Journal of Mid-life Health Journal of Mid-life Health
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   2015| July-September  | Volume 6 | Issue 3  
    Online since September 16, 2015

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Overview of research studies on osteoporosis in menopausal women since the last decade
Jyoti Thulkar, Shalini Singh
July-September 2015, 6(3):104-107
DOI:10.4103/0976-7800.165589  PMID:26538986
Purpose/Introduction: Osteoporosis is a multifactorial and slowly emerging global health problem. The lifetime risk of dying from hip fracture is same as that from breast cancer. One out of three women between age group of 50-60 years in India suffers from osteoporosis. Indian women have an early age of onset of osteoporosis as compared to western counterparts. There is need for early diagnosis, identification of high-risk groups and prevention and treatment of osteoporosis in the Indian context. The aim of this study was to review the literature published in last decade and compare the research in India with that in rest of the world. Materials and Methods: Research articles with key words menopausal, osteoporosis and bone mineral density were searched in Pubmed from January 2004 to December 2013. Articles were categorized according to year, place and objective of the studies. Results: In India more articles were published in year 2010-11 (53.3%), while outside the country a uniform distribution of studies was observed throughout the last decade. Objective of research was screening and diagnosis (36.7%) and risk factor identification (40%) in most of the Indian studies as compared to rest of the world. Research publications on prevention and treatment of osteoporosis are less in India (20%). Conclusion: Research focusing on diagnosis, prognosis, prevention and treatment are needed in India.
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Low vitamin D, and bone mineral density with depressive symptoms burden in menopausal and postmenopausal women
Abdulbari Bener, Najah M Saleh
July-September 2015, 6(3):108-114
DOI:10.4103/0976-7800.165590  PMID:26538987
Background: The reported association between vitamin D level and loss of Bone mineral densitometry measurements (BMD) has been controversial. Objective: The objectı;ve of the current study was to determine whether low vitamin D level and BMD are associated with depresive symptoms as burden in Arab women during the menopausal and postmenopausal period. Design and Setting: A cross-sectional descriptive study design was used at the Primary Health Care (PHC) Centers in Qatar. Subjects: A multi-stage sampling design was used and a representative sample of 1436 women aged 45-65 years were included during July 2012 and November 2013 and 1106 women agreed to participate (77.2%) and responded to the study. Materials and Methods: BMD (g/m 2) was assessed at the BMD unit using a Lunar Prodigy DXA system (Lunar Corp., Madison, WI). The antero-posterior lumbar spine (L2-L4) and the mean of the proximal right and left femur were be measured by two technician and then reviewed by one radiologist. Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes. Results: Of the 1436 women living in urban and rural areas, 1106 women agreed to participate (77.0%) and responded to the study. The mean age and standard deviation of the subjects was 53.8 ± 3.2. The median age of natural menopausal in the present study was 49 years (mean and standard deviation 49.5 ± 3.1 and postmenopausal was 58.1 ± 3.3). There were statistically significant differences between menopausal stages with regards to ethnicity, education level, systolic and dialostic blood pressure, parity, sheesha smoking and depressive symptoms. Overall 30.4% of women were affected with osteopenia/osteoporosis in premenopausal and postmenopausal (24.4% vs 35.7%; P = 0.0442). Osteopenia in premenopausal and postmenopausal (18.7% vs 29.3%; P = 0.030) and Osteoporosis (9.9% vs 15.9%; P = 0.049) were significantly higher in post-menopausal women than in premenopausal women (P = 0.046). Similarly, vitamin D deficiency was more prevalent among postmenopausal women than menopausal women. Overall, only 15.1% of women had optimum vitamin D level and 15.5% had severe, 33.2% had moderate vitamin D insufficiency and 36.3% had mild vitamin D insufficiency in menopausal and post menopausal women (P = 0.021). The study revealed that vitamin D level, hemoglobin level, serum iron fasting plasma glucose, calcium, triglycerides, high density lipid (HDL) cholesterol, low density lipid (LDL) Cholesterol, alkaline phosphate and magnesium were considerably lower in postmenopausal compared to menopausal women (P < 0.001). Conclusion: The current study revealed that there was a strong association between vitamin D level and BMD in Arab women during the menopausal and post-menopausal period.
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A rare case of occult abdominal tuberculosis with Poncet's disease mimicking Adult onset Still's disease
Isha Sood, Gaurav M Kasundra, Prathibha Shankaranarayana Supriya, Aradhana Gupta, Bharat Bhushan
July-September 2015, 6(3):125-128
DOI:10.4103/0976-7800.165593  PMID:26538990
A 50-year-old female presented with fever, symmetrical arthralgias, rash, painful oral ulcerations and alopecia since 8 weeks. Examination showed mild hepatospleenomegaly. Investigations revealed leucocytosis, neutrophilia, elevated sedimentation rate and raised ferritin levels (3850 ng/ml). Computerized tomography (CT) abdomen showed hepatospleenomegaly, mild ascitis and mild bilateral pleural-effusion. After ruling out occult infections, tuberculosis, malignancies and autoimmune diseases by appropriate investigations, and due to raised ferritin levels, adult onset stills disease (AOSD) was diagnosed. Patient responded to oral steroids initially, but after 7 days developed severe abdominal pain. Repeat CT showed multiple enlarged, necrotic and matted retroperitoneal lymph nodes with caseating granuloma on histopathology suggesting tuberculosis. Patient was given four-drug anti-tubercular treatment and she improved. Thus our patient of occult abdominal tuberculosis with reactive arthritis (Poncet's disease) presented with hyperferritinemia mimicking AOSD. We postulate that extreme hyperferritinemia can be seen in tuberculosis and tuberculosis must be conclusively ruled out before diagnosing AOSD in tropics.
  3,888 315 1
Elderly female with Autoimmune hemolytic anemia
Anupam Dey
July-September 2015, 6(3):132-133
DOI:10.4103/0976-7800.165596  PMID:26538992
Autoimmune hemolytic anemia (AIHA) is a rare disease with an estimated prevalence of around 17/100,000. It is often difficult to diagnose and treat AIHA, especially in elderly. A 60-year-old female was admitted with the complaints of low grade fever, on-off for 6 months, progressive fatigue and dyspnea on exertion. She was transfused with three units of blood within these 6 months. Examination revealed pallor, edema, hemic murmur, and palpable liver. Hb was 2.9 gm%, T Bil 5.2 mg/dl, ESR 160 mm, and reticulocyte count 44.05%. Direct Coombs test was positive, anti-nuclear antibody (ANA) and Anti ds DNA were positive. A diagnosis of systemic lupus erythematosus (SLE) with AIHA was considered and patient was transfused with two units of packed red cells and put on steroid (prednisolone) at 1 mg/kg body weight daily. After 3 weeks, her Hb had increased to 10.4 gm% with gross clinical improvement.
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Isolated renal hydatid cyst in a diabetic postmenopausal female
Monica Gupta, Ram Singh, Sarabmeet Singh Lehl
July-September 2015, 6(3):134-136
DOI:10.4103/0976-7800.165597  PMID:26538993
Isolated renal hydatid disease is very uncommon and is usually an unexpected disclosure during radiological imaging. Since it affects the kidney, renal mass, or colic, hematuria, pyuria, and dysuria are the predominant symptoms. We present a case of a 48-year-old diabetic postmenopausal female incidentally diagnosed with an isolated giant renal hydatid cyst while evaluating the cause of recurrent flank pain.
  3,255 230 3
Endometriosis presenting as carcinoma colon in a perimenopausal woman
Tanuja Muthyala, Pooja Sikka, Neelam Aggarwal, Vanita Suri, Rajesh Gupta, Uma Nahar
July-September 2015, 6(3):122-124
DOI:10.4103/0976-7800.165592  PMID:26538989
Endometriosis is a common benign disease of reproductive age women, and can involve the intestinal tract. Inconsistent clinical presentation, similar features on radiological imaging and colonoscopy with other inflammatory and malignant lesions of the bowel makes the preoperative diagnosis of bowel endometriosis difficult. We present a case of a 42-year-old perimenopausal female clinically presented, investigated and managed in the lines of carcinoma of sigmoid colon. She underwent terminal ileac resection with end to end anastomoses, Hartmann's procedure and total hysterectomy with bilateral salpingoophorectomy. The histopathological report revealed endometriosis of small intestine, large intestine, mesentery, right ovary and adenomyoma of uterus. Thus, bowel endometriosis should also be considered as differential diagnosis in reproductive age women with gastrointestinal symptoms or intestinal mass of uncertain diagnosis.
  3,203 282 2
Upper gastrointestinal bleed in a post menopausal woman due to combination of high first dose aspirin and clopidogrel prescribed for acute coronary syndrome
Vishal R Tandon, Rubeena Maqbool, Iram Kahkashan, Rashmi Sharma, Vijay Khajuria, Zahid Gillani
July-September 2015, 6(3):129-131
DOI:10.4103/0976-7800.165595  PMID:26538991
Combination of aspirin, clopidogrel and enoxaparin remains the standard treatment for acute coronary syndrome (ACS) but is known to increase the incidence of upper gastrointestinal bleed (UGIB). We hereby report an unusual case of gastrointestinal bleed (GIB) as it resulted inspite of proton pump inhibitor (PPI) prophylaxis within the second day of treatment in a post-menopausal woman (PMW) with high first dose of aspirin clopidogrel dual combination in a patient of ACS.
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Menopausal hormone therapy and ovarian cancer
Rod Baber
July-September 2015, 6(3):101-103
DOI:10.4103/0976-7800.165587  PMID:26538985
  2,959 323 1
A retrospective analysis of dermatoses in the perimenopausal population attending a tertiary care centre in South India
Shamma Aboobacker, Mohanan Saritha, Kaliaperumal Karthikeyan
July-September 2015, 6(3):115-121
DOI:10.4103/0976-7800.165591  PMID:26538988
Introduction: Menopausal is a normal physiologic aging process in women characterized by decreasing estrogen levels. The skin is an organ dependant on hormones, estrogen being the most important in case of females, thereby influencing both the biology of skin and composition. Studies show that the systemic effects of estrogen deprivation occur years after attaining menopausal, however cutaneous features have been noticed earlier. The purpose of this study is to evaluate the common disorders occurring in perimenopausal women of Indian ethnicity. Materials and Methods: A retrospective observational study of outpatient records from Dermatology clinic between 2005 and 2012. All female patients between 45-55 years of age from an outpatient register that outlines the final diagnosis made by a qualified dermatologist after investigations. The data was entered according to the pattern of dermatoses and their seasonal variation and analyzed were included. Results: A total of 8,156 cases were found. After analysis of the many variables, the most common dermatoses in the perimenopausal population were eczematous disorders (23.6%), followed by urticaria (12.4%) and papulosquamous disorders (10.7%). Of the eczematous disorders, allergic and photosensitive disorders were found to be more frequent. Conclusion: The leading dermatoses being eczema and urticaria in the perimenopausal population probably accounts for a tendency of exaggerated response to external factors. The population studied in the current study might be of significance due to complete lack of treatment in the form of hormone replacement therapy (HRT), while routine sun exposure and cultural practices predominate. However, evaluation with respect to individual factors is beyond the scope of the current study and may be necessary to define a causal relationship.
  2,960 260 -
Common mistakes done by authors in conduct and reporting risk factor (observational) studies
Sagar Borker
July-September 2015, 6(3):137-140
DOI:10.4103/0976-7800.165598  PMID:26538994
  2,906 227 -
Fertility at midlife
Duru Shah
July-September 2015, 6(3):99-100
DOI:10.4103/0976-7800.165586  PMID:26538984
  2,648 275 -