspiration biopsy in the diagnosis of azoospermia and oligospermia and to correlate cytologic and histologic diagnoses. STUDY DESIGN In this prospective study, 50 infertile males selected from the infertility clinic of Guru Tegh Bahadur Hospital were studied. Fine needle aspiration cytology (FNAC) smears from both testes of 27 azoospermic and 23 oligospermic patients (sperm count < 10 million per milliliter) were stained with May-Grünwald-Giemsa and Papanicolaou stain. Differential counting of 500 spermatogenic cells was done, and the number of Sertoli cells per 500 germ cells was determined for calculating the spermatic index and Sertoli cell index, respectively. FNAC and testicular biopsy were performed under local anesthesia as a minor surgical procedure. RESULTS Six groups were identified on FNAC smears from azoospermic patients: I. normal spermatogenesis (8), II. hypospermatogenesis (2), III. maturation arrest (2), IV. Sertoli cells only (6), V. atrophic pattern (7), and VI. Leydig cell predominance (2). In oligospermic patients two groups were identified: I. those with normal spermatogenesis (4), and II. those with subnormal spermatogenesis (19). Correlation with histopathologic examination was seen in 81.5% azoospermic and 65.2% oligospermic patients. CONCLUSION Qualitative and quantitative evaluation of testicular FNAC provides useful information on both azoospermic and oligospermic patients. FNAC performed under local anesthesia is an acceptable outpatient procedure that consistently yields sufficient diagnostic material in all patients.

Role of newer methods of diagnosing genital tuberculosis in infertile women.

Genital tuberculosis is an important under-diagnosed factor of infertility. A vast majority of cases are asymptomatic and diagnosing them will help in treating such patients. We conducted a retrospective study in a tertiary care hospital of Delhi with an aim to compare different methods i.e., histopathological examination (HPE), acid-fast bacilli (AFB) smears, Lowenstein-Jensen (LJ) culture, BACTEC culture and polymerase chain reaction deoxyribonucleic acid (PCR-DNA) for diagnosing endometrial tuberculosis in infertile women. The data from 546 samples of endometrial biopsy histopathology, AFB smears and LJ culture was collected and then analyzed. Of these, HPE for tuberculosis was positive in 13, LJ culture in 10, AFB smear was positive in one case. BACTEC and PCR-DNA were feasible for 90 patients and PCR-DNA was positive in 20 and BACTEC in eight patients. Out of 20 patients with PCR positive results, 15 were only PCR positive and were subjected to hyster-laparoscopy and five had evidence of tuberculosis. Thus, none of the available tests can pick up all cases of genital tuberculosis, but conventional methods i.e., histopathology and LJ culture still has an important role in the diagnosis of endometrial tuberculosis in government setups where BACTEC and PCR are not performed routinely due to lack of resources.

To Evaluate the Efficacy of Combination Antioxidant Therapy on Oxidative Stress Parameters in Seminal Plasma in the Male Infertility

INTRODUCTION Infertility is defined as inability to conceive after 1 year of unprotected intercourse and it affects 7% of male population and 8-10% of couples. According to estimates WHO, 13-19 million couples in India are infertile. Oxidative stress is the causative factor in 25% of infertile males. AIM To study the efficacy of antioxidant therapy on oxidative stress parameters in seminal plasma of infertile male. MATERIALS AND METHODS Forty patients of male infertility were enrolled in study after two abnormal semen analyses reports at 2-3 weeks interval, of oligozoospermia and/or asthenozoospermia, as per WHO guide line 1999. First semen sample was collected at a time of enrollment of study and second semen sample was collected three months after combined antioxidant therapy. Semen samples from the infertile male (the second confirmatory sample of oligoasthenozoospermia) were taken and after liquefaction semen sample were utilized for various analyses, 0.5 ml of sample for standard semen analysis, 1.2 ml sample for separation of seminal plasma to evaluate Oxidative stress (OS) parameters like Malondialdehyde (MDA), Protein Carbonyl (PC) and antioxidant capacity by Glutathione (GSH). We followed the patient for three months after completion of the treatment. RESULTS Semen parameters - Out of 40 patients recruited in the study group 7 patients had only oligospermia (1 to 20 million/ml) and 31 patients had oligoasthenozoospermia (motility range 0-50%) and 2 patients had oligoasthenoteratozoospermia. There was no patient with asthenospermia alone as abnormal semen parameters. After the three months treatment with combined antioxidants the semen parameters like count (mean SD = -1.70±1.44) and motility (mean +SD= -9.56±9.05) were significantly increased (p-value=0.000). Oxidative Stress Assessment - The level of MDA which is a marker of oxidative stress was significantly lower after the three months therapy of antioxidants (p-value=0.002) whereas another marker which is denoted by PC was also lower after the treatment but not statistically significant (p-value=0.584). The level of antioxidants GSH also significantly increased after the treatment (p-value=0.000). After the treatment out of 40, five patients conceived (16.7%). CONCLUSION As we have seen through this study antioxidant dramatically reduced the oxidative stress markers and enhancing the antioxidant enzymes. They should be used on routine basis in case of male infertility.

Fallopian Tube Herniation: An Unusual Complication of Surgical Drain

Background. Surgical drains have been used since time immemorial, but their use is not without complications. By presenting this case we aim to describe an uncommon complication of herniation of fallopian tube following the simple procedure of surgical drain removal. Case Presentation. This case describes a 23-year G2P1L1 who underwent an emergency cesarean section for obstructed labor with intraperitoneal drain insertion. The patient had an uneventful postoperative period, drain was removed on day 4, and she was discharged. She presented on day 8 with the complaint of soakage of drain site dressing. On examination an edematous, tubular structure with early sign of necrosis was seen coming out of drain site and a provisional diagnosis of appendix herniation was made. On emergency laparotomy fallopian tube was seen coming out through the drain site and salphingectomy was done. Conclusion. Drains are not a substitute for good surgical technique. Although herniation of intestine, omentum, appendix, gall bladder, and ovary have been reported, we could not find any case of fallopian tube herniation in the literature searched by us.

Detection of endometrial nerve fibres – a novel technique to diagnose endometriosis

Purpose To detect the presence of nerve fibres by immunohistochemical staining method using anti-PGP9.5 antibody in the eutopic and ectopic endometrium of patients with endometriosis. Methods Patients presenting with pelvic pain and/or infertility were subjected to premenstrual endometrial biopsy during laparoscopy. Thirty patients diagnosed with endometriosis formed the study group and 30 patients with no histological/laparoscopic evidence of endometriosis formed the control group. Endometrial biopsy tissue of all the 60 patients along with biopsy from endometriomas and peritoneal implants of confirmed cases of endometriosis (n = 30) were subjected to immunohistochemical staining to detect nerve fibres. Results Neural elements were observed in the eutopic endometrium of 24/30 cases (80%) in the study group and in none of the controls (p<0.01), while the sections from endometriomas and peritoneal implants demonstrated nerve fibres in all the 30 cases of confirmed endometriosis. The nerve fibres in the endometrial tissue were heterogeneously distributed and were sparse in number with an observed density of <1 nerve fibre/mm2 while they were present in large numbers in the ectopic endometrium (10 ± 3 nerve fibre/mm2). Also, the presence of nerve fibres in the eutopic and ectopic endometrium positively correlated with the intensity of pain (p<0.001). Conclusion Eutopic endometrium exhibited positivity for nerve fibres in 24 out of 30 cases of proven endometriosis, though the density of nerve fibres was low as compared to that reported in a few studies.

Growing teratoma syndrome: A rare complication of germ cell tumors

and osteoblasts in case of bony lesions. In metastatic carcinoma, clusters of cells in acinar or glandular pattern with features of malignancy are seen, whereas osteoblasts can be differentiated by the absence of typical clear cytoplasm or perinuclear halo as seen in plasmacytomas. Knowing the radiosensitivity of the tumor, the patient was treated with radiation, 30 Gy in 10#(fractions), 3 Gy/#(fraction) over a period of 5 weeks. Eight months posttreatment, he was locoregionally controlled.

Comparison of diagnostic accuracy of PCR and BACTEC with Lowenstein–Jensen culture and histopathology in the diagnosis of female genital tuberculosis in three subsets of gynaecological conditions

abstract The prevalence of female genital tuberculosis (FGTB) in India has been estimated to be about 19%. Despite an array of diagnostic tests being available, the goal of early diagnosis and treatment remains elusive. The present study was planned to identify better diagnostic tests for early detection of FGTB and also to compare their diagnostic accuracy with the existing standard diagnostic tests in three subsets of gynaecological conditions (infertility, menstrual abnormalities and pelvic inflammatory disease). Total of 90 patients recruited in three groups of 30 each underwent endometrial sampling. The biopsied tissue was sent for histopathological examination, AFB smear examination, culture in Lowenstein-Jensen (L–J) and BACTEC 460 TB culture media and nested PCR testing. BACTEC had a sensitivity of 40% with a specificity of 90% while PCR showed a sensitivity and specificity of 62.5% and 54%, respectively, as compared to conventional methods (L–J culture or histopathology). Addition of PCR to BACTEC improved sensitivity from 40% to 52%. Hence, we conclude that combination of BACTEC and PCR had an improved detection as compared to conventional tests with an advantage of early results.

Comparison of metabolic and endocrinal parameters in obese and nonobese women of polycystic ovarian syndrome with normal controls

Aim: The aim of this study is to compare the metabolic and endocrinal parameters between obese and nonobese polycystic ovarian syndrome (PCOS) women with normal controls. Materials and Methods: The study was a cross-sectional comparative study. One-hundred PCOS women were randomized into two groups: Group I obese (n = 50) and Group II nonobese (body mass index [BMI] cutoff <23 kg/m 2 ). Fifty non-PCOS normal weight women formed the control Group III. Metabolic parameters (lipid profile, blood sugar profile, and serum insulin) and endocrinal parameters (serum luteinizing hormone [LH], follicle-stimulating hormone, and testosterone) were compared between the three groups. Results: Mean age of all the groups was comparable. A significantly higher waist circumference was seen in Group I; however, waist-hip ratio (WHR) was comparable between obese and nonobese PCOS groups. Between Groups I and II, mean fasting blood sugar, mean values of impaired glucose tolerance (IGT), and clinical hyperandrogenism were statistically comparable. Degree of insulin resistance (IR) in Group I versus Group II (44% vs. 36%) and of metabolic syndrome in Group I (20%) versus Group II (8%) was statistically comparable. Degree of hypertension (P = 0.001), IGT (P = 0.001), and dyslipidemia were higher in nonobese PCOS group versus normal group. Mean values of serum LH, serum fasting insulin, and serum testosterone were significantly different in nonobese PCOS women when compared with normal. Prevalence of IR (36% vs. 8%; P < 0.01) and metabolic syndrome was significantly higher in nonobese PCOS than normal controls. Conclusion: PCOS per se has evolved as a risk factor for endocrinal and metabolic derangements irrespective of the BMI status. Prevalence of IR and metabolic syndrome is high in nonobese PCOS as compared to normal controls, risks being as high as that in obese PCOS.

Assessment of Redox Imbalance in Idiopathic Fetal Growth Restricted Pregnancies

Background: Fetal growth restriction (FGR) is one of the most significant causes of perinatal morbidity and mortality. The known causes are poor maternal nutrition, hypertensive disorders complicating pregnancy, maternal medical disorders (multiple pregnancy, congenital fetal malformations), and lifestyle influences. However, in vast majority of cases, the cause still remains unknown. Recent studies have suggested the role of oxidative stress in the pathophysiology of FGR. The aim of this study was to evaluate non-enzymatic oxidative stress biomarkers in maternal and cord blood of idiopathic FGR cases. Methods: A total of 100 women subjects aged 18 to 35 years, who fulfilled the recruitment criteria, were enrolled in the study after taking an informed written consent. Non-enzymatic oxidative stress was measured by the quantification of 8-hydroxy-2-deoxy-guanosine (8-OHdG), malondialdehyde (MDA), protein carbonyl, reduced glutathione (GSH) and ferric reducing ability of plasma (FRAP) in maternal and cord blood samples of FGR pregnancies of idiopathic origin and compared with those of normal healthy mother-infant pairs. Results: The levels of 8-OHdG, MDA and protein carbonyl were significantly higher in the ‘idiopathic’ FGR group as compared to the controls, where as the GSH and FRAP were significantly lower. Conclusion: Increased oxidative stress has been found significantly associated with the increased risk of developing idiopathic FGR.