Browsing by Author "Shuchi Jain"

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A case of endometriosis in episiotomy scar with anal sphincter involvement and extension into ischiorectal fossa
(Jaypee Brothers Medical Publishers (P) Ltd, 2014) Shuchi Jain; Soma Ghoshal; Mohan Kumar; Madhu Jain
Episiotomy scar endometriosis is characterized by presence of endometrial tissue (glands and stroma) and is a rare condition. It may also extend and involve the anal sphincter. The ideal treatment is wide excision to prevent recurrence but it may cause fecal incontinence, if the anal sphincter is involved. We describe here a case with much deeper extension into ischiorectal fossa. She was treated with wide local excision and primary sphincteroplasty. She has remained free of recurrence up to 12 months follow-up. © 2014, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.
A Prospective Observational Study Comparing Contrast-Enhanced Ultrasonography (CEUS) and Magnetic Resonance Imaging (MRI) in Evaluating Adnexal Lesions
(Springer, 2025) Roshni Mandal; Shuchi Jain; Shivi Jain; Madhu Jain
Aim: To study and compare the number, size, location, and character of adnexal lesions identified by CEUS and MRI and correlate the results with gross intra-operative and histopathological findings. Background: CEUS is a newly emerging diagnostic modality. It involves the administration of intravenous contrast agents consisting of microbubbles. The distinguished acoustic properties of the gas in the microbubble enable it to produce high-frequency harmonics that enhance the ultrasound images. CEUS provides the ability to detect intralesional microvascularity. It can produce real time imaging and thus can be used during interventional procedures. Methods: It was a prospective observational study with a sample size of 150 study subjects. The contrast agent used in our study is commercially known as Sonovue, which is made of Sulphur hexafluoride microbubbles. Results: 150 cases of adnexal masses were studied. There was no significant difference between CEUS and MRI reports with respect to the size of the lesions as shown by a t-test (t = 0.06, p = 0.53) and Pearson correlation coefficient (r = 0.96, p = 0.001). Disagreement regarding character of the lesion was seen only in a few number of cases. Gross per-operative findings and histopathology reports showed 100% concordance with the investigative results. Conclusion: 150 subjects with adnexal masses were evaluated. No statistically significant difference was found between CEUS and MRI findings with regard to size, character, location, intra-operative appearance and histopathological results of the lesions. Thus we can conclude that CEUS can be considered an effective alternative to MRI for the evaluation of adnexal lesions. © The Author(s) 2025.
Clinical Profile of Obstetric Patients Getting Admitted to ICU in a Tertiary Care Center Having HDU Facility: A Retrospective Analysis
(Federation of Obstetric and Gynecologycal Societies of India, 2018) Soumya Ranjan Panda; Madhu Jain; Shuchi Jain
Background: The critically ill obstetric patient represents a challenge that usually requires a multidisciplinary approach. Lack of awareness and the absence of regular antenatal care make the critically ill patients to be referred late and sometimes in moribund conditions. The objective of the present study is to determine the incidence, predictors and outcome of obstetric ICU admissions. Methods: This retrospective study was conducted over a period of 2 year from July 2015 to June 2017 in Department of Obstetrics and Gynecology at Institute of Medical Sciences, BHU, Varanasi, India. Results: Out of a total of 4986 deliveries, 756 patients underwent HDU admission, while 92 obstetric patients were admitted to ICU during this study period. Maximum number of patients (73.91%) were in the age-group of 20–35 years, 64.13% of patients constitute lower socioeconomic status group, 68.47% of patients reside in rural area and there was inadequacy in receiving antenatal care in case of 60.86% of patients. Maximum number of patients were admitted for a period of 4–7 days. Blood transfusion (64.1%), the use of inotropic drugs (45.6%), central line placement (44.5%) and mechanical ventilation (26.08%) were the major interventions performed in ICU. Obstetric hemorrhage was found to be the most frequent clinical diagnosis leading to ICU admission (31.5%) followed by hypertensive disorders (25%). Conclusion: In addition to timely referral, health education and training of health professionals may improve clinical outcome and better obstetric practice, especially in countries like India. Obstetric ICU dedicated for the management of only obstetric patients should be constructed in order to compensate for heavy burden critically ill women. © 2017, Federation of Obstetric & Gynecological Societies of India.
Contrast-enhanced Ultrasonography vs Magnetic Resonance Imaging in the Evaluation of Uterine Lesions: A Prospective Observational Study
(Jaypee Brothers Medical Publishers (P) Ltd, 2025) Shuchi Jain; Roshni Mandal; Shivi Jain
Aim: To study and compare the number, size, location, and character of uterine lesions identified by contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) and correlate the results with gross intraoperative and histopathological findings. Background: Contrast-enhanced ultrasonography is a newly emerging diagnostic modality that has revolutionized ultrasound imaging. The technique involves the administration of intravenous contrast agents consisting of microbubbles of gas to the systemic circulation. The distinguished acoustic properties of the microbubbles enable them to produce high-frequency harmonics that are used to enhance the ultrasound images. Contrast-enhanced US provides the ability to detect intralesional microvascularity; therefore, it could be an effective alternative to computed tomography and MRI. It can produce real-time imaging, unlike MRI, which extends its applicability to the assessment of interventional procedures. The contrast agent used in our study is known as SonoVue, which is a second-generation contrast agent made of sulfur hexafluoride microbubbles. Methods: It was a prospective observational study carried out over a period of one year with a sample size of 32 study subjects. Women over 18 years of age who were undergoing evaluation for suspected uterine lesions were included in the study. Results: Fibroids – 21 cases of fibroids were studied. There was no significant difference between CEUS and MRI reports with respect to the size of the lesions as shown by a t-test (t = 0.13, p = 0.89) and Pearson correlation coefficient (r = 0.96, p = 0.001). Disagreement regarding location was seen only in a few number of cases. Gross perioperative findings and histopathology reports showed 100% concordance with the investigative results. Adenomyomas – 11 cases of focal adenomyomas and diffuse adenomyosis with focal lesions were studied. Among the 10 focal lesions reported, a t-test showed no significant difference (t = 0.05, p = 0.95) in sizes between CEUS and MRI reports, and a Pearson correlation coefficient suggested a high positive correlation (r = 0.92, p = 0.001). There was 100% concordance between CEUS and MRI findings regarding the character and location of the lesion, and histopathological results showed a discrepancy only in a single case. Conclusion: A total of 32 subjects with uterine lesions were evaluated. Contrast-enhanced ultrasonography and MRI findings were compared with regard to size, character, location, intraoperative appearance, and histopathological results. No statistically significant difference was found. This brings us to the conclusion that CEUS can be considered an effective alternative to MRI for the evaluation of uterine lesions. Clinical significance: An ultrasonography is the first sought investigation in any suspected uterine lesion. Therefore, the application of a contrast agent in the same setting makes the diagnosis all the more informative and effective. Contrast-enhanced ultrasonography has several advantages over CT and MRI. Since its first application in the late 1960s, US contrast agents have grown tremendously. Contrast-enhanced ultrasonography has the ability to add substantial value in imaging gynecological disease, and indications for its use in the female pelvis are expected to continue evolving. © The Author(s). 2025.
Diagnosis of Genital Tuberculosis in Infertile Women by Using the Composite Reference Standard
(Hindawi Limited, 2022) Riden Saxena; Kriti Shrinet; Sachchida Nand Rai; Kamal Singh; Shivi Jain; Shuchi Jain; Deeksha Singh; Shampa Anupurba; Madhu Jain
Female genital tuberculosis (FGTB) can be asymptomatic or even masquerade as other gynecological conditions. Conventional methods of FGTB diagnosis include various imaging, bacteriological, molecular, and pathological techniques that are only positive in a small percentage of patients, leaving many cases with undiagnosed condition. In the absence of a perfect diagnostic method, composite reference standards (CRSs) have been advocated in this diagnostic study. This study assesses the agreement between traditional diagnostic modalities using CRS and prevalent TB groups among different fallopian tube infertility manifestations. A total of 86 women with primary and secondary infertility were included in the study and subjected to bacteriological, pathological, and radiological examination for the diagnosis of FGTB. Results were evaluated statistically for concordance of the diagnostic tests to the CRS by sensitivity and specificity, while PPV and NPV were calculated for the performance of diagnostic tests of FGTB. We observed that 11.2% of women were found to be true positives by means of CRS. The positive findings by CRS were as follows: ultrasonography (13.9%), laparoscopy (14%), hysteroscopy (12%), GeneXpert (4.8%), culture (4.8%), polymerase chain reaction (4.8%), and histopathology (6.4%). GeneXpert and culture were found to have a perfect agreement with CRS. Hysterosalpingography, laparoscopy, and hysteroscopy have a fair agreement with CRS. Out of 43 women with tubal factor infertility, 6 women were found in the definitive TB group with mixed conditions of tubal manifestations. This study evaluates and demonstrates the reliability of the collective assessment of various diagnostic methods with CRS findings that help in identifying different TB groups of genital tuberculosis patients from all infertile patients by applying the criteria of CRS. © 2022 Riden Saxena et al.
Effect of Orlistat Versus Metformin in Various Aspects of Polycystic Ovarian Syndrome: A Systematic Review of Randomized Control Trials
(Federation of Obstetric and Gynecologycal Societies of India, 2018) Soumya Ranjan Panda; Madhu Jain; Shuchi Jain; Riden Saxena; Smrutismita Hota
Background: Polycystic ovarian syndrome (PCOS), a commonly prevalent endocrinopathy among reproductive age group women, is most often associated with obesity. Increased insulin resistance appears to be the central pathophysiologic mechanism responsible for various complications of PCOS. This makes ‘weight loss’ as the first-line treatment approach in PCOS. So various trials have tried to compare metformin (an insulin-sensitizing agent) and orlistat (an anti-obesity drug) aiming to achieve weight loss and hence higher ovulation rate for the group of obese PCOS patients. Keeping an eye on all these background facts, we designed this systematic review and metaanalysis to compare the effects of metformin and orlistat on various aspects of PCOS and to pick the better among the two drugs. Materials and Methods: This is a systemic review of randomized control trials that studied the effectiveness of orlistat versus metformin in terms of improvement in ovulation rate, weight loss, lipid profile, etc. Systematic literature search over the period January 2000–December 2016 was performed in the following electronic databases: Medline, embase, google scholar, pubmed and The Cochrane Library and only randomized controlled clinical trials were included in our study. All authors carefully went through all sources of information independently. Results: According to this study, weight loss, testosterone level after 4 weeks of treatment, total serum cholesterol and triglyceride level showed significant fall in orlistat-treated group. Conclusion: Our review shows that orlistat is a more effective drug than metformin and should be the preferred drug in obese PCOS in combination with weight loss. © 2018, Federation of Obstetric & Gynecological Societies of India.
Evaluating the effects of back massage during labour on delivery outcomes: A prospective study on primigravida mothers
(IP Innovative Publication Pvt. Ltd., 2024) Anitha Moncy; Madhu Jain; Ashok Kumar; Shuchi Jain; Akash Mishra; Sangeeta Kansal
Background and Objectives: The labor and delivery process can be stressful for parturient women, especially for primigravida mothers. Birth companions providing massage and emotional support can help make more pleasant birthing experience. This study aimed to assess the impact of back massage by trained birth companions on reducing analgesic use, pain intensity scores, and labor duration. Materials and Methods: The study was conducted on primigravida women. During antenatal care visits, companions in the intervention group were trained in massage techniques, while no training was imparted to companions in the control group. Data were collected using a pre-tested questionnaire during antenatal clinic visits and delivery A multivariable logistic regression model was used to assess the impact of massage on delivery outcomes while adjusting for significant confounding variables. Results: The study demonstrated a positive impact of back massaging on labor and delivery outcomes. Mothers in the massaged group were 2.27 times less likely to receive analgesics and 3.71 times more likely to experience a reduction in pain intensity scores of > 2 compared to those receiving usual care. Additionally, the massaged group had a 2.24 times higher likelihood of reducing labor duration to < 12 hours compared to the usual care group. Conclusion: Back massaging by trained birth companions is an effective intervention for reducing the use of analgesics, pain intensity scores, and the length of labor in primigravida women. © 2024 Author(s).
Fetomaternal outcome among women with mitral stenosis after balloon mitral valvotomy
(John Wiley and Sons Ltd, 2013) Shuchi Jain; Tapan K. Maiti; Madhu Jain
Objective To compare pregnancy outcomes among patients with non-operated mitral stenosis and those who had balloon mitral valvotomy before pregnancy. Methods In a study at a tertiary-care referral hospital in Kolkata, India, 48 women with mitral stenosis who delivered between July 2007 and June 2008 were separated into 2 groups according to whether they had cardiac surgery before pregnancy. Eighteen women in the test group had balloon mitral valvotomy before pregnancy, whereas 30 women in the control group had no cardiac surgery. Fetomaternal outcomes were compared between the 2 groups. Results In the control group, significantly more patients had palpitations (P = 0.032) and severe dyspnea (P = 0.017) than in the test group. The incidence of preterm labor in the test group (1/18) was lower than that in the control group (10/30) (P = 0.035). However, the groups did not differ in mode of delivery, mean birth weight, or neonatal complications. Conclusion Balloon mitral valvotomy improved maternal symptoms and should be done to prevent maternal morbidity and to reduce the incidence and complications of preterm labor. © 2013 International Federation of Gynecology and Obstetrics.
Gossypiboma: Contrast-enhanced computed tomography for detection and foolproof management
(Regional Institute of Medical Sciences, 2015) Shivi Jain; Shuchi Jain; Vaibhav Jain; Madhu Jain
The word ‘gossypiboma’ or ‘textiloma’ is used to describe a retained surgical sponge in the body after an operation. If it is left in the abdomen, it may cause serious morbidity and mortality of the patient as well as medico-legal problems. It varies between 1 out of 1,000-1,500 intra-abdominal operations and 1 out of 300-1,000 of all operations. Herein, we report two cases, the first presenting 1.5 years after cesarean section with fever and purulent vaginal discharge and the second, two years after with abdominal swelling and pain. The contrast-enhanced computed tomography (CECT) proved to be diagnostic and guided towards proper management. Imaging detected trans-visceral migration of the sponge in the first case and improved the prognosis. High degree of suspicion raised by imaging and correlation with clinical picture are the cornerstone for a good outcome. © 2014 Regional Institute of Medical Sciences. All rights reserved.
MTHFR C677T polymorphism is associated with hyperlipidemia in women with polycystic ovary syndrome
(2012) Madhu Jain; Priyanka Pandey; Narendra Tiwary; Shuchi Jain
Context: Women with polycystic ovary syndrome (PCOS) are prone for coronary artery disease (CAD), and hyperhomocysteinemia is an independent risk factor for CAD. MTHFR deficiency is the most common cause of hyperhomocysteinemia, thereby provoking a possible association between PCOS and MTHFR C677T polymorphism. AIMS: The aim of this study was to investigate an association of MTHFR C677T polymorphism with PCOS. Settings and Design: 92 women with PCOS (Rotterdam criteria) and 95 age-matched controls were compared with respect to MTHFR C677T polymorphism. The 2 genotypes (CC and CT) obtained were compared with clinical and laboratory parameters in women with PCOS. Materials and Methods: In a case-control study, clinical, biochemical, hormonal and genetic analysis (PCR-RFLP of peripheral leucocytes) was carried out on all women with PCOS as well as controls. Statistical Analysis: Student "t" test for quantitative and Chi-square test for nominal variables was used. For estimation of risk, odds ratio and 95% confidence interval were calculated. Results: The odds ratio of bearing a heterozygous genotype (CT) was 1.32 in women with PCOS as compared to controls (P = 0.48). No homozygous mutation (TT) was found in the study population. Serum cholesterol was more in heterozygous (CT) genotype (215.48 25.56 mg/dl) as compared to normal (CC) genotype (203.29 16.35 mg/dl) in women with PCOS ( P = 0.01). Similarly, serum triglyceride was more in heterozygous (CT) genotype (95.86 37.34 mg/dl) as compared to normal (CC) genotype (82.36 20.88 mg/dl) in women with PCOS ( P = 0.04). Conclusions: Although not statistically significant, there is a slightly higher prevalence of heterozygous (CT) genotype in women with PCOS. MTHFR C677T polymorphism when present may confer an increased susceptibility to develop hyperlipidemia in women with PCOS. More prospective studies are needed to confirm whether this hyperlipidemia due to MTHFR C677T polymorphism clinically manifests into CAD in long term in women with PCOS.
Platelet function disorder in women with heavy menstrual bleeding in Eastern Uttar Pradesh
(Regional Institute of Medical Sciences, 2021) Shuchi Jain; Nisha Rani Agrawal; Vijai Tilak; Ekhlak Mohammad; D. Dash; Madhu Jain
Background: Platelet function disorder (PFD) is turning out to be a major cause of heavy menstrual bleeding (HMB) in women. One should suspect for this entity and should look for it in all girls who have this issue since menarche to impart proper management. Objectives: This study was carried out to find the incidence of PFD in Patients with HMB referred to our tertiary care teaching hospital. Materials and Methods: Platelet aggregation in response to ristocetin-induced platelet aggregation (RIPA), Adrenaline, adenosine diphosphate, and Collagen was studied in 50 women with HMB and in the equal number of age-matched healthy women. Bleeding time and Platelet count were also measured. Results: Glanzmann’s thrombasthenia (GT) was detected in 5 and Bernard Soulier Syndrome (BSS) in 2 women with HMB. Macrothrombocytopenia was observed in BSS. RIPA was also significantly reduced in BSS but normal in GT. Coagulopathies should always be doubted in the presence of significant anemia. One should carry out the Platelet function studies when screening parameters like prothrombin time, partial thromboplastin time, von Willebrand factor, and factor VIII activity level are normal. Normal platelet count and morphology in addition suggest functional defects in platelets which can be detected by various aggregation studies, electron microscopy, flow cytometry, and thromboelastography. Conclusion: The clinicians treating women with HMB should be aware of PFD as an important etiology and the platelet function should be studied in all women with HMB in a phase-wise manner in order not to miss the diagnosis and also to make it more cost-effective. © 2021 Journal of Medical Society | Published by Wolters Kluwer-Medknow.
Prevalence of von Willebrand Disease in Patients with Heavy Menstrual Bleeding: An Indian Perspective
(Jaypee Brothers Medical Publishers (P) Ltd, 2021) Shuchi Jain; Nisha R. Agrawal; Vijai Tilak; Madhu Jain; Tej B. Singh; Krishna S. Piplani
Aim: The von Willebrand disease (vWD) is said to be the most common hemostatic disorder among the nonstructural causes of heavy menstrual bleeding (HMB). This study was carried out to find prevalence of vWD and its subtypes in patients with HMB referred to a tertiary healthcare center. Materials and methods: Two hundred patients with HMB and equal number of age-matched control were subjected to laboratory tests such as complete blood count, bleeding time, and clotting time. Prothrombin time (PT), activated partial thromboplastin time (APTT), and factor VIII (FVIII):C assay were done manually. von Willebrand factor (vWF:Ag) antigen assay and vWF:Ag collagen binding (CB) were done by enzyme-linked immunosorbent assay (ELISA). Platelet aggregation study with ristocetin was done to find the different subtypes of vWD. Results: vWD and its subtypes were diagnosed in 25 out of 200 women with HMB with a prevalence of 12.5%. Type III vWD was the commonest (15/25, 60%), followed by type II (7/25, 28%) and type I (3/25, 12%). Among the various subcategories of type II, type IIB was conspicuously absent and type IIN was the most frequent (5/7, 71%). Conclusion: vWD should always be considered as one of the possible bleeding disorders in patients with HMB particularly in those referred to a tertiary care center. It was detected in 12.5% of such women, and type III was the most frequent type encountered among its various subtypes. Clinical significance: Detection of vWD and its various subtypes at the earliest opportunity would help the treating physician to plan out a definite line of management and save many women from unwarranted hysterectomies and also improve their quality of life and reproductive potential. © The Author(s).