Journal of Mid-life Health Journal of Mid-life Health
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   2017| January-March  | Volume 8 | Issue 1  
    Online since March 14, 2017

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Screening methods(clinical breast examination and mammography) to detect breast cancer in women aged 40–49 years
Navneet Takkar, Suman Kochhar, Priyanka Garg, AK Pandey, Usha Rani Dalal, Uma Handa
January-March 2017, 8(1):2-10
DOI:10.4103/jmh.JMH_26_16  PMID:28458473
Objective: The aim of this study is to detect breast cancer rate, nodal status, tumor size, and associated risk factors using clinical breast examination (CBE) and mammography as screening tools in women aged 40–49 years. Materials and Methods: A total of 500 women were screened in a time period of 2 years, between the ages of 40–49 years for breast cancer. Screening tools used were CBE and mammography. Clinical history and risk factors related to breast cancer were recorded. CBE was performed to detect any breast pathology followed by mammographic screening. Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories were used for reporting breast imaging on mammography. For women with dense breasts or an inconclusive mammography report, ultrasonography was performed to assess the lesion/s. Suspicious lesion was subjected to fine-needle aspiration cytology or an open surgical biopsy for a confirmatory diagnosis. Women with history of breast cancer were excluded from the study. Results: CBE was normal in almost 90% of the women. Screening mammography revealed Breast Imaging Reporting and Data System (BI-RADS) I and BI-RADS II in 58.4% and 34.6% of women, respectively. Only 7% of women belonged to BI-RADS III and none in BI-RADS IV category. Conclusion: The study findings are in agreement with the recommendations of the World Health Organization, US preventive task force and UK guidelines that recommend screening mammography in women starting at 50 years.
  10,022 834 6
Quality of life among menopausal women: A community-based study in a rural area of West Bengal
Nabarun Karmakar, Somak Majumdar, Aparajita Dasgupta, Sulagna Das
January-March 2017, 8(1):21-27
DOI:10.4103/jmh.JMH_78_16  PMID:28458476
Introduction: During menopausal transition, there is a lot of fluctuation in the hormone levels making the peri and postmenopausal women susceptible to various mental and physical disorders. There is considerably lack of awareness about the effects of the menopausal symptoms in women in India. Studies on issues relating to menopause, especially among rural women, are also lacking. With this background, the current study was carried out in a rural area of West Bengal with the objective to assess the quality of life (QOL) of peri-menopausal women. Methodology: The study was carried out among 100 peri and postmenopausal women (40–60 years) in Dearah village of West Bengal which is the rural field practice area of All India Institute of Hygiene and Public Health during February–March 2014. The questionnaire used as study tool had two parts - Part 1: Sociodemographic characteristics. Part 2: About QOL due to menopausal symptoms based on four domains (vasomotor, psychosocial, physical, and sexual) using the 29-item Menopause-Specific Quality of Life Questionnaire. Results: Occurrence of vasomotor symptoms was average with 60% of them reporting hot flushes and 47% sweating. Most prevalent psychosocial symptoms reported were feeling of anxiety and nervousness (94%) and overall depression (88%). Physical symptoms were quite varying in occurrence with some symptoms such as feeling tired or worn out, decrease in physical strength and lack of energy occurring in 93% of the women to only 5% suffering from growth of facial hair. Overall sexual changes were reported among 49% who reported of avoiding intimacy with a partner and 26% complained of vaginal dryness. Conclusions: The results support that menopause causes both physical and psychiatric problems. Education, creating awareness and providing suitable intervention to improve their QOL are important which should be imparted to menopausal women at both individual and community level.
  8,464 995 13
Efficacy of transcutaneous electrical nerve stimulation in the treatment of chronic pelvic pain
Nidhi Sharma, Kaja Rekha, Jayashree K Srinivasan
January-March 2017, 8(1):36-39
DOI:10.4103/jmh.JMH_60_16  PMID:28458478
Background: Chronic pelvic pain is prevalent in 2% of women population globally. The etiology is multifactorial. Even in the absence of pelvic pathology, there is a subgroup of women who do not respond to analgesic and anti-inflammatory therapy. Chronic pelvic pain can be inhibited by direct inhibition of impulses in the preganglionic afferent neuron by closing the hypothetical gate in the dorsal horn of the spinal cord. Transcutaneous electrical nerve stimulation (TENS) is based on the gate control theory of abolishing the painful stimuli by providing simultaneous inputs in larger myelinated nerve fibers. Aims and Objectives: This study was designed to assess the effectiveness and safety of TENS in idiopathic chronic pelvic pain. Methods: It is a prospective, experimental study to evaluate the effectiveness of TENS versus placebo in reducing pain severity in chronic pelvic pain (G1 = 30, G2 = 32, G3 = 30, and G0 = 30). Patients with chronic pelvic pain due to benign lesions of genital tract, gastrointestinal, and renal disorders were excluded from the study after performing an ultrasound study of abdomen and pelvis. Ten treatment sessions (5 sessions/week) of 30 min were conducted. Observations and Results: There was a significant improvement in pain scores in TENS group as compared with control group, and two patients were completely pain free following TENS therapy. Conclusion: In women patients with idiopathic chronic pelvic pain, TENS can be a useful intervention. TENS units are safe, economical, and easily commercially available.
  6,926 885 4
Gestational gigantomastia: Asystematic review of case reports
Mishu Mangla, Deepak Singla
January-March 2017, 8(1):40-44
DOI:10.4103/jmh.JMH_92_16  PMID:28458479
Introduction: Gestational gigantomastia (GG) is a rare disease characterized by diffuse, extreme, and incapacitating enlargement of one or both breasts during pregnancy. Although benign, it can lead to a great social, emotional, and physical disability. A good and complete knowledge regarding this rare but distressing clinical situation is a must among all practicing physicians especially obstetricians. Materials and Methods: A systematic review of all the case reports and short case series, published in the English language in various databases in the last 40 years, i.e. 1976 to 2016 was carried out. The main aim was to provide a summary and critical analysis of all the data and evidence regarding GG published in recent years. Results: After considering all inclusion and exclusion criteria, a total of fifty case reports were finally analyzed. The risk factors, geographical distribution, associated diseases, and the main treatment modalities used for GG are discussed in detail in this article. Conclusion: Multidisciplinary team effort in the form of obstetrician, plastic surgeon and anesthetist, and pediatrician is required for a successful fetomaternal outcome.
  6,709 596 5
Ormeloxifene–Looking beyond contraception
Tapasi Pati, Kabita Chanania, Satyabhama Marandi, Jagadish Hansa
January-March 2017, 8(1):17-20
DOI:10.4103/jmh.JMH_71_16  PMID:28458475
Aims: This study is aimed at finding out a logical solution for perimenopausal menorrhagia in normal or bulky uterus. Settings and Design: The study is carried out at a tertiary care hospital at Odisha. In our setup, nearly 900 hysterectomies are done per year out of which 60% are for menorrhagia with bulky uterus. Subjects and Methods: There were sixty cases of menorrhagia between the ages of 40 and 55 years who completed child bearing treated with ormeloxifene. Their endometrial thickness (ET) and hemoglobin (Hb) level were determined at the start of the study and also at 6 months and compared. At 1 year from the start of treatment, patients' satisfaction and status of menstrual cycle were reassessed. Statistical Analysis Used: Age and parity variables were expressed as mean ± standard deviation and range. We used the paired samples t-test to estimate the mean, median, range, P and t value. All statistical analyses were performed using SPSS software version 11.5 (IBM Corp) and tests of statistical significance were two-sided and differences were taken as significant when P < 0.05. Results: After 1 year of follow-up, 90% of patients found to be amenorrhoic and only two out of them presented with mild irritability and vasomotor complaints which resolved with counseling and placebo therapy. There was a significant reduction (P < 0.0001) in ET and rise in Hb level (P < 0.0001). Conclusions: Ormeloxifene is a safe drug which can be used to treatment of perimenopausal bleeding with minimal focal pathology.
  4,705 395 3
Role of vitamin D in urogenital health of geriatric participants
Harmanpreet Kaur, Ripan Bala, Madhu Nagpal
January-March 2017, 8(1):28-35
DOI:10.4103/jmh.JMH_84_16  PMID:28458477
Introduction: Role of Vitamin D is very well known for the functioning of many body organs. However, its role in the postmenopausal women in relation to various genitourinary disorders has been recognized recently. The main objective of this study was to evaluate role of Vitamin D in vaginal health, prolapse, bladder and bowel function, and bacterial vaginosis (BV). Materials and Methods: This was a randomized controlled study in which 200 geriatric female patients of 65–78 years of age divided into two groups comprising study and control group with 100 participants in each. Detailed obstetrical, gynecological, and clinical history was elicited. Detailed examination regarding the prolapse, urinary and bowel functions, and bacterial infections was done followed by follow-up of 3 and 6 months each. Chi-square and independent t-test used for data analysis. Results: Mean modified vaginal health index (MVHI) among patients with pelvic floor diseases was statistically significant with P = 0.0472. There was a visible increasing trend in Vitamin D deficiency with increase in time since menopause (P = 0.1193). Patients with pelvic floor disease had mean Vitamin D statistically significant with P = 0.0462. With increase in Vitamin D levels, MVHI was found to be better. The association of mean Vitamin D levels among patients with urinary incontinence as compared to controls was significant with P = 0.0460. Association of mean Vitamin D levels in patients with fecal incontinence and BV as compared to controls was not statistically significant with P = 0.6304 and 0.79, respectively. Low Vitamin D levels were associated with high mean parathyroid hormone (PTH) levels statistically significant with P = 0.034. MVHI was found to increase significantly with Vitamin D supplementation at 3 and 6 months' follow-up. There was increase in Vitamin D and calcium levels and fall in serum PTH levels at 3 and 6 months. Conclusions: Vitamin D levels were associated with a decreased risk of pelvic floor disorders, improved MVHI in women in geriatric age group.
  4,072 410 4
Hormone replacement therapy reduces lipid oxidation directly at the arterial wall: A possible link to estrogens' cardioprotective effect through atherosclerosis prevention
Carlos Gómez Escalante, Silvia Quesada Mora, Laura Navarro Bolaños
January-March 2017, 8(1):11-16
DOI:10.4103/0976-7800.201967  PMID:28458474
Background: The first step in atherosclerosis formation is the ingurgitation of an oxidized low-density lipid (LDL) molecule by a macrophage which then turns into a foam cell within the vascular wall and initiates a cascade of inflammatory responses. Could it be that the potential cardioprotective effect observed in women receiving hormone replacement therapy (HRT) is modulated by estrogen's capacity to decrease LDL oxidation in the vascular wall and thus decrease atherosclerotic foam cells? Materials and Methods: Thirty-four adult female Wistar rats were divided into three groups. All were double oophorectomized. After recovery, Group 1 received Estradiol Valerate subcutaneous (SC) (2.5 mg/kg/week), Group 2 Estradiol Valerate SC (2.5 mg/kg/week) + Progesterone SC (10 mg/kg/48 h), and Group 3 Placebo SC. After 10 weeks, all rats were sacrificed and a vascular dissection performed. Malondialdehyde (MDA) was measured directly on the vascular extract to determine lipid oxidative levels and HRTs' effect. Renal and hepatic tissue was also studied. Total antioxidant status (TAS) was measured to determine overall oxidative behavior. Results: Vascular MDA levels for Group 1 = 80.80 (±16.8) μmol/ml/g, Group 2 = 107.69 (±24.9) μmol/ml/g, and Group 3 = 140.96 (±32.4) μmol/ml/g. ANOVA (P < 0.05), with a post hoc Bonferroni corrective t-test, showed that both Group 1 and 2 have statistically significant lower levels of MDA than Group 3. Renal tissue showed less oxidative damage in the HRT groups, while hepatic tissue showed an inverse behavior with less lipid oxidation in the placebo group. TAS decreased with oophorectomy in all groups but decreased less in both groups that received HRT compared to placebo (P < 0.05). Conclusion: HRT significantly reduces lipid oxidation directly in the arterial wall.
  3,908 365 2
Coexisting leiomyomata peritonealis disseminata and ovarian leiomyoma
Babita Khangar, Varuna Mallya, Nita Khurana, Poonam Sachdeva, Swati Kashyap
January-March 2017, 8(1):45-47
DOI:10.4103/jmh.JMH_96_16  PMID:28458480
Leiomyoma is the most common tumor seen affecting women mostly of reproductive age groups. It is composed of smooth muscle cells that are positive for smooth muscle actin on immunohistochemistry. Leiomyomata peritonealis diss´╗┐eminata (LPD) is characterized by nodules that stud the peritoneum. It is seen in association with hormone-producing ovarian tumors and coexisting leiomyomas of the uterus. Association with mesenteric leiomyomas has been reported. Ovarian leiomyomas are very rare tumors of the ovary and coexisting LPD with ovarian leiomyomas has not been reported before. We present this rare case of LPD and ovarian leiomyoma.
  3,189 249 -
President IMS 2017
Suvarna Khadilkar
January-March 2017, 8(1):1-1
  2,758 247 -
Multidisciplinary opinion on challenges in the medical management of polycystic ovarian syndrome
Sudhaa Sharma, Neelam Aggarwal
January-March 2017, 8(1):48-49
  2,501 177 -