Ovarian Loss in Laparoscopic and Robotic Cystectomy Compared Using Artificial Intelligence Pathology.

A Comparison of Ovarian Loss Following Laparoscopic versus Robotic Cystectomy As Analyzed by Artificial Intelligence-Powered Pathology Software. Background and Objective: To compare the area of ovarian tissue and follicular loss in the excised cystectomy specimen of endometrioma performed by laparoscopic or robotic technique. Methods: Prospective observational study performed between April 2023 to August 2023. There were 14 patients each in Laparoscopic group (LC) and Robotic group (RC). Excised cyst wall sent was for to the pathologist who was blinded to the technique used for cystectomy. The pathological assessment was done by artificial intelligence-Whole Slide Imaging (WSI) software. Results: The age was significantly lower in LC group; the rest of demographic results were comparable. The mean of the median ovarian area loss [Mean Rank, LC group (9.1 ± 15.1); RC (8.1 ± 12.4)] was higher in LC group. The mean of the median total follicular loss was higher in LC group (8.9 ± 9.2) when compared to RC group (6.3 ± 8.9) and was not significant. The area of ovarian loss in bilateral endometrioma was significantly higher in LC group (mean rank 7.5) as compared to RC group (mean rank 3) - (P = .016) despite more cases of bilateral disease in RC group. With increasing cyst size the LC group showed increased median loss of follicles when compared to RC group (strong correlation coefficient 0.347) but not statistically significant (P = .225). AAGL (American Association of Gynecologic Laparoscopists) score did not have any impact on the two techniques. Conclusion: Robotic assistance reduces the area of ovarian and follicular loss during cystectomy of endometrioma especially in bilateral disease and increasing cyst size. It should be considered over the laparoscopic approach if available.

Comparative Study of Vaginal Hysterectomy and Total Abdominal Hysterectomy in Non-descent Uterus in a Rural Tertiary Care Center.

Aim To study the role of vaginal hysterectomy in non-descent uterus and to compare it with abdominal hysterectomy with respect to operative time, intraoperative blood loss and complications, ambulation, and postoperative complications. Materials and methods A prospective non-randomized study was carried out on 200 cases at a rural tertiary care center in B.G. Nagara, Karnataka, India for a period of 18 months after obtaining institutional ethical committee approval. One hundred patients underwent a vaginal hysterectomy, and there other 100 underwent an abdominal hysterectomy for similar indications. Results Mean age, parity, mode of delivery, BMI, uterine size, and anesthesia were similar between the groups. The most common indication was fibroid uterus (50%). It was found that the vaginal hysterectomy group was associated with significantly reduced mean operative duration and a decline in postoperative Hemoglobin when compared to the abdominal hysterectomy group. Patients who underwent vaginal hysterectomy had less postoperative pain and were ambulated earlier and discharged earlier. Also, postoperative complications were more common in those who underwent abdominal hysterectomy. Conclusion Vaginal hysterectomy is a safe and the least invasive route and is associated with lesser complications and should be chosen as the preferred method of hysterectomy, whenever feasible.

Regularity, treatment adherence and outcome among diabetic patients in primary care: an overview

Early detection and compliance to prescribed treatment is the cornerstone to avert life threatening complications among those with non-communicable diseases (NCD). Assessing regularity of visits, adherence to medication and its correlates can help in devising effective strategies to improve medication adherence. The objective of the study was to review about regularity, treatment adherence and outcome among diabetic patients in primary care. In this literature review, electronic data sources viz. Pub Med, Proquest, Google Scholar, Research gate with the use of the keywords or Mesh words like “Diabetes,” “Primary Health care” “Treatment adherence” “Regularity of treatment” “process of care indicators” and “outcome indicators” were searched. The searches were limited to studies reported in English and were available as free full text from January 2009 to June 2018. Related articles including descriptive cross-sectional, cohort, randomized controlled trials, qualitative studies and systematic reviews were also extracted and refined further. From our review it’s clearly evident that the level of Diabetic care in terms of regularity and follow-up is suboptimal compared to standards established in developed nations. There is a wide scope for improvement in diabetic care as demonstrated successfully in many nations using regular clinical audit, which needs future introspection.

Rare occurrence of fungal thyroiditis – A case report

Fungal thyroiditis is extremely rare and its true incidence still happens to be the tip of an iceberg. We present here the case of an immunocompetent 35-year-old woman who presented with a left thyroid nodular goiter, and an incidental detection of Aspergillus infection. The accurate diagnosis of thyroid Aspergillosis is important, since there is every need to prevent further complications due to the occurrence of a disseminated disease. We report a case of 35-year-old woman presenting with a solitary left thyroid nodule.