Impact of Structured Counseling with Trained Counselors in Choosing a Modern Contraceptive Method in India.

OBJECTIVE: The study was designed to determine the impact of structured counseling by trained contraceptive counselors in a real-life clinical setting on the adoption of modern contraceptive methods in comparison with past contraceptive experience. METHODS: Current study was a retrospective, non-interventional design, from the data collected in the time period of March to September 2013 across four clinics with predominant obstetric and gynecological practice. Three hundred and fifty-one women consulting for contraception were counseled by trained counselors using standardized counseling tools. RESULTS: Of the 351 women counseled, 40.74 % (n = 143) had never used a contraceptive (no method) and 42.74 % (n = 150) women whose partner had or were using a "male condom." Post-counseling by a trained counselor, there was a significant (p < 0.001) increase in modern contraceptive use (91.74 %, n = 322) versus prior counseling (52.14 %, n = 183) proportion of women who had or were using a modern contraceptive. The change observed for each method pre-counseling (usage history) to post-counseling was as follows: combined oral contraceptive (COC) 1.99-5.41 %, progesterone-only pill (POP) 0.85-30.48 %; copper intrauterine device (Cu-IUD) 4.27-29.4 %; injectable contraceptive 1.71-20.51 %; male condom 42.74-1.42 %; no method 40.74-7.41 %; traditional 7.12-0.85 %; and sterilization 0.28-1.71 %. CONCLUSION: This study is a first of its kind, conducted in the private sector, and clearly highlights the benefits of a trained counselor in contraceptive counseling with a significant proportion of women choosing a modern contraceptive. With a busy private practice, a trained counselor facilitates the clinician's role and helped the women to choose a suitable modern contraceptive method.

Neurofibromatosis with male breast cancer--risk factor or co-incidence? Report of two rare cases.

The genetic link between neurofibromatosis and breast cancer has recently intrigued the researchers and breast practitioners alike. While the association is well established in females, the same cannot be said for the male breast cancer due to paucity of cases. With only two cases reported previously, our knowledge is sparse. We hereby report two cases of male breast cancer with neurofibromatosis.

Giant dermatofibrosarcoma protuberans: A rare presentation over face.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive, soft tissue tumor. Its occurrence over face is very rare. We are presenting a case of giant DFSP over left cheek, which produces oncological, functional and esthetic challenges and deals by multidisciplinary team. We also reviewed the relevant literature in short.

Transverse testicular ectopia with bilateral pyocoele: case report and brief review of literature.

Transverse testicular ectopia (TTE) is a rare anomaly in which both testis descend through a single inguinal canal and enter to same hemiscrotum. To the best of our knowledge, we are reporting a new variant of TTE with right inguinal hernia with bilateral pyocoele. In this case, both testes descend separately through corresponding inguinal canal and present in single right scrotum. There is no report of bilateral orchidectomy for this variant of TTE with bilateral pyocoele with calcified necrosed testes. We also describe its embryology and management in brief, and review the previously reported cases.

Postoperative bleeding in an elderly patient from acquired factor V inhibitor: rapid response to immunosuppressive therapy.

Acquired factor V inhibitor is a rare but potentially life-threatening hemorrhagic disorder caused by the development of autoantibodies directed against coagulation factor V. The management of acute bleeding and inhibitor eradication is the mainstay of the treatment. The authors report a case of a 79-year-old man who underwent right hip arthroplasty and postoperatively, when on Coumadin for deep venous thrombosis prophylaxis, developed bleeding from the surgical site with a hematoma and abnormal coagulation parameters. Further workup revealed an acquired factor V inhibitor. The approach to treat this rare and challenging disorder is discussed. The patient responded rapidly with disappearance of factor V inhibitor titers after initiation of treatment with rituximab, prednisone and cyclophosphamide.

Overuse of acid suppression therapy in hospitalized patients.

BACKGROUND: Acid suppression therapy (AST) is one of the most commonly prescribed classes of medications in hospitalized patients. Multiple studies have shown that AST is overused during inpatient admissions. However, minimal data is available regarding the frequency and patient characteristics of those discharged on unnecessary AST. The aims of the study were to examine administration of AST on admission, to characterize the patient population discharged on unnecessary AST and to determine predictive factors for inappropriate administration of AST in hospitalized patients. METHODS: A retrospective chart review of randomly selected patients admitted to the general medicine service at University of Florida Health Science Center/Jacksonville from August to October 2006 for appropriateness of AST was done. The admitting diagnosis, indications for starting AST, type of AST used, and discharge on these medications was recorded on a case by case basis. RESULTS: Seventy percent of patients were started on AST on admission. Of these, 73% were unnecessary. Stress ulcers prophylaxis in low risk patients or the concomitant use of ulcerogenic drugs motivated initiation of therapy most frequently. Sixty nine percent of patients started on inappropriate AST were discharged on the same regimen. Admitting diagnosis, age of patient, length of stay, or concomitant use of ulcerogenic drugs did not predict continuation of unnecessary AST at discharge. CONCLUSION: AST is overused in hospitalized patients. This primarily occurred in low risk patients and was compounded by continuation at discharge. This significantly increases cost to the health care system and the risk of drug interactions.

Predictors of toxicity and toxicity profile of adjuvant chemotherapy in elderly breast cancer patients.

Women older than 70 years have been underrepresented in breast cancer adjuvant chemotherapy trials due to concerns about toxicity, safety and tolerance of chemotherapy. The aim of our study was to assess the tolerance of chemotherapy in older women with breast cancer and determine patterns of toxicity including the impact of age, chemotherapy regimen, functional status and comorbid conditions on this toxicity. We retrospectively reviewed the charts of early stage (stages 1 and 2) breast cancer patients older than 70 years from 1998 to 2004. A total of 62 patients, with mean age of 74.3 years, were identified. Chemotherapy was completed in 89% patients. Overall 79% completed chemotherapy without any significant side-effects, dose reductions, or breaks during chemotherapy. Using logistic regression model increasing age was not associated with early termination of chemotherapy (p = 0.19, OR: 0.868, 95% CI: 0.7-1.076). However, increasing age, lower functional status, and higher comorbidity index scores were associated with reduction in dose and breaks in chemotherapy. None of the patients who received pegfilgrastim prophylactically developed high-grade neutropenia. Our study suggests that adjuvant chemotherapy is safe in elderly patients. Older patients with good functional status and low comorbidity index scores tolerate chemotherapy as well as the younger patients. Prophylactic use of pegfilgrastim may reduce occurrence of severe neutropenia and related toxicity such as febrile neutropenia in the elderly patient.

Control of cardiovascular risk factors and use of aspirin in diabetic patients remain elusive.

OBJECTIVES: Type 2 diabetics are at higher risk for cardiovascular disease. To reduce this risk, the American Diabetes Association recommends traditional cardiovascular disease risk factor modification, reducing hemoglobin A1c (HbA1c), and the use of aspirin for patients over 30 years of age. The goal of this study was to analyze how well these goals were achieved in type 2 diabetics. METHODS: Patients with type 2 diabetes from July 2004 to June 2005 were included. Data were collected on demographics, preexisting coronary artery disease (CAD), blood pressure control, HbA1c, low-density lipoprotein cholesterol level, and microalbuminuria. RESULTS: One hundred thirty-nine patients were included (18% had CAD). Blood pressure was controlled in 46.04% of patients; 41.72% reached target HbA1c; 47.48% reached target low-density lipoprotein cholesterol; and 43.88% had microalbuminuria. No significant difference was noted between diabetics with or without CAD. Aspirin was used in 64% of patients with CAD and in 28.15% patients without CAD. CONCLUSIONS: Optimal cardiovascular risk modification was achieved in less than 50% of type 2 diabetics. Aspirin remains underused for primary prevention. These results highlight the continued difficulties in achieving control of diabetes to the extent recommended by American Diabetes Association guidelines.

Mediastinal pancreatic pseudocyst--a case report and review of the literature.

Pancreatic pseudocyst, a common complication of acute or chronic pancreatitis, in rare instances may also extend to the mediastinum. A case of 67-year-old woman presenting with a triad of chest pain, dysphagia, and dyspnea is presented. The patient had an episode of acute alcoholic pancreatitis 1 year before presentation. Chest radiography on admission showed a retrocardiac opacity. Two-dimensional echocardiography revealed an echolucent mass compressing the left atrium. A subsequent upper gastrointestinal series for her dysphagia showed extrinsic compression of the distal esophagus. Finally a definitive diagnosis was made with computed tomography (scan), which revealed a 19 x 12 cm pseudocyst extending from the body of pancreas into the thorax and compressing the esophagus and the cardiac chambers. A mediastinal pseudocyst can cause symptoms due to compression or invasion of surrounding structures. The fluid collection may enlarge slowly and hence the symptoms can be delayed as in our patient. The pseudocyst was successfully treated using endoscopic ultrasound-guided transesophageal drainage. Approximately 50 cases of mediastinal extension of the pancreatic pseudocyst in the world literature are reported. At this time, this is only the second time that successful drainage of a mediastinal pseudocyst using a transesophageal approach under endoscopic ultrasound guidance has been reported. The literature was reviewed for clinical presentation, complications, and available treatment options for mediastinal pancreatic pseudocysts.

Hypertrophic cardiomyopathy and symptomatic conduction system disease in cardiac amyloidosis.

Cardiac involvement is the most important prognostic factor in primary amyloidosis (AL). The clinical presentation of amyloid cardiomyopathy is varied and may manifest as heart failure, brady or tachyarrhythmias, syncope, angina and rarely with features of hypertrophic cardiomyopathy and advanced symptomatic conduction system disease. The management of amyloid cardiomyopathy has always been a dilemma, as most of the drugs used in congestive heart failure are contraindicated. This report describes a 70-year-old woman who presented with syncope, severe diastolic heart failure, features of hypertrophic cardiomyopathy and severe symptomatic conduction system disease requiring a pacemaker. Amyloidosis was diagnosed on endomyocardial biopsy after abdominal fat aspirate was negative for amyloid. The patient eventually expired due to end-stage congestive heart failure.

Bacterial pericarditis and tamponade due to nonencapsulated Haemophilus influenzae complicating a case of adult community-acquired pneumonia.

We report a case of bacterial pericarditis in an immunologically competent adult female caused by nonencapsulated Haemophilus influenzae (H influenzae) that was complicated by the acute development of life-threatening pericardial tamponade. H influenzae is a gram-negative coccobacillus, a pathogen most frequently associated with childhood exanthema (otitis media, meningitis) and, less frequently, adult pneumonia. Encapsulated, type b, or typable H influenzae is the strain implicated in childhood infections. On the other hand, nonencapsulated or nontypable H influenzae is the specific strain most often associated with exacerbation of chronic obstructive airway disease. Bacterial pericarditis caused by either subtype of H influenzae is exceedingly rare. We have located only 15 previously reported cases of H influenzae pericarditis occurring in adults in the world medical literature, the majority of which date back to the pre-antibiotic era. In 12 of these 15 cases (the only cases in which typing could be accomplished), the encapsulated strain of H influenzae was cultured from the pericardial fluid. Thus, to the best of our knowledge, we are reporting here the first case of bacterial pericarditis caused by nonencapsulated H influenzae in an immunologically competent adult.