Background: The objective of the study was to study the pattern of prophylactic antibiotics usage in caesarean sections in Indian settings.Methods: A cross-sectional observational study was done on women undergoing elective and emergency caesarean sections in the Department of obstetrics and gynecology who were given antibiotics according to the existing trends in the hospital.Results: Almost 72% women received prophylactic antibiotics within 30-60 minutes of skin incision while rest 28% received it before 60 minutes. In post-operative period around 80% of the women received injectable antibiotics for 48 hours, 12% for 72 hours and rest 8% received antibiotics for more than 72 hours. 90% of the patients received injections ceftriaxone 1 gm IV BD, gentamycin 80 mg IV BD metronidazole 400 mg iv TDS while 10% received injection Ampicillin 500 mg QID along with Injection Metronidazole 400 mg iv TDS and injection gentamycin 80 mg IV BD. Two percent of the cases developed wound sepsis and required change to higher antibiotics.Conclusions: In spite of recommendations by International Guidelines for single dose of prophylactic antibiotics, multiple doses are being given. There are no Indian guidelines for antibiotic prophylaxis in cesarean sections and as a result, various combinations of antibiotics are being given for variable duration leading to antibiotic resistance and increased cost of treatment.
Background Parasitic fibroids are a rare type of fibroids without direct uterine attachment. They pose a diagnostic dilemma and often present atypically. Case description We report a rare case of large secondary parasitic fibroid in a 24 year unmarried female who presented with history of lump abdomen for 6 months. She had history of laparoscopic myomectomy done 2.5 years back for the same complaint with histopathology report suggestive of leiomyoma. On examination, it was found to be subserosal pedunculated fibroid. All the tumor markers were negative except CA 125 which was 225 IU/mL. Exploratory laparotomy was done. Uterus was normal size and seen separately. Bilateral tubes and ovaries were normal. A mass of size 30 × 22 × 15 cm, firm in consistency occupying all the quadrants of abdomen, was observed. It had no attachment to the uterus or to the bowel. Mass weighing 6.5 kg was removed completely and sent for histopathology. HPE report confirmed leiomyoma. Her postoperative period was uneventful. Conclusion If the patient had prior history of myomectomy and mass is separate from the uterus with its blood supply away from uterus, diagnosis of parasitic leiomyoma should be considered. Clinical significance During morcellation procedures, a thorough inspection and washing of peritoneal cavity must be carried out, and endoscopic bag should be used to prevent secondary parasitic leiomyoma. How to cite this article Kurude VN, Gitte V, Raheja A, et al. Giant Parasitic Fibroid Mimicking Gist: A Clinical Dilemma. J South Asian Feder Menopause Soc 2020;8(1):49–51.
Background: In low- and middle-income countries epidural analgesia is generally not available and practically no form of labor analgesia is given to the majority of the parturient. The purpose of study was to evaluate the safety and efficacy of tramadol as a labor analgesic during first stage of labor.Methods: Pregnant women admitted in the labor room satisfying the eligibility criteria were randomized to receive intramuscular injection of either 100 mg tramadol or 2 ml distilled water. Visual analogue score (VAS) was assessed at the beginning and every hour till 4 hours. Pain satisfaction, duration of second stage of labor, fetal heart rate, mode of delivery, and any maternal side effects of the study drug were recorded. Neonatal evaluation using Apgar score at 1 and 5 minutes was done. For statistical analysis Student t-test, Chi Square test and Fisher’s exact test were used.Results: Total of 86 women were included in the study. The VAS scores were significantly lower in the tramadol group at 1, 2 and 3 hours after the administration. Pain relief satisfaction was significantly higher in the tramadol group. Rate of cervical dilatation, duration of the second and the third stage, need for instrumental delivery or lower segment caesarean section, rate of fetal distress and Apgar score at one and five minutes were comparable in both the groups. Nausea was significantly higher in tramadol group.Conclusions: Tramadol is a safe and efficacious drug which is inexpensive, easily available and easy to administer with few minor side effects. It can be used as a labour analgesic as an alternative to epidural analgesia in settings where epidural analgesia is not available. Trial registration: Clinicaltrials.gov PRS registration number: NCT02999594.
Ovarian steroid cell tumors are sex-cord stromal tumors that arise from lutein cells or leydig cells. These are very rare-accounting for <0.1% of all ovarian tumors.. Some of these tumors may be functional and secrete hormones. Nearly 56-77% of the cases present with hyperandrogenism. Rarely steroid cell tumors may arise in the adrenal cortex from the adrenal rest cellsWe report a case of a 60-year old lady who presented with gradual onset abdominal distension for two years. She had no other complains and had undergone hysterectomy 20 years back. Her abdomen was over distended due to a large, tense cystic, non-tender mass. Imaging studies revealed a large, mainly cystic abdominopelvic mass; however its origin could not be made out. The left adrenal gland was found to be bulky but morphologically normal. Serum DHEAS levels were normal thus ruling out adrenal pathology. Serum levels of CA 125 and CEA were also normal. Exploratory laparotomy was done. A large thin walled cyst occupied the pelvis and abdomen. . It measured 25x20x16cm and contained 4.2 litre of straw colored fluid. The fluid was drained and the entire cyst wall was excised. Ovaries were not visualized. Frozen section report of the cyst wall was suggestive of a neuroendocrine tumor. Final histopathology report was of benign steroid cell tumor not otherwise specified.
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