An Evaluation of Risk Factors for HPV (Human Papilloma Virus) and its Association with Development of Cervical Carcinoma
Page Numbers : 90-94
DOI : 10.36348/sijog.2021.v04i04.002
Background: Cervical cancer is a preventable disease unlike other cancers. HPV infections have a long incubation period to cause cervical cancer. Other risk factors like early age of conception, illiteracy, low socioeconomic status, use of OCPs for a long period of time, low folate level, high parity and smoking predisposes to cervical cancer. Materials and Method: Present study aimed to identify the risk factors responsible for HPV infections and its association with development of cervical carcinoma in women of age group 20 to 65 years with history of white discharge, blood-stained discharge; heavy menstrual flow, intermenstrual spotting, and postcoital bleeding attending Gynaecology OPD samples of cervical scrapping, Pap smear, Visual Inspection with Acetic Acid (VIA) and Visual Inspection with Lugols Iodine (VILI) was taken for detection for high-risk groups for cervical cancer and its association with different risk factors. Results: HPV infection prevalence in our study was 20% among total of 100 patients. PCR positivity was highest among the age group 30-39 years. HPV infection was highest among the age group 19-20 years. Multiparous women having 3 or more children had shown high positivity for HPV- DNA. Illiterate women and women with only up to primary education had shown the highest HPV infection and it was 18 %. Nonvegetarian women had highest HPV infection. Major symptom of the PCR positive cases was white discharge. PCR for HPV-DNA was 100% positive in women who had cervical growth. Conclusion: Our study shows the importance of Pap smear and HPV-DNA testing of women in our country where prevalence and risk factors are extremely high. It can identify and help in preventing or treating the condition at exceedingly early stage.
April 11, 2021
Neuroendocrine Cancer of the Breast: A Rare Entity
Primary neuroendocrine carcinomas of the breast (NEBC) represent a rare subtype of breast cancer, accounting for 2-5%. They generally present a more aggressive clinical form with a strong tendency to local and distant recurrence compared to other types of invasive breast carcinoma and they do not present specific clinical or radiological characteristics. We report the case study of a 58 years old female patient with primary neuroendocrine carcinoma of the breast.
The process itself of staging of the disease during pregnancy and the treatment should comply with current standards, to the extent possible. Surgery and/or chemotherapy are considered to be fundamental methods of treatment for invasive cervical cancer during pregnancy. Tactics in the treatment of such patients is determined by a range of factors and depends on gestational age at the time of diagnosis, the stage of the disease, tumor size, as well as on the involvement of regional lymph nodes and the woman’s desire to continue pregnancy. Case Description: A 32 year-old patient, grand multipara, admitted for spontaneous metrorrhagia of low abundance during a 7 month pregnancy (date of last menstrual period is inaccurate) for which she consulted in the private sector where she underwent a gynecological examination that showed a tumoral process of the cervix, and then a biopsy that revealed a cervical squamous cell carcinoma. The patient was then referred to our departement for further care; we decided to perform a C-section at 34 weeks of ammenorrhea, giving birth to a male infant with a birth weight of 2300g, and then a CRC. Conclusion: The incidence of cervical cancer in pregnancy is itself not very high, and the symptoms are easily confused with other diseases in pregnancy. During pregnancy, gynecological examination is limited, and therefore, the rate of misdiagnosis is higher. The treatment of cervical cancer during pregnancy is related to many factors, such as tumor size, pathological type, period of gestation, lymph node involvement, and patients' willingness to maintain pregnancy.
Original Research Article
April 5, 2021
A Study on Critical Care Obstetrics’ in Eclampsia Patients-ICU Management and Maternal Outcome in Obstetrics and Gynaecology Department, Dhaka Medical College Hospital
Dr. Fowzia Yasmin, Dr. Aklima Akter, Dr. Farida Begum
Page Numbers : 82-89
DOI : 10.36348/sijog.2021.v04i04.001
Introduction: Eclampsia is a very serious and relatively frequent complication of pregnancy which is considered as ‘obstetrical tragedy’ to the unborn fetus the mother and to the obstetricians. Early diagnosis and proper treatment can reduce the maternal mortality due to eclampsia. Aim of the study: The aim of this study was to assess the maternal outcome of intensive care management for the critically ill eclamptic patients admitted in Dhaka medical college Hospital. Methods: This longitudinal prospective study was conducted in Eclampsia ward and ICU Ward of Dhaka medical college Hospital from January to December of 2004. Sixty Seven very critically ill eclampsia patients were included in this study. Relevant information regarding demographic, during pregnancy, complications, past history of eclampsia, history of antenatal check-up, including drug history were collected. Result: In this study among the 757 eclampsia patient, 67 (8.85%) were critically ill. Maternal mortality was 43.11% due to eclampsia. 70% patients had very high diastolic blood pressure, 44.77% patients have severe oliguria, and 61.69% patients had severe degree of proteinuria. 26.86% of patient’s level of consciousness was less than 5. Unavailability of bed is the prime (75%) cause of delay in shifting patient to ICU ward. Those treated by peritoneal dialysis recovered completely (100%). 25.37% patients had HELLP syndrome and 20.89% had CVA. The most common cause of maternal death in eclampsia ward was cerebrovascular accident 31.42% and in ICU multiorgan failure (33.33%). Mortality was very high among the patients who were with no ante-natal check-up (82.23%). Twenty patients received ICU support and mortality is 12 (60%), but among those 47 patients not received support mortality is 35 (75%). Conclusion: Many patients come to the Hospital at the terminal stages, not only with primary complications but also with many secondary complications. Therefore, a last minute best management effort should be given to everyone by when the complications are diagnosed, a teamwork approaches by multidisciplinary health care.
March 30, 2021
Woman with Partial Androgen Insensitivity Syndrome and Bilateral Sertoli Cell Tumor: A Rare Case Report
Dr. Tandra Ghosh, Dr. Shakeela Ishrat, Prof Jasmine Banu, Prof Md Ruhul Amin, Dr. Nighat Sultana, Dr. Sadia Afrin Munmun, Dr. Mumtahena Amir, Dr. Abhijit Roy
Page Numbers : 67-71
DOI : 10.36348/sijog.2021.v04i03.005
Partial Androgen Insensitivity Syndrome (PAIS), a 46XY disorder of sexual differentiation where there is partial loss of function of androgen receptors (AR). The spectrum of clinical presentation can vary in adult from phenotypic female with mild virilization to under virilized male with or without genital ambiguity. Case description: A 25 years old woman presents with primary amenorrhea, ambiguous genitalia and features of mild virilization like hirsutism and voice change. After admission in Reproductive Endocrinology and Infertility Department of Bangabandhu Sheikh Mujib Medical University, she underwent genitoplasty, vestibuloplasty and bilateral gonadectomy. Histopathology of the atrophic testes revealed Sertoli cell tumor. Conclusion: Partial Androgen Insensitivity Syndrome (PAIS) is presented clinically as ambiguous genitalia, as predominant female to male phenotype with varying degree of virilization. Multidisciplinary approach of management aims at appropriate sex assignment, reconstructive surgery, gonadectomy to prevent tumor genesis and hormone replacement therapy.
Original Research Article
March 30, 2021
Demographic and Clinical Features of Patients with Subfertility
Dr. Polly Ahmed, Dr. T.A Chowdhury, Dr. Kaniz Mahmud
Page Numbers : 76-81
DOI : 10.36348/sijog.2021.v04i03.007
Aim and Background of the study: Subfertility is an intricate health problem which is rising dramatically. Patient’s demographic factors along with pelvic pathology significantly important for uprising trend. The aim of this study was to evaluate the demographic and clinical characteristics of patients with infertility specially identifying the ovulatory disturbance, tubal factors, pelvic adhesion and endometriosis by Laparoscopy. Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh from May, 2007 to October 2007. The sample size was 100.Result: In this study, among 100 patients 68% had primary and 32% had secondary infertility. 55.9% were within 20 to 30 years age group and 44.1% above 30 years age in primary subfertility. 21.9% were within 20 to 30 years age group and 78.1% above 30 years age group in case secondary subfertility. 58% patients were house wife. 42% of patients were service holder they were teacher and other professional personnel. In this study majority (77%) of patients are from upper-middle class and middle class family. Out of all patients of primary infertility 58.8% had regular, 44.2% had irregular cycle 30% had scanty, 20% had menorrhagia and 29.4% had dysmenorrhea. Within secondary infertility
group 87.5% had regular, 12.5% had irregular cycle 25% had scanty, 21.4% had menorrhagia and 75% had dysmenorrhea. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4%right & 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right & 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases. In this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder. In this study, Pouch of Douglas was normal in 77% cases, 7% had endometriotic deposits 16% had adhesion and obliteration of Pouch of Douglas. In this study 74% of patient had normal size of uterus, 3% had uterus smaller than normal size and 23% had bulky uterus. 83% patient had freely mobile uterus and rest had restricted mobility. Conclusion: From analyzing the findings, we recommend that awareness developing program about the factors affecting infertility should be taken. Laparoscopy is more convenient, conclusive & more precise for diagnosing the cause of subfertility. Early diagnosis and treatment should be encouraged among couple.
March 30, 2021
Woman with Unclassified Mullerian Anomaly, Polycystic Ovary Syndrome and Infertility: A Case Report
Dr. Shakeela Ishrat, Dr Farhana Parveen, Dr. Muhammad Jasim Uddin, Dr. Sabiha Sultana, Dr. Mehnaz Mushtary Shume, Dr. Serazoom Munira, Dr. Sheikh Farhana Huda
Page Numbers : 72-75
DOI : 10.36348/sijog.2021.v04i03.006
Mullerian anomalies cannot always be defined in one or the other class, as described by the American Society of Reproductive Medicine. One such unclassified anomaly incidentally found in a infertile women with polycystic ovary syndrome, was difficult to diagnose with existing imaging modalities. The final diagnosis was not made until after the surgeries including diagnostic laparoscopy and hysteroscopy.