Renu Misra

Genital tuberculosis in Indian infertility patients

Objectives: To analyze the clinical and laparoscopic features of 40 infertile women with genital tuberculosis. Materials and methods: This prospective clinical study was carried out at a tertiary care hospital from October 1, 2004, to August 30, 2006, with 150 infertile women in whom there was clinical suspicion of genital tuberculosis. All underwent diagnostic laparoscopy and biopsy for confirmation and other causes of infertility were excluded. Results: Among the 40 infertile women affected with genital tuberculosis there were cases of primary (n = 30) and secondary (n = 10) infertility; pelvic pain (n = 8); menorrhagia (n = 9); oligomenorrhea (n = 7); hypomenorrhea (n = 8); and primary (n = 2) and secondary (n = 2) amenorrhea. There were histories of pulmonary (n = 9) and abdominal tuberculosis (n = 6), ectopic pregnancy (n = 4), and antitubercular treatment (n = 10) in 10. There were cases of positive Mantoux test results (n = 2); endometrial aspiration showing tubercular endometritis (n = 10); positive acid‐fast bacillus culture results (n = 1); and positive polymerase chain reaction results (n = 9). Laparoscopic examination revealed abnormally dilated, tortuous, and blocked fallopian tubes (n = 13); peritubal and periovarian adhesions (n = 18); Fitz Hugh Curtis syndrome (n = 15); omental adhesions (n = 18); and bowel adhesions (n = 15). Hysteroscopy revealed flimsy intrauterine adhesions (n = 7). All patients were treated for tuberculosis and 13 were counseled for in‐vitro fertilization and embryo transfer or adoption. Conclusion: Genital tuberculosis is common in India and a combination of clinical and laparoscopic diagnoses, along with endometrial histopathologic studies, acid‐fast bacillus culture, and polymerase chain reaction assays provides the best available method for the diagnosis of genital tuberculosis in infertile women.

Metformin therapy in women with polycystic ovary syndrome.

To determine the clinical, biochemical, hormonal, and ultrasonographic effects of 6 months of metformin therapy in women with polycystic ovary syndrome (PCOS) and compare with pretherapy parameters.

LycoRed as an alternative to hormone replacement therapy in lowering serum lipids and oxidative stress markers: A randomized controlled clinical trial

Aim:  Menopause is a pro‐atherogenic state with a sharp rise in the incidence of coronary artery disease. This pilot study was designed as an equivalence randomized clinical trial to explore the potential of LycoRed (containing 2000 µg lycopene) as an alternative to hormone replacement therapy (HRT) for the prevention of coronary artery disease in postmenopausal women.

Evaluation of glyceryl trinitrate, misoprostol, and prostaglandin E2 gel for preinduction cervical ripening in term pregnancy

Aim: To compare the efficacy of glyceryl trinitrate (GTN), dinoprostone and misoprostol for preinduction cervical ripening in primigravida at term.

A unique congenital mullerian anomaly: Robert's uterus.

Roberts uterus or asymmetric septate uterus is an uncommon uterine mullerian anomaly first reported by Robert in 1970. It has two uterine cavities with one being blind causing menstrual retention. Till date only 17 such cases have been reported in literature. A unique congenital mullerian anomaly; asymmetric septate uterus with noncommunicating right sided hemicavity and haematometra a normal extrauterine morphology with right ovarian maldescent and stage III endometriosis was diagnosed on laparotomy. (excerpt)

Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding.

Objective: To compare the acceptability, efficacy, adverse effects, and user satisfaction of a levonorgestrel intrauterine system (LNG‐IUS) and transcervical resection of the endometrium (TCRE) for the treatment of dysfunctional uterine bleeding.

Uterine artery embolization versus laparoscopic occlusion of uterine vessels for management of symptomatic uterine fibroids

To evaluate the efficacy and complications of uterine artery embolization (UAE) versus laparoscopic occlusion of uterine vessels (LOUV) in the management of symptomatic fibroids.

A rare case of primary invasive carcinoma of vagina associated with irreducible third degree uterovaginal prolapse

Primary carcinoma of vagina accounts for less than 2% of all gynecological malignancies. We report a rare case of primary invasive carcinoma of vagina with a third degree uterovaginal prolapse which is even rarer. Mrs X a 60-year-old postmenopausal P5 L4 lady reported to us with complaints of something coming out per vaginum for the past 10 years along with blood stained discharge and difficulty in micturition for the last 4 months. On examination there was third degree cervical descent with a grade three cystocoele and rectocoele. A 4 x 5 cm ulcer was present on middle third of right lateral vaginal wall with marked edema and induration of surrounding tissue. The prolapse was irreducible; was reduced under intravenous sedation with difficulty. On per vaginam examination uterus was normal in size there was no adnexal mass right paracolpium was involved up to lateral pelvic wall and left paracolpium was free. Rectal mucosa was free on per rectal examination (FIGO Stage III). Cervical smear was normal. Biopsy of the ulcer revealed invasive keratinising squamous cell carcinoma of vagina. Chest X-ray was normal. (excerpt)

A rare case of primary mesenteric gastrointestinal stromal tumor with metastasis to the cervix uteri

BackgroundGastrointestinal stromal tumors are CD117 (C Kit) positive mesenchymal neoplasms, that may arise anywhere in the gastrointestinal tract. Their current therapy is imatinib mesylate before or after surgery.Case presentationWe describe a case of 17-year-old female with metastasis to the cervix uteri of a primary mesenteric gastrointestinal tumor.ConclusionSurgery remains the mainstay of known curative treatment. The manifestations of GIST are not restricted to the typical locations within the bowel; may have very unusual metastatic sites or infiltrations per continuitatem.

Pregnancy with chronic kidney disease: Outcome in Indian women

BACKGROUND Fetal survival and the risk of accelerated renal damage are the two major concerns with pregnancies complicated by chronic kidney disease. Although fetal survival has increased significantly due to improved antenatal and neonatal services, the maternal and neonatal morbidity is still considerable. METHODS This retrospective analysis of 51 pregnancies was conducted at a tertiary care center in India to estimate the risk of obstetrical complications, perinatal morbidity and mortality, and the effect of pregnancy on renal function in women with different types and severity of renal disease. RESULTS The type of renal disease and the degree of renal insufficiency did not have a significant effect on the chances of successful pregnancy outcome once the pregnancy had progressed beyond the first trimester. The risk of prematurity was significantly increased when the diastolic blood pressure was >/= 90 mm Hg at conception (OR 8.3, CI 1.6-41.5). All patients with a diastolic blood pressure > 100 mm Hg delivered preterm. Hypertension worsened in 16 (35.5%) women during pregnancy, of which 13 had to be terminated preterm because of uncontrolled blood pressure. Serum creatinine deteriorated during pregnancy in 32.5%, the percentage increase showing a significant inverse correlation to the baseline creatinine clearance. CONCLUSIONS Hypertension at conception was a significant independent factor influencing the gestational age at delivery. The baseline renal function did not correlate with the risk of acceleration of hypertension during pregnancy. However, the deterioration of renal function during pregnancy had a significant inverse correlation to basal creatinine clearance.