Objective: To evaluate the health status, age of menopause, and its symptomatology amongst Himachali middle-aged women. Materials and Methods: A community based cross-sectional study was done from Jul 07 to Jan 08. A structured questionnaire was given to 100 menopausal women from general community of Himachal Pradesh in Shimla. Results: Mean age of menopause was 44.54 years. Main symptoms associated with menopause were reported as fatigue (62%), hot flashes (56%), Cold sweats (52%), and backaches (51%). Other ailments associated with menopause were arthritis (25%), hypertension (23%), and diabetes (6%). Conclusion: Mean age of menopause was 44.54 years. Chief comorbid conditions were arthritis and hypertension.

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Background: Bladder cancer is the fourth most common malignancy in men and the eighth most common in women. It causes 8% of all malignancies in men and 3% of all malignancies in women. The trend of bladder cancer is increasing in Iran. This study was conducted to estimate the survival rate of bladder cancer based on life table method. Materials and Methods: In this study, at first, data were collected based on individual variables of 514 patients suffering from bladder cancer and referred them to cancer registry center of Shiraz University of Medical Sciences from 2001-2009. Data were collected at two stages and analyzed by life table method and Wilcox on test. Significant level considered at 0.05. Results: Our findings showed that probability of survival accumulation at the end of 1, 3, 5, 10 years in patients with bladder cancer were equal to 0.8989, 0.7132, 0.5752 and 0.2459 respectively. There was significant difference in survival rate among age groups and treatment types (P < 0.05). However, we did not observe any difference in survival time based on smoking (P = 0.578), alcohol (P = 0.419) and education level (P = 0.371) of patients. Conclusion: The overall survival rate of bladder cancer in the present study was less than other areas. Patients' age and treatment type were the influential factor in survival time. So continuous screening for early diagnosis suggested for older people.

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Background: To study the menopause related symptoms affecting the quality of life (QOL) of perimenopausal women in order to understand the prevalence and plan for the interventions. Materials and Methods: Two hundred and nine women were evaluated for perimenopausal symptoms using a 29 item MENQOL questionnaire. Results: The physical and psychosocial symptoms were found to be more prevalent than the vasomotor and sexual symptoms. Conclusion: Perimenopausal symptoms widely vary in women populations, accurate recording and understanding of which is essential to plan effective interventions to improve the QOL.

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Extra mammary Paget's disease (EMPD) is a rare condition, which affects postmenopausal women. Wide local excision may not be appropriate in elderly patients with extensive disease. It is an uncommon malignant neoplasia with a high local recurrence rate. The standard treatment is local excision of the affected area with adequate margins; however, 40~45% of cases recur after surgery within 4 years. Although surgery is currently considered the preferred primary treatment for EMPD, it has a high relapse rate due to the multifocal nature of the disease. Hence, RT in selected cases of EMPD of vulva may be beneficial.

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Objective: To determine discordance in the diagnosis of osteoporosis among postmenopausal Indian women using hip and spine Dual-energy X-ray Absorptiometry. Materials and Methods: The study included postmenopausal women who underwent bone mineral densitometry (BMD) for suspected osteoporosis at a referral hospital at Hyderabad, India. The BMD measures at the hip and spine were used to derive T-scores and to determine the prevalence of discordance. Factors potentially associated with discordance were explored in univariate and a multivariate regression model. Results: The mean age of the 348 postmenopausal women in the study was 53.62 ± 8.94 years (median 53.00 years, range 27.00 to 84.00 years). Major discordance was seen in 16.67% (95% confidence intervals [CI]: 12.73, 20.60) of the study population and minor discordance in 34.48% (95% CI: 29.46, 39.50%) of the study population. Age >50 years (adjusted odds ratios [OR]: 2.60, 95% CI: 1.24, 5.46, P value = 0.01), premature menopause (adjusted OR: 2.94, 95% CI: 1.27, 6.81, P value = 0.03), and multiple pregnancies (adjusted OR: 2.64, 95% CI: 1.28, 5.41, P value = 0.008) were found to be significantly associated with major discordance. Conclusions: The large prevalence of discordance may reflect the differences in osteoporosis in different populations and suggests the need to redefine ranges and risk factors used for the diagnosis of osteoporosis in India.

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Women's sexuality is highly capricious and multifaceted. Sexual functioning is an imperative component of women's lives and has progressively received public health, medical and even pharmaceutical attention. Sexual functioning, however, declines with age, leading to much debate about the contribution of menopause to sexual activity and functioning among women. The past two decades have witnessed an explosion of research into female sexuality. It is now understood that healthy and satisfying sexual function may extend all through the life cycle, and does not finish with end of child bearing years. Very few women's healthcare physicians are adequately trained to monitor a woman's sexual health through her menopausal transition and beyond, much less how to treat the sexual problems that can arise during this special time. The strong association of physical health and psycho-social factors with sexual functioning accentuates the clinical domineering to explore these factors when discussing women's apprehensions regarding sexual dysfunction. It is need of hour to create scientific evidence to help women's health care physicians understand the requirements of women in these special years of her life and help deliver the care they need and so rightly, deserve.

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Optimal management of menopause requires the expertise of a multi-disciplinary health team, each equipped with different skills necessary for the patient to enjoy optimal quality of life. A holistic approach is required to manage menopause. Holistic approach conceptualizes the involvement of patient's physical, psychological and social needs while planning therapy. It not only includes the biological aspect of menopause, but also the impact of psychosocial factors on diagnosis and therapy, as well as diet, exercise, nutraceuticals and other forms of therapy. Holistic care of menopause implies a patient centered approach which utilizes available health care resources to meet all medical, surgical, and psychological needs of the patient, using a variety of non pharmacological and drug therapies, while involving all concerned stakeholders to optimize the patient's micro and macro-environment.

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Much has been written about patient-centered care (PCC) in medical literature. PCC has been praised as the ultimate objective of medicine by some. However, critics have pointed out the obvious: The antonym of PCC is doctor-centered medical care. Is doctor-centered care wrong? And what do we practice if we do not follow PCC? Can physicians transfer all responsibility for decision making to patients, in the name of PCC? Do patients have a right to choose outcomes, and make clinical decisions to achieve those outcomes? Most of the work on PCC has been done in the fields of family medicine and primary care. Minimal publications are available to highlight the role of PCC in endocrinology and diabetology. This brief communication discusses some concepts of PCC, and expands upon this term, to assess its relevance to diabetology.

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Central pontine myelinolysis is a demyelinating condition affecting the pons characterized by an acute progressive quadriplegia, dysarthria, dysphagia, and alterations of consciousness. Pathologic features include prominent demyelination in the central pons with sparing of axons and neurons. This condition is usually associated with systemic disorders such as hyponatremia, chronic alcoholism, liver failure, severe burns, malignant neoplasms, hemorrhagic pancreatitis, hemodialysis, and sepsis. There are limited reports of psychosis in patients with central pontine/extrapontine myelinolysis (CPEM). We have described a case of CPEM with psychosis as a complication which recovered completely with treatment given for short duration using low dose atypical antipsychotic (quetiapine). We also discuss etiopathology and clinical outcome of psychosis in this rare neurological disorder.

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With the advances in the treatment of cancer, the chances of survival have increased today. The five-year relative survival rate is about 66%. With the increasing survival rate, it is important to identify the late effects of cancer and its therapy. One of the most serious events experienced by cancer survivors is the diagnosis of a new cancer. Case: A 32-year-old unmarried female diagnosed as ovarian cancer in the year 2010. She was treated with three cycles of chemotherapy followed by surgery. Histopathology was well-differentiated adenocarcinoma. She received three more cycles of chemotherapy after surgery. She was under follow-up and developed vaginal vault carcinoma after a disease-free interval of 2 years. The biopsy was suggestive of squamous cell carcinoma. She was treated with radiation for vaginal cancer successfully. This case indicates that female gynecological cancers with different histology may occur in minimum period of interval even in the absence of any predisposing factors like human papilloma virus infection.

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Journal of Midlife Health, in existence for 2½ years, has been working to disseminate information and research in the field of midlife health, including menopause management. This bibliometric review aimed to assess the coverage of this journal across article types, country, and specialty of origin. An online analysis of all the published articles from 2011 to July 2012 was carried out by the authors. Datas collected were analyzed by descriptive statistics. The journal has succeeded in ensuring broad-based, comprehensive, multidisciplinary coverage of midlife health-related issues, as shown by the variety of types of articles published, the emphasis on original articles, the international authorship, and the wide spectrum of medical and surgical specialties covered.

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With significant increase in ageing populations and life expectancies worldwide; the recent resurgence of the health problems associated with vitamin D inadequacy; and the role that vitamin D inadequacy might play in other chronic diseases, concern regarding inadequate vitamin D levels has emerged into the forefront of medicine.

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