With the increasing number of published case reports and studies, probability of newborns acquiring COVID-19 infection through vertical transmission is on rise. Although the modes of transmission for neonatal COVID-19 infection are becoming clearer, the clinical spectrum in the form of radiology and laboratory parameters have still not been studied well. We report a case of a preterm neonate, whose mother had tested positive for COVID-19 infection before delivery. The neonate was asphyxiated and had meconium aspiration syndrome. RT-PCR of her endotracheal secretions for COVID-19 tested positive within 24 hours of life and at 72 hours. The laboratory investigations were suggestive of cytokine storm syndrome (CSS) and the CT scan chest supported the diagnosis of COVID-19 pneumonia. This is probably the youngest neonate with COVID-19 infection showing CSS.
Objective: To evaluate the efficacy of saline infusion sonohysterography as a primary screening tool in cases of postmenopausal bleeding and correlate the results with the findings of histopathological examination. Materials and methods: This prospective observational study involved 34 postmenopausal patients with postmenopausal bleeding who attended the OPD of Obstetrics and Gynaecology at Deenanath Mangeshkar Hospital over a period of 4 years and were advised saline infusion sonohysterography (SIS). All women underwent transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) followed by histopathological examination. The sensitivity, specificity, PPV, and NPV for TVS and SIS were analyzed using the HPE report as a gold standard. The advantages and limitations of the screening test were evaluated. Results: The most common abnormalities detected on SIS were thickened endometrium seen in 13 cases (38.2%), followed by polyps (11 cases, 32.4%), thin endometrium (6 cases, 17.6%), submucous fibroids (3 cases, 8.8%), and undetermined (1 case, 2.9%) among our study population with a mean age of 52 ± 7.4 years. Diagnostic accuracy of SIS in identifying patients with intrauterine abnormalities was 91.2%, better than TVS. The sensitivity, specificity, PPV, and NPV of SIS in the detection of intrauterine abnormality was 96.2%, 71.4%, 92.9% and 83.3%, respectively. In this study, the diagnostic accuracy of SIS in identifying patients with abnormal histopathology was 88.2%.
Conclusion:Saline infusion sonohysterography can be considered to be a valuable tool in the early workup of postmenopausal bleeding as it is an outpatient, lesstime-consuming procedure and noninvasive with no requirement for anesthesia. Clinical significance: Saline infusion sonohysterography is a sensitive tool and is superior to TVS used alone for evaluation of the uterine cavity. Saline contrast hysterosonography, in combination with HPE if necessary, can become the standard diagnostic procedure in women with postmenopausal bleeding, the gold standard being hysteroscopy.
It is very rare to have a lymphomatous involvement of ovary. Malignant lymphoma of ovary is a well-known late manifestation of disseminated nodal disease. Primary ovarian lymphoma with ovarian mass as an initial manifestation is a rare entity and may have varied presentations which can cause confusion to the physician and cause delay in diagnosis. Study presents a case of non-Hodgkin’s lymphoma where the initial presentation was fever with weight loss, and was evaluated as pyrexia of unknown origin. When no other cause of fever was identified PET-CT was done showing metabolically active uterine mass with no lymphadenopathy. Exploratory laparotomy was planned followed by hysterectomy with bilateral salpingo ophorectomy with omentectomy. Ovarian malignancy was detected intraoperatively, which was diagnosed as diffuse large B cell lymphoma, NHL double expresser phenotype on histopathology and IHC. Patient was started on chemotherapy and is doing fine.
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