Journal of Mid-life Health Journal of Mid-life Health
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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 13 | Issue 2
Page Nos. 91-193

Online since Friday, September 16, 2022

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EDITORIALS  

Welcome - First step forward p. 91
Maninder Ahuja, Yashodhara Pradeep
DOI:10.4103/jmh.jmh_154_22  
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Azadi Ka Amrit Mahotsav - Celebrations of 75th Independence Anniversary of India - Healthy Aging! p. 93
Maninder Ahuja
DOI:10.4103/jmh.jmh_153_22  
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REVIEW ARTICLES Top

Does coronavirus disease 2019 kill more elderly men than women due to different hormonal milieu p. 96
Apurva Tandon, Vishal R Tandon, Sudhaa Sharma, Annil Mahajan
DOI:10.4103/jmh.jmh_37_22  
Preliminary data depicts a much greater prevalence and high case-fatality rate in advanced age males as compared to age-matched women with severe acute respiratory syndrome-coronavirus-2 infections with high morbidity, mortality, high referral, and admission to intensive care unit with severe sequelae. However, the literature search revealed both for and against studies in this context. Thus, at present, in light of the mixed studies, it cannot be established whether low testosterone levels in aging hypogonadal males create a permissive environment for severe response to coronavirus disease 2019 (COVID-19) infection and can it increase the morbidity or mortality, or on the contrary if the virus inhibits androgen formation. Hence, it is highly warranted to establish the said hypothesis by conducting large statistically powered clinical studies in future. Further, it is highly indicated that impact of sex hormones and gender on the incidence and case fatality of the disease and hormones as a treatment according to sex and gender for COVID requires further scientific research by the research community before it is actually recommended to mitigate the COVID-19 disease course among elderly men and women at large.
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Xerostomia – A comprehensive review with a focus on mid-life health p. 100
Lisa Elizabeth Jacob, Meenakshi Krishnan, Anju Mathew, Anuna Laila Mathew, Tibin K Baby, Anand Krishnan
DOI:10.4103/jmh.jmh_91_21  
Xerostomia is defined as the subjective complaint of a dry mouth. Xerostomia is common in menopausal women owing to the hormonal changes which take place during midlife. Studies show a higher incidence of oral cancer in the postmenopausal period which substantiates the theory of estrogen deficiency in carcinogenesis. Radiotherapy in the treatment of these cancers can lead to oral dryness. Other etiological factors of xerostomia include systemic diseases commonly occurring in middle-aged individuals and xerogenic drugs. Saliva plays a pivotal role in the maintenance of oropharyngeal health and xerostomia can severely impair the quality of life. The aim of this review was to provide vital information pertaining to the etiology, signs, diagnosis, and treatment of xerostomia with an emphasis on midlife health. The articles for this review were obtained from PubMed Central, Google Scholar, EBSCO, Science Direct, Medknow, Scopus, EMBASE, Web of Science, and authorized textbooks published between 1988 and 2021.
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ORIGINAL ARTICLES Top

Burden of osteopenia and osteoporosis among postmenopausal women in India: A systematic review and meta-analysis p. 107
DS Anupama, Judith Angelitta Noronha, Kiran K V Acharya, Mukhyaprana M Prabhu, Jyothi Shetty, Ravi Shankar, Baby S Nayak
DOI:10.4103/jmh.jmh_207_21  
Aim: Postmenopausal osteoporosis is a major public health problem around the world. The objective of this systematic review is to determine the prevalence of osteoporosis in postmenopausal women in India. Materials and Methods: This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified relevant studies through a search of literature published from 2010 to January 2021 in the databases PubMed, Web of Science, ProQuest, CINHAL, and PEDro databases. We searched for cross-sectional studies involving India that were published in English. Results: There was a total of 1631 hits in the initial search and out of which 60 studies were selected for full-text review. Twelve studies were selected for qualitative analysis. Excluded studies were 48 with reasons: 20 studies had included other diseases such as knee arthritis, celiac diseases, diabetes mellitus, and kidney diseases. Eleven studies included premenopausal women, young adults, and men. Ten studies outcomes were different, and seven studies were excluded as they have done retrospective analysis and were commentaries. The pooled prevalence of osteoporosis at the lumbar spine region was 29%, the hip region was 6% and the femoral neck region was 29% whereas the pooled prevalence of osteopenia at the lumbar spine region was 37%, the hip was 6%, and femoral neck region was 37%. Conclusion: This systematic review found that postmenopausal women are at significant risk of developing low bone mineral density, and the prevalence of osteoporosis and osteopenia was high in the lumbar area.
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Glimpse into the lifestyle of doctors p. 115
Ruchika Garg, Prabhat Agrawal, Akhil Pratap Singh, Mohita Agrawal, Prashant Gupta
DOI:10.4103/jmh.jmh_201_21  
Background: Lifestyle disorders are on rise world over. Also, the role of doctors as leaders in propagating healthy lifestyles needs to get a reality check. Aims and Objectives: This study aimed to investigate the prevalence of lifestyle disorders, eating habits, nutrition patterns, and lifestyle of doctors by assessing health-related behaviours considering gender and other relevant demographic parameters. The objectives of the present study are to find out the relationship of lifestyle disorders among doctors and to study lifestyle disorders and related behaviour among male and female doctors and other subgroups. Materials and Methods: Online survey was conducted using Googledoc in June to August 2021. Descriptive statistical analysis has been carried out in the present study. The student's t-test (two tailed, independent) has been used. Results: About 50% rated a happiness quotient of 7 and 8. Surgeons had more diabetes and hypertension than physicians. Prevalence of hypertension was more in self-employed males versus males in job. About two-third participants scored ≥ 80% on healthy lifestyle score. Conclusion: Our results call for a well-thought strategy to overcome the financial and technological hindrances to accurately identify health risk factors and plan corrective interventions. A healthy lifestyle both in terms of diet and exercise should be incorporated into the schedules of doctors.
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Translation, reliability, and validity test of odia version of menopause-specific quality of life questionnaire among postmenopausal women for menopausal symptoms p. 121
Saswatika Beura, Lipilekha Patnaik, Manisha Sahu
DOI:10.4103/jmh.jmh_222_21  
Introduction: The Menopause-specific Quality of Life (MENQOL) questionnaire was developed in 1996 to assess the health-related quality of life (QOL) in the menopausal transition and it addresses the degree to which menopausal symptoms had bothered women. The objective of this study was to translate the MENQOL questionnaire in the Odia- regional language of India and validate it for usage in the Odia-speaking menopausal women. Methods: The original English questionnaire MENQOL with 1-month recall period was translated by the researchers. According to instructions by Mapi Research Trust, the questionnaire was forward and backward translated, followed by participant testing and proofreading. Validity and reliability were evaluated by the following tests: internal consistency (reliability), stability (test-retest reliability) with Cronbach's alpha correlations, Pearson's correlation coefficients, and content validity index. Results: A total of 80 postmenopausal women participated in the study. The ICC score and Cronbach's alpha value of all the four domains such as vasomotor, psychosocial, physical, and sexual of both MENQOL English and Odia (MENQOL-E and MENQOL-O) versions recommended excellent homogeneity. The internal consistency using the Cronbach's alpha showed high reliability (0.993) between the MENQOL-E and MENQOL-O questionnaires. Conclusion: The MENQOL-O questionnaire will be used at the individual to community health-care settings to measure QOL and those identified with lower menopause-related QOL, they may get support and care.
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Effectiveness of Tai Chi exercise program on sleep, quality of life, and physical performance in postmenopausal working women p. 127
Ayushi Rajkumar Jain, Doss Prakash Sundarajan
DOI:10.4103/jmh.jmh_223_21  
Background: Menopause being an unavoidable time in every woman's life brings up various challenges. Inevitable changes in body systems affect the life of a woman permanently. The symptoms constitute the postmenopausal syndrome which further affects the quality of life (QOL). Women spend most of the time working during the menopausal transition period and also during postmenopause. The discussion of symptoms is still considered a taboo. Exercise intervention to reduce the symptoms related to menopause which can show a positive impact on health status and work needs to be incorporated. Methodology: Tai Chi exercise intervention was given for 8 weeks to the women who achieved natural menopause and were included in the study (n = 76). They were assessed for sleep, QOL, and physical performance before and after the intervention. Results: A significant difference was observed in all the outcomes after 8 weeks of intervention (Sleep Quality Scale (SQS)-t = 7.57, P = 0.0001; WHOQOL-BREF-t = 7.56, P = 0.0001; and Physical Performance Test PPT-t = 19.93, P = 0.0001). The results were consistent due to the active participation and high adherence rate of the individuals to the protocol. Conclusion: Our study revealed that besides being low velocity and low impact exercise, Tai Chi was a safe and effective mode of treatment in postmenopausal working women. In this group approach sessions were interactive and improved socialization skills because it was conducted in a community setting minimum equipment's and greater feasibility. Hence, this could also be incorporated in different age group population.
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Evaluation of the safety and efficacy of resection of endometrial polyps and submucosal fibroids in an outpatient setting in a large district general hospital in the UK p. 133
Nanak Bhagat, Sumitra Pappala, Prasanta Chattopadhyay, Sangeeta Das
DOI:10.4103/jmh.jmh_154_21  
Background: Conventionally, endometrial pathologies of varying complexity have been surgically treated as inpatients under a general or regional anesthetic. Aim: In this paper, we evaluate the safety and efficacy of hysteroscopic morcellation of endometrial pathology in the form of endometrial polyps (EPs) and submucosal fibroids in an outpatient setting for both simple and complex lesions using the Myosure™ device. Methods: Two hundred and forty-nine hysteroscopic resections were performed in an outpatient setting at the < BLINDED FOR REVIEW > from May 2014 to March 2021. The median age of the patients was 54 years. More than half of the patients presented with postmenopausal bleeding; 64% were diagnosed with EPs and 24% with submucous fibroids (SMFs). The size, topography, extension, penetration, and wall classification system scoring system were used to grade them as simple (≤4) or complex (≥5) pathologies. Results: 90% of pathologies were simple (≤4), of which complete resection was carried out in 95% of patients; 10% of the pathologies were complex (≥5), of which 63% had complete resection. Two patients with complex pathologies returned for completion surgery as a two-step procedure. No procedure was abandoned due to the patient intolerance. The median intraprocedure pain score visual analog scale was 5/10 and immediate postprocedure pain score was 1/10. Notably, there was no intra- or post-procedure complications. Conclusion: Outpatient resection of endometrial pathology, both simple and complex, can be safely and effectively performed using hysteroscopic morcellator (Myosure™) and is accepted and well tolerated by patients.
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Role of incontinence severity index in evaluating severity and impact of treatment of stress urinary incontinence p. 139
Jai Bhagwan Sharma, Vivek Kakkad, KK Roy, Rajesh Kumari, Kavita Pandey
DOI:10.4103/jmh.JMH_113_20  
Background: Stress urinary incontinence (SUI) is a common ailment in affecting quality of life. This study was performed to see role of incontinence severity index (ISI) in evaluating severity of SUI and to see the impact of treatment of SUI. Materials and Methods: A total of 40 women with the diagnosis of SUI on history and clinical examination were enrolled. ISI was calculated on all the women before treatment. All women were treated with either conservative treatment (pelvic floor exercises, life style modification, and duloxetine therapy) (4, 10%) or Burch's colposuspension (18, 45%) or tension-free obturator tape (18, 45%) as per clinical situation after discussion with patients. ISI was again calculated 6 months after treatment. Results: Mean age, parity, body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m2, respectively. All 40 (100%) patients had SUI with the mean duration of symptoms being 4.04 years. A total of 11 (27.5%) had moderate SUI (ISI 3–6), while 24 (60%) had severe SUI (ISI 8–9), while 5 (12.5%) had very severe SUI (ISI 12). Range of pretreatment ISI was 3–12 with mean being 8.8 ± 3.2. Posttreatment ISI reduced significantly with range of 1–4 and mean of 1.3 ± 0.4 (P < 0.001). The reduction was significant for all the groups, but there was no significant difference in efficacy of three treatment groups. Statistical analysis was done using SPSS IBM Version 2-1-0 using Chi-square test, Fisher's Extract test, and ANOVA test as appropriate. Conclusion: ISI is a useful modality to evaluate the severity of SUI and to see the impact of treatment modalities on SUI.
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Combination of B-mode ultrasound and doppler ultrasound in approaching to uterine intracavitary pathologies among women above 40 years with abnormal uterine bleeding: A multicenter-based study from vietnam p. 145
Phuc Nhon Nguyen, Van Tuan Nguyen
DOI:10.4103/jmh.jmh_93_22  
Objectives: To determine the role of B-mode ultrasonography combined with Doppler ultrasonography in diagnosing uterine intracavitary pathology in perimenopausal and postmenopausal women with abnormal uterine bleeding (AUB). Patients and Methods: This prospective observational study included 150 women aged >40 years with AUB hospitalized at Hue University Hospital and Hue Central Hospital between 6/2016 and 6/2019. All participants were investigated by B-mode transvaginal ultrasound and Doppler transvaginal ultrasound, and the result of sonography was compared to the histopathological endpoint. Results: The morphological features, structure, margin, border line of the endometrial-mass lesion, intracavitary uterine fluid, and Doppler signal clearly differed between benign and malignant intracavitary pathologies (P < 0.0001). However, echogenicity had a limited value in distinguishing between uterine intracavitary pathologies (P = 0.1). The sensitivity and specificity of the pedicle sign in diagnosing endometrial polyps were 50.0% and 97.6%, respectively; for the circular pattern in subendometrial fibroids were 46.2% and 100.0%, respectively; for the multiple vessel pattern in endometrial cancer were 64.0% and 96.0%, respectively, and for the scattered-vessel pattern in endometrial hyperplasia were 43.96% and 56.43%, respectively. Conclusions: Ultrasound B-mode combined with Doppler as a noninvasive tool was significantly valuable in the diagnostic procedures for uterine intracavitary pathology in perimenopausal and postmenopausal women with AUB. It could also help differentiate malignant diseases from benign endometrial changes.
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Five-year follow-up in patients with transobturator tape – A retrospective observational study p. 152
Ruchika A Verneker, Vineet Mishra, Nimish Tutwala, Sunita Lamba
DOI:10.4103/jmh.jmh_185_21  
Background: Stress urinary incontinence (SUI) could be due to urethral hypermobility due to the weakening of the pelvic floor muscles which support the urethra and bladder or the intrinsic sphincter deficiency. The mid-urethral tape acts as an anchored pubo-urethral neo-ligament thus increasing the level of mid-urethral support. The purpose of this study is to evaluate the safety and efficacy of transobturator tape (TOT) for SUI at 5 years of follow-up. Materials and Methods: This was a retrospective observational single-arm study of 40 patients. Ten patients were lost to follow-up; hence, only 30 patients were included in the study. Patients who underwent TOT from 2010 to 2012 were followed up till December 2017. Patients were evaluated for early and late postoperative complications and efficacy of the tape at 5 years. Results: The mean age of the patients with SUI was 48.07 (standard deviation ± 9.38). About 76.66% (n = 23) of patients had only pure stress incontinence, whereas 23.3% of patients (n = 7) had mixed urinary incontinence (MUI). The cure rate in our study was 93.33% at 5 years. Out of the seven patients with MUI, urge incontinence was cured in 71.42% (n = 5). De novo urgency was observed in 6.6% (n = 2). No major complications such as bladder and bowel perforation, vascular hemorrhage, or mesh erosion were seen. Patient satisfaction was graded as excellent in 46.66% (n = 14), good in 30% (n = 9), and poor in 23% (n = 7). Conclusion: TOT for stress incontinence has a high cure rate and very good efficacy at 5 years. No major complications are seen when the procedure is performed by expert hands.
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Salivary menopausal markers and oral health status – A hidden hook up p. 157
B Soundarya, F Massillamani, S Kailasam, G Jayashree, N Narmadha, N Sornaa
DOI:10.4103/jmh.jmh_61_21  
Aim and Objectives: The aim of our study was to evaluate salivary estradiol and salivary calcium in postmenopausal women with varying degrees of oral dryness. The primary objective was to establish the interrelationship between salivary parameters and oral health status among menopausal women and compare the same with premenopausal women and normal controls. Materials and Methods: The study included 60 women Group I consisted of healthy menstruating women between 25 and 34 years of age. In Group II premenopausal women between 35 and 45 years of age were present and Group III consisted of menopausal women between 45 and 60 years of age. Unstimulated saliva was collected from the participants and estradiol analysis was done using ELISA method and calcium analysis was done using Arsenazo III reaction using colorimetric method. The oral health status in these patients was determined by using xerostomia score, Russell's periodontal score, and oral hygiene index. The values obtained were subjected to statistical analysis and the results were derived. Results: On oral examination, most of them had poor oral hygiene, periodontal disease, and moderate to severe levels of xerostomia. Salivary estradiol levels were low and salivary calcium levels were high among postmenopausal women and as salivary estradiol levels decreased there was an increase in xerostomia scores and salivary calcium. And also as salivary calcium levels increased the periodontal disease scores increased. All parameters were within normal limits among healthy menstruating women. Conclusion: Saliva can be a preferred medium and an emerging alternative for serum to estimate estradiol and calcium levels. As a dentist, we have to educate them about the oral changes they will experience during menopause and emphasize its strong association between low estradiol levels. Oral hygiene instructions should be given for the maintenance of healthy periodontium. Menopausal women who experience severe postmenopausal symptoms can be identified and the dentist and gynecologist can work hand in hand to treat the symptoms of these women.
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Knowledge and perceptions regarding climacteric among rural women in Jammu District of UT of J and K, India: A cross-sectional study p. 163
Kiran Bala, Riya Gupta, Rajiv Kumar Gupta, Najma Akhtar
DOI:10.4103/jmh.jmh_217_21  
Background: The word Climacteric is shrouded in a culture of silence in our country, more so in the vast rural swathes of India. This survey was carried out to assess the knowledge and perceptions regarding climacteric in rural females of the Jammu district. Materials and Methods: The present study was conducted in the Kot-Bhalwal health block of Jammu district. A sample of 215 was calculated assuming a minimum prevalence of 65% of menopausal symptoms. Using a two-step simple random sampling technique, a total of 245 postmenopausal women from four villages of the health block were interviewed using a semi-structured questionnaire. Results: Among the sources of information about climacteric, family and friends were prime sources followed by community elders. About one-third (35.10%) of the respondents had no discussion about climacteric with anyone. The majority of the participants had a positive perception of climacteric and described it as a feeling of relief. About 77.9% of study participants rated their health as poor to fair. However, about one-fourth of women had taken health checkups for menopause-related symptoms. None of the respondents had any clue about oncological screening. Conclusion: Despite positive perceptions, there is a need to dispel the misconceptions with rigorous awareness and counseling. The role of village-level health workers along with ANM at Sub Health Centers/Health and wellness centers is the game-changer in this context. Every opportunity including Antenatal clinics should be utilized to educate as well as screen menopausal females for various health problems.
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How effective the mindfulness-based cognitive behavioral therapy on quality of life in women with menopause p. 169
Jennifer Britto John, D Vinoth Gnana Chellaiyan, Sujata Gupta, Ramgopal Nithyanandham
DOI:10.4103/jmh.jmh_178_21  
Introduction: In woman's life menopause can cause psychological and somatic disturbances. Psychological and behavioural intervention is effective in reducing menopause-related symptoms. Aims: The present study was done to find effectiveness of mindfulness-based cognitive behavioural therapy (MBCT) on quality of life among menopausal women. Methods and Material: The present study was double-blind randomized trial conducted among menopausal women at tertiary care hospital, Chennai, Tamil Nadu. The study was conducted among 50 women who had attained menopause. They were randomly divided into intervention (n = 25) and control (n = 25) groups. The MBCT was given once a week to intervention group over eight one-hour sessions and control group received no intervention. The data collection instruments included a demographic questionnaire, Kupperman's index, and menopause-related quality of life questionnaire, which were fulfilled by both groups before, immediately after, and 2 weeks after completion of intervention. Paired t-test was applied before intervention and at 10 weeks for both the groups. Results: The difference between the scores before and after intervention i.e after 10 weeks in all the domains and total domain was significant in intervention group compared to control group. Conclusions: Mindfulness based approaches may improve severity of vasomotor and psychological symptoms of menopause, thus enhancing quality of life.
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The impact of soy isoflavone supplementation on the menopausal symptoms in perimenopausal and postmenopausal women p. 175
Shrutika Khapre, Ujjwala Deshmukh, Sheela Jain
DOI:10.4103/jmh.jmh_190_21  
Introduction: Approximately one-third of a woman's life is spent in the menopausal phase. The unpleasant menopausal symptoms are unacceptable as a part of routine life. Indications of menopausal hormone therapy (MHT) are for alleviation of vasomotor symptoms, prevention of osteoporosis, and genitourinary symptoms associated with menopause. MHT is associated with an increased risk of breast cancer, cerebrovascular accidents, and coronary heart disease. Soy isoflavones have been extensively used as an alternative treatment in patients who cannot take MHT. The evidence of the efficacy of isoflavones in the literature is equivocal. Aim: The aim of the study was to evaluate the efficacy of soy isoflavone supplementation on menopausal symptoms in perimenopausal and postmenopausal women and to evaluate the effect on blood pressure (BP) and body mass index (BMI). Materials and Methods: A questionnaire-based prospective observational study was undertaken involving 39 perimenopausal and 61 postmenopausal women, who were prescribed 40 mg soy isoflavone supplements twice daily for 12 weeks. Menopause Rating Scale questionnaire was given to the patients before starting soy isoflavone therapy and at the end of the treatment; BP and BMI were also noted. Results: The total score of both the groups was comparable at baseline. Among perimenopausal and postmenopausal women, the highest score was noted in symptoms of somatic domain. At the completion of our study, the total scores improved significantly by 38.6% and 33.3% in perimenopausal and postmenopausal women, respectively. The greatest improvement was seen in somatic subscale (42.5%) and psychological subscale (42.5%) and the least in urogenital subscale (16.1%) for perimenopausal women. For postmenopausal women, the greatest improvement was seen in psychological subscale (40.0%) and the least in urogenital subscale (14.2%). Conclusion: Soy isoflavone supplementation is beneficial in both perimenopausal and postmenopausal women, more so in perimenopausal women. There is no beneficial effect of soy isoflavone supplementation on lowering systolic BP and BMI.
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BRIEF COMMUNICATION Top

Counselling for testosterone therapy in mid life men p. 185
Sanjay Kalra, Ameya Joshi, Atul Dhingra, Deep Dutta, Sambit Das
DOI:10.4103/jmh.jmh_240_20  
Testosterone is frequently used for the optimization of mid-life health. This therapy is effective and safe if accompanied by adequate counseling, before prescription, and during administration. In this opinion piece, we discuss the style and substance of medication counseling for testosterone therapy. The role and scope of counseling are highlighted, with a focus on screening, diagnosis, medication counseling, sexual counseling, and monitoring. This article should prove useful for all health care professionals.
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CASE REPORT Top

Sarcomatous nodules associated with mucinous neoplasms of ovary: A report of two cases p. 190
Navpreet Kaur, Dimple Chaudhary, Vishal Singh, Varuna Mallya, Nita Khurana, Poonam Sachdeva, YM Mala
DOI:10.4103/jmh.JMH_77_19  
Ovarian mucinous neoplasms (benign/borderline/malignant), one of the common surface epithelial tumours of ovary, at times can be associated with mural nodules. These mural nodules can either be sarcomatous, sarcoma like or anaplastic carcinomatous. The nodules can be single or multiple and appear solid, white to brown in color. Sarcomatous nodules tend to occur in older patients and microscopically are poorly circumscribed , comprising of a population of pleomorphic spindled cells. Two cases of sarcomatous nodules associated with ovarian mucinous neoplasm are being presented here.
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LETTER TO EDITOR Top

Correlation between robotic gynecological surgeries and port site hernia p. 193
Christos Iavazzo, Alexandros Fotiou, Nikolaos Vrachnis
DOI:10.4103/jmh.jmh_204_21  
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