Papers by Dr nalini Sharma
Journal of Mid-life Health
Endometrial stromal sarcoma (ESS) is a rare malignant tumor that constitutes about 0.2% of all ut... more Endometrial stromal sarcoma (ESS) is a rare malignant tumor that constitutes about 0.2% of all uterine malignancies and 10% of uterine sarcomas. ESS is generally misdiagnosed as leiomyoma or endometrial polyp and typically discovered on histopathological examination postoperatively because of its rarity. Endometrial stromal tumors are composed of cells resembling normal endometrial stroma in its proliferative phase. The histologic diagnosis of the high grade is made if there is a high-grade sarcoma with a high mitotic index and nuclear anaplasia. The mean age of presentation of high-grade endometrial sarcoma is about 61 years with the most common presenting complaint is menorrhagia. The median overall survival for high-grade endometrial sarcoma is 53 months with optimal cytoreduction. A 49-year-old woman P2 L2 presented with nonspecific complaint of discharge and spotting per vaginum. In the present case, the provisional diagnosis by clinical findings as well as imaging was in favor of the inversion of submucous fibroid. Preoperative histopathological examination and immunohistochemistry confirmed the diagnosis of high-grade undifferentiated ESS. Haultain's operation followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. The patient was referred to another center for radiotherapy. From there, she was lost to follow-up. Rarity of endometrial stromal tumor limits the clinician view to diagnose it preoperatively. We were fortunate to have preoperative histopathological diagnosis of ESS. Furthermore, as ESS is rare and undifferentiated stromal sarcoma is even rarer, literature is lacking on its optimal management. Hence, it is important for all clinicians to keep the high degree of suspicion for ESS while working up any case of abnormal uterine bleeding.
Cureus, 2021
Introduction Hypertensive disorders frequently complicate pregnancy and contribute substantially ... more Introduction Hypertensive disorders frequently complicate pregnancy and contribute substantially to maternal and perinatal morbidity and mortality. Identification of risk factors for hypertensive disorders of pregnancy (HDP) can help determine the particular patient group which requires appropriate intervention. Methods This prospective cross-sectional hospital-based study conducted from January 2016 to January 2019 included all pregnant women beyond 20 weeks of gestation complicated by HDP. The objectives were to determine the incidence of HDP and associated maternal and perinatal mortality and morbidity rates along with factors influencing it. Data collected were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed with the Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY). Results In our study, out of 5460 deliveries, 402 (7.4%) cases had HDP, 27.6% had gestational hypertension, 27.6% had mild preeclampsia, 33.6% had severe preeclampsia, and 11.2% had eclampsia. Fifty-four (13.4%) cases required admission in the intensive care unit and 12 (2.9%) ended in maternal deaths. The cause of maternal mortality was cerebral hemorrhage in eight (66.6%) cases and pulmonary edema in four (33.3%) cases. All maternal deaths occurred in women with severe preeclampsia and eclampsia and eclampsia was significantly higher. Maternal deaths were more when systolic blood pressure (SBP) was ≥ 160mmHg, diastolic blood pressure (DBP) was ≥ 110mmHg, significantly more with 3+ proteinuria, but no association was found with age, parity, booking status, socioeconomic status, gestational age, or mode of delivery. All mothers with HDP received treatment with antihypertensives. There were 60 (14.9%) cases of perinatal mortality. Perinatal deaths were more in unbooked cases and preterm HDP, significantly more with SBP ≥160 mmHg, DBP ≥110 mmHg and ≥2+proteinuria, but no association was found with parity or mode of delivery. Besides mortality, there was a significant burden of maternal and perinatal morbidity, which was more in women with severe preeclampsia and eclampsia. Conclusion Routine antenatal screening for HDP in all pregnant women with appropriate and timely interventions in women at risk may help reduce HDP-related maternal and perinatal morbidity and mortality.
Indian Journal of Case Reports, 2019
Abdominal pregnancies are rare types of ectopic pregnancies with high rates of maternal and perin... more Abdominal pregnancies are rare types of ectopic pregnancies with high rates of maternal and perinatal morbidity and mortality. Abdominal pregnancy accounts for up to 1.4% of ectopic pregnancies. We report a case of term live abdominal pregnancy without malformation with implantation of the placenta into the uterus and anterior abdominal wall, discovered during a planned obstetric hysterectomy indicated for placenta accreta. Abdominal pregnancy is a serious and potential life-threatening condition. Diagnosis and management can be difficult especially in developing countries. A high index of suspicion is key for timely diagnosis and intervention to prevent life-threatening complications.
Obstetrics & Gynecology International Journal, 2018
Background: More than 50% of women in the developing countries are affected with iron deficiency ... more Background: More than 50% of women in the developing countries are affected with iron deficiency anaemia. Ongoing blood loss in women with heavy menstrual bleeding can pose a difficulty to combat anaemia in these patients. Ferric carboxymaltose (FCM) is a novel molecule which can be safely administered at large doses in a very short time. Objective: This prospective study was designed to study the efficacy and safety of ferric carboxymaltose in treating anaemia in women with heavy menstrual bleeding. Material and method: This hospital based prospective study included 65 anaemic (Hb<10 gm%) women with heavy menstrual bleeding. Diagnosis of iron deficiency anemia was established by peripheral blood smear and serum ferritin level. About 1000mg FCM was given by infusion in15 minutes and improvement in haemoglobin and serum ferritin was assessed 14 days after the infusion. Any side effects were recorded during the study. Results were statistically analysed by paired t test. Result: The mean haemoglobin before and after administration of FCM infusion were 7.71±0.66 gm% and 10.33±1.21 gm% respectively. The mean difference in haemoglobin was 2.62 gm%. (p < 0.0001).The mean ferritin level before and after FCM infusion were 26.77±22.0ng/ml and 254.75±70.00 ng/ml respectively. Mean difference in ferritin was 227.97ng/ml (p <0.0001).No major adverse reactions were seen. Conclusion: This study demonstrated the safety and efficacy of FCM in treating anaemia in patients with heavy menstrual bleeding and should be considered in such women to avoid the possible need of blood transfusion.
Journal of reproduction & infertility
Tuberous sclerosis, also known as tuberous sclerosis complex (TSC), is a rare genetic condition t... more Tuberous sclerosis, also known as tuberous sclerosis complex (TSC), is a rare genetic condition that mainly causes hamartomas to develop in different parts of the body. TSC, an autosomal dominant trait with variable penetrance, can adversely affect maternal and fetal outcome. In this paper, a case of maternal and fetal tuberous sclerosis having fetal cardiac rhabdomyoma detected in utero at 26 weeks was reported who subsequently had fetal demise at 31 weeks. Tuberous sclerosis is a rare genetic condition that mainly causes development of hamartomas. In tuberous sclerosis, a cardiac rhabdomyoma is the only sign that can be detected prenatally. In maternal tuberous sclerosis, fetal ECHO is advisable after 24 weeks. A pregnancy complicated by maternal or fetal tuberous sclerosis deserves careful observation and the fetus should undergo prenatal fetal Doppler echocardiography and if possible magnetic resonance imaging for evaluation of other fetal structures including brain and renal pa...
Journal of Menopausal Medicine, 2017
The occurrence of a second primary cancer in a cancer survivor is well documented. It may be sync... more The occurrence of a second primary cancer in a cancer survivor is well documented. It may be synchronous or metachronous. Incidence of metachronous cancer involving cervix is 0.82% to 1.33%. One such metachronous cancer is that of breast and cervix. We present a case of a woman who received tamoxifen for invasive ductal cancer of breast following a modified radical mastectomy and subsequently developed adenocarcinoma of cervix after six month of tamoxifen therapy. The role of tamoxifen in pathogenesis of cervical cancer and that of human papillomavirus infection in pathogenesis of both cancer of cervix and breast cancer has been well recognized. In our patient, the adenocarcinoma of cervix (rare occurrence) which is likely due to six month of tamoxifen therapy is a perplexing question. Women diagnosed and treated for breast cancer need to be followed up for development of other metachronous gynecological cancers.
The Journal of Obstetrics and Gynecology of India, 2017
Background The incidence of post-partum anaemia (PPA) is 14-24%. Treatment of PPA with injectable... more Background The incidence of post-partum anaemia (PPA) is 14-24%. Treatment of PPA with injectable iron replenishes the iron store. Ferric carboxymaltose complex (FCM) is a non-dextran containing intravenous iron agent, having a very low immunogenic potential, designed to be administered in large doses in a short period of time.
Journal of reproduction & infertility
95% of Tuberculosis (TB) of the female genital tract (FGT) is located in tissues other than the c... more 95% of Tuberculosis (TB) of the female genital tract (FGT) is located in tissues other than the cervix. A rare case of primary TB of the cervix which was diagnosed coincidently in a patient of endometrioma was reported in this study. A 34 year old nullipara, a diagnosed case of endometrioma had a small cervical growth. Pap smear and biopsy was taken and sent for histopathological examination. Her histopathological examination revealed multiple epitheloid cell granuloma and langerhans type giant cell caeseation. Ziehl neelsen staining was positive for acid fast bacilli (AFB). The patient was started on antituberculosis under directly observed therapy along with oral contraceptive pills. Patient was on regular follow-up and clinically she was doing well. Although cervical tuberculosis is very rare but for an abnormal looking cervix, cervical tuberculosis should be considered in the differential diagnosis in woman of all the age groups especially in areas where tuberculosis is rampant ...
Annals of Indian Academy of Neurology, 2015
expected. [2] GBS can occur in any trimester of pregnancy and post-partum period but particularly... more expected. [2] GBS can occur in any trimester of pregnancy and post-partum period but particularly in third trimester and first 2 weeks post-partum. GBS is known to worsen in post partum period due to an increase in delayed type of hypersensitivity. The neglect regarding study of GBS complicating pregnancy may have resulted from one of many gaps in our arbitrary medical division of labor (no pun intended). Other investigators having taken the position that pregnancy is someone else's business, the more remote consequences of pregnancy and the puerperium have been left for the obstetricians, who are kept busy enough with short term outcomes. [2] Delayed diagnosis is common in pregnancy or immediate postpartum period because the initial non-specific symptoms may mimic changes in the pregnancy. [3] The relation between GBS and pregnancy or delivery is of special interest because of the dramatic character of GBS symptoms in a woman facing delivery. The purpose of this study was to quantity the risk of GBS for the mother during the pregnancy and postpartum periods and look for correlation between pregnancy and GBS. It has never been reported to the best of author's knowledge and belief.
Journal of Neurosciences in Rural Practice, 2012
ABSTRACTAcute respiratory failure is an uncommon initial presentation of myasthenia gravis (MG). ... more ABSTRACTAcute respiratory failure is an uncommon initial presentation of myasthenia gravis (MG). In our case a 22-year-old woman of unrecognized MG presented to the emergency department with isolated respiratory failure as the first presenting symptom. Initially she presented with dysphonia and was managed by speech therapist and ENT surgeons for 3 months. Subsequently, she presented with signs and symptoms of sepsis and went into acute respiratory failure. This case highlights the need to consider MG in the differential diagnosis of an otherwise unexplained respiratory failure in the critical care setting.
Indian Journal of Plastic Surgery, 2010
We present a case of carpal tunnel syndrome (CTS) due to compression of the median nerve within t... more We present a case of carpal tunnel syndrome (CTS) due to compression of the median nerve within the carpal tunnel, caused by cysticercosis. Nerve conduction studies revealed severe CTS. Magnetic resonance imaging suggested an infl ammatory mass compressing the median nerve in carpal tunnel. The histological diagnosis was consistent with cysticercosis. The case resolved with conservative treatment. Such solitary presentation of entrapment median neuropathy as CTS caused by cysticercosis is extremely rare. To our knowledge, this is the only case of its kind reported in literature till date.
Annals of Indian Academy of Neurology, 2008
Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS) is under evaluat... more Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS) is under evaluation in developing countries like India, especially in areas such as western Utter Pradesh, where it is overly crowded and there is poor affordability. This study was done to evaluate recombinant tissue plasminogen activator r-tpa in acute ischemic stroke in hyper acute phase, in selected patients of western Utter Pradesh, in terms of feasibility and effectivity. Open, non randomized study. Thirty two patients were classified using Trial of ORG 10172 in Acute Stroke treatment (TOAST) criteria (large artery atherosclerotic = 8; cardio embolic = 6; small vessel occlusion = 14; other determined etiology = 2; undetermined etiology = 2). The mean time to reach the hospital was 2 h (1.15-3.0), the mean door to CT scan 20 min (10-40) and door to r-tpa injection was 30 min (24-68). The National Institute of Health Stroke Scale (NIHSS) scores ranged from 11-22 (mean 15.5 +2.7). The dose of r-tpa administered was 0.9 mg/kg. Twenty one patients (65.6%) showed significant improvement on the NIHSS score, at 48 h (4 points). (Mean change = 10; range = 4-17). At one month, 25 (78%) recorded improvement on the Barthel index (mean change = 45%). One developed frontal lobe hemorrhage and another developed recurrent stroke; one died of aspiration; and four showed no improvement. Modified Rankin score (m RS) was administered at the end of three months to 28 patients (90%); however, the rest could not be directly observed. The average modified Rankin Score was 1.2 (0-2). Hyperacute thrombolysis was found feasible and effective in selected patients with AIS from western Utter Pradesh and who had poor affordability.
Indian Dermatology Online Journal, 2011
Although carbamazepine is the most common cause of Stevens Johnson syndrome (SJS) a new antiepile... more Although carbamazepine is the most common cause of Stevens Johnson syndrome (SJS) a new antiepileptic drug, oxcarbazepine which is structurally related to carbamazepine, has also been rarely shown to induce SJS. Here we report a case with SJS, which was induced by oxcarbazepine.
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Papers by Dr nalini Sharma