A Cross-sectional Case-control Study of Depression in Incontinent Women.

BACKGROUND: Urinary incontinence (UI) presents in over 50% menopausal women affecting their quality of life leading to depression and hence needs addressal and treatment as very few of them seek medical help. AIMS: Our aim was to determine the prevalence of depression, and the correlation of severity of UI with depression in incontinent women versus continent controls. METHODOLOGY: A cross-sectional case-control study of previously diagnosed 100 incontinent women (Stress/Urgency/Mixed) was done over a period of 3 months. The severity of UI was assessed on Patient Incontinence Severity Assessment (a form of Likert scale) and depression was assessed on a validated Patient Health Questionnaire-9 scale. STATISTICAL ANALYSIS: The statistical analysis was performed using SPSS version 19.0. RESULTS: Most of our cases were 51-60 years, with Urge UI being the most predominant (88%). Hundred percent of our incontinent patients were depressed, with 48% and 45% being severely and moderately severely depressed, respectively. A highly significant correlation was found between the severity of incontinence, amount of leakage, leaking pattern, and depression. CONCLUSION: All of our incontinent patients were depressed, with the severity of depression increasing with the severity of incontinence.

Short and Long Term Follow up and Efficacy of Trans Obturator Tape for Management of Stress Urinary Incontinence.

BACKGROUND: Stress urinary incontinence (SUI) is involuntary leakage of urine on raised intra- abdominal pressure which adversely affects quality of life usually requiring surgical treatment. METHODS: This is a prospective study of efficacy, cure rates and complications of tension free transobturator tape (TOT) surgery on 85 women with SUI. Pre-operatively and 6 months post-operatively International consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) scores were calculated for all patients to know the severity of incontinence and efficacy of tape. RESULTS: Mean age, parity, body mass index and mean duration of symptoms were 45.78 years, 2.68, 26.38 kg/m2 and 3.85 years, respectively. SUI was demonstrated in all cases on cough stress test and Bonney's test. Mean operative time, blood loss, post-operative analgesic injections, post- operative stay and post- operative catheterisation were 23.28 min, 45.50 ml, 1.2 injections, 1.2 days and 1.2 days. Various complications noted were excessive bleeding (3.52%), urinary retention (7.05%), urinary urgency (8.23%), urinary tract infection (2.35%), surgical site infection (1.17%), groin pain (28.23%) and mesh exposure (3.52%). At 6 months follow-up, the complete cure rate was 83.52% , partial cure rate was 11.76% and failure rate was found to be 4.70% whereas it was 79.16%, 12.0% and 8.33% respectively at 3 years follow up. 2 patients (2.35%) required burch colposuspension and 12 patients (14.11%) required pelvic floor exercises and duloxetine therapy for their symptoms. Mean pre- operative ICIQ-SF score reduced post- operatively (17.8 ± 4.67 to 2.71 ± 1.42) (p value = 0.001). CONCLUSION: Study demonstrates short and long-term efficacy and safety of TOT for surgical management of SUI.

Complete duplicated hindgut anomaly presenting in adolescence: Six Ostia in perineum.

A 17-year-girl presenting with features of intestinal obstruction and managed with colostomy was referred for continuing to pass feces per anus despite a functioning colostomy. She was diagnosed with a rare congenital anomaly with duplication of urethra, bladder, vagina, uterus, anus, and distal colon; all openings close together in the perineum. Excision of the obstructed duplicated colon was done. The anomaly and its features are discussed with review of literature.

Chronic versus New-Onset Hyponatremia in Geriatric Patients Undergoing Orthopedic Surgery.

BACKGROUND: Hyponatremia is a common electrolyte disorder encountered in geriatric population undergoing an orthopedic surgery and is associated with adverse clinical outcomes. There is a paucity in literature comparing the effects of chronic- and new-onset hyponatremia on patient outcomes. MATERIALS AND METHODS: A prospective study on 220 patients of age ≥60 years with an orthopedic injury was carried out over 1 year. The aim of this study was to determine the prevalence of chronic hyponatremia during hospitalization and the incidence of new-onset hyponatremia developing perioperatively and compare between the two groups with regard to the severity of hyponatremia, perioperative morbidities, serum sodium level trend in the early postoperative period, and mortality. RESULTS: The prevalence of chronic hyponatremia was 14.1%, with an incidence of new-onset hyponatremia of 22.7%. Patients who developed new-onset hyponatremia were mostly of mild grade (130-134 mmol/L) and were significantly different from those with chronic hyponatremia who were more likely to be of profound grade (<125 mmol/L). When aggressively managed with adequate sodium corrections and strict monitoring, new-onset hyponatremia corrected within 48 h, whereas chronic hyponatremia had a gradual rise in serum sodium levels and did not achieve full correction within 48 h (P < 0.05). Those with chronic hyponatremia had a longer duration of hospital stay (P < 0.0001). No significant differences were obtained in mortality between the two groups. CONCLUSIONS: Patients developing new-onset hyponatremia are of milder grade and recover faster. Patients with chronic hyponatremia require a more cautious approach as they are more likely to be of profound grade and take longer time to correct.

Are Biomarkers Predictive of Anthracycline-Induced Cardiac Dysfunction?

BACKGROUND: The early detection of anthracycline- induced cardiotoxicity is very important since it might be useful in prevention of cardiac decompensation. This study was designed with the intent of assessing the usefulness of cardiac troponin T (cTnT) and NT- Pro BNP estimation in early prediction of anthracycline induced cardiotoxicity. MATERIALS AND METHODS: In this prospective study histologically proven breast cancer patients who were scheduled to receive anthracycline containing combination chemotherapy as a part of multimodality treatment were enrolled. Baseline cardiac evaluation was performed by echocardiography (ECHO) and biomarkers like cardiac troponin T (cTnT) and N terminal- pro brain natriuretic peptide (NT- Pro BNP). All patients underwent cTnT and NT- Pro BNP estimation within 24 hours of each cycle of chemotherapy and were followed up after 6 months of initiation of chemotherapy. Any changes in follow up ECHO were compared to ECHO at baseline and cTnT and NT- Pro BNP levels after each cycle of anthracycline-based chemotherapy. RESULTS: Initial data were obtained for 33 patients. Mean change in left ventricular diastolic diameter (LVDD) within 6 months was 0.154± 0 .433 cms (p value=0.049). Seven out of 33 patients had an increase in biomarker cTnT levels (p value=0.5). A significant change in baseline and follow up LVDD was observed in patients with raised cTnT levels (p value=0.026) whereas no change was seen in ejection fraction (EF) and left atrial diameters (LAD) within 6 months of chemotherapy. NT- Pro BNP levels increased in significant number of patients (p value ≤0.0001) but no statistically significant change was observed in the ECHO parameters within 6 months. CONCLUSIONS: Functional monitoring is a poorly effective method in early estimation of anthracycline induced cardiac dysfunction. Estimation of biomarkers after chemotherapy may allow stratification of patients in various risk groups, thereby opening window for interventional strategies in order to prevent permanent damage to the myocardium.

Effect of atorvastatin on hs-CRP in acute coronary syndrome.

AIMS: To evaluate the effect of a lower dose (20 mg) of atorvastatin on hs-CRP concentrations in patients with ACS. METHODS: Group A (n = 50) patients received atorvastatin 20 mg day(-1) for 4 weeks in addition to standard anti-anginal treatment. Group B (n = 50) patients received standard anti-anginal treatment without atorvastatin. RESULTS: hs-CRP concentrations decreased in both groups, but the decrease was greater in group A. The decrease in hs-CRP was also significantly greater in the subgroups of smoking, hypertension and past history of cardiovascular disease with atorvastatin. CONCLUSIONS: The use of a lower dose (20 mg) of atorvastatin can offer an attractive approach for early treatment of patients with ACS.

Comparison of two methods of estimation of low density lipoprotein cholesterol, the direct versus friedewald estimation.

Current recommendations of the Adult Treatment Panel and Adolescents Treatment Panel of National Cholesterol Education Program make the low-density lipoprotein cholesterol (LDL-C) levels in serum the basis of classification and management of hypercholesterolemia. A number of direct homogenous assays based on surfactant/solubility principles have evolved in the recent past. This has made LDL-C estimation less cumbersome than the earlier used methods. Here we compared one of the direct homogenous assays with the widely used Friedewald's method of estimation of LDL-C to see the differences and correlation. We used direct homogenous assay kit to estimate serum LDL-C and high-density lipoprotein cholesterol (HDL-C). Serum Triglyceride (TG) and Total Cholesterol (TC) was estimated and using Friedewald's formula LDL-C was calculated. The LDL-C level obtained by both methods in 893 fasting serum samples were compared. The statistical methods used were paired t-test and Pearson's correlation.There was significant difference in the mean LDL-C levels obtained by the two methods at the TG levels <200 mg/dl (p<0.02) and TC levels >150 mg% (p<0.001). The correlation coefficient (r) between Friedewald's and direct assay estimation was 0.88. Friedewald's method classified 23.5 % of patients as high cardiac risk whereas there were 17.58% by direct assay.Both had good correlation even though the serum triglyceride and total cholesterol levels affect the difference in LDL-C estimated by both methods. Taking into account the cost and performance, Friedewald's method is as good or even better for classifying and managing patients.