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The most common presenting feature of endometrial carcinoma (EC) is abnormal uterine bleeding. Bone metastasis, as a presenting feature of EC, is very unusual which is usually restricted to pelvis and vertebrae. The occurrence of foot metastasis is exceedingly rare. We report a case of a postmenopausal female presented with pain and swelling involving right foot. Biopsy revealed metastatic adenocarcinoma. The patient denied any history of vaginal bleeding or other gynecological symptoms. Bone scan suggested increased uptake in multiple tarsal bones. Uterine curettage confirmed the diagnosis of endometrial adenocarcinoma. The patient was successfully treated with debulking surgery, palliative radiotherapy to the right foot, bisphosphonates, and systemic chemotherapy with marked improvement in local symptoms and is under follow-up for the last 6 months after completion of the treatment. An extensive review of the literature, to the best of our knowledge, did not reveal many cases of acrometastasis as a presenting feature of EC
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Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and represents a substantial socioeconomic burden. Co-morbidities are more in COPD patients. Cardiovascular disease is one of the co-morbid conditions in COPD. Arterial stiffness has a strong predictive value for cardiovascular events, which can be assessed non-invasively. Various predictors of arterial stiffness between stable COPD patients and healthy volunteers were measured and compared.Methods: COPD patients attending pulmonary medicine outpatient services were screened for enrolment. It was a prospective case control study with enrolment of fifty COPD stable cases and fifty healthy control, who were matched for their age and sex. All eligible participants were subjected to focused history and physical examination as per structured questionnaire, followed by spirometric examination, periscope test, arterial blood gas analysis and six- minute walk test (6MWT).Results: Increased arterial stiffness was observed in COPD patients over a wide range of severity of airway obstruction. Distance walked in 6MWT and spirometric values were significantly lower in COPD group as compared to healthy group.Conclusions: It was concluded that vascular changes, which are predictive of cardiovascular disease remain as cardiovascular risks in mild or early lung disease. A strong relationship between COPD, systemic inflammation, arterial stiffness and cardiovascular disease had been found which needs to be explored further. It was finally concluded that targeted therapeutic approach has broad aspect in reducing cardiovascular risks and has potential for improved prognosis in COPD.
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Background:Nutritional abnormalities & Cognitive decline are frequent systemic manifestations associated with COPD. The study aimed to investigate and compare the cognitive & nutritive parameters in COPD with age matched healthy controls, and to find association between cognitive impairment & nutrition parameters. Methods: 100 subjects were recruited, and divided into two groups. Group I consisted of fifty consecutive physician diagnosed COPD patients & Group II included fifty healthy volunteers respectively. The spirometric parameters recorded were FEV1 (Liters), FVC (liters), FEV1/FVC ratio(% predicted),FEF 25%75%(liters/sec). Anthropometric measurements included Body Weight, Height and BMI measurements. Nutritional status was assessed using mini nutritional questionnaire (MNA). Body composition was assessed by four-frequency bioelectric impedance analysis (BODY STAT, QUADSCAN, USA). The following parameters were calculated: FFM, FFMI & FMI. The exercise capacity was assessed by the six minute walking distance test (6MWD). MMSE (mini mental state examination) and MOCA (montreal cognitive assessment) were used for cognitive function. All the recordings were compared within and between groups and correlation was also computed between MMSE, MOCA and MNA score. Results were analyzed using SPSS,version 16 & Pearson correlation coefficient. Results: We found out that COPD patients showed decline in all the parameters as compared to healthy controls. And, great strength of association was found between MNA & MOCA in COPD patients. Conclusion: Thus our study indicates that COPD patients have age independent loss of muscle mass as well as cognition, and loss of cognition is associated with decline in nutritional parameters or vice versa.
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Background: Six Minute Walk Test (6MWT) has demonstrated good reliability and validity as an assessment for exercise tolerance for moderate to severe COPD. 6MWD is a known to be a preferred outcome for this test; however, it does not account for differences in body weight that are known to influence exercise capacity. Aim of current study was to correlate of distance product (6MWWORK) with various variables in study group of patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: Sixty patients of diagnosed COPD underwent pulmonary function test and 6MWT. Correlation coefficients were calculated for the 6-Min Walk Distance (6MWD) and 6MWORK with variables of pulmonary function and 6MWT. Results: The mean of 6MWD was 312.0 ± 21.2 meters and mean 6MWWORK was 31246 ± 2414 kg.m in the study population. 6MWD significantly correlated with age (r = 0.25), height (r = 0.42), body mass index (r = -0.32) and body weight (r = 0.48). 6MWORK yielded higher correlation coefficients than did 6MWD when correlated with FEV (r = 0.66 vs. 0.35), FEV1/FVC ratio (-0.46 vs. -0.24). The ROC curve demonstrated that 6MWORK had a significantly larger calculated area under the curve (P <0.05) than 6MWD with FEV1. Conclusion: 6MWWORK is an improved outcome of 6MWT to monitor functional capacity in patients of chronic obstructive pulmonary disease.
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Background & objectives: Although depression is a significant co-morbid condition in chronic illnesses, little is known about the prevalence or risk factors for depressive symptoms in patients with chronic obstructive pulmonary disease (COPD) in India. This study was undertaken to investigate the presence and risk factors of depression in the COPD patients attending a tertiary care health facility in north India. Methods: COPD was classified according to GOLD stages based on forced expiratory volume in one second (FEV1) in 126 stable patients. Depression was examined by administering the nine-item Hindi version of Patient Health Questionnaire-9 (PHQ-9). Linear regression model was used to examine association between predictor variables and risk of depression with adjustment of age and sex. Cronbach alpha was calculated to assess internal consistency of PHQ-9. Results: In the study population as whole, 33.3 per cent patients showed moderate to severe depressive symptoms whereas 20.6 per cent patients had major depressive disorder on PHQ-9 Scale. Educational and occupational status, body mass index, FEV1, respiratory symptoms, physical impairment and dyspnoea were found to be potential predictors of depression in COPD patients. Interpretation & conclusions: One fifth of the patients with COPD had severe symptoms of related to depression, which was especially higher with severity of COPD. Hence, the patients with COPD should focus on management of these two conditions. Further, future studies should be conducted to assess the role of depression management and timely treatment of it in patients with COPD.
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Background & objectives: Although depression is a significant co-morbid condition in chronic illnesses, little is known about the prevalence or risk factors for depressive symptoms in patients with chronic obstructive pulmonary disease (COPD) in India. This study was undertaken to investigate the presence and risk factors of depression in the COPD patients attending a tertiary care health facility in north India. Methods: COPD was classified according to GOLD stages based on forced expiratory volume in one second (FEV1) in 126 stable patients. Depression was examined by administering the nine-item Hindi version of Patient Health Questionnaire-9 (PHQ-9). Linear regression model was used to examine association between predictor variables and risk of depression with adjustment of age and sex. Cronbach alpha was calculated to assess internal consistency of PHQ-9. Results: In the study population as whole, 33.3 per cent patients showed moderate to severe depressive symptoms whereas 20.6 per cent patients had major depressive disorder on PHQ-9 Scale. Educational and occupational status, body mass index, FEV1, respiratory symptoms, physical impairment and dyspnoea were found to be potential predictors of depression in COPD patients. Interpretation & conclusions: One fifth of the patients with COPD had severe symptoms of related to depression, which was especially higher with severity of COPD. Hence, the patients with COPD should focus on management of these two conditions. Further, future studies should be conducted to assess the role of depression management and timely treatment of it in patients with COPD.
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For ancient period moon has been held responsible for many biological activities. That way, lunar cycle, by activity of moon, has been held responsible for increase in number of child birth. In this retrospective, observational study, we examined a total of 9890 full-term spontaneous deliveries as well as non-elective cesarean sections that occurred throughout 12 lunar months (February 7 th , 2008-January 25 th , 2009) in a rural medical college to evaluate the influence of the lunar position on the distribution of deliveries among Indian population. Student's 't' test and ANOVA were used for statistical analysis where each delivery was considered as a single measure. We found no significant differences in the frequency of births during various phase of lunar cycle regardless of route of delivery. Our observations do not support the hypothesis of a relationship between lunar cycle and the frequency of obstetric deliveries.
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Background. Asthma is a major public health problem worldwide. However, there is limited data on asthma prevalence among school children in Shimla. The present study was undertaken to determine the prevalence of asthma in Shimla city and also to examine the different factors influencing its occurrence. Methods. This was a questionnaire-based study (International Study of Asthma and Allergies in Childhood [ISAAC] protocol) carried out in four randomly selected schools in the city of Shimla. The questionnaire was pre-tested in 50 school children. The age group included in the study was 6-13 years. The questionnaire was distributed to all the children (n=1136). A response rate of 89.5% was achieved. The socio-economic status was determined on the basis of monthly income (cumulative square root value method). The ISAAC questionnaire was given standard scores. Various factors influencing the prevalence of asthma, such as socio-economic status, history of asthma and other allergic disorders in the family, type of cooking fuel used, history of active and passive smoking were elucidated from the history. Results. Overall prevalence of asthma in our study was found to be 2.3 percent. Boys had a higher prevalence (3.1%) than girls (1.4%). We found a significant association between asthma prevalence and family history of asthma and other atopic manifestations. There was no significant association of socio-economic factors and exposure to smoking with prevalence of asthma. Conclusion. In the present study, the prevalence of bronchial asthma in school children in the age group of 6-13 years is 2.3 percent.