Journal of Global Medical Education and Research

Introduction: Hypogonadotrophic-hypogonadism is caused by defective GnRH release and results in abnormal gonadotrophin levels thus impaired pubertal development and primary infertility. Hypogonadotrophichypogonadism appears with varied syndrome complexes both phenotypically and genotypically 

Case Report: A 20 yrs old married female came with complaints of primary amenorrhea and infertility. No history of cyclic abdominal pain, trauma at birth, chronic illness in past and eating disorders. On physical examination, her height was 155cms, weight 46kgs. Her breast was developed to tanner stageI/II, pubic and axillary hair to tanner stage II/III. She had average intellectual ability and normal sense of smell. On local examination, her vulva and vagina appeared normal, and uterus was of small size. USG showed infantile uterus and small ovaries, FSH – 0.23mIU/ml, LH- 0.27mIU/ml, Estradiol – 33 mIU/ml, TSH and Prolactin levels were within normal limits. MRI showed hypoplasia in the anterior pituitary. Karyotype was 46XX. No significant positive history on pedigree  charting.

Discussion: With the breakthrough in molecular genetics, identification of genetic abnormality has become possible for the diagnosis the pattern of familial inheritance. Thus management of cases of hypogonadotrophic hypogonadism should not be restricted to individual patient but proper pedigree charting and genetic diagnos must always be added to optimize the management. These cases need hormonal treatment to develop their secondary sexual characters as well as for fertility.

Conclusion: A through workup of young females presenting with primary amenorrhoea is often rewarding for the patient and the physician. Appropriately timed hormonal treatment can help in proper development of secondary sexual characters as well as fertility.

Keywords: Hypogonadotrophic-Hypogonadism; Primary Amenorrhoea.

 

Women presenting with primary amenorrhoea require extensive work up. Swyer syndrome or pure 46XY gonadal dysgenesis is a condition with external female phenotype, but fail to attain menarche at the usual age with sexual infantilism. Person with this disorder have female external genitalia but the uterus and fallopian tubes are present, though underdeveloped. They lack functional gonads (ovaries or testes), instead, they have streak gonads. We are reporting a case of young female presenting as primary amenorrhoea, detailed work up revealed it to be Swyer syndrome with partially developed breasts, hypoplastic uterus, and absent streak gonads. These cases are very rare, and require early gonadectomy. This case illustrates a rare case of gonadal dysgenesis and demonstrates the importance of counselling on the options of treatment, especially regarding treatment of dysgenetic gonads, need for replacement therapy and future fertility options.

Keywords: Swyer Syndrome; Pure XY Gonadal Dysgenesis; Gonadectomy.

 

Educators and professionals in medical colleges are facing the challenge of patient safety and imparting adequate, knowledge and skills to their young budding doctors in all aspects of medicine and surgery; as patients are also becoming increasingly concerned that students and residents are “practicing” on them.Educators have faced these challenges by restructuring curricula, developing innovative teaching sessions, and increasing selfdirected learning. A disconnect still exists between class room teaching and the real patient experience. Many students still find it difficult to translate class room gained knowledge into clinical situations. Medical Simulation has been proposed to as a step to bridge this gap. Simulation is already in use in many other industries with success. Vast amount of medical information available on internet has revolutionised the teaching and medical practice for the learner as well as the patients. Patients today are better informed and aware about their disease and expect to receive treatment in expert hands with no error. Simulation can help in dealing with different clinical and surgical scenarios and practicing them to gain proficiency. This article reviews the utility of simulation in medical education.

Keywords: Simulation; Mannequin Simulator; Partial Task Simulator; Graduate Medical Education; Undergraduate Medical Education and Continuing Medical Education.

 

Medical education all over the world has undergone significant changes keeping pace with the knowledge advancement as well as technological revolution which has taken the world in its storm. Medical education now needs to be community oriented and need based to our society, so the medical graduates is able to deal with the common problems efficiently. Both the government and the medical teachers need to be work in harmony to produce efficient medical graduates capable of dealing common problems and performing common medical procedures independently. This article highlights the all these issue and suggests few changes which might be seful to bring out a positive change in medical education in India.

Keywords: Medical Education; Medical Colleges; Medical Teachers; Medical Graduates.

 

Consent is an essential requirement for surgery, intervention, treatment, for participation in medical research. Same is true for research involving students and residents for research involving educational research. Informed consent is a process where a patient makes an informed and voluntary decision about medical care. One of the major element of consent is information received, its comprehension and decision making of the participants. It not only protects the rights of the patient but is also an important piece of evidence for the doctor if any medico-legal problems occur. In this paper intricacies involved in consent and limits are addressed.

Keywords: Consent; Informed Consent; Decision Making for Treatment.

 

The establishment of pneumoperitoneum is the first step in laparoscopic surgery. Laparoscopic abdominal surgery requires the creation of successful pneumoperitoneum, as it plays an important role in prevention of complications occurring at the time of entry. Various techniques are used to create pneumoperitonium of which Direct trocar insertion is one procedure. A study was carried out to decrease the trocar insertion time in turn facilitating the decrease in operative time. In this study 36 patients who underwent different laparoscopic surgeries were included, the time taken for the insertion of first trocar was recorded. the time taken in our series was 12±2 (10 to 14) minutes in open method and 7±2 (5 to 9) minutes in Direct (blind) trocar insertion. Thus the time taken for direct trocar insertion was less when compared to open method. The direct trocar insertion described in our series is faster, requiring less rotatory movements and force and is safe.

Keywords: Pneumoperitonium; Veress Needle; Direct Trocar Insertion.

 

Chronic cholecystitis is the most frequent inflammatory disease of gallbladder. Cholelithiasis produces diverse histopathological changes in gallbladder mucosa namely acute and chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia and carcinoma. The variable appearance of gallbladder in chronic cholecystitis is reflection of differences in the degree of inflammation and fibrosis. This study was aimed to tudy the frequency and pattern of histopathological alteration in gallbladder mucosa in cholelithiasis in surgically esected specimens. The correlation between duration and severity of disease based on pathological changes was also assessed in order to elucidate the importance of early cholecystectomy. The study was conducted on 100 cases of chronic cholecystitis. The age of the patients ranged from 20 to 78 years with peak incidence 47.65% above third decade. Inflammatory mononuclear infiltrate was present in all 100 cases. The infiltrate was mild in 43% cases, moderate in 40% cases and severe in 17% cases. Fibrosis was mild in 38%, moderate in 18% and severe in 10% cases. Gallbladder malignancy was seen in 4 cases, with 1 case of mild dysplasia and 3 cases of severe dysplasia. The conclusion of the study suggest that grading of chronic cholecystitis should be used in routine reporting of gallbladder specimens so as to give complete information to surgeon.

Keywords: Cholethiasis; Carcinoma Gallbladder; Dysplasia.

Developing countries suffers the dual burden of population explosion and unmet need of contraception across the country; however the trend may not be same everywhere. Unmet need of contraception coupled with their beliefs and choices largely based on unreliable sources of information and hearsay has a significant impact on fertility. Unregulated fertility can disrupt the health of a woman and her family, but has a much greater economic burden to the country. This questionnaire based study was conducted with the aim to gain insight into the contraceptive use, knowledge, practices and their beliefs regarding different contraceptives in young eligible married women of reproductive age [18-45 yrs] in the urban women attending gynecology OPD. Most women belonged to urban areas and the mean age was 29.5 years. Most were parous , majority being Para 2. Media [TV, radio and newspaper] and the elder women in family and neighbours were the main sources of information. Very few of them visited a clinic / nearby hospital for contraceptive advice. Majority women were aware about different contraceptives, both temporary and permanent. There were awareness about the emergency contraception also, but very low [34%]. There were many myths associated with contraception especially with IUCD eg- long term side effects, causing pain abdomen, cancer, migration to head, chest and long term fertility problems etc. Even with combined OCP many believed it may cause cancer of uterus and long term health hazard, though were not clear about the type of hazards. Permanent method of sterilisation were the commonest method used in the study group [38%]; however very few couples had vasectomy. Fear of impotency, long term health problems and cancer were the concerns. This study stresses the importance of further strengthening the family planning program in this part of the country along with addressing the myths and concerns for adequate utilisation of the services. This being a hospital based study may not be a true representative of contraceptive prevalence practices of western Rajasthan.

Keywords: Contraception; Awareness; Practices of Contraception; Myths for Contraception.