Postmenopausal endometrial carcinoma presenting as urinary incontinence: a case report

Endometrial carcinoma (EC) most commonly presents with postmenopausal bleeding (PMB) or blood tinged vaginal discharge. Watery vaginal discharge is usually reported in fallopian tube malignancy. We reported a case of EC where she had profuse watery discharge from private part mimicking urine and so patient visited urologist for urinary incontinence and was later diagnosed as endometroid adenocarcinoma. A 73 year old female presented with history of passing urine involuntarily for last 3 months. Endometrial biopsy revealed endometrial endometroid adenocarcinoma-FIGO grade-2. FDG PET-CT scan revealed primary neoplastic pathology of uterus or endometrium with no lymphadenopathy. PMB or vaginal discharge in women with high risk factors like obesity, diabetes mellitus, unopposed oestrogen exposure needs prompt evaluation. PMB is highly suspicious of malignancy arising from cervix or uterus but copious watery discharge should also be evaluated thoroughly with ultrasound and confirmation of underlying malignancy with hysteroscopic guided endometrial sampling should be done

Seismic Design and Detailing of RC Framed Structure using E Tabs

There is a sudden release of energy resulting in creation of seismic waves hence causing an earthquake. The land of India is divided into 4 seismic zones from Zone 2 to Zone 5. The size of the earthquakes ranging from being so weak that they are not even felt and are as strong so as to destroy whole cities. Structures in seismic prone zones are vulnerable to seismic excitations. Majority of old structures are constructed without considering seismic hazards. The excitations occur without warning in areas around the world leading to cause major damage and fatalities. Hence it is necessary to evaluate the performance of structures under seismic excitations so as to strengthen them. The two methods available for the same are classified as Static and Dynamic. Static methods mainly are code compliance whereas dynamic methods are pushover methods such as response spectra, displacement coefficient and time history etc. In this paper, a G+4 RC framed structure is analyzed using dynamic analysis and the results of stresses were compared with different load combinations. The result obtained is presented in the tabular from and compared using graphical equations. The analysis has been performed in different seismic zones where the soil type is medium

Analysis of G + 4 Storey Framed Structure using E-Tabs

The main objective of this project is to analyze a G+4 storied building using ETABS v9.7.4.This analysis includes load calculations manually and then analyzing the whole structure by using ETABS. Design methods used in ETABS analysis are Limit State Design conforming to IS 456:2000. The design of a multi-storey building involves tasks viz.Modeling, load calculations, analyzing, designing, detailing etc. from which some of the tasks were done manually. Initially, the analysis of a G+3 building was done and manual checking of the accuracy of the software with our results were done. The final work contained theproper analysis and of a G+4 3-D RCC building to meet the specified purpose and requirements. The dynamic analysis of the building was performed considering the seismic loads apart from dead and super-imposed loads in accordance to IS 1893(part I): 2002.The supports at the base of the structure were considered as pinned. The codes of practice to be followed were also specified for design purpose with other important details. The analysis of beams and columns of the building were performed on the ETABS whereas the ductile detailing was done manually

A systematic review of prescription pattern monitoring studies and their effectiveness in promoting rational use of medicines

Prescription pattern monitoring studies (PPMS) are a tool for assessing the prescribing, dispensing and distribution of medicines. The main aim of PPMS is to facilitate rational use of medicines (RUM). There is paucity of published data analysing the effectiveness of PPMS. The present review has been done to assess the effectiveness of prescription pattern monitoring studies in promoting RUM. Data search was conducted on internet. A multitude of PPMS done on different classes of drugs were collected and analyzed. PPMS using WHO prescribing indicators were also included. The present article reviews various prescription pattern monitoring studies of drugs conducted all over country and abroad. It was observed in the majority of such studies that physicians do not adhere to the guidelines made by regulatory agencies leading to irrational use of medicines. This in turn leads to increased incidence of treatment failure, antimicrobial resistance and economic burden on the patient and the community as a whole. The treatment of diseases by the use of essential drugs, prescribed by their generic names, has been emphasized by the WHO and the National Health Policy of India. We conclude that the prescription monitoring studies provide a bridge between areas like rational use of drugs, pharmacovigilance, evidence based medicine, pharmacoeconomics, pharmacogenetics and ecopharmacovigilance. In India, this is the need of the hour to utilise the data generated by so many prescription pattern monitoring studies done in every state and on every drug, so that the main aim of promoting rational use of drugs is fulfilled

A cyano analogue of boswellic acid induces crosstalk between p53/PUMA/Bax and telomerase that stages the human papillomavirus type 18 positive HeLa cells to apoptotic death

The p53 tumor suppressor pathway is disrupted by human papillomavirus (HPV) in over 90% of cervical cancers. HPV E6 protein promotes the degradation of p53 thereby inhibiting its stabilization and activation. This study demonstrates that treatment with a novel cyano derivative of 11-keto-;2-boswellic acid, i.e. butyl 2- cyano-3, 11-dioxours-1,12-dien-24-oate (BCDD) reduced the viral E6 mRNA expression and lead to the accumulation of transcriptionally active p53 in the nucleus of HPV18 HeLa cells following DNA damage.Western blot analysis showed that BCDD robustly up regulated time-dependent expression of p53/PUMA/p21 whereas it deprived cells essentially of p-AKT and NF-;AB cell survival signalling cascade. BCDD appeared to gear up PUMA activation through p53 pathway and that both p53 and p21 translocated heavily into the nucleus. Simultaneously, it inhibited anti-apoptotic Bcl-2, augumented Drp-1 expression, disrupted mitochondrial functions causing the activation of proapoptotic proteins and caspases activation. Additionally,BCDD inhibited telomerase expression that's likely to result in a marked reduction of the tumorigenic potential of high-grade cervical cancers. Consequently BCDD caused apoptotic death in cervical cancer cells as evidenced by DNA fragmentation and PARP-cleavage. Further, BCDD did not affect the extrinsic signalling transduction pathway as depicted by its null effect on caspase-8. The in vivo anticancer activity of BCDD was investigated in Ehrlich Ascites carcinoma model where it exhibited tumor regression by 48% at 30 mg/kg, i.p.,in mice. These findings indicated that BCDD is a potential candidate that may be found useful in the management of cervical cancer

Tuberculosis-diabetes screening: how well are we doing? A mixed-methods study from North India

This item is not available on ChesterRep.Setting: Public health care facilities in Sonipat District, Haryana State, India. Objectives: To assess 1) the proportion of tuberculosis (TB) patients screened for diabetes mellitus (DM) and vice versa, 2) factors associated with screening, and 3) the enablers, barriers and solutions related to screening. Design: A mixed-methods study with quantitative (cohort study involving record reviews of patients registered between November 2016 and April 2017) and qualitative (interviews of patients, health care providers [HCPs] and key district-level staff) components. Results: Screening for TB among DM patients was not implemented, despite documents indicating that it had been. Of 562 TB patients, only 137 (24%) were screened for DM. TB patients registered at tertiary and secondary health centres were more likely to be screened than primary health centres. Low patient awareness, poor knowledge of guidelines among HCPs, lack of staff and inadequate training were barriers to screening. Enablers were the positive attitude of HCPs and programme staff. The key solutions suggested were to improve awareness of HCPs and patients regarding the need for screening, training of HCPs and wider availability of DM testing facilities. Conclusion: The implementation of bidirectional screening was poor. Adequate staffing, regular training, continuous laboratory supplies for DM diagnosis and widespread publicity should be ensured