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Aim: Abnormal uterine bleeding (AUB) is a common gynaecological complaint affecting around 10-30% women during reproductive years. It adversely affects a woman's life, leading to psychological, medical, social and sexual problems. We aim to study the efficacy of a levonorgestrel intrauterine system (LNG-IUS) in 100 women suffering from AUB. Methodology: A retrospective study was carried out at a private nursing home in Mumbai over a period of 4 years. A total of 100 patients aged 30 years to 50 years (average age = 42.9 years) who underwent LNG-IUS insertion for abnormal uterine bleeding were studied. Cases were evaluated according to clinical findings, hemogram and transvaginal ultrasound. The women were called for follow-up at 1 week, 1 month, 6 months, 1 and 2 years to analyse type and amount of bleeding and development of amenorrhea. Results: At the end of 6 months, 75% patients experienced decreased menstrual blood loss. Five patients underwent removal of the LNG-IUS at the end of 6 months as they experienced no relief of symptoms. At the end of 2 years, 95% patients were fully satisfied with the LNG-IUS insertion. Conclusion: A levonorgestrel intrauterine system significantly reduces bleeding in menorrhagia due to benign causes and is found to be highly effective in the management of various gynaecological pathologies such as endometrial polyps, adenomyosis and endometrial hyperplasia when insertion perfomed after dilatation and curettage/polypectomy. It has proven to be superior to various surgical and other non-surgical treatment modalities.
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A 59-year-old post-menopausal female presented with complaints of per vaginal spotting for 3 months. Histopathological examination of contents of dilation and curettage revealed endometrial carcinoma (FIGO stage I), along with benign endocervical polyps. MRI also showed presence of left-sided structure indicative of ectopic pelvic kidney. The patient underwent laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy and bilateral ilio-obturator lymph node dissection. Dissection was started along the left pelvic plane. The left pelvic kidney was seen, and left ureter was located and confirmed below the uterus. The patient withstood the procedure well. Anomalies of pelvic anatomy, such as a malpresentation of the kidney and ureter, may prove as surgical challenges while performing open and laparoscopic surgery. However, in depth preoperative imaging, meticulous intraoperative dissection and proper identification of surrounding structures reduces the risk of such complications.
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Anti-MDA5 antibodies characterise a distinct phenotype of dermatomyositis in adults as well as children, with ethnic disparity in clinical presentation and severity. They often present as a diagnostic conundrum with rash, ulceration, and polyarthritis, but minimal muscle disease. Mechanic's hands are typically associated with anti-synthetase syndrome, but their presence in anti-MDA5 antibody positive patients, although reported, is not well known. We present the case of a boy in whom mechanic's hand heralded a relapse of juvenile dermatomyositis which was suspected based on remotely assessed patient-reported outcome measures on teleconsultation. This report suggests that mechanic's hands should also prompt testing for myositis antibodies including anti-MDA5 in Indian children with JDM. Diligent awareness of the condition, and timely use of patient reported outcome measures of muscle power and skin assessment may guide management while delivering remote care in challenging situations such as a global pandemic.
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Scholarly journals are hubs of hypotheses, evidence-based data, and practice recommendations that shape health research and practice worldwide. The advancement of science and information technologies has made online accessibility a basic requirement, paving the way for the advent of open access publishing, and more recently, to web-based health journalism. Especially in the time of the current pandemic, health professionals have turned to the internet, and primarily to social media, as a source of rapid information transfer and international communication. Hence, the current pandemic has ushered an era of digital transformation of science, and we attempt to understand and assess the impact of this digitization on modern health journalism.
