Polycystic ovarian syndrome (PCOS) is a heterogenous condition accounting for
serious health complications. The present study was conducted to assess the
early clinical, biochemical, and radiological features in obese, non-obese young
women with PCOS as compared to non-PCOS women. The study was conducted on 120
young women (18–22 years) with 80 having features of PCOS [40 obese
(BMI≥25 kg/m2) and 40 non-obese
(BMI<25 kg/m2) PCOS] as cases and 40 without PCOS as
controls in a rural tertiary care center of Northern India over one year
(2017–2018). After enrolment of cases and control, the anthropometric
measurements, early clinical symptoms, and biochemical and ultrasonographic
features were compared between the groups. Statistical analysis was done using
SPSS software version 22.0 (p-value<0.05). A significant difference in
anthropometric measurements were observed between obese and non-obese PCOS
cases. Clinical features like acne, acanthosis nigricans, and hirsutism were
more prevalent in obese PCOS as compared to non-obese and controls. On
ultrasound, PCOS cases had a significantly increased number of peripherally
arranged ovarian follicles, and ovarian volume. The LH: FSH ratio was
significantly higher in cases as compared to controls. The levels of serum LH
(10.04±1.60 vs. 8.93±2.40 mIU/ml) and total testosterone
(2.71±0.39 vs. 2.21±0.39 pg/ml) were higher in
obese PCOS as compared to non-obese PCOS cases. In conclusion, clinical,
biochemical, and radiological features can be used in the early diagnosis of
PCOS. Obesity is an independent risk factor for PCOS and is associated with an
increased risk of complications.
Background:Recent developments in assisted reproductive technology focus on potential advances to improve its success rate. Atosiban, a combined oxytocin/vasopressin V1a receptor antagonist, is a novel class of drug involved in basic priming of the uterus for successful implantation during embryo transfer (ET).Objectives:The objective of this study is to evaluate the efficacy of atosiban (study group) in ET patients in comparison to placebo (control group) regarding implantation rate (IR), clinical pregnancy rate (CPR), and ongoing pregnancy rate and to assess the safety profile of atosiban.Materials and Methods:A total of 320 women undergoing in vitro fertilization-ET at a tertiary care hospital were enrolled in the study. In the study group, atosiban was given as initial intravenous (IV) bolus injection 0.9 ml (6.75 mg), 30 min before ET followed by continuous IV infusion of atosiban. In the control group, placebo (normal saline) was infused at the same rate and dose. Pregnancy was confirmed 14 days after ET by β-human chronic gonadotropin level. IR and CPR were determined by doing transvaginal sonography 3 weeks and 6 weeks postET, respectively.Results:In women with atosiban treatment, the positive pregnancy rate and CPRs were 41.25% and 36.25%, respectively. The IR per embryo transferred was 17.5%. No major side effects of atosiban were noted among enlisted patients. The miscarriage rate and ectopic pregnancy rate were low (12.12% and 4.54%, respectively). Forty-two women had singleton gestation, while twin and triplet pregnancies were encountered in 13 and 3 women, respectively. No congenital anomalies were observed during an antenatal scan at 18–20 weeks in ongoing pregnancies. The positive pregnancy rate, the CPR, and the IR in the control group was 35%, 30%, and 16.5%, respectively, which was significantly lower than the atosiban group.Conclusion:Atosiban reduces uterine contractions and increases endomyometrial perfusion, both of which have potential benefits regarding improved IRs, CPR, and ongoing pregnancy rates. Atosiban has a good embryonic safety profile.
The influence of pregnancy on the subsequent course of pre-existing nephrotic syndrome is controversial as also the effect of membranous glomerulonephritis on maternal and perinatal outcome. We describe a case of successful pregnancy outcome in Hepatitis B reactive patient with pre-existing nephrotic syndrome (renal biopsy proven case of Membrano-proliferative Glomerulonephritis). She had regular nephrology consultation and her renal disease was well compensated. After sonographic confirmation of live intrauterine pregnancy at 9th gestational week, patient was given methylprednisolone (5mg once daily). Antihypertensive drugs were also given. At 35 weeks of gestation, patient went in labour and cesarean section was performed in view of previous caesarean section. Feto-maternal outcome was good. The intrapartum and postpartum period was uneventful. Renal functions were well preserved. A vigourous healthy 1.93 kg baby was discharged with mother in a stable condition after receiving hepatitis B immunoglobulin.
Traumatic female urethral avulsion in the absence of a pelvic fracture is an exceedingly rare entity. We report a case of 26 years old lady with crescentic tear of anterior urethra from pubic symphysis. Management consisted of primary urethral repair.
Intrauterine contraceptive devices are extremely effective and long lasting. They were intended for long term use and were retained for year’s altogether. Menopausal ladies often present with Lippes Loop in situ either deliberately or forgotten. We report a case of 80 years old patient who came with complaints of pain in lower abdomen and vaginal discharge and had Lippes Loop insitu, which was inserted 45 years back. The inserted Lippes Loop thread was not seen in clinical examination but visualized on Transvaginal Ultrasonography along with pyometra. It was removed under hysteroscopic guidance.
Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates with the ideal scenario involving prompt diagnosis and early aggressive treatment with plasma exchange in a postpartum hemolytic uremic syndrome patient.
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