Journal of Mahatma Gandhi University of Medical Sciences and Technology

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2020 | September-December | Volume 5 | Issue 3

Original Article

Vatsal Thakral, Swati Garg, Prateek Suren

Evaluation of Endometriosis in Infertility: Incidence, Clinical Features, and Laparoscopic Findings

[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:4] [Pages No:73 - 76]

Keywords: Adhesions, Dyspareunia, Endometriosis, Hysterolaparoscopy, Infertility

PDF  |  DOI: 10.5005/jp-journals-10057-0133  |  Open Access |  How to cite  | 

Abstract

Background and objective: Endometriosis is defined as the presence of endometrial glands and stroma-like lesions outside of the uterus. To study the incidence, clinical features, and their association with laparoscopic findings in patients with endometriosis who underwent evaluation for infertility. Materials and methods: It is a hospital-based prospective study conducted at the Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Hospital, Jaipur, from January 2019 to June 2020 among women with complaints of infertility who underwent diagnostic hysterolaparoscopy. Results: In our study, out of 104 infertile patients who underwent diagnostic laparoscopy for evaluation of infertility, 32 patients (30.8%) had endometriosis, 21 patients had involvement of pouch of Douglas (POD) followed by the uterus and the ovaries. Most of the patients belonged to stage III (37.5%) followed by stage I and stage II. 22.1% of patients with endometriosis had dysmenorrhea followed by chronic pelvic pain and dyspareunia in 18.3 and 14.4%, respectively. In our study, 68.8% of patients with endometriosis had primary infertility and 31.2% had secondary infertility. Symptoms, such as, chronic pelvic pain, dysmenorrhea, and dyspareunia, in endometriosis patients were statistically significant. 65.7% of patients with endometriosis had adhesion. Conclusion: Endometriosis in infertile females is very common and it is increasingly being detected by diagnostic modalities like laparoscopy in the evaluation of infertility. Though most females are asymptomatic or have symptoms like dysmenorrhea, chronic pelvic pain, and dyspareunia which raise the suspicion of endometriosis.

Original Article

Pradyot Shahi, Brijesh Sharma, Mahesh Solanki

A Comparison of 0.3% Topical Nifedipine Ointment vs Lateral Sphincterotomy in the Treatment of Chronic Anal Fissure

[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:6] [Pages No:77 - 82]

Keywords: 0.3% Nifedipine ointment, Anal fissure, Lateral internal sphincterotomy

PDF  |  DOI: 10.5005/jp-journals-10057-0135  |  Open Access |  How to cite  | 

Abstract

Introduction: A chronic anal fissure is a common anorectal condition associated with high sphincter pressure and a reduction in mucosal blood flow, with secondary local ischemia and a poor healing tendency. The principle of treatment is breaking the cycle of pain, spasm, and ischemia thought to be responsible for the development of fissure in ano. Aim: To assess and compare the topical application of 0.3% nifedipine and lateral internal sphincterotomy as treatment modalities in patients diagnosed with chronic anal fissure. Materials and methods: This study was a prospective comparative study where 100 patients who presented in a surgical outpatient department of MGMCH, Jaipur with complaints of the painful passage of stool, with or without bleeding of >6 weeks duration, diagnosed to be having chronic anal fissure, were randomly selected and classified into two groups, each consisting of 50 patients. The patients in the first group were subjected to pharmacological sphincterotomy using topical application of 0.3% nifedipine while patients in group II were subjected to lateral sphincterotomy. Outcomes in each group were followed up at 2, 4, 6, 8, and 12 weeks. Results: In our study, fissures at 4, 6, 8, and 12 weeks were healed in 78, 86, 92, and 90% patients, respectively, in the nifedipine ointment group whereas in the lateral sphincterotomy group fissures at 4, 6, 8 and 12 weeks had healed in 88, 92, 98, and 98% patients, respectively. Nineteen patients (38%) developed side effects in the nifedipine group, compared with 10 patients (20%) in the sphincterotomy group. Conclusion: With good treatment outcome nifedipine ointment has the potential to become the first-line treatment for chronic anal fissures. It represents a new, promising, effective alternative to lateral internal sphincterotomy but in case pharmacological therapy fails, lateral sphincterotomy is the surgical option of choice.

Original Article

Sonam Chaudhary, Seema Sharma, Swati Garg

A Comparative Study of Transvaginal Cervical Length at 11–14 Weeks and at 18–22 Weeks of Gestation for the Outcome of Pregnancy

[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:5] [Pages No:83 - 87]

Keywords: Ectopic pregnancy, Gestation, Transvaginal

PDF  |  DOI: 10.5005/jp-journals-10057-0137  |  Open Access |  How to cite  | 

Abstract

Background: Spontaneous preterm birth (SPTB) represents a major cause of neonatal morbidity and mortality worldwide. Transvaginal cervical shortening is a predictor of preterm birth. Prediction of preterm labor by measurement of cervical length through transvaginal sonography when coupled with appropriate preterm birth prevention strategies, has been associated with reductions in SPTB in asymptomatic singleton pregnant women. Materials and methods: This prospective observational study was conducted on 210 pregnant women attending the ANC OPD in the department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College Jaipur, during the time period of January 2017 to June 2018 and fulfilling the inclusion and exclusion criterion for the study. Detailed history taking and pre-evaluation done as per prestructured proforma followed by transvaginal ultrasonography with GE VOLUSON 730 PRO TVS probe IC 5–9 H instrument with 5–9 MHz which was done by a single operator after taking consent. Cervical length was measured at 11–14 weeks and subsequently, the subjects were followed up between 18 weeks and 22 weeks for the repeat readings. Statistical analysis was done to determine the significance of cervical length in predicting preterm labor. The analysis was done using SPSS version 20 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software program. Results: In our study, 180 patients had a significant correlation of cervical length at 11–14 and 18–22 weeks in relation to preterm and term delivery. The mean cervical length of the study group at 18–22 weeks was 3.14 mm. Conclusion: Transvaginal ultrasonographic measurement of cervical length is an effective tool for the evaluation of preterm delivery risk.

Original Article

Ketan Patel, Jitendra K Mangtani, Neelkamal Gupta, Shavan K Yadav

To Analyze Patients of Post-cholecystectomy Symptoms after Cholecystectomy

[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:3] [Pages No:88 - 90]

Keywords: Cholecystectomy, Common bile duct stone, Post-cholecystectomy syndrome

PDF  |  DOI: 10.5005/jp-journals-10057-0136  |  Open Access |  How to cite  | 

Abstract

Introduction: Post-cholecystectomy syndrome (PCS) comprises a group of abdominal symptoms that occur after cholecystectomy. Post-cholecystectomy syndrome is defined as a group of heterogeneous symptoms. It consists of upper abdominal pain, vomiting, and dyspepsia, which occur after cholecystectomy. Although this term is not accurate, it comprises biliary and non-biliary disorders, possibly not related to cholecystectomy. Aim: To analyze the clinical evaluation for post-cholecystectomy symptoms. Objectives: To identify the causes for post-cholecystectomy symptoms. To identify preoperative factors (h/o endoscopic retrograde cholangiopancreatography (ERCP), attacks of cholecystitis) associated with post-cholecystectomy symptoms. Materials and methods: A prospective clinical hospital-based study was done on 100 patients at a tertiary care referral hospital in the department of general surgery. All cases of post-cholecystectomy who had clinical symptoms of PCS cases in which follow-up ultrasonography (USG) and liver function test (LFT) were done. Results: In our study, 100 patients were taken who developed PCS after cholecystectomy. Among all patients, 16% patients developed PCS due to biliary etiology. Among 16% of patients, the most common cause is recurrent common bile duct (CBD) stone (6%) and the second most common cause is retained CBD stone (3%) and sphincter of Oddi dysfunction (3%). Discussion: This analysis provides a qualitative overview of etiologies of abdominal symptoms after cholecystectomy. Based on the etiologies of persistent and incident symptoms after cholecystectomy provided in this review, we identified the cause of long-term symptoms after cholecystectomy. Conclusion: In our study, PCS developed mainly due to non-biliary etiology considered 84% and biliary etiology considered only 16%. Female has a higher risk to developing post-cholecystectomy symptoms compared to male after cholecystectomy.

Original Article

Aviral Gupta

Clinical and Laboratory Profile of COVID-19 Patients Presenting to a Tertiary Care Hospital in Jaipur, Rajasthan: An Observational Study

[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:5] [Pages No:91 - 95]

Keywords: C-reactive protein, Coronavirus disease 2019, Neutrophil:lymphocyte ratio

PDF  |  DOI: 10.5005/jp-journals-10057-0129  |  Open Access |  How to cite  | 

Abstract

Background: In this study, we aim to report the clinical and laboratory profile of 187 coronavirus disease 2019 (COVID-19) patients admitted to a tertiary care hospital in Jaipur, Rajasthan, India. Materials and methods: Case records were accessed retrospectively, and demographic profile, clinical presentation, and two laboratory markers [neutrophil:lymphocyte ratio (NLR) and C-reactive protein (CRP)] were evaluated in 187 patients with confirmed COVID-19 infection. Patients were divided into two groups for analysis—recovered/discharged group and mortality group. Results: In our study, the mortality rate was 11.8% (22 out of 187 cases) with similar age and sex distribution between the two groups. A higher proportion of patients in the mortality group had severe disease as compared to the recovered group (72.7 vs 8.5%). Patients who died had a longer mean duration of symptoms before admission (5.2 vs 3.3 days), with a lower duration of hospital admission (5.6 vs 10.6 days) as compared to the recovered group. Fourteen out of 22 patients in the mortality group required non-invasive or invasive ventilatory support at admission, compared to 21 out of 165 patients who recovered; and 86.4% of patients who died had comorbidities vs 43.6% of those who recovered. The mean NLR was over 3.5 times higher and mean CRP at admission nearly 2.6 times higher in the mortality group.

CASE REPORT

Vikram Sharma, Harshdeep Dhaliwal, Satyapal Yadav

Primary Intraosseous Carcinoma Arising in a Mandibular Keratocystic Odontogenic Tumor: A Case Report

[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:4] [Pages No:96 - 99]

Keywords: Keratocystic odontogenic tumor, Mandible, Primary intraosseous carcinoma, Primary intraosseous squamous cell carcinoma

PDF  |  DOI: 10.5005/jp-journals-10057-0126  |  Open Access |  How to cite  | 

Abstract

Primary intraosseous carcinoma (PIOC) is a rare squamous cell carcinoma (SCC) arising within the jaw, which has no initial connection with the oral mucosa, overlying skin, antral or nasal mucosa. Primary intraosseous carcinoma is also designated as odontogenic carcinoma because it is considered to develop from the epithelium involved in odontogenesis. It is considered a rare lesion, but may not be as rare as commonly believed. It may arise de novo or as a consequence of malignant transformation of a benign cyst or tumor. It is locally aggressive with a poor prognosis. A case of primary intraosseous SCC of the mandible, with evidence of origin in an odontogenic cyst, is presented.

CASE REPORT

Niharika Jain, Parul Gautam, Abha Mathur, Mohan Lal Yadav

A Rare Case of “Symptomatic Bilateral Adrenal Myelolipoma”

[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:3] [Pages No:100 - 102]

Keywords: Adipose tissue, Adrenal gland, Hematopoietic, Incidentaloma, Myelolipoma

PDF  |  DOI: 10.5005/jp-journals-10057-0127  |  Open Access |  How to cite  | 

Abstract

Introduction: Adrenal myelolipoma is a benign neoplasm composed of mature adipose tissue and scattered islands of hematopoietic elements. Although the true incidence of these tumors is unknown, the incidence estimated to be is quite less. These lesions are usually unilateral and asymptomatic and are very rarely found as bilateral tumors. Aims and objectives: To present a rare case of “Symptomatic Bilateral Adrenal Myelolipoma”. Materials and methods: A 53-year-old woman presented with complaints of pain abdomen for 6 months. Physical examination was unremarkable. Computed tomography (CT) scan of the abdomen revealed a well-defined, round lesion bilaterally with heterogeneous attenuation suggesting the possibility of myelolipoma. The patient was subjected to bilateral adrenalectomy and the bilateral adrenal masses were sent for histopathological examination. Results: The histopathological evaluation of masses confirmed the diagnosis of bilateral adrenal myelolipoma. Conclusion: Although mostly discovered as an “incidentaloma”, the diagnosis of adrenal myelolipoma warrants through diagnostic study. Surgical resection is the mainstay as it prevents complications, such as spontaneous rupture and hemorrhage of the mass.

SURVEY

Priya R Sharma, Esha Nagpal, Kamal Bajaj, Garima Gaur, Vikas Jharwal, Siddharth Mehta

Patient's Perception Regarding the Choice of Their Orthodontist: A Questionnaire Study

[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:4] [Pages No:103 - 106]

Keywords: Attire, Orthodontist, Perception

PDF  |  DOI: 10.5005/jp-journals-10057-0139  |  Open Access |  How to cite  | 

Abstract

The objective of this study was to evaluate parents’ preferences of the age, sex, appearance, and attire of orthodontists. Two subjects (one male and one female) were asked to pose for photographs wearing various combinations of attire (casual, scrubs, white coat, and formal), hairstyle. Survey participants were presented with choice sets and asked to select the most and least preferred provider photographs. A total of 100 orthodontic patients participated in the computer-based survey. The results indicated that there were significant differences due to provider sex (p = 0.0013), provider age (p < 0.0001), dress (p < 0.0001), and hair (p < 0.0001). The most preferred providers were the younger female and the older male. Formal attire or scrubs was the most preferred style of dress. There was also a preference for the provider to have his/her hair in a controlled style.

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