Journal of Mid-life Health Journal of Mid-life Health
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   2016| April-June  | Volume 7 | Issue 2  
    Online since July 4, 2016

 
 
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REVIEW ARTICLES
Coronary artery disease and its association with Vitamin D deficiency
Ramesh Aggarwal, Tauseef Akhthar, Sachin Kumar Jain
April-June 2016, 7(2):56-60
DOI:10.4103/0976-7800.185334  PMID:27499590
Coronary artery disease (CAD) has become the latest scourge of humankind and referred to in this article as CAD, is the end result of the accumulation of atheromatous plaques within the walls of coronary arteries that supply the myocardium, a process also known as atherosclerosis and manifests mostly in the form of chronic stable angina or acute coronary syndrome. Vitamin D has attracted considerable interest recently due to its role in a number of extraskeletal disease processes including multiple sclerosis, malignancies, diabetes mellitus, and CAD. It is also known as sunshine vitamin due to its production in the body following exposure to ultraviolet rays, and it is a unique vitamin as it acts like a hormone with its receptor present in a wide range of tissues including endothelium, which is the important mediator of atherosclerosis and subsequent CAD. A large number of studies conducted in the past have provided the basic scientific framework and this article attempts to explore the role of Vitamin D deficiency in the pathogenesis of CAD and stresses the need for further research to fill up gap in our knowledge.
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Role of therapeutic fasting in women's health: An overview
Pradeep M.K Nair, Pranav G Khawale
April-June 2016, 7(2):61-64
DOI:10.4103/0976-7800.185325  PMID:27499591
Fasting is a therapeutic tool practiced since millennia by different cultures and medical systems heterogeneously. PubMed and Google Scholar search engines were searched using the keywords “fasting,” “intermittent fasting,” “calorie restriction,” “women's health,” “women's disorders,” “fasting and aging,” and “fasting and health.” All the animal and human studies which address women's health and disorders were included in the review. Fasting has shown to improve the reproductive and mental health. It also prevents as well as ameliorates cancers and musculoskeletal disorders which are common in middle-aged and elderly women. The present studies available have limitations such as majority of the studies are preclinical studies and human studies are with lesser sample size. Future studies should address this gap by designing medically supervised fasting techniques to extract better evidence. Nevertheless, fasting can be prescribed as a safe medical intervention as well as a lifestyle regimen which can improve women's health in many folds.
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CASE REPORTS
Xanthogranulomatous endometritis presenting as pyometra and mimicking carcinoma on imaging
Col Ajay Malik, Sharmila Dudani, Brig N.S Mani
April-June 2016, 7(2):88-90
DOI:10.4103/0976-7800.185326  PMID:27499597
Xanthogranulomatous endometritis (XGE) is an uncommon but well-established histopathological entity seen affecting the kidney and gallbladder. Involvement of the endometrium is very rare, with only a few case reports in world literature till date. Histologically, it is characterized by the replacement of the endometrium by sheets of foamy histiocytes, plasma cells, lymphocytes, giant cells, and siderophages. We present a case of a 74-year-old female who presented with foul-smelling discharge and postmenopausal bleeding of a short duration. Clinical examination and imaging studies revealed a pyometra, cervical stenosis. A suspicion of carcinoma was raised. Since XGE may mimic an endometrial carcinoma clinically and pathologically, knowledge of this unusual and rare inflammatory pathology is important for both the gynecologists and the pathologists.
  - 2,195 215
Complete molar pregnancy in postmenopausal women
Jasmina Begum, Pallavee Palai, Seetesh Ghose
April-June 2016, 7(2):91-93
DOI:10.4103/0976-7800.185328  PMID:27499598
Gestational trophoblastic disease (GTD) is an abnormal proliferation of trophoblastic tissue during pregnancy. It is a disease of reproductive age, and a few cases have also been seen in women with advanced age, although it is extremely rare in postmenopausal women. Here, we describe an uncommon case of complete hydatidiform mole (CHM) in a postmenopausal woman, who has presented to us with complaints of bleeding per vagina, vomiting with 22 weeks size gravid uterus. Ultrasound finding along with raised serum beta-human chorionic gonadotropin (α -HCG) 400,000 mIU/ml suggested the diagnosis of CHM. In view of postmenopausal status and future risk of postmolar gestational trophoblastic neoplasia, we performed a total abdominal hysterectomy . Uterus was 20 cm × 15 cm × 15 cm filled with cystic, grapes such as vesicles. Microscopic examination demonstrated generalized trophoblastic proliferation with hydropic degenerated villi suggested of benign CHM. Follow-up showed steady fall in serum α -HCG level and no evidence of any residual disease. A suspicion of GTD should be kept in mind while evaluating a patient with peri- or post-menopausal bleeding so that it will prevent a delay in diagnosis and treatment.
  - 2,653 275
A rare case of renal metastasis from squamous cell carcinoma of the cervix
Maithili Mandar Kulkarni, Siddhi Gaurish Sinai Khandeparkar, Avinash R Joshi, Vishakha Kothikar
April-June 2016, 7(2):94-96
DOI:10.4103/0976-7800.185330  PMID:27499599
Cervical cancer is the most frequent type of cancer in women in many developing countries. Squamous cell carcinoma of the cervix spreads principally by lymphatics and less commonly through blood vessels. The most frequent sites for those who develop distant metastasis include lungs (21%), lumbar and thoracic spine (16%), and para-aortic lymph nodes (7%). Metastasis to the kidney is extremely rare with <10 previously reported cases. We report a case of renal metastasis from squamous cell carcinoma of the cervix detected in end-stage kidney due to hydronephrosis.
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A transvaginal removal and repair of vesicovaginal fistula due to mesh erosion
Vineet V Mishra, Tanvir Tanvir, Sumesh Choudhary, Nilesh Goraniya
April-June 2016, 7(2):97-99
DOI:10.4103/0976-7800.185332  PMID:27499600
Vesicovaginal fistula (VVF) is a devastating social problem. It can either result from obstetric trauma or following gynecological surgeries, malignancy, or radiation. We present a case of a 70-year-old woman who had a VVF following mesh augmentation surgery for anterior compartment prolapse. She required a transvaginal removal of the eroded mesh followed by a transvaginal repair of VVF using a Martius flap, 6 weeks later. Transvaginal removal of mesh is technically feasible and a good approach. Timing and route of surgery should be individualized.
  - 2,210 221
EDITORIALS
Greetings from the new chief editors
Sudhaa Sharma, Neelam Aggarwal
April-June 2016, 7(2):53-53
DOI:10.4103/0976-7800.185333  PMID:27499588
  - 2,014 214
Calcium fortification or supplementation in postmenopausal females: Recent controversy
Neelam Aggarwal, Sudhaa Sharma
April-June 2016, 7(2):54-55
DOI:10.4103/0976-7800.185331  PMID:27499589
  - 2,167 268
ORIGINAL ARTICLES
Postoperative pain relief following hysterectomy: A randomized controlled trial
KP Raghvendra, Deepak Thapa, Sukanya Mitra, Vanita Ahuja, Satinder Gombar, Anju Huria
April-June 2016, 7(2):65-68
DOI:10.4103/0976-7800.185327  PMID:27499592
Background: Women experience moderate to severe postoperative pain following total abdominal hysterectomy (TAH). The transversus abdominis plane (TAP) block is a new modality for providing postoperative pain relief in these patients. Materials and Methods: The present study was a single center, prospective randomized trial. After the Institutional Ethics Committee approval and informed consent, patients were randomized to either epidural group: Epidural block placement + general anesthesia (GA) or TAP group: Single shot TAP block + GA. Patients in both the groups received standard general anesthetic technique and intravenous tramadol patient-controlled analgesia in the postoperative period. Patients were monitored for tramadol consumption, visual analog scale (VAS) both at rest and on coughing, hemodynamics, and side effects at 0, 2, 4, 6, 8, 12, and 24 h postoperatively. Results: The total consumption of tramadol in 24 h was greater in TAP group as compared to epidural group (68.8 [25.5] vs. 5.3 [11.6] mg, P< 0.001). The VAS scores at rest and on coughing were higher in TAP group as compared to the epidural group at 6, 8, 12, and 24 h postoperatively (P < 0.05). None of the patients in either group had any adverse effects. Conclusion: Epidural analgesia provided greater tramadol-sparing effect with superior analgesia postoperatively as compared to TAP block in patients up to 24 h following TAH.
  - 3,518 477
Type II endometrial cancers: A case series
Flora D Lobo, Eliz Thomas
April-June 2016, 7(2):69-72
DOI:10.4103/0976-7800.185335  PMID:27499593
Introduction: Endometrial carcinoma ranks 3rd in India among gynecological malignancies. Endometrial cancer (EC) can be classified into two distinct groups – type I and type II, based on histology, which differs in molecular, clinical and histopathological profiles. Type II is nonestrogen dependent, nonendometrioid, more aggressive and carries poor prognosis. Although type II cancers contribute only about 10% of EC incidence, they present at advanced age and cause approximately 50% recurrence and deaths with a low 5-year, overall survival rate. Type II EC are also characterized by genetic alterations in p53, human epidermal growth factor-2/neu, p16 and E-cadherin. Materials and Methods: Endometrial carcinomas diagnosed from endometrial biopsies and hysterectomy specimens received in the Department of Pathology, Kasturba Medical College, Mangalore, from January 2007 to June 2012 were included in the study. Clinicopathological analysis of the 84 cases of EC was done with emphasis on morphology. p53 immunostaining was performed in two cases of serous carcinoma. Results: Out of a total of 84 cases of EC, ten cases were of type II (11.9%). Out of which, eight were serous carcinoma (9.5%) and two clear cell (2.4%). p53 immunostain was strongly positive in the serous papillary carcinomas. The age of the patients ranged from 45 to 75 years. Myometrial invasion was more than half. Treatment was hysterectomy followed by aggressive chemotherapy. Conclusion: Of the type II EC, serous carcinoma is the most common type. Clinical presentation and prognosis differs in comparison to type I EC, thus the recognition of this type of EC is pivotal.
  - 3,016 294
Abnormal uterine bleeding in perimenopausal women: Correlation with sonographic findings and histopathological examination of hysterectomy specimens
Bharat Talukdar, Sangita Mahela
April-June 2016, 7(2):73-77
DOI:10.4103/0976-7800.185336  PMID:27499594
Background: Abnormal uterine bleeding (AUB) is a frequently encountered gynecologic complaint in perimenopausal woman and also the most common cause of hysterectomy in this age group. Objective: Evaluation of various clinical presentations of perimenopausal AUB and it is ultrasonographic and histopathological correlation of hysterectomy specimens. Materials and Methods: This study was carried out in the Department of Obstetrics and Gynaecology among perimenopausal women who underwent hysterectomy for AUB. The clinical presentations, ultrasonographic findings, and histopathological reports of hysterectomy specimen were correlated. Results: Among 103 number of hysterectomized cases for AUB, most of the patients were between 40 and 45 years of age (67.97%) and menorrhagia was the dominant clinical presentation. The majority (45.63%) of cases were diagnosed as fibroid uterus by ultrasonography with 89.13% sensitivity and 89.47% specificity. Histopathological reports of myometrium showed 44.66% fibromyoma, followed by 34.95% of the normal myometrium. Histopathology of endometrium revealed hyperplasia in the most cases (56.31%) where simple typical type was the predominant. Conclusion: Uterine fibroid was the leading cause of AUB and radiological, pathological evaluation correlated well to diagnose fibroid.
  - 3,956 513
Clinical, radiological, and histopathological analysis of paraovarian cysts
Avantika Gupta, Purnima Gupta, Usha Manaktala, Nita Khurana
April-June 2016, 7(2):78-82
DOI:10.4103/0976-7800.185337  PMID:27499595
Introduction: Paraovarian cyst arise from either mesothelium or from paramesonephric remnant. These present as either adneal mass or as an incidental finding. Diagnosis is usually established on ultrasound and it is important to differentiate these from ovarian cyst. Material and Methods: The present study is a retrospective analysis of 32 women with a confirmed diagnosis of paraovarian cyst after surgery. The clinical profile, symptoms and radiological findings of these patients were noted from the hospital records. A correlation was made with the surgical findings and the final histopathological diagnosis. Results: Only 2 patients were postmenopausal and one case was diagnosed during pregnancy. Ultrasound accurately diagnosed paraovarian cyst in 87.5% patients. 78% paraovarian cysts were found to be simple and none had any malignant change. We reported a higher incidence of cystic adenomatoid tumor in these paraovarian cysts. Conclusion: In our study, most paraovarian cysts occur in reproductive age group and present as an adnexal mass. Ultrasound is the diagnostic modality and a paraovarian cyst needs to be differentiated from ovarian cyst. Most of them were simple cysts on histopathology.
  - 8,625 517
Burgeoning menopausal symptoms: An urgent public health concern
Praveen Kulkarni, BB Savitha Rani, D Sunil Kumar, Renuka Manjunath
April-June 2016, 7(2):83-87
DOI:10.4103/0976-7800.185329  PMID:27499596
Introduction: Demographic and epidemiological transitions have increased the life expectancy of people in India. This has resulted in higher burden of morbidities related to aging. The National Health programmes have focused mainly on the health of women in reproductive age groups and neglected their health thereafter. Thus, there is a need to explore the bio-social correlates of menopausal symptoms among women, which can influence their quality of life. Subjects and Methods: This cross-sectional community-based study was conducted in the urban slum of Mysore for 3 months. A total of 100 postmenopausal women in the age group of 40–65 years residing in the field practice area of Urban Health Training Centre were selected by simple random sampling method from the database of households. Details regarding socio-demographic characteristics, postmenopausal symptoms, and factors associated with them were collected in a pretested structured pro forma by interview technique. Results: Among 100 women included in the present study, mean age at menarche and menopause was 13.45 ± 1.72 and 46.7 ± 5.2 years, respectively. The most common postmenopausal symptom was joint pain (92%) followed by physical and mental exhaustion (84%), depression (76%), irritability (73%), hot flushes, and night sweats (65%). There was a significant positive correlation between age of the women, duration of life after menopause, and postmenopausal symptoms. Conclusion: There is a high burden of postmenopausal symptoms which have shown an increasing trend with advancement of age. This calls for establishment of specific health interventions for postmenopausal women in the health-care settings.
  - 2,485 318
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