Swati Agrawal

ORIGINAL RESEARCH—ENDOCRINOLOGY: A Comparative Study of the Effects of Local Estrogen With or Without Local Testosterone on Vulvovaginal and Sexual Dysfunction in Postmenopausal Women

INTRODUCTION A significant number of postmenopausal women suffer from distressing problems because of urogenital atrophy secondary to the decline in circulating estrogen levels. Treatment with topical hormones may provide relief in such women when used judiciously. AIM To study the effects of local estrogen with or without local testosterone on urogenital and sexual health in postmenopausal women. METHODS Seventy-five postmenopausal women symptomatic for urogenital atrophy and sexual dysfunction were randomly divided into two study groups and one control group. The women in study group 1 received local estrogen cream; study group 2 received local estrogen and testosterone cream; the control group received nonhormonal lubricant KY gel for 12 weeks. The urogenital and sexuality score, along with the vaginal health index and the vaginal maturation index (VMI), was calculated at the beginning of therapy and 12 weeks later. MAIN OUTCOME MEASURES Changes in the urogenital and sexuality score along with vaginal health index and VMI. RESULTS After 12 weeks of therapy, there was a significant improvement in all the four study parameters, which correlated well with the improvement in symptoms of urogenital atrophy and sexual dysfunction in both the study groups as compared with the control group. Improvement in sexuality score was greatest with combined estrogen-androgen therapy. There were no adverse effects and the therapies were well accepted without any compliance issue. CONCLUSION Local estrogen either alone or with androgen is highly effective in relieving symptoms of urogenital atrophy and in improving sexual function in symptomatic postmenopausal women.

Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study

Objective. To compare the fetomaternal outcome in women with spontaneous preterm labor, with or without bacterial vaginosis (BV). Methods. One hundred and fifty-two pregnant patients presenting with spontaneous preterm labor between 28 and 35 weeks of gestation were screened for BV using Amsel’s criteria and Nugent score, and were divided into two groups of 30 patients each, based on the BV positive or negative screen. Both the groups were followed till puerperium, and the fetal–maternal outcome was studied. The data was analyzed using Chi-square test and Man–Whitney test. Results. BV was detected in 37 out of 152 women with preterm labor (24.34%). There was a significant increase in the incidence of respiratory distress (14% vs. 6%), requirement of intermittent positive pressure ventilation (IPPV) (14% vs. 5%), admission in neonatal intensive care unit (NICU) (15% vs. 6%), and duration of NICU stay >2 days (15% vs. 6%) in patients with BV. No significant difference was found in the mean birth weight, Apgar score, incidence of neonatal sepsis, perinatal mortality, and postpartum fever between the two groups. Conclusions. BV is a risk factor for increased neonatal morbidity. More research is needed for designing appropriate screening and treatment guidelines for prevention of adverse outcomes associated with BV.

Trial of labour after previous caesarean section: The predictive factors affecting outcome

A prospective observational study was conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, India on 300 pregnant women with one previous caesarean section fulfilling the eligibility criteria for trial of labour, to study the predictive factors and the outcome of trial of labour. The data obtained were analysed according to mode and outcome of labour and was then subjected to statistical analysis. The success rate of trial of labour was found to be 53.6%. Favourable Bishops score (p = 0.000), spontaneous onset of labour (p = 0.005) and history of previous delivery after caesarean (p = 0.007) were significantly associated with a successful outcome of trial of labour. Higher chances of vaginal delivery were found with breech as an indication of previous caesarean section, i.e. 67.1% as compared to 39% with non-progress of labour as an indication.

Maternal serum interleukin-6 and its association with clinicopathological infectious morbidity in preterm premature rupture of membranes: a prospective cohort study

Objective: To analyze the association of maternal serum interleukin-6 (IL-6) with fetomaternal outcome in preterm premature rupture of membranes (PPROM). Methods: Serial serum IL-6 levels were measured in 45 women with PPROM at gestation 24–34 weeks. The women were followed till pueperium and fetomaternal outcome as well as the histopathology of the placenta and the umblical cord was studied. The data were analyzed using t test and χ2 test. Results: IL-6 levels ≥ 8 pg/ml were significantly associated with puerperal sepsis and neonatal sepsis. Histological chorioamnionitis and funisitis were demonstrated in 48.8% and 13.3% women respectively and significantly correlated with elevated serum IL-6 levels and fetomaternal infection. A cut-off value of IL-6 of 8 pg/ml was found to correctly diagnose 19 out of 23 patients with infectious morbidity and showed the best sensitivity (82.6%) and specificity (86.3%) as compared to the total leucocycte count (TLC) and C-reactive protein (CRP) in diagnosing infection in PPROM. Conclusion: Maternal serum IL-6 can be used as a biomarker to predict preclinical asymptomatic infection in PPROM with good sensitivity and specificity.

A rare case of cervical tuberculosis simulating carcinoma cervix: a case report

BackgroundThis is an unusual case of a 26-year-old P2L2 lady who presented with chief complaints of pain abdomen and irregular bleeding p/v with history of post-coital bleeding.Case reportOn per speculum examination, cervix was replaced by an irregular friable growth, which was bleeding on touch. A clinical diagnosis of carcinoma cervix was made but the cervical biopsy revealed granulomatous inflammation with presence of acid-fast bacilli on cervical smear consistent with tuberculosis. The patient responded to six months of anti-tubercular therapy.ConclusionTo conclude, cervical tuberculosis should be considered in the differential diagnosis of carcinoma cervix in young women with suspicious cervix.

Rare Adrenal Gland Emergencies: A Case Series of Giant Myelolipoma Presenting With Massive Hemorrhage and Abscess

Introduction: Adrenal Myelolipoma is a rare benign neoplasm, which contains mature adipose tissue and variable amounts of haematopoietic elements. Most lesions are small and asymptomatic, discovered incidentally during autopsy or imaging studies performed for other reasons. Case Presentation: Here we reported a series of two cases of giant myelolipomas of the adrenal gland; first one the largest tumor reported so far presented with massive hemorrhage and the second case introduced with its rare unreported presentation of adrenal myelolipomas i.e. a large abscess. Discussion: Adrenal myelolipoma is a rare and asymptomatic tumor usually discovered incidentally in less than 1% of population on autopsy or imaging performed for other reasons. There is an increasing incidence of large adrenal myelolipoma (> 10 cm) presenting with life threatening and recurrent retroperitoneal hemorrhage along with other complications as abscess. To avoid such a life-threatening situation, authors recommend close monitoring and consideration of urgent surgical intervention for tumors larger than 4 cm at presentation or increase in size or change in appearance during follow-up.

Gravid uterus as a content of anterior abdominal wall incisional hernia

intravenous gadolinium (Warshak et al. 2006). It provides information about the site and depth of placental infiltration as well as involvement of the extrauterine surrounding organs (Baughman et al. 2008). Large vascular flow voids may provide a clue about the extent of vascularity in the uterus and parauterine tissues. This may have significant implications in terms of management issues. MRI is not operator-dependent and provides information about the extent of invasion in all three planes. Serial imaging is a useful tool to monitor the progress by demonstrating gradual resorption of the placenta.

Correlation of bone mineral density with biochemical markers in post menopausal women

To evaluate the magnitude of bone loss in postmenopausal women and to study the effect of a selective estrogen Receptor Modulator, raloxifene, on bone loss by quantitative ultrasound of calcaneus and serum bone specific alkaline phosphatase (BAP). Postmenopausal women with ostesopenia/osteoporosis were assigned randomly to receive placebo (n=30) or raloxifene (60mg/d, n=30) with calcium (500mg/day) and vitamin D (250 IU/day). The bone mineral density (BMD) and BAP levels were measured at the beginning of therapy and six months later. They were subjected to statistical analysis (t test, p value) using SPSS statistical package. 70% of postmenopausal women suffered from osteopenia/osteoporosis. After raloxifene therapy, there was improvement in the BMD but this was not statistically significant (p>0.05). There was a fall in the value of serum BAP by 26.6% (p<0.05). Raloxifene has a favourable effect on bone turnover as evident from changes in BMD and a significant fall in serum BAP.

A prospective study to evaluate the role of laparohysteroscopy in unexplained infertility

Abstract Laparoscopy is considered as the preferred modality for the diagnosis of pelvic pathology but its timing and use in the investigation of infertility is an area of debate. A prospective observational study was conducted between 1 November, 2009 and 31 March, 2011, in which 30 women with unexplained infertility with at least three failed cycles of COH and IUI were included and subjected to laparohysteroscopy. On laparoscopy, pelvic abnormalities were found in 11 (36.7%) women. On hysteroscopy, intrauterine lesions were detected in two (6.7%) of the women. The commonest pelvic pathology detected was adhesions followed by minimal to mild endometriosis. Operative procedures were done in nine (30%) cases. Since laparoscopy was not only diagnostic but also therapeutic in a significant number of cases, it was concluded that laparoscopy is beneficial following failure of empirical treatment in women with unexplained infertility while the routine use of hysteroscopy requires further assessment.

A Case Series & Review of Literature of Angiomyolipoma with Medical & Surgical Perspective

The angiomyolipoma of renal origin is a rare benign tumour composed of fat cells, smooth muscle cells, and thick-wall blood vessels. Mostly these are sporadic origin, asymptomatic and benign in nature. Here we present two cases of Renal angiomyolipoma (AML) presenting as fever, pain, perirenal haematoma & frank haematuria. After initial stabilization, evaluated by contrast enhanced computer tomography (CECT) & diagnosed as renal angiomyolipoma because of low Hounsfield areas (10-20HU) suggestive for fat. Patient later underwent angiography with selective angioembolisation. Post intervention period was uneventful and was treated by an oral Everolimus 10 mg daily for a period of one year in first case & partial resection was done in second case. On two year follow-up both patients were doing well & had normal renal function without any recurrence. Embolisation is the emergency treatment of choice for bleeding angiomyolipoma. When preventive treatment is considered a nephron sparing approach by either transarterial embolisation or partial nephrectomy is clearly important. While angiomyolipoma in both kidneys or in solitary functioning kidneys, renal preservation is mandatory in order to avoid need for renal replacement therapy. Also, recently approved drug Everolimus may be considered for patients not suitable for surgery particularly in tumour seen with tuberous sclerosis.