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ObjectivesThis study aimed to assess sexual health and quality of life (QoL) in endometrial cancer survivors and the factors influencing these variables.MethodsA mixed method design comprising quantitative (cohort design) and qualitative (face-to-face interviews) aspects was chosen. A total of 132 patients who underwent surgery alone, surgery followed by adjuvant vaginal brachytherapy, or surgery followed by chemotherapy and radiation were included. Female Sexual Function Index (FSFI) and Functional Assessment of Cancer Therapy General (FACT-G) questionnaires were used to assess the participants’ sexual health and QoL at 6 months and 1 year post-treatment. Multivariate logistic regression models were used to analyze the factors associated with general and sexual well-being.ResultsAt 1 year, 89% of the participants still had low sexual function scores. Survivors over 50 years (OR 284.7, 95% CI 13 to 364, p<0.001) and educated below graduate level (OR 26.8, 95% CI 2 to 370, p=0.014) had low sexual function scores. Patients who had surgery alone had better QoL than those who received adjuvant radiation. Women who had surgery, chemotherapy, and radiation had the lowest QoL scores (OR 6.4, 95% CI 2.1 to 19.5, p=0.001). All scores improved with time.ConclusionsThis study demonstrated the high prevalence of low sexual function and poor QoL in endometrial cancer survivors. There was a communication gap between the women and their partners as well as their healthcare providers. This study highlights the need for discussion about the survivors’ sexual well-being and QoL.

Introduction Carcinoma vulva is a rare gynaecological malignancy accounting for 5%, but is associated with significant surgical complication rate of 40%- 60%. The study introspects different complications encountered following vulval carcinoma surgeries. Methodology This is a retrospective study conducted in the Gynaecologic Oncology Department of a Tertiary Care Hospital in India, where electronic medical records of patients with vulval carcinoma who underwent surgery between 1 January 2016 and 31 October 2021 were reviewed and analysed. Results A total of 33 patients were identified during this period. The mean age was 60.1 (SD 11.7), and the median body mass index was 26.5(range 38). Most (21, 63%) of them belonged to FIGO I (surgical staging for vulval cancer 2009). Radical wide local excision was performed among 23 patients, and 10 underwent radical vulvectomy. Three of them underwent concomitant flap repair with V–Y flaps. Inguinofemoral dissection was performed among thirty patients. Squamous cell carcinoma was the most common histology. Thirteen patients received adjuvant treatment. The average time to adjuvant treatment was seven weeks. There were 16 (48%) observed complications, most commonly wound breakdown—inguinal wound (5, 15%) and vulval wound breakdown (6,18%). The wound breakdowns were managed conservatively with antibiotics and dressing. Lymphocyst aspiration was done among two patients and interventional lymphangio-embolization in one. One vulval wound breakdown underwent flap reconstruction. Conclusion The complication rate was 48% of whom most patients had minor complications (14/16: Clavein–Dindo grade 1 and grade II). The mainstay treatment for vulval carcinoma is surgery combined with inguinofemoral lymph node dissection with or without adjuvant radiation. Lymphadenectomy majorly contributes to post-operative morbidity. Proper selection of patients, multi-disciplinary discussion, and sentinel node mapping can minimize post-operative complications.

Purpose To study the pattern of serum CA19-9 in adnexal masses and its accuracy in diagnosing malignancy. Methods A cross-sectional study of 267 women with an adnexal mass, who underwent CA 19-9 testing prior to surgery. Descriptive statistics and diagnostic test characteristics were used. Results There were 115 benign, 13 borderline and 139 malignant cases. CA 19-9 was elevated in 68 patients (25.5%) when a cut-off of 33 IU/ml was considered. Among the benign, borderline and malignant tumours, 26, 38.5 and 23.7%, respectively, had elevated CA 19-9. Among patients with benign tumours, CA 19-9 was elevated in 48% of the dermoids, 29.6% of the mucinous tumours and 15.9% of the others. There were 131 epithelial (34 mucinous, 97 non-mucinous types), 18 non-epithelial tumours and three metastatic to the ovaries. CA19-9 was raised in 30 (26.1%) of benign, five (38.5%) borderline and 33 (23.7%) of malignant tumours. Elevated CA 19-9 was seen in 15 (34.1%) of the mucinous type, 32 (23.5%) of the non-mucinous type and 21 (27.3%) of the non-epithelial tumours. Conclusion CA 19-9 is most likely to be raised in ovarian mucinous tumours and dermoid cysts. It is not a good test for malignant ovarian tumours.

Study designRetrospective study.ObjectiveTo analyse the orthotic walking outcome of patients with Low Thoracic Spinal Cord Injury (LT-SCI).SettingThe Rehabilitation Institute at Christian Medical College, Vellore, India.MethodsData between January 2005 and June 2015 were retrospectively collected from electronic medical reports of patients with motor complete LT- SCI who were admitted for the comprehensive rehabilitation program. The orthotic walking outcome of these patients was measured by the Walking index for SCI version II (WISCI II). Demographical and clinical parameters were measured and their association with the walking outcome was analyzed using regression analysis.ResultsA total of 430 patients were identified within the study period. Eighty-five percent of people (n = 365) achieved walking at the time of discharge (WISCI II level 12 = 260 and level 9 = 105). Out of 11 demographical and clinical parameters considered, eight of them were found to be significant predictors of walking in the univariate analysis. Age less than 30 years had the highest odds of predicting WISCI II level 9 and level 12 than those older in the multivariate analysis (OR 17.58; 95% CI 7.35–42.03). Single neurological level T12 increased the chance of achieving WISCI II level 12 by 10 times (OR 10.2; 95% CI 3.8–27.36).ConclusionsOrthotic walking for persons with motor complete low thoracic spinal cord injury is an achievable goal through a comprehensive rehabilitation program. The factors identified in this study will help rehabilitation professionals strategically select the ideal candidate for orthotic gait training.

PurposeLimited published data exist on the clinical epidemiology of atrial fibrillation (AF) in South Asia including India. Most of the published data are from the Western countries and the Far East. The Kerala AF registry was initiated to collect systematic, prospective data on clinical characteristics, risk factors, treatment pattern and outcomes of consecutive AF patients who consulted cardiologists across the state of Kerala, India.ParticipantsAll newly diagnosed and previously reported patients aged ≥18 years with documented evidence of AF on ECG were included. Patients with transient AF due to infection, acute myocardial infarction, alcohol intoxication, metabolic abnormalities and AF seen in postoperative cases and critically ill patients with life expectancy less than 30 days were excluded.Findings to dateA total of 3421 patients were recruited from 53 hospitals across Kerala from April 2016 to April 2017. There were 51% (n=1744) women. The median age of the cohort was 65 (IQR 56–74) years. Hypertension, diabetes mellitus and dyslipidaemia were present in 53.8%, 34.5% and 42.2% patients, respectively. Chronic kidney disease was observed in 46.6%, coronary artery disease in 34.8% and heart failure (HF) in 26.5% of patients. Mean CHA2DS2-VASc score of the cohort was 2.9, and HAS-BLED score was 1.7. Detailed information of antithrombotic and antiarrhythmic drugs was collected at baseline and on follow-up. During 1-year follow-up, 443 deaths (12.9%) occurred of which 332 (9.7%) were cardiac death and 63 (1.8%) were due to stroke. There were 578 (16.8%) hospitalisations mainly due to acute coronary syndrome, arrythmias and HF.Future plansCurrently, this is the largest prospective study on AF patients from India, and the cohort will be followed for 5 years to observe the treatment patterns and clinical outcomes. The investigators encourage collaborations with national and international AF researchers.Trial registration numberCTRI/2017/10/010097.