Context: Functional ability considered a proxy for healthy aging, not only related to mental and physical health but it also determines social well-being. Eliciting the determinants of functionality components among the elderly will assist in evolving with appropriate plans at both domiciliary and facility level to eliminate their sufferings and disabilities. Aim: The aim of this study is to find out the magnitude of poor functional status among the elderly and its predictors. Materials and Methods: This is a community-based cross-sectional study conducted among 246 geriatric people in a rural area of West Bengal from August 2017 to December 2017; data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Logistic regression analysis was performed to find out the factors associated with poor functional status (activities of daily living [ADL] and instrumental ADL [IADL]). Results: The study concluded that 32.4% and 59.3% were dependent for basic ADL and IADL, respectively. Binary logistics showed people aged >70 years, female gender, less than primary level education, widowed/separated, who lived in the joint family, poorest percentile of economic status, who were depressed and who suffered from multimorbidity had increased odds of dependency for ADL and IADL. In multivariate logit regression, age >70 years and depression remained significant for ADL; in addition, marital status, education, and family type remained significant for IADL. Conclusion: There should be a provision for community-based comprehensive geriatric health and disability assessment, as it enables older people to avert the illness at the early stage, to delay the onset of disabling diseases. This will ensure their participation in the upliftment of the society, and they thus will be less dependent on their progeny.

Context: The urogynecological problems in women increase with age. The National Health Services (NHS) is experiencing an increase in the demand for and costs of health and social care for women in midlife. It is a relatively new subspecialty which requires a holistic approach to a patient symptoms and expert skills to overcome demands from aging female population and fulfilling patient expectations. Aims: The aim of the study was to analyze the referral pattern in relation to urogynecological symptoms referred to district general hospital in the United Kingdom and in turn to understand the gravity of the situation for improving the care of these women. Subjects and Methods: This was a retrospective study of case notes of women attending the gynecological outpatient clinic led by an urogynecology subspecialist at district general hospital in the United Kingdom having attended the clinic with symptoms suggestive of pelvic floor dysfunction. Results: We identified 777 women who attended the clinic with symptoms of pelvic floor dysfunction. The most frequently stated reason for referral was pelvic organ prolapse, followed by primary urinary incontinence. Majority of the patients (44%) had prolapse at diagnosis and 26% of the patients had multiple symptoms related to pelvic floor dysfunction after a urogynecologist's consultation, 5% of the patients had combined symptoms diagnosed at urogynaecology clinic. Majority of the referrals were from the general practitioners (43%). Conclusions: The study revealed that health practitioner referring the women needs better understanding of the urogynecological symptoms and with a better understanding and a thorough symptom treatment can be initiated for various symptoms at the same time. This allows patients' multiple symptoms improvement, avoids repeat referrals from primary care, avoids repeat visits to the clinics, avoids repeat interventions, and improves patients' satisfaction and therefore saves NHS resources.

Breast phyllodes are rare fibroepithelial neoplasms. Various classifications adopted to grade them into benign, borderline and malignant but the presently used one is the WHO classification of 2012. Trucut biopsy is a sensitive prediagnostic tool to grade phyllodes. But features can sometimes be overlapping making it difficult to grade it. In this study, an effort has been made to compare the morphology of trucut and histolopathology specimens. Sensitivity of the trucut bopsy in diagnosing benign and malignant phyllodes is calculated and is being compared with other studies. Hence due to varied morphological features sole diagnosis should not be based on trucut biopsy.

Aims and Objectives: The aim was to evaluate the comparative efficacy and safety of escitalopram versus desvenlafaxine in postmenopausal women with depression and anxiety in our study cohort. Materials and Methods: A randomized, open-label, intention-to-treat, comparative study was conducted over a period of 1 year. Group 1 (n = 20) patients received tablet escitalopram 10 mg once daily orally which was increased to 20 mg/day when needed at the first follow-up. Group 2 (n = 20) patients received tablet desvenlafaxine 50 mg once daily orally which was increased to 100 mg/day when needed at the first follow-up. Patients were followed at 3 and 6 weeks. Primary endpoints were change in baseline scores (recorded as mean ± standard deviation) of Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), and safety was also assessed and compared. Results: Forty patients completed the study. Escitalopram was statistically better than desvenlafaxine in reducing depression after 6 weeks of treatment (P < 0.05). Both the drugs were found to be equally effective in treating anxiety. Furthermore, they showed comparable safety and tolerability. Conclusion: Escitalopram appears to be more effective on short-term basis in treating depression, and both the drugs appear equally effective in combating anxiety. Furthermore, they appear to be equally safe and well tolerated in postmenopausal women with depression and anxiety.

Background: Abnormal uterine bleeding (AUB) is a common problem affecting the women of reproductive age group and may also have a significant impact on their physical, social, and emotional aspects directly affecting their quality of life. The International Federation of Gynecology and Obstetrics (FIGO) devised a universally acceptable system of nomenclature and classification, namely PALM–COEIN classification of AUB in the year 2011. The objective of the present study was to analyze the structural (PALM) and functional (COEIN) component of FIGO system in the Indian scenario. Materials and Methods: Three hundred patients with complaints of AUB were taken. A clinical diagnosis according to PALM–COEIN system was made after thorough history and clinical examination. Additional investigations if required were done, and endometrial sampling or hysterectomy was done whichever indicated. A histological diagnosis was made, and each case was allocated a category according to PALM–COEIN classification. A clinicopathological correlation was done in the hysterectomy cases for structural causes (PALM). Results: Leiomyoma (30%) was the most common cause of AUB closely followed by adenomyosis (29.66%) overall. The clinicopathological correlation in hysterectomy cases was good with concordance rate of 85.03%. The concordance between clinical and pathological diagnoses for AUB-L, AUB-A, AUB-M, and AUB-A, L was statistically significant with P < 05 in positive cases. However, additional finding of adenomyosis was diagnosed in 48.2% of the cases apart from primary clinical diagnosis. Conclusion: A good clinicopathological correlation was seen in the cases when classified according to PALM–COEIN classification. The system also provides for consideration of multiple etiologies contributing toward AUB both clinically and histopathologically. However, histopathology remains the cornerstone in establishing the accurate diagnosis as the cases without specific symptoms can be missed clinically.

Filariasis is a major public health problem in tropical and subtropical countries such as India. It is caused by nematodes, principally Wuchereria bancrofti and Brugia malayi and is transmitted by the Culex mosquito. W.bancrofti accounts for 90% of cases of lymphatic filariasis. Filaria of the breast with axillary lymphadenopathy and lymphedema, mimicking breast carcinoma has been previously reported. Microfilariae have also been previously observed as coincidental findings with various inflammatory and neoplastic lesions. Few examples are hemangiomas of the liver, meningiomas, intracranial hemangioblastomas, uterine cervix, pharyngeal, urinary bladder, preputial and metastatic carcinomas, melanomas, and leukemia.Here, we report an unusual case of filarial infection of a metastatic axillary node in a case of invasive breast carcinoma, observed in a modified radical mastectomy specimen. Previous cases reported in literature have reported microfilaria in metastatic axillary node detected on cytology specimens; histological diagnosis, though reported, is rare.

The understanding of ovarian malignancy pathogenesis has greatly increased with identification of varied genomic mutation profiles, which directs the clinical behavior of the tumors. The present case describes the rare subtype of pure transitional cell carcinoma which is no more included in the newer World Health Organization (WHO) classification as the WHO labels it as a type of high-grade serous ovarian cancer with transitional cell differentiation, although in our case no serous component was identified. Hence, with revised classification of ovarian malignancies, it is important to report all rare subtypes in order to understand their biology and behavior.

Gossypiboma is an uncommon but avoidable condition, which is mostly asymptomatic initially and difficult to diagnose but can cause serious postoperative complications. It is a mass lesion due to surgical sponge or swab if retained in the body after the surgery. Gossypiboma has a vague presentation, and it is difficult to diagnose. In patients with a prior history of surgery having soft-tissue masses or localized pain abdomen, gossypiboma should be included in the differential diagnosis. We are reporting a case of a 33-year-old woman referred to our center with a complaint of vague abdominal pain, mild distension for the past 7 days, and discharge from the stitch line for the past 1 day. After investigation, diagnosis of gossypiboma was made and an exploratory laparotomy was performed to remove the retained surgical mop.