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Introduction: There have been major changes in the classification and treatment of patients with idiopathic inflammatory myositis (IIM) in the last 2 decades. A major challenge is to identify the parameters that can affect the outcome and prognosis of these patients. Here, we have longitudinally followed a well‐characterized cohort of IIM patients in a rheumatology center and reported the outcome using the validated tools. Method: Patients with a clinical diagnosis of IIM and a follow‐up duration of greater than 2 years were prospectively included in the study. The duration of the study was 6 years: July 2016–July 2022. Clinical details and follow‐up were recorded using pro‐formas and outcomes were noted using validated tools. Ethics approval and written informed consent were taken. Results: Forty patients had a clinical diagnosis of IIM. Mean follow‐up duration was 43.8 (15) months. Out of 40 patients, 32 (80%) achieved remission (8 patients each were off corticosteroid and off treatment for >6 months), 5 (12%) expired and 3 (8%) had active disease. Disease course was non‐relapsing in 22/35 (73%) patients. Mean manual muscle testing‐8 score (n = 29) and myositis disease activity assessment tool score (n = 35) at the final visit were 75.6 (6.8) and 0.048 (0.07) respectively. Thirteen patients had damage (37%). Patients with disease duration >1 year at the time of presentation were more likely to develop chronic‐continuous disease course (P =.023, odds ratio [OR] = 7.6), more frequently required second‐line or third‐line immunosuppression (P =.001, OR = 24) with higher myositis damage index score (p =.0002, OR = 47). Conclusions: IIM patients had good outcomes with the majority achieving remission and near‐complete muscle recovery. However, the patients presenting late to the rheumatologists were more likely to have smoldering disease, more immunosuppressive medicines, and greater accumulated damage. [ABSTRACT FROM AUTHOR]

Objective: We explore the continuum between the two diagnoses of c-section scar pregnancy (CSP) and early placenta accreta spectrum (PAS), the role of pelvic magnetic resonance imaging (MRI) as a diagnostic aide, interventions to reduce morbidity and mortality, and surgical considerations of a robotic-assisted total laparoscopic hysterectomy for definitive management of an early pregnancy loss impacted by CSP/PAS. Case(s): A thirty-six-year-old pregnant female with seven prior cesarean sections presents with life-threatening vaginal bleeding after an early pregnancy loss at home. In the hospital, pelvic ultrasound demonstrates a retained placenta, and MRI further reveals findings concerning for a new diagnosis of CSP and early PAS. After medical stabilization and multidiscipliary treating planning, she underwent uterine artery embolization followed by robotic-assisted total laparoscopic hysterectomy. She was discharged on postoperative day one and recovered well. Final pathology confirmed placental invasion through the endo-myometrium with uterine serosa only overlying the attached placenta consistent with a diagnosis of an abnormal placentation disorder. Conclusion: Here we describe a severe presentation of early PAS after an early pregnancy loss and the role of MRI and multidisciplinary collaboration in successful management. Discussion between minimally invasive gynecology, maternal-fetal medicine, and radiology specialists is critical in management of a c-section scar pregnancy and placenta accreta spectrum disorder. MRI has an emerging and important independent role in visualizing critical anatomy and surgical planning. [ABSTRACT FROM AUTHOR]

Background: Abnormal uterine bleeding (AUB) is a common and devastating condition affecting women of all ages. Among all patients attending gynecology outpatient department clinic, more than one-third patients are related to AUB, and this proportion rises to 70% in the perimenopausal and postmenopausal age. The condition has a high reported prevalence rate of 17.9% in India. Aims and Objective: To compare endometrial sampling histopathology by Pipelle curette versus Karman cannula in patients with AUB at a tertiary care hospital in Northwest Rajasthan. Materials and Methods: It was a prospective study conducted on 100 female patients of all age groups attending the department of obstetrics and gynecology over a period of 1 year with clinical diagnosis of AUB. After detailed history, examination, and relevant investigations, each patient was subjected first to endometrial aspiration using Pipelle curette followed by endometrial aspiration using Karman cannula No. 4. Samples collected were sent for histopathological assessment and the results were compared. Results: In our study, in 84% of cases, samples obtained by both Pipelle curette and Karman cannula were adequate. In 5% of cases, samples were inadequate by both methods. In 10% of cases, Karman cannula sample was adequate, but Pipelle curette sample was inadequate. In 1% of cases, sample could not be obtained by both procedures due to stenosed nulliparous cervix with large fibroid obstructing cervical os. Considering Karman cannula as the standard, Pipelle curette endometrial sampling demonstrated 100% sensitivity, specificity, positive and negative predictive value (PPV and NPV), and accuracy with regard to diagnosis of adenocarcinoma and endometrial hyperplasia. For secretory endometrium, the corresponding values were 76.5%, 100%, 100%, 95.4%, and 99%, respectively. With regard to proliferative endometrium, sensitivity, specificity, PPV, NPV, and accuracy were 92%, 96%, 98.6%, 80%, and 93%, respectively. With regard to atrophic endometrium, specificity, NPV, and accuracy were 100%, 99%, and 99%, respectively. Pipelle curette had a concordance rate of 87.5% with hysterectomy specimen, while Karman cannula had a concordance rate of 100%. Conclusion: Both Pipelle curette and Karman cannula endometrial aspiration biopsy are easy to perform, efficient, and safe outpatient endometrial sampling procedure in recognizing the endometrial lesions including malignancy and endometrial hyperplasia; however, Karman cannula had more adequate sample than Pipelle curette. [ABSTRACT FROM AUTHOR]