Association of serum homocysteine with vitamin B12 and folate levels in women with pre-eclampsia in a tertiary health care center in Nepal.

BACKGROUND: Pre-eclampsia is a syndrome that chiefly includes the development of new-onset hypertension and proteinuria after 20 weeks of pregnancy. Pre-eclampsia is one of the major causes of mortality and morbidity in Nepal. Hyperhomocysteinemia may be a cause of the endothelial dysfunction provoked by oxidative stress in pre-eclampsia. This study was designed to evaluate the association of homocysteine with Vitamin B12 and folate in patients with pre-eclampsia. METHOD: An observational cross sectional study was performed in the Gynecology and Obstetrics Department of TUTH involving seventy two subjects with pre-eclampsia. Blood pressure, urinary protein levels, serum homocysteine, Vitamin B12 and folate levels were compared in both mild and severe forms of pre-eclampsia. Concentration of Vitamin B12 and folate were measured using Vitros ECI and homocysteine was measured using CLIA. SPSS 23.0 was used to analyze the data. Tests were performed with Mann Whitney Test and Spearman's rank correlation test. A p-value < 0.05 was considered statistically significant. RESULTS: This study showed no significant difference in age and weeks of gestation in both mild and severe forms of pre-eclampsia. Mean concentration of homocysteine was higher (13.1 ± 6.4 micromol/L) in severe Pre-eclampsia as compared to mild cases (7.6 ± 2.8 micromol/L). Mean concentration of folate was lower in severe cases (35.4 ± 24.1 micromol/L) when compared with mild cases of pre-eclampsia (57 ± 23.4 micromol/L). CONCLUSION: Homocysteine levels were increased in severe Pre-eclampsia when compared with mild pre-eclampsia and this finding can be used to predict and prevent complications in patients with pre-eclampsia.

Pregnancy in an isthmocele: A rare case from Nepal.

An infrequent form of ectopic pregnancy, pregnancy in an isthmocele can be hazardous due to hemorrhage or uterine rupture. With no clear guidelines for the management of this condition, surgery is the preferred option.

Cyst of rete ovarii: A case report.

Rete ovarii giving rise to cysts, and benign and malignant tumors is a rare entity. Radiological and histopathological examinations can be used to make the diagnosis of rete cyst and differentiate it from cystic tumor of ovarian origin, with surgery being the treatment of choice.

Synchronous primary endometrium and ovarian carcinoma: A case report.

Synchronous tumors of the female genital tract are rare and should be differentiated from primary endometrial or ovarian tumors with metastasis as the two entities have different therapeutic and prognostic implications.

Bilateral ovarian mucinous carcinoma (stage III) with omental involvement and incidental hydronephrosis: A rare case report.

INTRODUCTION: Though ovarian malignancies are common, mucinous ovarian carcinomas of high grade are rare. They usually occur in a young female under 40 years of age. Here, we present a case of mucinous ovarian carcinoma (stage III), with omental involvement and incidental hydronephrosis in a 67-year-old female patient. CASE PRESENTATION: A 67-year-old female patient presented to us with a history of lower abdominal pain for 2 months and per-vaginal discharge for the last 6 days. On deep palpation of the abdomen, a nodular mass occupying the suprapubic region was found. Bimanual palpation revealed a mass on the right and left adnexa. After visualization of septate cystic mass bilaterally on CECT, she was planned for staging laparotomy with bilateral salpingo-oophorectomy (BSO) with infra-colic omentectomy with peritoneal cytology. Incidentally, a horseshoe-shaped kidney with right mild hydronephrosis was found. After surgery and histopathologic examination, mucinous ovarian carcinoma (stage III), with omental involvement was confirmed. DISCUSSION: Mucinous ovarian carcinomas are rare malignancies, with different natural history, molecular profile, and prognosis as compared to other epithelial tumors of the ovary. These carcinomas can be either primary or secondary (those metastasized to the ovary from elsewhere), and this differentiation is essential. The therapeutic approach to the patients depends upon the stage at which these carcinomas are diagnosed. CONCLUSION: Mucinous ovarian carcinomas are rare and have unique features among the epithelial ovarian carcinomas. Appreciation of these features will surely make a positive impact in improving the management and thus the prognosis of these carcinomas.

Correlation of Body Mass Index on Semen Parameters.

BACKGROUND: Studies done to determine relation of increase in Body mass index and semen parameters have shown conflicting results, some showing negative correlation others showing none. This study aimed to find out if there is any association between them in our population. METHODS: A cross-sectional study was performed in an infertility clinic in 2018/19 reviewing records from which Body mass index of male partner and results of semen analysis noted. Participants were grouped according to Body mass index; normal: 18.5-24.99 kg/m2, overweight: 25-29.99 kg/m2 and obese: >30 kg/m2. Different semen parameters such as volume, total count, concentration and motility were compared between different Body mass index groups to determine if there is any association between them. RESULTS: Total 249 participants enrolled with mean Body mass index of 25.1 + 3.4 years. Semen volume decreased with increase in Body mass index (p value 0.063) and sperm count was lower in overweight and obese group compared to normal Body mass index group (p value 0.449) suggesting insignificant negative correlation of Body mass index with semen volume and sperm count. However there was insignificant weak positive correlation of Body mass index with sperm concentration and progressive motility (p value 0.668 and 0.973 respectively). Overweight persons were 3.14 times likely to have hypovolemia (OR:3.14; 95%CI: 1.51-6.53) and obese persons were 1.19 times likely to have oligospermia (OR:1.19 95% CI: 0.42-3.36) compared to persons with normal Body mass index. CONCLUSIONS: Body mass index has insignificant negative correlation with semen volume and total sperm count and persons with higher Body mass index were more likely to have hypovolemia and oligospermia compared to person with normal Body mass index.

Elderly Gravida with Bombay Blood Group and Placenta Previa Managed with Autologous Blood Transfusion.

The Bombay blood group is a rare blood type with an incidence of around one in a million. There is no known reported case of an obstetric patient with the Bombay blood group from Nepal. People with this rare blood group can receive blood only from those with the same blood type. We report an elderly gravida with the Bombay blood group who had a pregnancy complicated by diabetes, placenta previa, and transverse lie (back up) following an in vitro fertilization. Placenta previa posed a greater risk of hemorrhage and hence the need for transfusion. The main challenge was arranging blood for transfusion, and as the Bombay blood group was unavailable, she was managed with autologous blood transfusion which was performed for the first time in a pregnant lady in our institute. She underwent Cesarean section for placenta previa with transverse lie, and both mother and baby were sent home in good health.