Mature Cystic Teratoma at Fallopian Tubes: A Case Series.

Benign tumors of the fallopian tube are uncommon. Teratomas are most frequently found in the ovary and fallopian tube teratoma is extremely rare. To date, around 70 cases have been described, and most of them were discovered by chance. Here we present two cases of fallopian tube dermoid cyst. The first case is of a woman who was unable to conceive for 4 years with a right ovarian dermoid. She was managed with laparoscopic cystectomy when she was found to have a small teratoma-like lesion at the fimbrial end of the left fallopian tube. The second case is of a female who underwent elective caesarian section and was found to have a teratoma-like lesion at the right fallopian tube. Histopathology of both cases were reported as mature cystic teratoma. These cases suggest the need for careful examination of the pelvic organs for other pathology apart from the primary surgical sites. Keywords: case reports; dermoid cyst; fallopian tube; infertility.

Twin to Twin Transfusion Syndrome: A Case Report.

Twin-twin transfusion syndrome occurs in multiple gestations and involves a chronic flow of blood from one twin to another twin and is a rare entity. We present a case of 32-years-old primigravida with a twin pregnancy who presented with increasing abdominal girth inappropriate with her gestational age at 21 weeks of her pregnancy. Ultrasound findings were suggestive of twin-twin transfusion syndrome. The patient was provided with treatment options but due to polyhydramnios and short cervix, the patient went into spontaneous labour the same day with a poor pregnancy outcome. Twin-twin transfusion syndrome leads to a high rate of perinatal morbidity due to its poorly understood aetiology and difficulty in diagnosing and treatment. Early diagnosis during antenatal ultrasound is important in reducing morbidity and mortality rates. Keywords: case reports; fetoscopy; oligohydramnios; polyhydramnios; twins.

Dexamethasone treatment may mitigate adverse effects of vitamin D deficiency in hospitalized Covid-19 patients.

AIMS: We have previously demonstrated that vitamin D deficiency might be associated with worse outcomes in hospitalized Covid-19 patients. The aim of our study was to explore this relationship with dexamethasone therapy. METHODS: We prospectively studied two cohorts of hospitalized Covid-19 patients between March and April and between September and December 2020 (n = 192). Patients were tested for serum 25-hydroxyvitamin D (25-OH-D) levels during admission. The first cohort not treated with dexamethasone (n = 107) was divided into vitamin D deficient (25-OH-D ≤ 30 nmol/L) (n = 47) and replete subgroups (25-OH-D > 30 nmol/L) (n = 60). The second cohort treated with dexamethasone (n = 85) was similarly divided into deficient (25-OH-D ≤ 30 nmol/L) (n = 27) and replete subgroups (25-OH-D > 30 nmol/L) (n = 58). Primary outcome was in-hospital mortality and secondary outcomes were elevation in markers of cytokine storm and ventilatory requirement. RESULTS: No mortality difference was identified between cohorts and subgroups. The "no dexamethasone" cohort 25-OH-D deplete subgroup recorded significantly higher peak D-Dimer levels (1874 vs. 1233 µgFEU/L) (p = 0.0309), CRP (177 vs. 107.5) (p = 0.0055), and ventilatory support requirement (25.5% vs. 6.67%) (p = 0.007) compared to the replete subgroup. Among the 25-OH-D deplete subgroup higher peak neutrophil counts, peak CRP, peak LDH, peak ferritin, and lower trough lymphocyte counts were observed, without statistical significance. In the "dexamethasone" cohort, there was no apparent association between 25-OH-D deficiency and markers of cytokine storm or ventilatory requirement. CONCLUSION: Vitamin D deficiency is associated with elevated markers of cytokine storm and higher ventilatory requirements in hospitalized Covid-19 patients. Dexamethasone treatment appears to mitigate adverse effects of vitamin D deficiency.

Optimal combination treatment regimens of vaccine and radiotherapy augment tumor-bearing host immunity.

A major obstacle to immunotherapy is insufficient infiltration of effector immune cells into the tumor microenvironment. Radiotherapy greatly reduces tumor burden but relapses often occur. Here we show that the immunosuppressive tumor microenvironment was gradually established by recruiting Tregs after radiation. Despite tumors being controlled after depletion of Tregs in the irradiated area, improvement of mice survival remained poor. A much better antitumor effect was achieved with vaccination followed by radiation than other treatments. Vaccination followed by radiation recruited more effector T cells in tumor regions, which responded to high levels of chemokines. Sequential combination of vaccination and radiotherapy could elicit distinct host immune responses. Our study demonstrated that optimal combination of irradiation and vaccination is required to achieve effective antitumor immune responses. We propose a combination regimen that could be easily translated into the clinic and offer an opportunity for rational combination therapies design in cancer treatment.

Study of Menopausal Symptoms using Menopause Rating Scale at a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Menopause is the permanent cessation of menstruation for more than a year resulting from the loss of follicular activity of the ovaries. It is manifested by vasomotor, psychological, and urogenital symptoms which can be assessed by an internationally accepted scale known as Menopause Rating Scale. This study was conducted to find out the issues of perimenopausal women and proceed for management and proper counseling. METHODS: A descriptive cross-sectional study was conducted among women visiting the gynecological outpatient department of a tertiary care hospital from June 2017 to May 2018 using the Menopause Rating Scale. Ethical approval was taken from the Institutional Review Committee (reference number: 20122016). Convenient sampling was done. Statistical Package for the Social Sciences version 20.0 was used for data analysis. Point estimate at 90% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 189 perimenopausal women interviewed, the mean age of menopause was found to be 50.2±2.1 years. The most common gynecological symptoms among the study population was abnormal uterine bleeding 66 (34.9%) followed by abnormal vaginal discharge 50 (26.5%). Among symptoms in Menopause Rating Scale, the depressive mood was found in 99 (52.4%) cases followed by joint and muscular discomfort 88 (46.6%) and bladder problems in 87 (46%). None of the women had a score on the Menopause Rating Scale more than 16 and did not require management for their problem. CONCLUSIONS: Most of the women didn't know menopausal symptoms. However, none required intervention from gynecologists for their problems reflecting better quality of life.

Multi-drug resistant extended-spectrum beta-lactamase producing E. coli and Salmonella on raw vegetable salads served at hotels and restaurants in Bharatpur, Nepal.

OBJECTIVE: Antimicrobial resistance among the bacteria present in ready-to-eat foods like vegetable salads is an emerging concern today. The current study was undertaken to investigate the presence of multi-drug resistant extended-spectrum ß-lactamase (ESBL) producing E. coli and Salmonella spp. in raw vegetable salads served at hotels and restaurants in Bharatpur. A total of 216 salad samples were collected from three different grades of hotels and restaurants and examined for the presence of E. coli and Salmonella spp. in Microbiology laboratory of Birendra Multiple Campus by conventional microbiological techniques. RESULTS: Out of 216 samples, 66 samples (35.2%) showed the presence of Salmonella spp. whereas E. coli was recovered from 29 (13.4%) samples of which 3 samples harbored E. coli O157: H7. Antibiotic susceptibility testing revealed that 9 (13.6%) Salmonella and 4 (13.8%) E. coli isolates were detected as multi-drug resistant. Total ESBL producers reported were 5 (7.57%) Salmonella and 4 (13.8%) E. coli. The study also assessed a significant association between occurrence of E. coli and Salmonella with different grades of hotels and restaurants, personal hygiene and literacy rate of chefs and with the type of cleaning materials used to wash knives and chopping boards (p < 0.05). The findings suggest an immediate need of attention by the concerned authorities to prevent the emergence and transmission of food-borne pathogens and infections antimicrobial resistance among them.

Abdominal Cocoon Syndrome following Primary Subfertility Management with IVF-ET.

Abdominal cocoon syndrome is a rarely encountered surgical emergency first described by Foo et al. in 1978. This condition is characterised by a thick fibrous membrane which encases the small bowel partially or completely. Diagnosis of this condition is usually made per operatively and the treatment of choice is surgical release of entrapped bowel. This is a case report of abdominal cocoon syndrome diagnosed during laparotomy done with the provisional diagnosis of abdominal pregnancy following In vitro fertilization- embryo transfer. A 30 Years lady was admitted at Kathmandu Medical College for suspected ovarian hyper stimulation syndrome following In vitro fertilization- embryo transfer. Conservative treatment was done as the first line of management. Failing this, she was treated surgically with the provisional diagnosis of abdominal pregnancy. Abdominal cocoon syndrome was observed intraoperatively. Patient was managed medically with injection due to raised ßhCG level and empty uterine cavity. Intrauterine gestational sac was seen after about seven weeks of In vitro fertilization- embryo transfer. Pregnancy was terminated medically and patient was discharged. Sub fertility is a common gynecological problem. Its management may sometimes produce challenging health hazards. Thorough screening for medical and surgical illness is very important before proceeding to any kind of assisted reproductive technologies. A multidisciplinary approach is very important to manage such cases. Keywords: abdominal cocoon syndrome; embryo transfer; In Vitro fertilization; ovarian Hyper stimulation syndrome; sub fertility.