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Table of Contents
April-June 2015
Volume 6 | Issue 2
Page Nos. 51-94
Online since Wednesday, June 17, 2015
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COMMENTARY
First do not harm
p. 51
Marc Jamoulle
PMID
:26167053
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ORIGINAL ARTICLES
Comparative study between pap smear and visual inspection with acetic acid (via) in screening of CIN and early cervical cancer
p. 53
Ashish Kumar Bhattacharyya, Jyan Dip Nath, Harajyoti Deka
DOI
:10.4103/0976-7800.158942
PMID
:26167054
Background:
Cervical cancer is the second most common among women globally. In most cases of Assam, Ca Cervix is detected late due to lack of effective screening programme.
Aim:
To screen the patient at Gynaecology OPD at the age 18-60 yrs by doing pap smear, VIA (Visual Inspection with Acetic Acid) and to detect sensitivity and specificity for detecting CIN and early Ca Cervix.
Material and Method:
It is a cross sectional study of 300 women (18- 60 yrs) who fulfill selection criteria. The pap smear and VIA are done in these cases. In positive cases, cervical biopsy and histopathological studies are done, The sensitivity and specificity of each test are determined and compared.
Result and observation:
The positive result detected from cytology are 22, VIA was positive in 52 cases. The histology of 19 cases are suggestive of CIN and Ca Cervix.
Discussion:
The findings were compared with other studies and evaluated.
Summary:
The most common finding in per speculum examination is cervical erosion. The sensitivity of VIA is 89% (versus pap smear-52%) the specificity of VIA is 87% (versus pap smear-95%). The accuracy VIA is 87% compared to pap smear-93%.
Conclusion:
The lack of effective and implementable screening programme lead to reporting of advanced cases of Ca Cervix. If detected at CIN or early Ca cervix stage, effective treatment can be provided with encouraging results. Therefore effective & implementable Ca Cervix screening need to be provided in our country.
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Endometrial evaluation by ultrasonography, hysteroscopy and histopathology in cases of breast carcinoma on Tamoxifen therapy
p. 59
Alka Jindal, Manjit K Mohi, Manjeet Kaur, Balwinder Kaur, Risham Singla, Shaunik Singh
DOI
:10.4103/0976-7800.158947
PMID
:26167055
Introduction:
Tamoxifen, a nonsteroidal antiestrogenic agent, is used widely as adjunctive therapy for women with breast cancer. Most studies have found that the increased relative risk of developing endometrial cancer for women taking Tamoxifen is two to three times higher than that of an age-matched population. So we designed this study to assess the endometrial status in patients taking Tamoxifen for breast carcinoma.
Material and Methods:
The study was conducted at Govt. Medical College and Rajindra Hospital, Patiala, India. A total of 50 patients of Ca Breast taking Tamoxifen were selected as per study criterion and TVS performed. If endometrial thickness was more than 5 mm hysteroscopy and endometrial HPE was done and data analysed.
Results:
On ultrasonography 35 patients (70%) had an endometrial thickness up to 5 mm. 15 patients (30%) had an endometrial thickness more than 5mm. Out of these, 11 patients, i.e. 22% of total, had an endometrial thickness of 5.1 to 10 mm and 2 patients, i.e. 4% of total had an endometrial thickness of more than 20 mm. Hysteroscopy was done on 11 patients. Out of these 8 patients had a normal hysteroscopic appearance whereas 3 patients had an abnormal hysteroscopic picture. Endometrial HPE of these 11 patients revealed 2 patients had secretory changes, 1 had polyp change, 1 had atrophic endometrium, 3 had simple endometrial hyperplasia, 1 had endometrial adenocarcinoma and 4 patients were reported to have scanty curetting.
Conclusion:
The duration of Tamoxifen therapy turned out to have a relationship with the incidence of endometrial carcinoma (
P
< 0.0001). Also, a relationship was observed between the duration of Tamoxifen therapy and symptom status of the patients (
P
< 0.0001). This correlation did not extend to duration of Tamoxifen therapy and endometrial thickness. (
P
= 0.190). This correlation did not extend to duration of Tamoxifen therapy and endometrial thickness. (
P
= 0.190).
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Vitamin D deficiency in postmenopausal women with pelvic floor disorders
p. 66
Preethi Raja Navaneethan, Aruna Kekre, Kuruthukulangara Sebastian Jacob, Lilly Varghese
DOI
:10.4103/0976-7800.158948
PMID
:26167056
Introduction:
The aim of this study is to evaluate the association of vitamin D deficiency and pelvic floor disorders (PFD) including pelvic organ prolapse (POP) and stress urinary incontinence in postmenopausal women.
Materials and Methods:
This is a prospective case control study on 120 women with or without symptoms of PFD. Relevant history and clinical examination were conducted. Serum 25-hydroxy vitamin D levels were measured in all women. Chi square and student t test were used to test significance of association. Logistic regression was used to adjust for age. Odds ratios and 95% confidence intervals were calculated.
Results:
Of the 120 postmenopausal women included, 51 had PFD on clinical examination. Of the 51 cases, 28 women had POP and 14 women had stress incontinence (SUI) while nine women had both POP and SUI. The study showed that vitamin D levels were significantly lower in women with PFD than those without PFD. Menopausal status of more than 5 years was also significantly associated with PFD.
Conclusion:
Findings suggest association of vitamin D deficiency and PFD in postmenopausal women. In addition, postmenopausal women have a high prevalence of vitamin D deficiency indicating a need to evaluate vitamin D levels in these women.
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Prediction of osteoporosis using dental radiographs and age in females
p. 70
Guduba Vijay, Parita K Chitroda, Girish Katti, Syed Shahbaz, Irfan Baba, Bhuvaneshwari
DOI
:10.4103/0976-7800.158952
PMID
:26167057
Aims and Objectives:
To evaluate the role of dental radiograph as a screening tool for diagnosis of osteoporosis in females.
Materials and Methods:
In the present study, 50 women between the age group of 40-60 were recruited, and patients with systemic disorder and taking calcium supplements, and women who are not willing for investigation were excluded. Their detailed medical history was obtained and dental radiographs were made, bone mineral density was measured at left radial bone using ultrasound. The radiographs were subjected to image analysis method using manual tracing of gonial angle, antegonial angle, antegonial depth, antegonial index, mental index and mandibular cortical index. Statistical discrimination analysis was applied to predict the presence of osteoporosis. With use of these indices, the sensitivity and specificity of orthopantomograph (OPG) radiograph to assess age-related changes in bone were compared. Radiomorphometric indices (RMI) were also scrutinized to depict the sensitivity and specificity of each index in the prediction of osteoporosis.
Results:
Study results showed no significant differences between bone mineral density (BMD) and radiomorphometric analysis in the diagnoses of osteoporotic females. Out of 29, diagnosed as osteoporotic by radiograph 23 were confirmed by BMD and six were diagnosed as osteopenic. Among the six indices used, AGA and AGD showed more reproducible results.
Conclusion:
With our study results, we come to an arrival that OPG radiographs show overall sensitivity of 0.75 or 75% and specificity of 0.81 or 81% in the diagnosis of osteoporosis, and that anti gonial angle (AGA) and anti gonial depth (AGD) are the most reliable indices. Hence, we conclude that panoramic-based RMI can be used as an ancillary method in the diagnosis of osteoporosis.
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Rheumatological disorder (RD) in Indian women above 40 years of age: A cross-sectional WHO-ILAR-COPCORD-based survey
p. 76
Susheel Kudial, Vishal R Tandon, Annil Mahajan
DOI
:10.4103/0976-7800.158955
PMID
:26167058
Aim and Objective:
To evaluate rheumatological profile among Indian women above 40 years.
Materials and Methods:
A cross-sectional survey was carried out for a period of one year using pre-validated questionnaire of COPCORD /WHO-ILAR. Those who complain of pain, tenderness, stiffness or swelling were subjected to clinical evaluation and diagnosis was established using the ACR's criteria for various RDs.
Results:
Mean age of the patients was 55.06 ± 6.82 years, mean age at menopause was 47.30 ± 2.50 years and the mean time since menopause was 9.077 ± 5.43 years. Among the total population evaluated (
N
= 130), 37.69% women presented with RD and 37.06% women among the menopausal women had RD with the most common being low backache (16.92%), followed by osteoarthritis (12.30%), fibromyalgia (3.84%) and rheumatoid arthritis (2.30%). The most common site involved was knee (9.23%) followed by lumbar spine (8.46%), hip (3.07%) and other sites (16.92%) such as neck, upper back, hand joints, shoulder, thighs, etc. Study failed to show any statistical correlation with any socio-demographic or other parameters of interest with RD. HAQ-DI (Health Assessment Questionnaire Disability Index) was found to be highly significant (
P
< 0.000) in 13.84% women when correlated with RD.
Conclusion:
The prevalence of RD is substantially high among Indian women above 40 years demanding attention of health care providers.
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Yoga: Managing overweight in mid-life T2DM
p. 81
Ashwini Sham Tikhe, Subramanya Pailoor, Kashinath Metri, Tikhe Sham Ganpat, Nagendra Hongasandra Ramarao
DOI
:10.4103/0976-7800.158959
PMID
:26167059
Background:
The dramatic rise in the prevalence of obesity and type 2 diabetes mellitus (T2DM) is associated with increased mortality, morbidity as well as public health care expenses worldwide. Previous research suggests that yoga holds promise for obesity and T2DM management.
Objective:
The objective of the present study was to assess the effect of intensive integrated approach of yoga therapy (IAYT) on body fat and body mass index (BMI) and resting metabolism in mid-life overweight patients with T2DM (BMI, Mean ± SD, 27.05 ± 4.51).
Materials and Methods:
Twenty-four mid-life patients (6 females) with T2DM (Age, Mean ± SD, 55.38 ± 7.96 years) participated in the study and practiced IAYT for 7 days. The IAYT works at five layers of human existence (physical, vital, mental, intellectual and bliss) to bring positive health. The body fat and BMI and resting metabolism were recorded before and after IAYT using Karada Scan body composition monitor HBF-375 from Omron Healthcare Singapore PTE LTD.
Statistical Analysis:
SPSS-16 was used to analyze the data. Shapiro-Wilk test showed that the data was not normally distributed. Further, the Wilcoxon signed-ranks test was used to analyze the change in means of pre- and post-measurements.
Results:
Data analysis showed that there was a significant decrease in body fat and BMI and resting metabolism (in all assessments,
P
< 0.001).
Conclusion:
The present study suggests that 7 days practice of IAYT has a great promise for the management of overweight in mid-life patients with T2DM. Additional well-designed studies are needed before a strong recommendation can be made.
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CASE REPORTS
Clear cell carcinoma of cervix in a postmenopausal woman: A case report
p. 85
Subrata Pal, Sritanu Jana, Kingshuk Bose
DOI
:10.4103/0976-7800.158964
PMID
:26167060
Clear cell carcinoma of cervix is a very rare neoplasm accounting only 4% of all cervical adenocarcinomas. Intrauterine exposure to diethylstilbestrol (DES) is supposed to be causative factor for clear cell adenocarcinoma in childhood and young-age patients. We are reporting a case of clear cell carcinoma of cervix in a 49-years-old multiparous post-menopausal woman, who had no exposure to DES (in-utero) or synthetic non-steroidal estrogen.
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Uterine lipoma with a coincidental brenners tumor in the ovary in postmenopausal women: A case report
p. 88
Yasmeen Khatib, Richa D Patel, Madhura Dande
DOI
:10.4103/0976-7800.158966
PMID
:26167061
Pure uterine lipoma is a rare entity with only a few cases having been reported in the literature. They usually develop in postmenopausal woman and are mistaken for leiomyomas both clinically and on ultrasound examination. Magnetic resonance imaging (MRI) is the best modality for its preoperative diagnosis. Uterine lipoma has been reported in association with other lesions like endometrial carcinoma, cervical carcinoma and struma ovarii. We present a case of pure lipoma of the uterus with a coincidental benign brenners tumor of the ovary in a 60-year-old female. Patient presented with pain in the abdomen and a preoperative diagnosis of leiomyoma was made based on ultrasonography findings. Gross examination revealed a fatty tumor with a nodule in the right ovary. Microscopy confirmed the presence of pure uterine lipoma with a co-existent brenners tumor of the ovary. To the best of our knowledge this is the first case of uterine lipoma to be reported in association with ovarian brenners tumor.
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Lymphangioma circumscriptum of the vulva: Report of a rare case
p. 91
Anuradha Sinha, Jyoti Prakash Phukan, Shilpa Jalan, Subrata Pal
DOI
:10.4103/0976-7800.158968
PMID
:26167062
Lymphangioma circumscriptum (LC) is a form of lymphangioma characterised by benign dilation of lymphatic channels, which affects the skin and subcutaneous tissues. The most common sites of LC are mucosa of mouth, tongue, groin, axilla, trunk and proximal region of extremities. Vulva is a rare site of LC. In this report, we are presenting a case of LC of vulva occurring in a 60-year-old female without any obvious reason. The patient presented with multiple genital wart-like papular lesions in the vulva. Biopsy of lesion reveals LC. She was treated with vulvectomy and showed no sign of recurrence till date.
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LETTER TO EDITOR
Body iron stores in middle-aged patients with DM and obesity
p. 94
Sim Sai Tin, Viroj Wiwanitkit
DOI
:10.4103/0976-7800.158970
PMID
:26167063
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© Journal of Mid-life Health | Published by Wolters Kluwer -
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