Cervical cancer awareness, knowledge, behavioural patterns, and practice of screening and vaccination in females of hilly regions of North India - A hospital-based observational study.

Aim: The mainstay of cervical cancer elimination and control is an effective screening and education program. The present study was conducted to assess awareness about cervical cancer, knowledge of cervical cancer symptoms, risk factors, screening and vaccination, attitude towards various aspects of cervical cancer, and screening and vaccination practices amongst women of Uttarakhand. Method: The present study was a prospective observational study. A total of 215 patients were recruited from Gynecology OPD, AIIMS, Rishikesh, from January to December 2021, and 195 women meeting the eligibility criterion were finally analyzed based on the KAP questionnaire interview method. Results: The study population had 40% illiterate participants. Of all participants, 87% were aware of cervical cancer as a disease entity, only 0.5% had good knowledge, and 99.5% had poor knowledge of symptoms, risk factors, screening, and vaccination for cervical cancer. 87% showed a favourable attitude. Only 1 out of 195 participants was ever screened previously, and none of them were vaccinated. Conclusion: The main hindrance in the context of hilly or challenging-to-serve areas is mainly the education and information services. The resource allocation to difficult health-inaccessible areas is required to bring a major change in practices for prevention of cervical cancer; this can be dramatically improved by population-based screening and vaccination programs at affordable prices.

May-Thurner Syndrome in a Case of Left Iliofemoral Vein Thrombosis With Contralateral Tubo-Ovarian Abscess in the Post-postpartum Period.

May-Thurner syndrome (MTS) is a rare, yet important, differential diagnosis in reproductive-age women with deep vein thrombosis (DVT). It is characterized by the compression of the left common iliac vein by the right common artery against the lumbar vertebra. The condition is complicated by recurrent DVT with pulmonary thromboembolism (PTE). Here is a case of multiparous women in early puerperium with right tubo-ovarian abscess and left lower limb DVT likely due to MTS. The diagnosis was further complicated by the presence of persistent thrombocytosis but a myeloproliferative neoplasm was ruled out by genetic mutation testing. She was given anticoagulants, and laparotomy was done for the excision of the tubo-ovarian mass in view of the persistent fever not responding to injectable antibiotics. PTE in the postoperative period was managed by anticoagulants followed by an inferior vena cava (IVC) filter for the risk of recurrent DVT and/or PTE in an MTS case.

Ureteric Leiomyosarcoma.

Ureteric leiomyosarcoma is a rare but aggressive tumor among other sarcomas. There is no established epidemiological data due to the scarcity of literature on this uncommon disorder. The present literature comprises about 20 case reports mostly of women above 40 years of age. The presenting complaint is mostly pain in the abdomen with only a few reporting urological symptoms like hematuria. Understandably, this tumor is diagnosed by histopathological examination with immunohistochemistry. We report one such case of a 32-year-old female who underwent an exploratory laparotomy with preoperative suspicion of adnexal neoplastic mass only to find normal ovaries and left ureteric tumor intraoperatively. She was managed with excision of the tumor with partial resection of the involved ureter and end-to-end anastomosis of the ureter followed by chemotherapy and radiation.

Maternal-Fetal Characteristics of Pregnant Women With Severe COVID Disease and Maternal-Neonatal Characteristics of Neonates With Early-Onset SARS-CoV-2 Infection: A Prospective Data Analysis.

Introduction COVID-19 and its mutants have significantly impacted the health care system, claiming numerous lives and adding to the morbidity. The data are scarce to describe the effect of disease severity on pregnancy outcomes, the possibility of mother-to-child transmission, and neonatal outcomes of COVID-positive babies. This study aimed to report the maternal and fetal characteristics of pregnant women with severe COVID disease as well as maternal and neonatal characteristics of neonates with early-onset SARS-CoV-2 infection. Materials and methods This is a prospective data analysis of pregnant women with severe COVID disease and neonates with early-onset SARS-CoV-2 infection. The disease parameters including demographic data, clinical presentation, investigations, management, and maternal and neonatal outcomes were recorded and analyzed. Results India has faced three waves till now. At the study center, a total of 165 (60, 68, and 37 in the first, second, and third waves, respectively) COVID-positive pregnant women were admitted during all three waves. No severe COVID disease with pregnancy was noted in the first and third waves. During the second wave (March to June 2021), 15 pregnant women were found to have severe COVID disease. All of them had COVID-related symptoms, with the majority requiring supplementary oxygen at presentation. Nine of these women had intrauterine fetal demise at admission. Nearly 73% were in their second trimester, and the rest were in the third trimester. There was raised total leukocyte count and alanine transaminase in 73% and raised aspartate transaminase in all cases. All of them were admitted to the intensive care unit. Two women in their third trimester had a termination of pregnancy by cesarean section, and one of the neonates had early neonatal death due to perinatal asphyxia. Both the neonates were COVID-19 positive. Eleven women with critical illness succumbed to the disease. No neonate was found to have early-onset SAR-CoV-2 infection during the first and third waves. Only 11 neonates tested positive for SARS-CoV-2 at the time of birth during the second wave. None of them had any COVID-related symptoms. Preterm birth was reported in four cases. The average Apgar scores at 1 and 5 minutes were 6.9 and 8.09, respectively. The average birth weight was 2,551.81 grams. All neonates were initially kept in the neonatal intensive care unit. Out of 11, four neonates required treatment in the form of positive-pressure ventilation, chest compressions, high-flow nasal oxygen, and non-invasive and invasive ventilation. Neonatal mortality was documented in two cases. Six mothers had one or more positive results in either amniotic fluid, placental membrane, or vaginal or cervical swab, highlighting the possibility of antepartum or intrapartum transmission. Conclusion Severe COVID disease during pregnancy was associated with high rates of intrauterine fetal demise and maternal mortality. Raised liver enzymes might be taken as a predicting factor for severe disease. On the other hand, early-onset neonatal SARS-CoV-2 infection is mostly asymptomatic and has a good prognosis. Additionally, mother-to-child transmission of SARS-CoV-2 is possible in the antepartum and intrapartum periods.

Impact of Pregnancy on Susceptibility and Severity of COVID-19: A Hospital-Based Prospective Observational Study.

OBJECTIVE:  Pregnancy is a transient state of immunosuppression. The objective of this study was to ascertain whether pregnant women are more susceptible to coronavirus disease 2019 (COVID-19) than non-pregnant women and the impact of pregnancy on the severity of COVID-19 and associated morbidity and mortality. METHODS:  A prospective observational study was performed at All India Institute of Medical Sciences (AIIMS) Rishikesh for a period of two months. A total of 42 and 33 COVID-19 positive women were included in the obstetric and non-obstetric cohorts respectively. RESULTS:  Baseline characteristics were similar in both groups. Approximately 48% of the obstetric cohort had no COVID-19-related symptoms. Whereas, 100% of the non-obstetric cohort was symptomatic and had a significantly higher number of patients presenting with fever, cough, and breathlessness. The obstetric cohort had a significantly higher incidence of mild disease (p=0.009). In the obstetric cohort, the mean gestational age was 32.59 ± 2.57 weeks, with patients spread across all trimesters. Most of the patients with severe disease were in their second trimester. There was no difference in intensive care unit (ICU) admission, duration of ICU stay, duration of hospital stay, and mortality among both groups. A significantly smaller number of patients in the obstetric cohort required ventilatory support (p=0.0002). The maternal mortality rate was 16.67%. All of them had severe diseases requiring ICU admission. The cause of death was attributed to severe COVID pneumonia with septic shock in all cases. The mortality rate was comparatively higher (27.27%) in the non-obstetric group. CONCLUSION:  Pregnancy, unlike other immunocompromised conditions, does not seem to affect the prognosis of COVID-19 in terms of disease severity or mortality.

Annular cervical detachment during caesarean section.

Annular cervical detachment is a rare complication mostly associated with prolonged labour and the resultant vascular impairment. Although a remote possibility, such a complication is not unheard of with caesarean section. Here is one such case of annular detachment of cervix during caesarean section due to difficult delivery of fetus which was managed by repair of cut edges.

Youssef syndrome with a summary of management options.

Vesicouterine fistula is one of the rare varieties of urogenital fistula. Type I urogenital fistula or Youssef syndrome is characterised by menouria, amenorrhoea and urinary continence and it mostly follows lower segment caesarean delivery. There are only scattered case reports to help guide diagnostic and therapeutic options for this condition. These patients mostly need a combination of diagnostic modalities to confirm the diagnosis. Here, we present one such case of para 4 live 4 with classical symptoms of Youssef syndrome following a laparotomy for uterine rupture repair. CT urography confirmed the diagnosis and cystoscopy helped localise the exact location. Transabdominal fistula excision and repair was done. The paper also presents a summary of diagnostic and therapeutic options for this condition as reported in previous case reports for easy reference for practising gynaecologists and urologists.

Evaluate the Effectiveness of Enhanced Recovery After Surgery Versus Conventional Approach in Benign Gynecological Surgeries: A Randomized Controlled Trial.

Objective This study aimed to evaluate the effectiveness of enhanced recovery after surgery (ERAS) model versus conventional approach in benign gynecological surgeries (incorporating various routes of surgery). Methods This was a randomized controlled trial wherein patients undergoing gynecological surgery for benign indications from January 2019 to July 2020 were recruited and randomized into ERAS and conventional protocol groups using block randomization. The intended primary outcome was to compare the median length of hospital stay in both groups. "Fit for discharge" criteria were used to assess the length of stay as patients who belonged to hilly terrain with limited transportation facilities stayed for a longer duration. Results A total of 180 patients were recruited and 90 each was randomized into ERAS and conventional protocol groups. The difference in length of hospital stay between ERAS (36 hours, range 24-96 hours) and conventional group (72 hours, range: 24-144 hours) was significant (p<0.01). A statistically significant difference was noted in the time for recovery of bowel function and tolerance for diet in the ERAS group. No significant difference in complications and readmission (within 30 days) rate was seen between the two groups. Quality of life as assessed by the World Health Organization Quality of Life Brief Version (WHO-QOL BREF) on the day of discharge and day 30 was higher in the ERAS group in physical and psychological domains, while no difference was seen in environmental and social domains. Conclusion This study as an institutional experience strengthens the existing evidence regarding the efficacy of ERAS in reducing hospital stay and improving quality of life compared to the conventional perioperative management protocol.

Comparison of Clinical, Metabolic and Hormonal Effects of Metformin Versus Combined Therapy of Metformin With Myoinositol Plus D-Chiro-Inositol in Women With Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial.

Objective To compare the effects of metformin alone versus combined therapy of metformin with myoinositol (MI) plus D-chiro-inositol (DCI) in women with polycystic ovary syndrome (PCOS). Materials and methods This is a prospective, non-blinded randomized controlled trial conducted in newly diagnosed PCOS women aged 18 to 45 years. Group I received metformin 500 mg twice a day orally for 6 months while group II received metformin 500 mg twice a day orally along with MI 550 mg plus DCI 150 mg twice daily orally for six months. The primary outcome was a change in clinical, metabolic and hormonal parameters of the two groups from baseline to the end of six months of treatment. Results A total of 72 patients were randomized into two groups of 36 patients each. Statistically, a significant difference was seen in terms of mean global acne score (p=0.004) and cycle regularity (p=0.034) after six months of treatment in group II. A significant difference in values of luteinizing hormone (LH) (p=0.002), luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio (p=0.007), mean cholesterol (p=0.040), mean high-density lipoprotein (HDL) (p=0.049), mean low-density lipoprotein (LDL) (p=0.0001) and postprandial insulin (p=0.005) was also seen in group II at the end of treatment duration. No significant difference was seen between the two groups in terms of mean FSH, mean testosterone, mean dehydroepiandrosterone sulfate (DHEAS), mean triglyceride, mean fasting and postprandial blood sugar, fasting insulin and homeostatic model assessment of insulin resistance (HOMA-IR) index. Conclusion Combined therapy with metformin and MI plus DCI in women with PCOS and insulin resistance seems promising with the need for further studies with a greater sample size to evaluate the efficacy of this treatment.