Journal of Mid-life Health Journal of Mid-life Health
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   2017| July-September  | Volume 8 | Issue 3  
    Online since September 15, 2017

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Urinary incontinence, its risk factors, and quality of life: A study among women aged 50 years and above in a rural health facility of West Bengal
Bijit Biswas, Aritra Bhattacharyya, Aparajita Dasgupta, Anubrata Karmakar, Nazrul Mallick, Sembagamuthu Sembiah
July-September 2017, 8(3):130-136
DOI:10.4103/jmh.JMH_62_17  PMID:28983160
Context: Urinary incontinence (UI) is a chronic debilitating disease which is often under reported, but laid significant impact on one's quality of life (QoL) thus is of public health importance. Aims: The aim of this study is to find out proportion of rural women have UI, its associated risk factors and treatment-seeking behavior, QoL of affected women. Methods: This was a cross-sectional clinic-based study conducted from October 2016 to January 2017 among 177 women aged 50 years or above attending a rural health facility with a structured schedule. Data were analyzed using appropriate statistical methods by SPSS (version 16). Results: Forty-nine (27.7%) out of 177 women were found having UI. The most prevalent type of UI was stress UI (51.0%), followed by mixed UI (32.7%) and urge UI (16.3%). In bivariate analysis, study participants who were illiterate, having a history of prolonged labor, having a history of gynecological operation, normal vaginal deliveries (NVDs) (>3), diabetic, having chronic cough, having constipation, and having lower urinary tract symptoms (LUTS) had shown significantly greater odds of having UI. In multivariable illiteracy (adjusted odds ratio [AOR] - 2.41 [1.02–5.69]), NVDs (AOR - 3.37 [1.54–7.37]), a history of gynecological operation (AOR - 3.84 [1.16–12.66]), chronic cough (AOR - 2.69 [1.21–5.99]), LUTS (AOR - 2.63 [1.15–6.00]) remained significant adjusted with other significant variable in bivariate analysis. Those with mixed UI had 5.33 times higher odds having unfavorable QoL. Only 30.6% sought medical help. Treatment-seeking behavior shown negative correlation with QoL while fecal incontinence and LUTS shown possitive correlation. Conclusions: The study revealed that rural women are indeed at high risk of developing UI. Majority of them did not sought treatment for UI which is matter of concern. Generating awareness regarding UI may help to improve health-seeking behavior and QoL.
  6 6,318 735
Etiological and endoscopic profile of middle aged and elderly patients with upper gastrointestinal bleeding in a Tertiary Care Hospital in North India: A retrospective analysis
Pranav Mahajan, Vijant Singh Chandail
July-September 2017, 8(3):137-141
DOI:10.4103/jmh.JMH_86_17  PMID:28983161
Background: Upper gastrointestinal (GI) bleeding is a common medical emergency associated with significant morbidity and mortality. The clinical presentation depends on the amount and location of hemorrhage and the endoscopic profile varies according to different etiology. At present, there are limited epidemiological data on upper GI bleed and associated mortality from India, especially in the middle and elderly age group, which has a higher incidence and mortality from this disease. Aim: This study aims to study the clinical and endoscopic profile of middle aged and elderly patients suffering from upper GI bleed to know the etiology of the disease and outcome of the intervention. Materials and Methods: Out of a total of 1790 patients who presented to the hospital from May 2015 to August 2017 with upper GI bleed, and underwent upper GI endoscopy, data of 1270 patients, aged 40 years and above, was compiled and analyzed retrospectively. Results: All the patients included in the study were above 40 years of age. Majority of the patients were males, with a male to female ratio of 1.6:1. The most common causes of upper GI bleed in these patients were portal hypertension-related (esophageal, gastric and duodenal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia GAVE), seen in 53.62% of patients, followed by peptic ulcer disease (gastric and duodenal ulcers) seen in 17.56% of patients. Gastric erosions/gastritis accounted for 15.20%, and duodenal erosions were seen in 5.8% of upper GI bleeds. The in-hospital mortality rate in our study population was 5.83%. Conclusion: The present study reported portal hypertension as the most common cause of upper GI bleeding, while the most common endoscopic lesions reported were esophageal varices, followed by gastric erosion/gastritis, and duodenal ulcer.
  6 4,438 465
Correlation of two colposcopic indices for predicting premalignant lesions of cervix
Sweta Kushwah, Beenu Kushwah
July-September 2017, 8(3):118-123
DOI:10.4103/jmh.JMH_22_17  PMID:28983158
Cervical cancer is the second most common malignancy among women in India, mainly affecting the females of Peri-Menopausal age group. Colposcopy has been very useful for diagnosing cervical cancer to guide the biopsy. Reids and Scalzi proposed the Reids Colposcopic Index (RCI) to make colposcopic diagnosis less subjective, which is currently the most accepted scoring system. Recognizing the correlation of size of the lesion with likelihood of harbouring high grade disease, a new scoring system, the Swede score, has been devised by Strander et al in 2005. In present study we compared the Reids colposcopic index with Swede score. From the present study it is evident that Swede score of 8 or more has 100% specificity and can be used for performing direct excisional procedure as a “see-and-treat” method at this cut-off. This may be the preferred method for the treatment of high-grade CIN because it reduces the number of visits to the clinic and failure to receive treatment.
  3 10,220 691
Extensively metastasizing leiomyosarcoma: A diagnostic challenge
Arvind Ahuja, Poojan Agarwal, Rohan Sardana, Suryanarayanan Bhaskar
July-September 2017, 8(3):148-150
DOI:10.4103/jmh.JMH_60_17  PMID:28983164
Uterine leiomyosarcoma (ULMS) is a rare malignancy of the female genital tract and carries an extremely poor 5-year survival rate. It is known to metastasize early and to distant sites owing to a high propensity for hematogeneous spread. Lung, peritoneum, liver, and bone are relatively common sites of metastasis. Patient age, tumor size, FIGO stage, and grade of the tumor are important criteria for predicting metastasis. The incidence of ULMS is increasing, probably due to the use of improved imaging techniques and as a result of cancer patients' prolonged life expectancy. An early well thought diagnosis is only made possible if even in otherwise seemingly unsuspected cases, the histopathology slides are extensively screened and the treating clinician is alerted timely. We hereby report a case of an elderly female who underwent hysterectomy for resection of multiple fibroids in the uterus and later presented with distant metastasis to brain with the erosion of overlying skull bone, chest wall, and lungs. Microscopic features along with an extensive immunohistochemistry panel were used to ascertain tumor origin.
  2 2,788 223
Obesity and associated cardiometabolic risk among women from Tripura - A Northeastern State of India
Purnajita Sen, Sandeep Das, Samrat Hore, Surajit Bhattacharjee, Dipayan Choudhuri
July-September 2017, 8(3):110-117
DOI:10.4103/jmh.JMH_116_15  PMID:28983157
Introduction: Cardiometabolic health status of women is a serious public health concern. Markers of body fat content and their distribution are important indicators of cardiometabolic health risk in participants. In addition, socio-demographic status plays a determinant role. The aim of the study was to evaluate the influence of adiposity markers and socio-demographic determinants on various cardiovascular and metabolic risk factors in Indian women. Materials and Methods: The study was conducted on 388 women (age 25–65 years) from Tripura, a Northeastern state of India. Various obesity and atherogenic markers such as body mass index (BMI), waist circumference (WC), waist-hip ratio, waist - height ratio, high density lipoprotein-cholesterol (HDL-C)/total cholesterol, HDL-C/low density lipoprotein cholesterol, triglyceride/HDL-C ratio and traditional cardiometabolic risk factors such as high blood pressure, dyslipidemia, and glucose intolerance were evaluated in participant. The socio-demographic status included the level of education and monthly family income. Results: The cardiometabolic risk in postmenopausal women were higher than premenopausal women. The risk increases with age in both groups. Women with lower educational level and higher income group were found to be prone to higher cardiometabolic risk. Receiver operating characteristics analysis revealed central obesity marked by increased WC was a better predictor of cardiometabolic risk than general obesity marked by increased BMI. Conclusion: The cardiometabolic risk among both premenopausal and postmenopausal women are associated with central obesity which can be predicted by increased WC in the subject. Socio-demographic status of the participant plays a definitive role in determining cardiometabolic risk in women.
  2 3,758 316
Angioleiomyoma of uterus masquerading as malignant ovarian tumor
Sweta Singh, Monalisha Naik, Narbadyswari Deep Bag, Susama Patra
July-September 2017, 8(3):145-147
DOI:10.4103/jmh.JMH_47_17  PMID:28983163
Uterine angioleiomyoma is rare. A 40-year-old nulliparous woman presented with heavy menstrual bleeding (HMB) for the past 2 years and mass per abdomen with severe dysmenorrhea for three cycles. She had received 8 units of packed cell transfusion outside. Clinical examination revealed a huge 32-week-sized abdominopelvic mass with irregular margins. Ultrasonography (USG) of the abdomen and pelvis showed a large solid cystic mass on the right side of the abdomen with a well-defined hypoechoeic rounded lesion of size 5.7 cm × 5.0 cm, in the right lobe of the liver, with ovaries not being imaged separately. On color Doppler USG, there was moderate vascularity throughout. A provisional diagnosis of malignant ovarian tumor with hepatic metastasis was made. Her hemoglobin was 5.7 g/dl, and she had repeated episodes of HMB upon admission. She was transfused with 5 units of packed cells. Computed tomography (CT) showed a large fundal subserosal uterine fibroid on the right side, with a solid ovarian tumor measuring 5.0 cm × 4.5 cm on the left side, with ascitis, right-sided hydronephrosis, and a well-defined hypoechoeic lesion in the right lobe of the liver, suggestive of hepatic hemangioma. Tumor markers were within normal limits. In view of discrepancy in clinical findings, ultrasound, and CT report, CT-guided biopsy of the huge mass was done which revealed leiomyoma, with no evidence of mitosis, pleomorphism, or malignancy. Laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy was done. Histopathology revealed an angioleiomyoma uterus. At 1-year follow-up, she was asymptomatic, and the liver mass was stable.
  1 3,077 218
Education based on theory of planned behavior over sexual function of menopausal women in Iran
Zeinab Jalambadani, Gholamreza Garmaroodi, Mehdi Yaseri, Mahmood Tavousi, Koroush Jafarian
July-September 2017, 8(3):124-129
DOI:10.4103/jmh.JMH_44_17  PMID:28983159
Background: More than half of the sexual problems in menopausal women are due to insufficient knowledge or false beliefs about sexual function. Theory of planned behavior (TPB) is one of the important theories that explain the main process of adopting healthy behaviors. This study investigates the effect of education based on TPB over sexual function of menopausal women in Sabzevar, Iran. Materials and Methods: In this quasi-experimental study, the data were collected through a survey. This study included 180 Iranian menopausal women from five health center of Sabzevar city in Iran from 2016 to 2017. Using a questionnaire, demographic, anthropometric, and TPB by SPSS version 22 software were measured and analyzed. Results: After educational intervention, the average rates of knowledge, attitude, perceived behavioral control, and intention to sexual function in education group were increased meaningfully (sig <0.05); these changes were not meaningful in control group. Furthermore, there was no statistically meaningful difference in subjective norms between two groups after intervention. Conclusion: According to the findings, it is proposed that TPB be used to improve sexual function in Iranian menopausal women.
  1 5,397 317
Study of comparison between autonomic dysfunction and dyslipidemia in healthy postmenopausal women
Kavyach Yalamudi
July-September 2017, 8(3):103-109
DOI:10.4103/jmh.JMH_67_15  PMID:28983156
Background: Obesity, physical inactivity, and altered estrogen levels play an important role in contributing to disease risk profile and autonomic dysfunction in healthy postmenopausal women. This study was conducted to test the correlation between autonomic dysfunction and dyslipidemia in healthy postmenopausal women. Materials and Methods: This study was carried out on sixty healthy postmenopausal women before the age of 65 years, without any gross systemic disease. The following five autonomic functional tests were performed on the study group: heart rate response to deep breathing, heart rate response to Valsalva maneuver, heart rate response to standing up from supine position, blood pressure response to sustained hand grip, and blood pressure response to standing up from supine position. Fasting lipid profile of the study group was tested. Results and Conclusion: In the present study, autonomic dysfunction was found in 67% of healthy postmenopausal women. Among the sixty female healthy postmenopausal women included in the study, 68% were found to have dyslipidemia. In our study, there is a statistically significant correlation between autonomic dysfunction and dyslipidemia in healthy postmenopausal women. In these healthy postmenopausal women with increased serum cholesterol, serum low-density lipoprotein, and serum triglycerides, there was autonomic dysfunction which is statistically significant. There is no statistical significance on comparing serum high-density lipoprotein cholesterol with autonomic dysfunction in healthy postmenopausal women.
  1 3,634 303
Periductal stromal sarcoma of the breast with coexistent tuberculous mastitis
Bembem Khuraijam, Priyanka Saxena, Nita Khurana, Sushanto Negi
July-September 2017, 8(3):142-144
DOI:10.4103/jmh.JMH_14_17  PMID:28983162
Periductal stromal sarcoma is a rare low-grade biphasic malignancy arising from periductal breast stroma. This tumor is distinct from phyllodes as it lacks the characteristic leaf-like architecture. Tuberculous mastitis is an uncommon infection seen rarely in the breast parenchyma. We present a rare association between the two diseases, which to the best of our knowledge is the first case reported so far.
  - 2,533 227
Vitamin D and pelvic floor disorders
Sudhaa Sharma, Neelam Aggarwal
July-September 2017, 8(3):101-102
DOI:10.4103/jmh.JMH_88_17  PMID:28983155
  - 2,988 351