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Nyapathy V.,GSL Medical College and General Hospital | Mishra A.,GSL Medical College and General Hospital
Indian Journal of Medical Research | Year: 2014

Background & objectives: Uterine leiomyomas (fibroids) are common cause of morbidity in women of reproductive age group. High intensity focused ultrasound with the imaging guidance of magnetic resonance imaging (MRI) known as magnetic resonance guided focused ultrasound sonication (MRgFUS) is now available. However, there are no available studies with this non invasive modality of treatment in Indian subjects. The objective of this study was to determine the safety and clinical efficacy of MRgFUS in the treatment of uterine fibroids. Methods: This prospective study included 32 consecutive women with clinically symptomatic uterine fibroids who were treated with MRgFUS from February 2011 to October 2011. Pre and post treatment symptom severity scores (SSS) were assessed at the time of enrolment and at one, three and six months follow up using a validated uterine fibroids symptom - quality of life questionnaire (UFS-QOL). Pre and post treatment fibroids volumes were compared immediately after treatment and at six months follow up using contrast enhanced MRI scan. Non perfused volume (NPV) ratios were calculated and correlated with fibroid volume reductions immediately after the treatment and at the end of six months follow up. Results: This procedure was well tolerated by the patients and procedure related adverse effects were non significant. Significant reductions in SSS were seen at one, three and six month intervals after the treatment (P<0.01). Significant reductions were noticed in fibroids volumes at six months follow up compared to pretreatment fibroids volumes (P<0.01). Significant positive correlations were observed between NPV ratios and reduction in fibroids volumes at six months follow-up (r=0.659, P<0.01). Interpretation & conclusions: MRgFUS is relatively a safe and effective non invasive treatment modality for treating uterine fibroids in selected patients. Its long term efficacy is yet to be tested and compared with other available minimally invasive treatment options.


Mohapatra M.,GSL Medical College and General Hospital | Subramanya Y.S.,GSL Medical College and General Hospital
Indian Journal of Pathology and Microbiology | Year: 2016

Persistent Müllerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism characterized by retention of Müllerian duct derivatives in a phenotypically and karyotypically male patient. Deficiency of anti-Müllerian hormone (AMH) secretion or resistance to AMH action due to defective AMH-II receptor is presumed to cause such syndrome in the majority of cases. About 158 PMDS cases have been reported so far, out of which 31 cases are associated with testicular neoplasms. Herein, we describe an interesting case of young male initially diagnosed and treated for inguinal hernia, but finally diagnosed as 'PMDS of mixed anatomical variant (combined male and female type) with mixed germ cell tumor of left intra-abdominal testis' comprising components of seminoma and yolk sac tumor and treated successfully. © 2016 Indian Journal of Pathology and Microbiology | Published by Wolters Kluwer - Medknow.


Singh A.H.,GSL Medical College and General Hospital | Basu R.,GSL Medical College and General Hospital | Venkatesh A.,GSL Medical College and General Hospital
Biology and Medicine | Year: 2012

This is an aerobic bacteriological study of chronic suppurative otitis media to identify common pathogens and to evaluate their antibiotic susceptibility pattern. Hundred and fifty patients who had chronic ear discharge and had not received antibiotics recently were selected. Swabs were taken and cultured for bacteria aerobically. Antibiotic testing was done using modified Kirby-Bauer disk diffusion method. In addition to the usual antibiotics, three antibiotics commonly available as topical ear drops were tested. There were 192 bacterial isolates comprising mainly Staphylococcus aureus (36%), Proteus species (32%), Pseudomonas aeruginosa (24%), and coagulase-negative Staphylococcus (20%). Among the topical antibiotics, ciprofloxacin had the highest susceptibility rate (89%) for all the isolates tested followed by gentamicin (76.5%) and chloramphenicol (59.3%).


Himabindu Y.,GSL Medical College and General Hospital | Sriharibabu M.,GSL Medical College and General Hospital | Gopinathan K.K.,Center for Infertility Management and Assisted Reproduction | Satish U.,Center for Infertility Management and Assisted Reproduction | And 2 more authors.
Journal of Human Reproductive Sciences | Year: 2013

Objective: The objective of this study was to test the hypothesis that AMH and antral follicle count (AFC) are good predictors of ovarian response to controlled ovarian stimulation and to compare them. Materials and Methods: This observational cross-sectional study included 56 subjects aged between 25 and 42 years who were enrolled between 1 st January and 31 st December 2010 for their first intracytoplasmic sperm injection (ICSI) program. Baseline hormone profiles including serum levels of Estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), and Anti-mullerian Hormone (AMH) were determined on day 3 of the previous cycle. The antral follicle count measurements were performed on days 3-5 of the same menstrual cycle. Antral follicles within the bilateral ovaries between 2-6 mm were recorded. The subjects were treated with long protocol for ovarian stimulation. Ovulation was induced with 10,000 IU of human chorionic gonadotropin (hCG) when at least 3 follicles attained the size of more than 17 mm. Transvaginal oocyte retrieval was performed under ultrasound guidance 36 hours after hCG administration. An oocyte count less than 4 and absence of follicular growth with controlled ovarian hyper stimulation was considered as poor ovarian response. Oocyte count of 4 or more was considered as normal ovarian response. Results: Statistical analysis was performed using SPSS software trail version 16.0. Subjects were divided into 2 groups, depending on the ovarian response. The mean oocyte counts were 12.27 ± 6.06 and 2.22 ± 1.24 in normal and poor responders, respectively, ( P = 001). Multiple regression analysis revealed AMH and antral follicle count as predictors of ovarian response (β coefficient ± SE for AMH was 1.618 ± 0.602 ( P = 0.01) and for AFC, it was, 0.528 ± 0.175 ( P = 0.004). AFC was found to be a better predictor of ovarian response compared to AMH in controlled ovarian hyper stimulation. Conclusion: The observations made in this study revealed that both AMH and AFC are good predictors of ovarian response; AFC being a better predictor compared to AMH.


Surekha T.,GSL Medical College and General Hospital | Himabindu Y.,GSL Medical College and General Hospital | Sriharibabu M.,GSL Medical College and General Hospital
Journal of Human Reproductive Sciences | Year: 2013

Background: Fertility rates have started declining in India in the last few decades. The total fertility rate, which was 3.5 in 93-94 declined to 2.5 in 2005-6. Researchers attribute this fertility transition to concomitant socio-economic development. Decreasing ovarian reserve is an important contributor for age related infertility. Objectives: The objective of this study was to assess the association of ovarian reserve with socio-economic status (SES) with the available clinical ovarian reserve markers in reproductive age women. Materials and Methods: A total of 160 married women in the age group of 20-35 years, belonging to all three socio-economic strata were assessed for ovarian reserve using the clinical ovarian reserve parameters Antimullerian hormone (AMH), Antral follicle count (AFC) and follicular stimulating hormone (FSH). Analysis of variance was used to see the association of ovarian reserve with SES. Results: Both the ovarian parameters AMH and AFC have shown a significant association with SES (P = 0.000 for AMH and P = 0.023 for AFC). The association between FSH and SES was not significant (P = 0.147). Conclusions: Higher SES in this study was seen to be associated with better ovarian reserve as assessed by the available clinical ovarian reserve markers.


Mohapatra M.,GSL Medical College and General Hospital | Satyanarayana S.,GSL Medical College and General Hospital
Journal of Cytology | Year: 2013

Phaeohypomycosis is a clinical syndrome caused by melanised or dematiaceous fungi characterized by the presence of brown mycelial structures in tissue section. These fungi are associated with a repertoire of the clinical manifestations that includes superficial and deep local infection to disseminated infection. Herein, we describe the clinical and fine-needle aspiration cytology and histopathologic features of a case of subcutaneous phaeohypomycosis.


PubMed | GSL Medical College and General Hospital
Type: Case Reports | Journal: Indian journal of pathology & microbiology | Year: 2016

Persistent Mllerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism characterized by retention of Mllerian duct derivatives in a phenotypically and karyotypically male patient. Deficiency of anti-Mllerian hormone (AMH) secretion or resistance to AMH action due to defective AMH-II receptor is presumed to cause such syndrome in the majority of cases. About 158 PMDS cases have been reported so far, out of which 31 cases are associated with testicular neoplasms. Herein, we describe an interesting case of young male initially diagnosed and treated for inguinal hernia, but finally diagnosed as PMDS of mixed anatomical variant (combined male and female type) with mixed germ cell tumor of left intra-abdominal testis comprising components of seminoma and yolk sac tumor and treated successfully.


PubMed | GSL Medical College and General Hospital
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2014

Here, we present successful management of a patient with rupture of right sinus valsalva and ventricular septal defect. Aneurysm of the aortic sinus also known as sinus of valsalva (ASOV) is a rare cardiac defect which can be congenital or acquired. Right coronary sinus (most common) usually ruptures into the right ventricle causing left to right shunt as seen in our patient. Unruptured aneurysms cause obstruction to right ventricular outflow tract. A 29-year-old male patient presented with dyspnea, palpitations, easy fatigability and severe limitation of physical activity. Transthoracic echocardiography showed membranous out pouching of the right coronary cusp (RCC) into the right ventricle. Patient was medically managed with drugs. Under general anaesthesia, after instituting cardiopulmonary bypass (CPB) surgical repair with pericardial patch, closure of subpulmonic ventricular septal defect was performed. Patient vitals were stable after surgery and he was asymptomatic on the first follow-up after discharge.


PubMed | GSL Medical College and General Hospital
Type: Journal Article | Journal: Journal of human reproductive sciences | Year: 2014

Complete Androgen insensitivity syndrome is a disorder of hormone resistance characterized by a female phenotype in an individual with an XY karyotype. The pathogenesis of CAIS involves a defective androgen receptor gene located on X-chromosome at Xq11-12and end organ insensitivity to androgens, although androgen concentrations are appropriate for the age of the patient. There are three major types of androgen insensitivity syndrome: Complete androgen insensitivity syndrome, minimal androgen insensitivity syndrome, and partial androgen insensitivity syndrome. Management of androgen insensitivity syndrome includes multidisciplinary approach and involves gonedectomy to avoid gonadal tumors in later life. Hormone replacement therapy (HRT) and psychological support are required in long-term basis.


Himabindu Y.,GSL Medical College and General Hospital | Gopinathan K.K.,Center for Infertility Management and Assisted Reproduction | Pandey A.K.,BPS Government Medical College for Women | Sriharibabu M.,GSL Medical College and General Hospital
Indian Journal of Physiology and Pharmacology | Year: 2013

Increasing female literacy and employment have resulted in a clear rise in the age at which women conceive. As fertility starts to decline with advancing age more and more number of women are facing the problem of infertility and are seeking medical attention to over come this problem. This resulted in more number of women seeking medical help to over come the problem of Infertility. This age related decline in ovarian reserve is not uniform in all women of reproductive age. A number of ovarian reserve tests were developed to overcome this problem. But to date there is no ideal marker for predicting ovarian reserve and pregnancy outcome in assisted reproductive technology program (ART). Recent studies indicate that anti mullein hormone is a promising marker for predicting ovarian reserve and pregnancy out come. The aim of this study was to assess the influence of age on Anti-Mullerian Hormone (AMH) in ART program outcomes. Ninety-three subjects in the age group of 25 to 42 years were recruited to the study. All these subjects underwent controlled ovarian stimulation (COS) and later intracytoplasmic sperm injection (ICSI). Subjects were divided into four groups. AMH levels in positive and negative pregnancy subjects in the above and below 35years age groups were compared. AMH levels were correlated with other ovarian reserve parameters and clinical pregnancy out come in both the age groups. Statistically significant differences were found in AMH levels between positive and negative pregnancy subjects in the age group of 35 and above, but not in the age group below 35 years. There were positive correlations between AMH and other ovarian reserve markers and clinical pregnancy outcome in this age group. AMH and the number of retrieved oocytes (r=0.784, P<0.01), Antral Follicle count (AFC) (r=0.749, P<0.01) and Mature Oocytes (MII) (r=0.407, P<0.01) followed by Grade-I Embryos (r=0.433, P<0.01). The current study revealed that AMH levels are better correlated with ovarian reserve and clinical pregnancy out come in subjects aged 35 years and above.

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