Journal of Mid-life Health Journal of Mid-life Health
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   2014| July-September  | Volume 5 | Issue 3  
    Online since September 19, 2014

 
 
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REVIEW ARTICLES
Menopause and oral health
Vanita Suri, Varun Suri
July-September 2014, 5(3):115-120
DOI:10.4103/0976-7800.141187  PMID:25316996
Different phases of a woman's life: Puberty, menses, pregnancy, and menopause have varied influence on her oral health. During the menopause, women go through biological and endocrine changes, particularly in their sex steroid hormone production, affecting their health. Because the oral mucosa contains estrogen receptors, variations in hormone levels directly affect the oral cavity. A few oral conditions and or diseases are seen more frequently during post menopausal years. Role of hormones affecting the health of oro-dental tissues, as well as treatment by HRT in ameliorating these conditions is not clear. There is paucity of randomized controlled trials in this field and more data is needed, before the recommendations for oral health care in post menopausal women can be made. A gynecologist sitting in menopausal clinic should be aware of oral changes happening during this period, and dental needs of these women and should refer them to the dental specialists accordingly. On the other hand, a dentist should also be sensitized about the menopausal status of the woman, her HRT status and special preventive and treatment needs.
  8 5,124 994
ORIGINAL ARTICLES
Prevalence and correlates of fear of falling among elderly population in urban area of Karnataka, India
Abhay B Mane, T Sanjana, Prabhakar R Patil, T Sriniwas
July-September 2014, 5(3):150-155
DOI:10.4103/0976-7800.141224  PMID:25317002
Context: Falls are a major public health problem in the elderly population. Fear of falling (FOF) among elderly persons can compromise quality of life by limiting mobility, diminished sense of well-being and reduced social interactions. India is undergoing a demographic transitional phase with urban elderly population of 6.72% in 2001. The major challenge would be on the prevention of falls among them. Hence there is a need to highlight the problems related to fall faced by the elderly in India. Objective: To study the prevalence of FOF and its correlates among the elderly population in urban area. Materials and Methods: 250 elderly subjects above 60 years were randomly selected from urban area and interviewed for FOF using Short Fall Efficacy Scale-I (FES-I) , history of falls and risk factors. Results: The prevalence of FOF among the elderly was 33.2%. The significant correlates of FOF were educational status, family type, associated health problems, history of fall in past 6 months, worried of fall again among fallers, fearfulness of fall again among fallers, restriction of daily activities and depression among them. The insignificant correlates were gender and socio-economic status. Conclusion: FOF is a health problem among the elderly living in urban India needs urgent attention. It represents a significant threat to socialization, independence and morbidity or mortality. Knowledge of correlates of FOF may be useful in developing multidimensional strategies to reduce it among elderly.
  7 29,486 680
Prevalence of vitamin d deficiency among Indian menopausal women and its correlation with diabetes: A first Indian cross sectional data
Vishal R Tandon, Sudhaa Sharma, Shagun Mahajan, Kaplia Raina, Annil Mahajan, Vijay Khajuria, Zahid Gillani
July-September 2014, 5(3):121-125
DOI:10.4103/0976-7800.141188  PMID:25316997
Aim and Objective: To evaluate prevalence of Vitamin D deficiency and establish any correlation between diabetes and vitamin D deficiency among postmenopausal women. Materials and Methods: The 25-hydroxy vitamin D [25 (OH) D] concentrations were measured by competitive in-vitro quantitative immunoassay. The subjects were classified as vitamin D-deficient, insufficient or sufficient on the basis of 25 (OH) D concentrations of < 20 ng/mL, 20-30 ng/mL or > 30 ng/mL respectively. The apparently normal postmenopausal women (PMW) were subjected to fasting blood sugar levels to analyse any correlation between vitamin D deficiency and diabetes. Results: Vitamin D deficiency was observed in 53.35% of the population, 19.48% had insufficiency and 26.83% had adequate Vitamin D levels. In 12.14% of the study population fasting blood glucose was > 110 mg/dl and rest of the subjects were between the normal range which is 70-110mg/dl. Correlation between raised blood sugar levels and Vitamin D deficiency among PMW was non-significant (P = 0.324). Conclusion: High prevalence of vitamin D deficiency exists among apparently healthy Indian PMW. However, the current study failed to show any statistical correlation between vitamin D deficiency and existence of diabetes, which may be due to small sample size.
  5 4,103 504
CASE REPORTS
Recurrent pyometra and xanthogranulomatous salpingitis: A rare pathologic association in a postmenopausal lady
Neha Gami, Rajlaxmi Mundhra, Kiran Guleria, Vinod Kumar Arora, Shipra Garg
July-September 2014, 5(3):156-158
DOI:10.4103/0976-7800.141227  PMID:25317003
Xanthogranulomatous inflammation is a rare, non-neoplastic variant of chronic inflammation. Of the 15 reported cases of Xanthogranulomatous endometritis, majority (60%) were accompanied by endometrial carcinoma. We herein report a case of a postmenopausal woman presenting with recurrent pyometra who was suspected to be case of cervical tuberculosis and treated for the same. Inspite of antitubercular therapy, she had cervical stenosis and developed recurrent pyometra over the next 2 years requiring repeated drainage. She then underwent hysterectomy and was found to have co-existent Xanthogranulomatous salpingitis (XGS) on histopathological examination. Xanthogranulomatous inflammation is a rare pathological diagnosis that gynecologists need to be aware of while managing such patients.
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ORIGINAL ARTICLES
A measurement-specific quality-of-life satisfaction during premenopause, perimenopause and postmenopause in Arabian Qatari women
Abdulbari Bener, Anas Falah
July-September 2014, 5(3):126-134
DOI:10.4103/0976-7800.141190  PMID:25316998
Objective: The aim of this study was to use an instrument, the menopause-specific quality-of-life satisfaction in the state of Qatar for the premenopausal, menopause and postmenopausal period. Design: A cross-sectional descriptive study was used to generate menopause symptoms experienced by Arabian Gulf women. Measurement-specific quality-of-life satisfaction questionnaires and face-to-face interviews were performed. Setting: Primary Health Care (PHC) Centers in Qatar. Materials and Methods: A multistage sampling design was used and a representative sample of 1,500 women aged 40-60 years were included during July 2012 and November 2013, and 1,158 women agreed to participate (77.2%) and responded to the study. Results: The mean age and standard deviation of the subjects was 50.9 ± 6.1. The median age of natural menopause in the present study was 49 years [mean and standard deviation 49.9 ± 2.7]. The rate of consanguineous marriages in the sample was found to be 30.3%. There were statistically significance differences between menopausal stages with regard to ethnicity, education level, occupation, type of housing condition, and consanguinity. There were statistically significance differences between menopausal stages concerning BMI groups, Systolic BP, Diastolic BP, physical activity, parity, and sheesha smoking habits. Meanwhile, the present study revealed that the most common disease was found to be diabetes mellitus (11.4%), followed by hypertension (6.6%), asthma (5.6%) and CHD (2.5%), and the majority of subjects (69.5%) had no specific disease. The most frequent symptom was "aches in the back and neck" (49.2%), night sweat (37.2%), low backache (35.7%), feeling nervous (35.4%) followed by "aches in the muscles/joints" (34.6%), hot flashes (33.3%), decreased social activities (28.3%), decreased leisure activities (47.6%), difficulty sleeping (28.9%), mood swings (25.4%), and decreased concentration (28.3%), sexual activity (24.1%) and total energy level (26.7%). The lowest reported symptoms were "facial hair" at 16.1% followed by "dissatisfied with my personal life" at 18.1%. Cronbach's alpha scores, measuring the internal consistency of questions in each domain for physical, vasomotor, psychosocial and sexual were 0.883, 0.853, 0.697 and 0.805, respectively. The Spearman's rank correlation coefficient between domains indicated that there is highly significant concordance between the four domains (P < 0.001). Conclusion: A large number of factors were associated with experiencing menopausal symptoms and which had negative effects on the quality of life among Arabian women. The current study showed that climacteric symptom in menopausal Arab women is less than Western women, which may be influenced by socio-economic, genetics, environment and parity.
  2 4,404 593
REVIEW ARTICLES
Current concepts in voiding dysfunction and dysfunctional voiding: A review from a urogynaecologist's perspective
Debjyoti Karmakar, Jai B Sharma
July-September 2014, 5(3):104-110
DOI:10.4103/0976-7800.141185  PMID:25316994
Background: Female voiding dysfunction is a complex disorder, lacks definition, and is poorly understood and difficult to manage. Causes of Female Voiding Dysfunction: As there is no agreed classification of female voiding dysfunction, it is important to identify the several potential factors that might cause voiding dysfunction, namely anatomic, neurogenic, pharmacologic, endocrine, pharmacological and other causes. Presentation and Clinical Evaluation: Traditional and novel techniques are available and the importance and diagnostic dilemma related to these conditions need to be understood. We conclude by emphasizing the need to simplify the diagnosis and nomenclature of these conditions from a more clinical point of view as against an investigational perspective.
  2 3,985 478
Bisphosphonate drug holidays: Can we recommend currently?
Vishal R Tandon, Sudhaa Sharma, Annil Mahajan
July-September 2014, 5(3):111-114
DOI:10.4103/0976-7800.141186  PMID:25316995
Bisphosphonates (BP) are the mainstay of treatment for osteoporosis. Subtrochanteric or diaphyseal fractures have been reported with long term use of BP, which raised world-wide debate on two aspects, i.e., for how long the BP is to be given and potential advantages/role of BP drug holidays. BP accumulates in bone with some persistent protective effect after therapy is stopped endorses the concept. Theoretically, a drug holiday may be a considerable option to decrease risks of BP, which continuing the protection from fractures but the level of evidence and data supporting the concept of drug holidays is a week. Hence, no specific recommendations are available on BP drug holidays from major available treatment guidelines on postmenopausal osteoporosis. Hence, before it is recommended it requires more robust research in this field.
  2 3,421 598
CASE REPORTS
Postmenopausal choriocarcinoma: A rare case report
Sunil K Samal, Setu Rathod, Seetesh Ghose
July-September 2014, 5(3):159-161
DOI:10.4103/0976-7800.141229  PMID:25317004
Choriocarcinoma is a highly malignant epithelial tumor originating from trophoblast. It primarily occurs during the fertile period. Postmenopausal uterine choriocarcinoma is very rare. We present a case of choriocarcinoma in a postmenopausal lady developing 5 years after menopause. She presented with heavy postmenopausal bleeding along with passage of vesicles per vaginum. Serum beta-hCG was 96,484 mIU/ml. Emergency abdominal hysterectomy with bilateral salpingo-ooperectomy was done due to intractable bleeding following suction and evacuation. Histopathology revealed uterine choriocarcinoma. She was treated with EMACO regimen following which her beta-hCG returned to normal in five cycles. The patient is under regular follow-up and is doing well.
  1 3,397 252
ORIGINAL ARTICLES
Behavioral risk factors for noncommunicable diseases in working and nonworking women of urban slums
Shivani S Manjrekar, Mayur S Sherkhane, Jayaprakash V Chowti
July-September 2014, 5(3):143-149
DOI:10.4103/0976-7800.141220  PMID:25317001
Background: Noncommunicable diseases (NCDs) are an emerging public health problem, accounting for 80% of deaths in low and middle-income countries leading to a global epidemic. The increasing burden of NCDs is affecting poor and disadvantaged women population disproportionately, contributing to widening health gaps between and within countries. Globalization and urbanization have led to lifestyle changes among urban poor, which need to be understood, as the urban areas are undergoing rapid transitions. Objectives: To know prevalence and pattern of behavioral risk factors for NCDs in working and nonworking women of urban slums to initiate steps for preventive interventions. Materials and Methods: This was community based cross-sectional study conducted among women of urban slums in the age-group of 30-45 years on a voluntary basis. Data were collected by the house-to-house survey using predesigned and pretested proforma World Health Organization-Stepwise Approach to Chronic Disease Risk Factor Surveillance (WHO-STEPS 1 and 2 questionnaires). Descriptive statistics and Chi-square test were used for analysis. Results: Majority, 49% women were in the age-group of 30-35 years, with 60.5% belonging to Class IV socio-economic status. Stress was present in 38% working women as compared to 17% nonworking women (χ2 = 22.12, df = 1, P < 0.0001, HS). Nonworking women (25%) were less aware about common NCDs compared to (48%) working women (χ2 = 22.82, df = 1, P < 0.0001, HS). It was also found that 11% women were newly diagnosed with hypertension. Conclusion: Most of the women were not aware of the risk factors leading to NCDs. Screening and IEC activities need to be strengthened and hence that diagnosis and preventive measures can be implemented at an early stage of life.
  1 2,913 431
Granulosa cell tumor of ovary: A clinicopathological study of four cases with brief review of literature
BR Vani, K Geethamala, RL Geetha, Murthy V Srinivasa
July-September 2014, 5(3):135-138
DOI:10.4103/0976-7800.141211  PMID:25316999
Introduction: Adult granulosa cell tumor (GCT) is a rare ovarian malignancy having good prognosis in comparison with other epithelial tumors. The study aims to collect data of all granulosa cell tumors diagnosed in ESIC Medical College & PGIMSR, Rajajinagar, Bangalore over the last 3 years and to describe the patient profile, ultrasonographic and various histopathological features. Materials and Methods: A total of 4 granulosa cell tumors were diagnosed in ESIC Medical College & PGIMSR, Rajajinagar, Bangalore during the period from June 2010 to June 2013. The patient's age, clinical manifestations, radiological and histopathological findings were evaluated. Results: All 4 patients were diagnosed as adult granulosa cell tumor, three of four cases were in premenopausal age group and one case was in perimenopausal age. The clinical manifestations were menorrhagia and abdominal pain. Ultrasonographically, 2 cases of granulosa cell tumors were both solid and cystic and one case each was either solid or cystic. Histologically, variety of patterns like diffuse, trabecular, cords, spindle and clear cells were noted. Both Call-Exner bodies and nuclear grooves were observed in all cases. All four cases showed simple hyperplasia without atypia endometrial findings. Follow up on all patients revealed no evidence of recurrence. Conclusion: Granulosa cell tumor of the ovary is a rare ovarian entity. The important prognostic factor is staging of the tumor. Staging and histopathology helps in prediction of survival. Also diligent endometrial pathology has to be sorted to rule out endometrial carcinoma.
  1 4,335 477
EDITORIAL
The many hues of mid life health
Sonia Malik
July-September 2014, 5(3):103-103
DOI:10.4103/0976-7800.141184  PMID:25316993
  - 2,092 231
ORIGINAL ARTICLES
Reaching the unreached: Mobile surgical camps in a remote village of Himachal Pradesh
Sonal Bathla, George Verghese, Vinod Kalla, TC Sharma, Subrat Dam, Nirmala Agarwal, Sweta Balani, Priti Arora Dhamija, Deepa Agarwal, Praveen Kumar
July-September 2014, 5(3):139-142
DOI:10.4103/0976-7800.141215  PMID:25317000
Aims: The aim was to study the epidemiological factors responsible for pelvic organ prolapse (POP) in poor women of the remote village Shillai, do their POP quantification staging, to study the variety of surgeries conducted in mobile surgical camps in this area. Materials and Methods: Retrospective analysis of surgeries conducted in five mobile surgical camps in Shillai, Himachal Pradesh from 2009 to 2013, under "Project Prolapse". Results: A total number of surgeries conducted in five camps from 2009 to 2013 were 490 including 192 gynecological surgeries. Eighty-two percent of gynecological surgery was conducted for POP. Poor nutritional status (mean weight 41.1 kg), multiparty (mean 3.5), early marriage (mean age 18.2 years), unassisted home deliveries (100%), premature bearing down (23.8%), early postpartum resumption of strenuous activity (54.7%) and smoking (33%) contribute to the high incidence of POP. Anterior compartment prolapse was seen in 99% of patients undergoing surgery while posterior compartment prolapse was seen in 4% of patients. Vaginal hysterectomy with anterior repair with culdoplasty was the most common procedure performed (73.4%), and vault suspension was done in 3.6% subjects. The complication rate was negligible. Conclusion: Uterovaginal prolapse is not only socially embarrassing and disabling; its surgical treatment is complex and costly too. The free mobile surgical camps under "Project Prolapse" in Shillai, Himachal Pradesh has provided relief to old neglected, disabled women suffering from prolapse in this remote village. Parallel counseling of women and dais for safe hospital delivery and training subordinates in prolapse surgery may help in addressing the problem of POP in this area in the long run.
  - 4,042 275
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