Journal of Mid-life Health Journal of Mid-life Health
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   Table of Contents - Current issue
July-September 2022
Volume 13 | Issue 3
Page Nos. 195-266

Online since Saturday, January 14, 2023

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Burden of cancers in India: Stumbling blocks and vision of success p. 195
Maninder Ahuja
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In this issue – Cancer is a concern p. 199
Maninder Ahuja
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Osteopontin as a tumor marker in ovarian cancer p. 200
Shikha Rani, Alka Sehgal, Jasbinder Kaur, Dilpreet Kaur Pandher, Rajpal Singh Punia
Introduction: Ovarian cancer is associated with high morbidity and mortality. This is due to the nonspecific symptoms and no effective screening methods. Currently, carbohydrate antigen-125 (CA125) is used as a tumor biomarker for the diagnosis of ovarian cancer, but it has its own limitations. Hence, there is a need for other tumor biomarkers for the diagnosis of ovarian cancer. Objective of the study was to evaluate the diagnostic test characteristics of plasma osteopontin (OPN) in detecting ovarian malignancy and comparing its performance with CA125. Materials and Methods: This is a prospective cross-sectional diagnostic test evaluation. Women with adnexal mass detected by clinical or radiological examination were enrolled as suspected cases. Women who presented with other gynecological conditions were enrolled as controls. OPN and CA125 levels were measured in all enrolled subjects. Results: Among 106 women enrolled, 26 were ovarian cancer, 31 had benign ovarian masses, and 49 were controls. Median plasma CA125 levels were higher in subjects with ovarian cancer (298 U/ml; interquartile range [IQR]: 84–1082 U/ml vs. 37.5U/ml; IQR: 17.6–82.9U/ml; P < 0.001). CA125 sensitivity, specificity, positive, and negative likelihood ratios were 88.5%, 61.3%, 2.10, and 0.19, respectively. Median plasma OPN levels were higher in subjects with ovarian cancer (63.1 ng/ml; IQR: 39.3–137 ng/ml vs. 27 ng/ml; IQR: 20–52 ng/ml; P = 0.001). Sensitivity, specificity, positive, and negative likelihood ratios of OPN were 50%, 87%, 2.58, and 0.62, respectively. Conclusion: OPN levels were higher in ovarian cancer than in the benign ovarian mass and had better specificity than CA125. OPN can better differentiate between benign and malignant ovarian mass as compared to CA125.
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Prevalence of osteoporosis and associated risk factors among postmenopausal women: A cross-sectional study from Northern India p. 206
Mohammad Imran, Abhishek Singh, Anu Bhardwaj, Deepika Agrawal
Context: Prevalence statistics of postmenopausal osteoporosis and knowledge regarding its independent predictors are lacking, especially in India, where every third woman and every eighth man is suffering from it. Aim: This study aims to investigate the prevalence of osteoporosis and associated risk factors among postmenopausal women. Study Settings and Design: This was a hospital-based prospective cross-sectional study. Methods: This study was carried out among postmenopausal women, who attended orthopaedics outpatient department from August 2020 to July 2021 and 587 women ranging in age between 50 and 80 years who had confirmed menopause were enrolled for the study. Finally, 539 women were recommended for bone mineral density testing, using dual energy X-ray absorptiometry. Statistical Analysis: To analyze the differences between the groups, a Chi-square and Student’s t-test were used for the categorical and continuous variables, respectively. P < 0.05 was considered to show significant associations. Results: In our study, 54.7% of subjects belonged to <60 years of age group. Half of the subjects (51.9%) were illiterate. 37.7% of subjects were having 6 or more children. 14.5% of subjects were currently smoking or chewing tobacco. Age of menopause among 38.0% of subjects was after 50 years of age and duration of menopause at the time of enrolment in the study was more than 10 years in 48.8% of subjects. The prevalence of osteoporosis increased with the increase in the parity and increased number of abortions. Subjects with family history of symptoms related to osteoporosis, and fragility fracture; and self-history of fragility fracture had higher prevalence of osteoporosis (P < 0.05). Conclusion: In our study, the overall prevalence of osteoporotic fractures among postmenopausal females was 82.2% (osteoporosis: 37.5% and osteopenia: 44.7%). The findings of current study and previous studies clearly indicate the urgent need of collective efforts towards the growing problem of osteoporosis in postmenopausal women.
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Expression of poly(Adenosine Diphosphate-Ribose) polymerase protein in breast cancer p. 213
Akanksha, Shashi Prakash Mishra, Amrita Ghosh Kar, JS Karthik, Aviral Srivastava, Rahul Khanna, Ram Niwas Meena
Background: The use of poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors for breast cancer (BC) therapy is the subject of debate, and there is an urgent need to understand much the expression and prognostic role of the PARP1 protein. In this study, we have compared the expression of PARP between BC and benign breast disease (BBD) patients and also analyzed the association of PARP expression with clinicopathological parameters in BC. Methods: The study consists of 30 patients with newly diagnosed operable BC who were planned for surgery without neoadjuvant chemotherapy and 15 patients of BBD as a control between 2019 and 2021. Immunohistochemical analyses were performed prospectively on tissue samples. Anti-human PARP1 rabbit polyclonal antibody gives strong nuclear positivity. Internal control was the adipose tissue and the BBD acted as the external control. PARP1 expression was evaluated using the multiplicative quickscore method. Results: The mean age for BC patients was 51.30 ± 10.694 years (range: 25–75 years) while BBD was below 30 years. Overexpression of PARP was present in 25 (83.3%) and weak expression in 5 (16.7%) of BC patients compared to BBD, only 2 (13.3%) patients demonstrated an overexpression of PARP, and 13 (86.6%) patients showed weak expression which showed significant association (P < 0.001). In BC, nuclear PARP (nPARP) overexpression was seen in 22 (73.3%) patients and weak expression of nPARP in 8 (26.7%), whereas 5 (16.7%) patients showed cytoplasmic overexpression. On comparing expression of PARP with clinicopathological parameters, PARP overexpression was significantly associated with older population (age >50 years) (P = 0.002), postmenopausal women (P = 0.029), higher TNM stage (Stage II and III) (P = 0.014), higher histological grade (grade 2) (P = 0.043), and presence of lymphovascular invasion (P = 0.015). Enhanced PARP1 expression is closely correlated with positive estrogen receptor status (P = 0.001) and PR status (P = 0.001). Overall PARP and nPARP overexpression was significantly associated with ER- (P = 0.006 and P = 0.008) and PR-positive (P = 0.006 and P = 0.008) patients. The PARP and nPARP overexpression was significantly associated with nontriple-negative BC patients (P = 0.001 and P = 0.001). Conclusion: We have not come across any study in the literature to compare PARP expression in BC and BBD patients. On the basis of our observations, we concluded that PARP overexpression is a poor prognostic marker in BC.
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Evaluating clinical features in intracavitary uterine pathologies among vietnamese women presenting with peri-and postmenopausal bleeding: A bicentric observational descriptive analysis p. 225
Phuc Nhon Nguyen, Van Tuan Nguyen
Background: Intracavitary uterine pathologies (IUPs) may be resulting in vaginal bleeding in perimenopausal and postmenopausal women. Especially, malignant disease needed to be investigated due to its adverse impact on the quality of mid-life women as well as the burden of health-care costs in low- and middle-income countries such as Vietnam. Objective: Thereby, through this study, we aimed to assess the major clinical features of IUPs in women with perimenopausal and postmenopausal bleeding women. Materials and Methods: This was a cross-sectional observational study at Hue University Hospital and Hue Central Hospital from June 2016 to June 2019. The study enrolled 150 women above 40 years old involving with intrauterine bleeding. Results: The mean age of the study population was 51.51 ± 7.65. The most common symptom in perimenopausal women was menorrhagia, up to 62.2% of cases. In addition to intrauterine bleeding, there were 54.7% of cases had at least one other functional symptom, they were pale skin (35.9%), and lower abdominal pain (31.3). Endometrial hyperplasia (EH) was the most common pathology in both groups with perimenopausal and postmenopausal bleeding (PMB), respectively, 66.7% and 51.7%. In PMB group, endometrial cancer (EC) occupied approximately 38.3% following EH. Our study revealed age, menstrual characteristics, and diabetes in relation to malignant disease. Other factors seemed to be less associated with EC. Conclusions: Menorrhagia was the most common type of abnormal uterine bleeding in perimenopausal women. Besides vaginal bleeding, others symptoms such as pale skin, pelvic pain, and fatigue were also common. Length day and blood loss before hospitalization in perimenopausal women were greater significantly than that in postmenopausal women. Age, menstrual characteristics, and diabetes increased the risk of EC in women with PMB.
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Depression among Peri- and Post-Menopausal women during COVID-19 pandemic in Chandigarh, North India: A study from community p. 233
Sukriti Khatak, Madhu Gupta, Sandeep Grover, Neelam Aggarwal
Background: Peri- and post-menopausal women are vulnerable to suffer from mental health problems including depression, anxiety, and stress, which might have increased during the COVID-19 pandemic. Objective: To estimate the prevalence of depression and associated factors among peri- and post-menopausal women during the COVID-19 pandemic in Chandigarh. Materials and Methods: A community-based cross-sectional study was conducted among 200 urban peri- and post-menopausal women of age 40–60 years in Chandigarh, from May to June 2021. Patient Health Questionnaire-9, Generalized Anxiety Disorder 7, and EuroQol-5D validated tools were used to screen depression, anxiety, and quality of life (QOL). Fear of COVID-19 scale was developed as part of this study was used to assess the fear related to COVID-19 infection. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) software version 26.0. Binary multivariate logistic regression model was used to identify the predictors. Results: The prevalence of depression was 39% and anxiety 29.5% among peri-and post-menopausal women. The fear of COVID-19 infection (adjusted odds ratio [aOR] 8.43, confidence interval [CI]: 1.99–35.64; aOR 10.54, CI: 2.76–40.24) and sleeplessness (aOR 13.29, CI: 3.22–54.82) were the significant (P < 0.005) predictors of depression and anxiety, respectively. Fearful peri- and post-menopausal women (aOR 5.94, CI: 2.68–13.13) and widow status (aOR 7.08, CI: 1.10–45.28) were the significant (P < 0.005) predictors of poor QOL. Conclusions: The prevalence of depression was high among peri- and post-menopausal women during the COVID-19 pandemic. Fear of getting COVID-19 infection was significantly associated with depression, anxiety, and poor QOL.
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Epithelioid leiomyosarcoma of the uterus and the diagnostic challenge in diagnosing it on small biopsy p. 241
Durre Aden, Sufian Zaheer, Shruti Singh, Sunil Ranga
Epithelioid leiomyosarcoma of the uterus is a rare soft-tissue tumor of the pelvis with <1% cases. It can be asymptomatic or can reach an enormous size, resulting in chronic pelvic pain, postmenopausal bleeding, or may cause bowel and bladder dysfunction. The diagnostic dilemma arises especially when they have epithelioid morphology. This case is being presented because of its rare incidence along with the diagnostic dilemma it presented due to epithelioid morphology which is a very rare presentation, especially challenging on small biopsies. This case also highlights the usefulness of immunohistochemical markers, such as WT1, p53, and p16, which has important diagnostic as well as prognostic values in rare variants of usual tumors. Leiomyosarcoma per se is a highly aggressive tumor, therefore, timely diagnosis and management are advised.
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Synchronous primary endometrial and fallopian tube carcinoma with metchronous renal pelvis carcinoma in one patient: “Triple cancer- A rare occurrence” p. 244
Anchana Gulati, Reetika Sharma, Sudershan K Sharma
Triple primary cancers in one patient are a very rare finding and occur in only 0.5% of patients with cancers. Here, we report the case of triple malignancy in a 62-year-old woman who developed synchronous primary endometrial endometroid type and serous type of fallopian tube carcinoma, which is again a rare finding after 4 years of diagnosis of transitional cell carcinoma of the right renal pelvis.
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Leydig cell hyperplasia of ovary – An unusual finding in postneoadjuvant chemotherapy case of primary fallopian tube carcinoma p. 247
Kriti Chaturvedi, Meenakshi Rao, Souvik Saha, Jeewan Ram Vishnoi, Aasma Nalwa
A large number of high-grade serous ovarian carcinomas originate in the fallopian tubes. Neoadjuvant chemotherapy followed by surgery may lead to a number of chemotherapy-induced changes in the ovary, which may lead to an erroneous diagnosis. We present a rare case of a 55-year-old postmenopausal woman who was clinically diagnosed with carcinoma of the right ovary; on histopathologic evaluation after neoadjuvant chemotherapy, the primary site was found to be the right fallopian tube. The right ovary showed chemotherapy-related changes along with extensive Leydig cell hyperplasia. As the presence of Leydig cell hyperplasia in this setting is an unusual finding, it may pose a diagnostic dilemma for the pathologist; so an awareness of this entity is important to avoid misdiagnosis.
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Extrauterine adenomyosis coexistent with mature cystic teratoma: An extremely rare entity p. 251
Bindiya Gupta, Amita Suneja, Shalini Rajaram
Extrauterine adenomyosis is a rare entity. We present a case of a 32-year-old female who presented with this rare entity as a large abdominal mass and was a diagnostic and pathological dilemma.
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Lymphocytic hypophysitis: An underrated disease p. 254
Amruta Ashok Patil, Purwa Patil, Vaishali Walke
Lymphocytic hypophysitis (LYH) is a rare inflammatory disease in which lymphoplasmacytic infiltration of the pituitary gland can potentially lead to panhypopituitarism. This entity was first recognized in 1962 by Goudie and Pinkerton. We report the case of a 36-year-old nonpregnant female operated for a presumed nonsecreting pituitary adenoma. On intraoperative squash cytology and histology of excision biopsy confirmed the diagnosis of LYH. Review of the literature shows that most reported cases have occurred in women during pregnancy or during postpartum period. Many were accurately diagnosed only after biopsy or at necropsy. It is suspected to be an autoimmune endocrinopathy as concomitant lymphocytic infiltration of the thyroid and pituitary glands has been noted and antipituitary antibodies have been found in some instances. Clinically and radiologically, LYH may mimic a nonsecretory pituitary adenoma. Intraoperative diagnosis may prevent unnecessary excision of potentially functioning pituitary.
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Pleomorphic liposarcoma of breast, presenting as a recurrent breast tumor p. 257
Durre Aden, Sufian Zaheer, Divita Saxena, Sunil Ranga
Primary pleomorphic liposarcoma of the breast is a very rare mesenchymal tumor. Sarcoma arising in the breast constitutes <1% of all malignant breast tumors, and liposarcoma of the breast has an incidence of 0.3% of all mammary sarcomas. It is a very aggressive tumor with a high incidence of recurrences and distant metastasis. They can mimic primary invasive breast cancer clinically as well as radiologically. Histology and radiological evaluation of the patient help correctly type and grade this malignancy. On microscopy, the tumor is composed of pleomorphic tumor cells with atypical lipoblast with areas of necrosis and mitosis. We report one such rare case here.
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Universal cervical cancer immunization: India ready for a quantum leap p. 260
Maninder Ahuja, Priyanka Sharma, Avir Sarkar
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Colposcopy postmenopause: A challenge in cervical cancer elimination goal! p. 263
Ranu Patni
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Erratum: Welcome - First step forward p. 265

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Retraction: 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. 266

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