A Case Series on a Rare Gynecological Cancer and a Review of Recent Literature on Vulval Cancer.

Vulval cancer is a rare gynaecological malignancy. Though it has got excellent prognosis if diagnosed and treated early, but in most instances, women present late with advanced disease as they are too uncomfortable to discuss it with their doctors. Advanced vulval cancer is difficult to treat, has got poor prognosis and the treatment itself can cause morbidity and mortality. The authors describe three cases of isolated vulval cancer in a gynaecology centre in south Wales that had late presentation due to embarrassment despite noticing the lesion for long time and a brief review of the literature on its prevalence, clinical presentation, investigation and best management.

Hypothermia on admission and its association with neonatal mortality and morbidity in neonatal intensive care unit.

BACKGROUND: Neonatal hypothermia is a drop in the newborn's core temperature less than 36.5°C. It is crucial in neonatal morbidity and mortality, particularly in preterm infants. This research aimed to assess the incidence and risk factors of neonatal hypothermia and its effect on neonatal mortality and short-term morbidity during Neonatal Intensive Care Unit (NICU) admission. METHODS: This observational study was conducted on all neonates admitted to the NICU at Benha University Hospital. The core temperature was measured on admission for all admitted neonates and were followed up to assess the impact of hypothermia on short-term outcomes and mortality. RESULTS: A total of 323 neonates were admitted to the NICU throughout the research period. Thirty-five cases were excluded due to congenital anomalies or missing or late admission temperature recordings. The study included 288 neonates whose mean gestational age was 34.6±3.4 weeks, and their mean birth weight was 2.35±0.9 kg. Two-thirds (66%) of the neonates had core temperatures indicating hypothermia (axillary temperature of less than 36.5°C), one-third (33%) were normothermic, and only three (1%) were hyperthermic. Neonates with hypothermia had statistically lower gestational age, higher frequency of multiple births, prolonged need for respiratory support, higher rates of pulmonary hemorrhage, sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis, longer hospital stay, and mortality. CONCLUSIONS: There is a high incidence of neonatal hypothermia at NICU admission. Lower gestational age, increased multiples, lower APGAR score, lower birth weight, and lack of antenatal steroids were significantly associated with hypothermia at NICU admission. Hypothermia was found to be a significant factor contributing to increased mortality and morbidity rates in affected neonates.

Common Pitfall in Post Operative Fluid and Electrolyte Management: A Retrospective Study in Two Tertiary Centers in Bangladesh.

Evaluation of our practice and recommend an appropriate fluid regime to maintain the fluid and electrolyte balance in the post operative period. The drug chart and clinical notes were retrospectively analysed manually of 758 patients who underwent surgery from January 2020 to January 2022 in Enam Medical College Hospital and Ibnsina Medical College Hospital, Dhaka, Bangladesh were reviewed by 3 individual clinicians and the obtained data were analysed. Total 407 patients met the inclusion criteria for the study. Fifty seven (57) patients underwent emergency operation and 350 patients had elective surgery. The average fluid replacement was 2.5 L/day, average Sodium- 154 mmol/day, average potassium 2.0 mmol/day and average glucose 125 mmol/day. Post operatively 97 patients developed hypokalemia. Among them 25 patients developed severe hypokalemia. A simple pathway for prescribing post operative fluid and electrolyte was proposed so that patients during 1st post operative day requiring maintenance fluid will have 25-30 ml/kg/day of water, approximately 1-2 mmol/kg/day Sodium and chloride, 1 mmol/kg/day of potassium and approximately 50-100 gm/day of glucose.

A Case Series on Endometrial Cancer, Despite Endometrial Thickness Being Less than Four Millimetres and A Brief Review of Recent Literature on Endometrial Cancer.

The most common presentation of the most common gynaecological malignancy (Endometrial Cancer) is abnormal PV bleeding. Transvaginal sonography (TVS) is the first line investigation to assess the endometrial nature. Four to five (4-5) millimetre endometrial thicknesses is considered as the normal cut off in post menopausal women. But endometrial cancer can be present while endometrial thickness is less than 4mm. The author describes three cases of isolated endometrial cancer in Glangwili General Hospital in Wales, UK that was diagnosed despite endometrial thickness being less than 4mm and a brief review of the literature on its prevalence, risk factors, clinical presentation, diagnosis and therapeutic approach.

Development of a New Pathway during Covid Pandemic to Reduce the Waiting List in Hysteroscopy Clinic.

To develop an efficient and practical pathway to reduce the waiting list for outpatient hysteroscopy in patients with post menopausal bleeding. The clinical data was retrospectively analysed in Welsh Clinical Portal of 1339 patients who were referred for hysteroscopy as urgent suspected cancer over a period of 12 months (1st January to 31st December 2019) in Hywel DDA University Health Board in Wales, United Kingdom. A total of 1339 patients were referred for hysteroscopy over 12 months. Among them 133 patients underwent hysteroscopy for evaluation of PMB despite ET being less than 4 mm; 1.50% patients were on tamoxifen and 16.45% were on HRT. Biopsy was taken for 86.00% of patients. Among them 1.50% were reported as malignant, 72.00% benign and 9.80% as insufficient sample. Patients with PMB and ET less than 4 mm and without suspicious features on ultrasound and who are without clinical risk factors can be reviewed virtually (in virtual clinics) by consultants or senior doctor and can be discharged. They should be instructed to report back if they experience persistent bleeding and then they would need hysteroscopy for further evaluation.