Obs & Gynaecology


        

Case Discussion

internet query to find out appropriate place in India   Posted By Dr Salim    Date : 01-Apr-03   02:06 PM     Reply

Dear Sirs:

I am mailing this internet query to find out appropriate place in India where Mrs. Sakina Ahmed, 63, can seek medical help for her gyaenocological and/or urological problems.

Problems of Mrs. Sakina Ahmed are the following:

Mrs. Sakina Ahmed, aged 63, has been suffering from burning pain in the vaginal area accompanied with pain in the lower abdomen. The problem is pronounced mainly after micturation. The problem started in Vienna, Austria in mid October last, when she was visiting there for three weeks. She consulted a gaenecologist, who after testing the urine said that there was bacterial infection, and prescribed an antibiotic, which was changed to another antibiotic by another doctor. There was little improvement. The paps smear test findings were normal.

She was using Ovestine cream locally for about 8 years and she felt fine.

After coming back to Dhaka she visited a gaenocologist. The normal urine test showed no bacterial infection. The doctor prescribed gynoril suppository for 12 days. The problem subsided, but after few days it recurred and the same doctor advised the same suppository for another 12 days. The symptoms were less but no full relief. She went to the doctor again who suggested use of Primarin cream instead of Ovestine. Mrs. Ahmed does not tolerate Primarin as it induced bleeding when she used it some years ago. Ovestine suited her nicely sofar.

She visited another famous gaenecologist who advised use of Primarin also and gave Neosten suppository. Mrs. Ahmed due to her past bad experience did not use Primarin, but started using Neosten. The problem of burning and pain in the lower abdomen were elevated. She visited a nephrologist, and then an urologist. By following their advice she had her full abdominal sonography and urine culture done. The sonographic report was normal, but urine culture showed significant E-Coli growth more than 10 to the power 5. The sensitivity tests showed:

Rocephin S +++

Ciprofloxacin S+++

As prescribed, she used Ciprofloxcin 500 mg twice daily for 14 days, then once a day for 16 days. Sometimes, the problems appeared to be gone but relapsed again.

After a pause of 7 days urine was given for culture on 2 February 2003. E-Coli growth showed greater than 10 to the power 5. The sensitivity to antibiotics was the same as before. Also paps smear was done aaand it showed heavy staphilococcus infection. The sensitivity tests showed response to the same antibiotics shown above.

These results seemed puzzling. Hence urine was given for culture to another laboratory, ICDDRB at Mahakhali. The result showed no E-Coli growth at all.

After these conflicting results Mrs. Ahmed went to Singapore and had full check up at Gleneagles hospital. Urine culture showed no growth, but paps smear showed heavy growth of streptococcus. Her RA factor and tumour markers were all normal. The gyaenocologist prescribed Augmentin for 7 days.

Mrs. Ahmed came back to Dhaka and took Augmentin she brought from Singapore for 7 days. But her problems remained the same. She called the doctor in Gleneagles and she suggested taking advice from local doctor. Mrs. Ahmed visited the same gyaenocologist as before and the doctor prescribed her ovestine tablets for two weeks, plus ovestine cream for local application.

Two weeks of use of ovestine did not show any response. The doctor suggested high vaginal swab culture to be done at ICDDRB. The test showed growth of enterococcus faecalis. The sensitivity were the following:

Ampicillin, Gentamycin, Nitrofurantoin, Penicilllin, Ceftraixone.

The doctor prescribed Nitrofuantoin, 4 tabs per day for 7 days and 2 tabs per day for further 7 days, plus livial tab in the night and ovestine tab in the morning, as well as ovestine cream. After observing no improvement at all in 10 days, Mrs. Ahmed contacted the doctor who advised for second opininion. Mrs. Ahmed visited another gyaenocologist on 29 March. The doctor


Replies to the above case discussion :

Re : internet query to find out appropriate place in India - Dr.S.Mukherjee,M.B.B.S,M.D.,D.N.B.E.,M.R.C.O.G 28-Jan-04    08:08 AM




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