OBJECTIVE:The current study aimed to delve into the comparative clinical outcomes between external beam radiation therapy (EBRT) and sequential High Dose Rate Intracavitary Brachytherapy (HDRICBT) with or without concurrent cisplatin administration on the day of intracavitary brachytherapy (ICBT) insertion in women with locally advanced cervical cancer.METHODS:In this study, conducted between January 2017 and July 2018 at a leading institute in India, diagnosed and untreated patients of locally advanced carcinoma cervix were randomized into two groups. Arm 1 received concurrent cisplatin before each course of brachytherapy, while Arm 2 underwent brachytherapy alone. The outcomes were compared in terms of acute and late toxicities, treatment response, and follow-up. Data analysis was performed using SPSS 16, with statistical significance set at p < 0.05.RESULTS:Both study arms showed similar complete response (CR) rates of 73.3%, with no significant advantage of concurrent cisplatin before brachytherapy. However, a noteworthy trend emerged during follow-up. In the concurrent cisplatin group, the CR rate increased from 73.3% post 1 month of brachytherapy to 86.7% at 3 months and 83.3% at 6 months. Contrastingly, the control group showed CR rates of 73.3% post 1 month, 80% at 3 months, and 76.6% at 6 months. While not statistically significant, this observation suggests a possible enhancement in response rates with concurrent cisplatin and ICBT.CONCLUSIONS:Future studies focusing on the optimal drug, dosage, scheduling, and combining cisplatin with other agents are recommended to further explore the potential benefits observed in this study.

Objective: To evaluate differences in various fetal echocardiographic parameters in women with or without hyperglycemia during pregnancy. Material and Methods: We studied fetal cardiac structure and function in 50 uncomplicated singleton pregnancies and in 100pregnancies complicated by hyperglycemia. Maternal glycemic control was deemed adequate in 80 women and inadequate in 20. Fetal echocardiography was done to assess interventricular septal thickness and cardiac function, both systolic [ejection fraction (EF)] and diastolic [using E/A ratio, Ea value and E/Ea ratio]. All these parameters were compared between groups. Results: Fetal cardiac interventricular septal thickness during diastole was increased in hyperglycemicas compared to normal pregnant females (p value<0.05) and it was independent of glycemic control. Fetal cardiac systolic function as indicated by ejection fraction was also increased in hyperglycemic pregnant females (p value<0.05) but it was found to be decreased in uncontrolled diabetic females. Fetal cardiac diastolic dysfunction as indicated by low E/A ratio, low Ea value and increased E/Ea ratio was present in pregnant females with hyperglycemia and it was dependent on glycemic control of the patient (p value<0.05). Conclusion: Fetuses of diabetic mothers have increased incidence of cardiac dysfunction and it was related to control of diabetes.

Introduction: A large number of pregnancies are complicated by diabetes mellitus in the mother which is associated with the risk of various cardiac structural and functional complications in the neonates. A diagnostic tool is needed to detect these dysfunctions early. In contrast to conventional pulsed-wave Doppler, which is influenced by heart rate and the impact of volume changes on transmitral flow, tissue Doppler imaging is the mode of echocardiography that is relatively independent of the loading state. Two-dimensional (2D) speckle-tracking echocardiography-derived strain imaging is a new technology increasingly being used to estimate cardiac systolic and diastolic dysfunction and has superior prognostic value for predicting major adverse cardiac events. Objective: The objective of this study was to evaluate cardiac function in neonates of mothers with diabetes on echocardiography and differences in the extent of cardiac dysfunction between neonates of well-controlled and poorly controlled mothers with diabetes. Methods: This is a cross-sectional observational study which was done on 152 neonates born to mothers with diabetes (22 overt vs. 130 gestational and 23 well-controlled vs. 129 poorly controlled) and 96 born to nondiabetic mothers. Three modes of echocardiography, i.e. M-mode, Doppler (pulsed wave and tissue), and 2D speckle-tracking echocardiography, were done and cardiac functions were compared among different groups. Results: Infants of diabetic mothers (IDMs) had lower ejection fraction on M-mode echocardiography and lower values of global longitudinal strain on 2D speckle-tracking echocardiography along with significantly lower values of mitral and tricuspid E velocity and E/A ratio with higher values of A velocity on pulsed-wave Doppler. Tissue Doppler showed higher left ventricle E/E' in IDM implying more systolic as well as diastolic dysfunction in IDM as compared to non-IDM. In neonates born to mothers with poorly controlled diabetes, Doppler showed lower values of mitral and tricuspid E/A ratio and left ventricle E'/A' ratio signifying more diastolic dysfunction as compared to neonates born to mothers having good glycemic control. Similarly, neonates born to mothers with pregestational diabetes had significantly deranged systolic and diastolic functions. Conclusions: IDMs have significant cardiac dysfunction on echocardiography which is also related to the degree of glycemic control and onset of diabetes.

Abstract Objective: Determining whether non-surgical periodontal therapy (NSPT) will affect bone turnover biomarkers (BTMs) concentration in individuals with periodontitis. Materials and Methods: 60 females aged 18-45 years were divided into two groups Normal (N) (n= 20) and Chronic periodontitis (CP) (n= 40) after recruitment. Participants with periodontitis were assigned (NSPT). Full mouth clinical periodontal parameters, salivary and serum BTMs including C-terminal telopeptides of type I collagen (CTX), bone alkaline phosphatase (BALP), and Osteoprotegerin (OPG) were recorded for both groups and 21 days and 3 months after NSPT. Results: Except for BALP_ SER (p<0.023), all variables had highly significant differences (p<0.001). Except for CP (21 days) vs. CP (3 months), groups showed significantly greater levels of PI, PPD and CAL. Correlations between BTMs and periodontal measurements were weak to moderate after NSPT. The multiple linear regression model explained 46.7% of the total variability for PI, 50.1% for PPD, 54.1% for CAL and 29.3% for GI signifying association with BTMs among groups Conclusion: Our research showed the concentration of BTMs is greatly impacted by NSPT demonstrating the significance of NSPT on bone health in periodontitis. Additionally, we discovered that serum instead of salivary samples can be utilized as a diagnostic tool to measure BTMs concentration. Clinical Relevance - This study emphasizes the significance of regular periodontal evaluation and the use of non-surgical periodontal therapy (NSPT) to manage periodontitis and prevent further bone loss. It also highlights the value of using serum samples as a diagnostic tool to monitor bone health in periodontitis patients.

Studies suggest an association between poly-cystic ovarian syndrome (PCOS) and chronic periodontitis (CP), both being inflammatory conditions. However, insufficient evidence assesses the impact of this inflammation on bone metabolism and bone turnover markers (BTMs). The present study aimed to determine the association between BTMs, bone mineral density (BMD), and clinical periodontal parameters in PCOS women with CP. Three groups, each with 40 newly diagnosed (1) PCOS+CP, (2) PCOS alone, (3) CP alone, and fourth group (n = 20) systemically and periodontally healthy females aged 18–30 years were included in the study. Full mouth clinical periodontal parameters, C-terminal telopeptides of type I collagen (CTX), bone alkaline phosphatase (ALP), BMD and 25-hydroxyvitamin D (VD) were recorded for all. Low BMD (0.89 ± 0.11 g/cm2), increased CTX levels (2.76 ± 4.64 ng/ml), decreased bone ALP levels (11.09 ± 6.86 ng/ml), higher VD levels (289.02 ± 168.28 nmol/l) and poor clinical periodontal status were observed in PCOS + CP females. BMD-spine showed weak positive correlation with CTX, bone ALP, VD (r = 0.02, r = 0.07, r = 0.15, respectively) in PCOS + CP group. ANCOVA depicted covariates had no confounding effect. Multiple regression model explained 21.0% for BMD-spine and 12.7% for BMD-femur of total variability signifying association with all measured parameters among all groups. Enhanced inflammatory thrust by periodontitis increases CTX levels and decreases bone ALP and BMD levels in women with PCOS. Screening PCOS women for periodontal disease and vice versa may have a direct bearing on overall bone health.

Background: Abnormal uterine bleeding (AUB) is one of the most frequently encountered gynecological complaints in women associated with considerable morbidity and mortality. This study may help clinicians in our population to improve their therapeutic strategies by resorting to minimally invasive modalities and avoiding unnecessary hysterectomies. The aim of this study is to study the clinic-pathological spectrum and histological patterns various endometrial lesions in patients with AUB in accordance with PALM-COEIN classification. Methods: The present study was carried out on 265 patients over a period of 2 years in the Department of Pathology, Jawaharlal Nehru Medical College, A.M.U, Aligarh. Endometrial tissue was collected by dilatation and curettage (D and C) and endometrial biopsy and was sent to the histopathology laboratory for evaluation. Result: The most common clinical presentation was menorrhagia (43.4%), followed by metrorrhagia (19.3 %). Age of patients ranged from 15 to 70 years with peak incidence found in the 5th decade (41-50 years) (35.4%). On histopathological examination, nonstructural causes accounted for the majority of the diagnosis (37%) in which normal cyclical endometrium (AUB-E) was the commonest lesion seen in 37.8 % of cases. Endometrial hyperplasia (AUB-M) was the most common histopathological diagnosis 84(31.7%) amongst structural causes in our study. This was followed by endometrial polyp (AUB-P) in 12(4.5%) cases and endometrial carcinoma in 4(1.5%) respectively. Conclusion: Our study revealed a clustering of cases around peri-menopausal age group. Histopathological examination of endometrium is gold standard diagnostic tool in evaluation of AUB and there is an age specific association of endometrial lesions.

Background: Diabetes is the most common medical complication of pregnancy. Vitamin D deficiency which was initially considered only to influence bone metabolism, is now known to exert a wide spectrum of extra-skeletal effects. Vitamin D deficiency is closely associated with gestational diabetes mellitus, it also leads to adverse maternal and child outcome. Objective of this study was to compare the vitamin D levels in healthy pregnant women and women with gestational diabetes mellitus and to observe the feto-maternal outcome.Methods: This prospective study was carried out on 160 pregnant women between the age group 20-40 years attending the Obstetrics and Gynaecology department of JNMC, AMU, Aligarh from October 2016 to October 2018. Women were divided into group A- normal pregnant women and group B- women with GDM. Estimation of vitamin D was done in both the groups.Results: Mean vitamin D levels were lower in women with GDM as compared to normal pregnant women.Conclusions: Women with vitamin D deficiency have an increased risk of developing GDM and adverse feto maternal outcome as compared to those who had normal level of vitamin.

CD34 is a transmembrane glycoprotein that is thought to be involved in the modulation of cell adhesion and signal transduction. The connective tissue stroma of virtually all human organs contain large amounts of resident CD34+ fibrocytes, which are involved in multiple functions such as wound healing, secretion of cytokines and also participate in stromal remodeling. It has been seen in various studies that absence of CD34+ fibrocytes within the stroma is associated with invasive carcinomas. In our study, we also investigated the presence and distribution of CD34+ fibrocytes in cervical intraepithelial neoplasia, invasive cervical carcinoma and adjacent normal cervical stroma. It was seen that normal cervical stroma and the stroma adjacent to cervical intra epithelial lesions harbours a dense meshwork of CD34+ fibrocytes, whereas the stroma of invasive carcinoma was nearly devoid of this cell population. Early stromal invasion by squamous carcinoma was characterized by a focal loss of CD34+ fibrocytes. This can be used as a sensitive tool in detecting tiny foci of stromal invasion in early cancer.

Background: Unmet need for family planning is an important indicator for assessing the potential demand for family planning services. Currently married women who are not using any method of contraception but who do not want any more children are defined as having an unmet need for limiting and those who are not using contraception but want to wait two or more years before having another child are defined as having an unmet need for spacing. The sum of the unmet need for limiting and the unmet need for spacing is the unmet need for family planning. Materials and Methods: The study was a community based cross sectional study; it was conducted in the rural and urban field practice areas of Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh. Ever married women in the age group of 1549 years were surveyed and their reproductive behaviour was studied. Statistical analysis was done applying the chisquare test. Results: The prevalence of unmet need for FP was 25.9%, with spacing as 6.3% and limiting as 19.6%. The major reasons for unmet need for FP among were 28.1% perceived little risk of pregnancy, 22.9% were not using contraception because they were breast feeding, and 10% were not using contraception because their husband or family opposed it. Women’s Age, caste ,number of living children, poor inter-spouse communication were found to be associated with high unmet need for Family Planning. Conclusion : The study shows that the unmet need was higher among younger, illiterate, muslim women, women from scheduled and backward class and those having three to four living children. Unmet need was also higher among those women who had never discussed family planning with their husbands.

The purpose of this study was to compare the effects of ormeloxifene with medroxyprogesterone acetate in patients with abnormal uterine bleeding. 440 Patients were divided into two groups. In group A, ormeloxifene was given at the dosage of 60 mg twice a week for 3 months followed by 60 mg once a week for 1 month. In group B, medroxyprogesterone acetate was given at the dosage of 10 mg twice a day from day 5 to day 25 of the menstrual cycle. At follow-ups, patients were assessed for PBAC score, endometrial thickness by USG, hemoglobin level, and the side effects of drug therapy. There were 240 patients in group A and 200 in group B. Reduction in median PBAC score was 79.4 % in group A and 75 % in group B after 4 months of treatment. The mean duration of bleeding reduced to 4.8 from 9 in group A and 5 from 8.7 in group B. Mean hemoglobin was increased from 8.6 to 9.8 g % in group A and from 8.7 to 9.9 g % in group B; endometrial thickness was reduced from 7.7 mm to 6.8 mm in group A and from 7.4 mm to 6.9 mm in group B. We conclude from this study that ormeloxifene should be considered the first choice in the management of AUB, especially in the perimenopausal age group where amenorrhea is acceptable.

Introduction Vascular hamartomas are focal disordered overgrowth of mature tissue. These are benign lesions that may occur at any site in the body, but those of female pelvis are rare.Case Report A 30 -year -old nulliparous patient presented to us with complain of gradual distension of abdomen. On examination abdomen was tense and distended. Bimanual pelvic examination revealed a mass in right posterior fornix which was extending into the abdomen. The combined morphologic and immunohistochemical profile supported a diagnosis of vascular hamartoma of broad ligament.Conclusion To the best of our knowledge, the case we report here, is the first description of vascular hamartoma of the broad ligament in humans.

BACKGROUND:The term dysfunctional uterine bleeding (DUB) refers to any abnormal bleeding from the uterus, unassociated with tumour, inflammation and pregnancy. The histological diagnosis of DUB is very essential for adequate management especially in perimenopausal and postmenopausal females. The present study was undertaken with the aim of evaluating DUB in various age groups, carry out histopathological study of the endometrium and analyze its clinic-pathological patterns.METHODS:The study included 500 cases of atypical uterine bleeding, out of which 120 cases of DUB were included based on clinical features and detailed investigations. Study was conducted in Jawaharlal Nehru Medical College, Aligarh Muslim University, between March 2003 to December 2004 Endometrial tissue was collected by D&C procedure and the samples were sent for histopathological evaluation by pathologist.RESULT:Hyperplasia was the commonest endometrial pathology (20.5%) followed by luteal phase insufficiency (15.6%) and secretory endometrium (13.7%). Endometritis including tubercular endometritis (12.7%), post abortal (5.8%), proliferative (6.8%), polyp (3.9%), atrophic (3.9%), exogenous hormone changes (2.9%) and anovulatory cycles (6.8%) made up for the remaining lesions.CONCLUSION:DUB occurs secondary to a wide variety of functional and structural abnormalities, warranting a thorough evaluation especially in perimenoupausal females. Menorrhagia is a common symptom and the most likely etiology relates to the patient's age. Significant number of endometrial samples revealed pathology rendering endometrial curetting and biopsy an important procedure. Cervical cytology is a valuable adjunct however histopathology remains the gold standard in diagnosis.

Endometrial ossification is a rare entity in which bones are found in the uterus. Exact aetiopathogenesis is not known but the most accepted theory is metaplasia of stromal cells into osteoblast cells result in the formation of bones. The possibility of malignant mixed mullerian tumour should be in the mind of clinician and pathologist while making diagnosis. We hereby report an extremely rare case, which is among very few reported cases in the world, in which endometrial ossification presented in a perimenopausal female with polymenorrhagia. A 41-year-old multiparous patient presented with irregular bleeding per vaginum for the past two years. She was found to be a case of endometrial calcification with osseous metaplasia with presence of bones varying from 7mm - 1.5 cms size in the uterine cavity. She was successfully managed by total abdominal hysterectomy.

Gossypiboma is a rare condition caused by retained postoperative foreign bodies. The condition is under reported because of diagnostic difficulties and medicolegal implications associated with it. It may mimic a benign or malignant soft-tissue tumour in the abdomen and pelvis. A 22-year-old woman presented with non specific symptoms and was referred to us with radiological diagnosis of dermoid cyst. On laparotomy the mass was proved to be a gossypiboma resulted from gauze which was retained in caesarean section done two years back. Although gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of postoperative patients presenting with non specific complains and lump abdomen. Despite thorough history, physical examination, laboratory, and radiographical findings, usually gossypibomas are not suspected and remain an accidental finding. Employment of all preventive measures during surgical procedures and high index of suspicion in post operative patients are the key stones in its management.

International Journal of Medicine and Public Health,2015,5,1,98-101.DOI:10.4103/2230-8598.151271Published:January 2015Type:Original ArticleFamily planning differentials among religious groups: A study in IndiaNazish Rasheed, Zulfia Khan, Najam Khalique, Abdul Razzaque Siddiqui1, and Seema Hakim Nazish Rasheed, Zulfia Khan1, Najam Khalique1, Abdul Razzaque Siddiqui1, Seema Hakim2 Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, 1Departments of Community Medicine and 2Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India Abstract:Background: A woman's contraceptive use is largely influenced by the dictates of her religious faith. Acceptance of family planning methods is usually found to be poor among Muslims. This study assesses how acceptance of contraception and contraceptive choices varies across various religious groups. Objectives: (1) To determine the prevalence of contraceptive use among various religious groups. (2) To study the contraceptive use pattern among different religious groups. Materials and Methods: The study was conducted among ever-married women (15-49 years) residing in the field practice areas of Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh. The study was a community-based cross-sectional study. Current use and ever-use of contraceptives were assessed among women from various religious groups. The contraceptive choice among current users from different religious groups was studied in relation to use of spacing and terminal methods. Results: Current use of family planning methods was similar for Hindus (43.1%) and Muslims (44.1%). However, ever-use of contraception was found to be more among Muslims (72%) than Hindus (50.6%). Spacing methods were more popular among Muslim couples (84.3%) compared to Hindus (71.7%), whereas larger number of Hindu couples preferred terminal methods (28.3%) compared to Muslims (15.7%). Conclusions: Religion does play a role in the adoption of family planning and the specific method adopted for contraception. Keywords:Contraceptive use, Hindus, MuslimsView:PDF (459.63 KB)

Leiomyoma are the most common tumours of female pelvis .These are mostly composed of smooth muscle cells and variable amount of tissues from extracellular matrix. Most of the fibroids are located in body of uterus but only 1-2% are located in cervix. We report a case of 35 year old female who presented to us with a big vaginal mass ,pain, difficulty in walking and excessive bleeding and clinically differential diagnosis of chronic inversion , infected cervical polyp, procidentia and cervical fibroid was made but after preoperative evaluation , surgery and histopathology report it was diagnosed as cervical fibroid. Pedunculated cervical fibroid is a rare entity and patient presenting in shock is unusual presentation as in our case where we did not have the time for proper investigation and immediate measures had to be taken for the management.

ABSTRACT Cervical pregnancy is a pregnancy where implantation occurs in the cervix of uterus rather than occurring in the uterine cavity. It is a rare life-threatening condition so early diagnosis and treatment can save life. Here, we are reporting a case of cervical pregnancy which presented to us with amenorrhea and bleeding per vaginum after misoprostol intake. How to cite this article Parveen S, Hakim S. A Rare Presentation of Cervical Pregnancy. J South Asian Feder Menopause Soc 2014;2(1):40-41.

Developmental anomalies involving Mullerian ducts are one of the most fascinating disorders in Gynaecology. The incidence rates vary widely and have been described between 0.1-3.5% in the general population. We report a case of a fifteen year old girl who presented with primary amenorrhea and lower abdomen pain, with history of instrumentation about two months back. She was found to have abdominal lump of sixteen weeks size uterus. On examination vagina was found to be represented as a small blind pouch measuring 2-3cms in length. A rectovaginal fistula (2x2 cms) was also observed. Ultrasonography of abdomen revealed bulky uterus (size 11.2x6 cm) with 150 millilitre of collection. Adiagnosis of hematometra with iatrogenic fistula was made. Vaginal drainage of hematometra was done which was followed by laparotomy. Peroperatively she was found to have a left side unicornuate uterus with right side small rudimentary horn. Left fallopian tube and ovary showed dense adhesions and multiple endometriotic implants. Both cervix and vagina were absent. Total abdominal hysterectomy was done and rectovaginal fistula repaired. The present case is reported due to its rarity as it involved both mullerian agenesis with cervical and vaginal agenesis along with disorder of lateral fusion. This is an asymmetric type of mullerian duct development in which arrest has occurred in different stages of development on two sides. DOI: http://dx.doi.org/10.3329/bjms.v13i1.17500 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 101-104