Journal of Mid-life Health Journal of Mid-life Health
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   2017| October-December  | Volume 8 | Issue 4  
    Online since December 13, 2017

 
 
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REVIEW ARTICLE
Osteoporosis and periodontitis in postmenopausal women: A systematic review
Lata Goyal, Tarun Goyal, ND Gupta
October-December 2017, 8(4):151-158
DOI:10.4103/jmh.JMH_55_17  PMID:29307975
This systematic review was done to assess the strength of association between osteoporosis and chronic periodontitis in postmenopausal women, assessed by bone mineral density (BMD) and clinical attachment loss, respectively. The Pubmed, Cochrane central, EMBASE, and Google Scholar were searched from year 1990 to 2015 for studies on association between chronic periodontitis and osteoporosis. Studies measuring osteoporosis in terms of central BMD and periodontitis in terms of clinical attachment level were studied. Data were extracted and descriptive analysis was performed. Screening of 1188 articles resulted in 24 articles for review after reading the titles and abstracts. Fifteen studies were shortlisted for inclusion in systematic review. Ten of these studies showed an association between periodontitis and osteoporosis. It implies that patients with severe periodontitis should also be evaluated for systemic bone health and vice versa.
  10 6,848 2,273
ORIGINAL ARTICLES
Dietary intake, physical activity and body mass index among postmenopausal women
Chaya Ranasinghe, Pallavi G Shettigar, Meenakshi Garg
October-December 2017, 8(4):163-169
DOI:10.4103/jmh.JMH_33_17  PMID:29307977
Context: Nutrition plays a vital role in the quality of life in postmenopausal women. Aim: The aim is to determine the dietary intake, physical activity, and assess the body mass index (BMI) among postmenopausal women. Settings and Design: A community-based sample survey. Materials and Methods: The present study included 140 postmenopausal women (40–70 years) from Udupi, Manipal areas of Karnataka. The study was carried out between July and December 2013. Sociodemographic data were collected using a questionnaire. Anthropometric data included height, weight, waist, and hip circumference. Dietary intake was determined using 24 h dietary recall. Physical activity information was collected. Statistical Analysis Used: Data were analyzed using SPSS version 16 software. Paired t-test was performed to determine the dietary adequacy. Results: Obesity was 42.1% among the study participants. Increased WHR and waist circumference were 82.1% and 77.1%. Mean daily intake of calcium and saturated fatty acids were significantly higher than recommended dietary allowance (RDA) (P < 0.001). Mean intake of energy, protein, carbohydrate, mono and poly unsaturated fatty acid, fiber and sodium were significantly lower than RDA (P < 0.001). Average daily intake of cereals, pulses, roots and tubers, meat and products, fats and oils, green leafy, and other vegetables were significantly (P < 0.001) lower than RDA. Intake of fruits, milk and milk products, and sugar was significantly higher (P < 0.001) than RDA. Only 37.1% of women performed moderate or active exercises regularly. Conclusions: Even though, nutrient and food group deficiencies were observed among postmenopausal women physical inactivity and effects of menopausal transition instigate increased BMI imposing a need to educate on nutrition and physical activity.
  4 6,924 755
Psychosocial status and economic dependence for healthcare and nonhealthcare among elderly population in rural coastal Karnataka
Priyanka Dsouza Rent, Sudeep Kumar, Mackwin Kenwood Dmello, Jagannath Purushotham
October-December 2017, 8(4):174-178
DOI:10.4103/jmh.JMH_46_17  PMID:29307979
Introduction: The elderly who will constitute 10% of the Indian population by 2021 face problems such as deteriorating healthcare status, loneliness, and economic constraints among others. All these factors together may affect the psychosocial status of the elderly and their health-seeking behavior. With this background, the current study tried to evaluate the psychosocial status, economic dependence for health and nonhealth expenses and awareness regarding geriatric welfare services (GWS) among elderly patients. Materials and Methods: The study was carried out among 599 men and women aged above 60 who visited rural healthcare centers in two districts of Karnataka during September–December 2016. A semi-structured interview schedule was administered by a trained medical professional after taking informed consent. Results: Majority of the respondents said that they had company at home, interacted with people outside home and that their advice was honored. About 75.8% of the respondents reported that they were either partially or completely financially dependent on someone else. The mean cost of hospitalization was reported to be Rs. 11,086. Majority of those hospitalized depended on their children to pay for healthcare (66.9%), whereas 16.9% had availed government insurance schemes and 14.6% paid out of pocket. Nearly 64.9% of the respondents were aware of the GWS while 32.6% had used them. Conclusion: The absence of financial risk pooling mechanisms and social support may cause elderly to forego treatment because of the need to pay for healthcare and further deteriorate their psychosocial status. Government initiatives to improve healthcare and social services to the elderly maybe advocated.
  4 3,995 371
CASE REPORTS
Huge (9 Kg) broad ligament fibroid mimicking sarcoma of uterus: A case report and review of literature
Rajshree Dayanand Katke
October-December 2017, 8(4):191-193
DOI:10.4103/jmh.JMH_16_17  PMID:29307983
Fibroids are most common benign tumors of the uterus, mostly situated in the body of the uterus. Rarely, they arise from extrauterine sites with broad ligament fibroids being uncommon. We present a case of a 47-year-old female, multipara who presented in outpatient department in CAMA hospital with a history of sudden development of dysuria 10 days back. Intraoperatively, uterus was pushed to side and large broad ligament fibroid of 25 cm × 20 cm × 20 cm seen arising from right-sided broad ligament. The fibroid was densely adherent to bowel and bladder. Exploratory laparotomy with excision of broad ligament fibroid of 9 Kg with total abdominal hysterectomy with right salpingo-oophorectomy was done.
  3 4,636 231
ORIGINAL ARTICLES
Assessment of quality of life in treated patients of cancer cervix
Zakia Rahman, Uma Singh, Sabuhi Qureshi, Nisha , Kirti Srivastav, Anil Nishchal
October-December 2017, 8(4):183-188
DOI:10.4103/jmh.JMH_40_17  PMID:29307981
Aim: The aim of the study was to assess the quality of life (QoL) in women suffering from cancer cervix before and after the treatment, to study various factors affecting the QoL in these women, and to evaluate the impact of treatment modalities on the QoL. Materials and Methods: Women with cervical cancer attending Department of Obstetrics and Gynecology and Department of Radiotherapy who met the eligibility criteria were interviewed with a structured questionnaire of QoL, the European Organization for Research and Treatment of Cancer QLQ30, and its Cervical Cancer Module (Cx24). The baseline observations were recorded when the patient first reported, second evaluation was done at 3 months posttreatment, and the third evaluation at 6 months posttreatment. QoL domains along with sociodemographic and clinicopathological variables were analyzed. Results: A total of ninety patients were included for analysis, of which 5 were lost to follow up. A statistically significant improvement was found in physical, emotional function, pain, fatigue, and vaginal symptoms of the participants; however, there was no significant improvement in social, cognitive, or role functioning, body image, sexual activity, or sexual enjoyment. Vaginal and sexual function worsened significantly. Multivariate analysis showed that young women and those with a higher level of education had better QoL. Stage and type of cancer had little impact on the general QoL, but participants with earlier stage and well-differentiated cancer had better cancer cervix-specific QoL. Conclusion: The QoL of the participants in terms of physical (P = 0.04) and emotional functioning (P = 0.001) improved with treatment. Women with a higher level of education and early stage of disease had better QoL.
  2 4,424 597
CASE REPORTS
Scar endometriosis with rudimentary horn: An unusual and elucidative report of a case diagnosed on histopathology and immunohistochemistry
Varsha Chauhan, Mukta Pujani, Kanika Singh, Raina Chawla, Rashmi Ahuja
October-December 2017, 8(4):196-199
DOI:10.4103/jmh.JMH_69_17  PMID:29307985
Endometriosis is defined as the presence of functioning endometrial tissue outside the endometrial cavity. Scar endometriosis, also known as spontaneous abdominal wall endometriosis, is an unusual clinical presentation which often goes unnoticed. It usually develops after pelvic operations. The incidence has been estimated to be only 0.03%–0.15% of all cases of endometriosis. It can be either asymptomatic or present as abdominal wall pain at the site of surgical incision. It is most commonly diagnosed clinically or on ultrasonography. The treatment of choice predominantly remains surgical excision. We present a case of a 24-year-old female (known case of bicornuate uterus) who presented with chief complaints of abdominal pain for 1 month and 6 months after metroplasty. The patient was clinically diagnosed as a case of scar endometriosis with rudimentary horn and fistulous tract and taken up for surgery. Both the scar tissue and fistulous tract were removed and histopathology revealed only endometrial glands without stroma or hemosiderin-laden macrophages. Diagnosis of scar endometriosis was established on positive immunohistochemistry for estrogen and progesterone receptor in endometrial glands. Timely diagnosis and surgical excision of scar endometriosis along with close follow-up are necessary to prevent complications and recurrence.
  1 3,710 250
ORIGINAL ARTICLES
Uterine prolapse: Should hysterectomy specimens be subjected for histopathological examination?
Rupali Awale, Roma Isaacs, Shavinder Singh, Kavita Mandrelle
October-December 2017, 8(4):179-182
DOI:10.4103/jmh.JMH_80_17  PMID:29307980
Context: Uterine prolapse accounts for one of the common gynecological problems in India. The excised uterus is not expected to have any pathological finding other than atrophic endometrium and may be an ulcer because of the prolapse. Aims: The aim of this study is to assess the hysterectomy specimen for unsuspected pathology. Subjects and Methods: The study is done over two and half years at a tertiary care hospital. Hysterectomy specimens done with a clinical indication of prolapse were included in the study. Histopathological examination done, findings noted, and data analyzed. Statistical Analysis Used: Descriptive analysis was used in this study. Results: Of the total hysterectomy specimens, 55 (6%) were done for uterovaginal prolapse. Patients age ranged from 32 to 78 years; mean 51.1 ± 11.9 years. Majority (46; 83.6%) of the patients were above 40 years of age, whereas only (9; 16.4%) were <40 years of age (P < 0.0001) Vaginal hysterectomy was done in most 38 (69.1%) cases as compared to abdominal hysterectomy in 17 (30.9%) cases (P < 0.001). Adnexae were removed in only 3 (5.5%) cases as compared to 52 (94.5%) cases, in which adnexae were preserved (P < 0.001). Chronic cervicitis was seen in 100% of cases. Majority (18:32.7%) of the endometrium was in atrophic phase, secretory in 8 (14.5%), cystic regressive hyperplasia and chronic endometritis in 4 (7.2%) each. Myometrium was unremarkable in 43 (79%) cases, whereas focal adenomyosis in 12 (21%) cases. All the adnexa received were histologically unremarkable. Conclusions: Grossly unremarkable specimens can have unsuspected histopathological lesion which could be potential premalignant or malignant lesions. Therefore, all hysterectomy specimens should be subjected to the histopathological examination for accurate diagnosis and proper categorization of lesions.
  1 5,067 332
Association between dental health and osteoporosis: A study in South Indian postmenopausal women
Nitin Kapoor, Kripa Elizabeth Cherian, Binay Kumar Pramanik, S Govind, Manna Elizabeth Winford, Sahana Shetty, Nihal Thomas, Thomas Vizhalil Paul
October-December 2017, 8(4):159-162
DOI:10.4103/jmh.JMH_21_17  PMID:29307976
Aim: This study aims to objectively assess the dentition status in South Indian postmenopausal women and compare the dental health of osteoporotic participants with nonosteoporotic individuals. Materials and Methods: A total of 150 consecutive ambulatory South Indian postmenopausal women (>50 years of age) were assessed for their dental health using an internationally validated scoring system. Bone mineral density (BMD) was assessed using a dual-energy X-ray absorptiometry scanner. Results: About 39% of the participants were found to have osteoporosis and 23% had osteopenia at any site. More than half of them (57%) had poor dental health, and the predominant problems were cavities (43.5%) and loss of teeth (75%). Among 112 women who had tooth loss, the mean tooth loss was 4.8. The mean tooth loss among patients with normal BMD was 1.09 ± 1.2, in osteopenia was 2.1 ± 2, and in osteoporosis was 5.4 ± 2.8 (P < 0.01). The odds of having osteoporosis among the patients with three or more tooth loss were found to be 4.2 (95% confidence interval = 2.4–7.3). Conclusion: Postmenopausal women with osteoporosis had significantly higher number of tooth loss. Tooth loss may thus be used as a surrogate marker to predict osteoporosis.
  1 3,809 347
BRIEF COMMUNICATION
Current practices for treatment of uterine fibroids
Shalini Singh, Tanmay Thulkar, Monisha Pawanarkar, Jyoti Thulkar
October-December 2017, 8(4):189-190
DOI:10.4103/jmh.JMH_65_17  PMID:29307982
The treatment of uterine fibroids depends on symptoms of patients, size of the fibroid, desire for future pregnancy, and preference of the treating gynecologist. The present study was undertaken to compare treatment preferences in women desirous and nondesirous of pregnancy by an experienced gynecologist in symptomatic uterine fibroids. Newer medical or minimally invasive treatment modalities are increasingly being used for the treatment of fibroids. However, conventional surgical treatment such as myomectomy and hysterectomy are still preferred by gynecologists.
  - 3,260 312
CASE REPORTS
Early stage adenocarcinoma of cervix with ovarian micrometastasis
Pratibha Singh, Neha Mathur, Suyasha Vyas, Puneet Pareekh
October-December 2017, 8(4):194-195
DOI:10.4103/jmh.JMH_52_17  PMID:29307984
Adenocarcinoma of cervix is a rare malignancy of cervix. It is an aggressive tumor with a high incidence of metastasis. Ovarian metastasis in early stage adenocarcinoma is rare. Metastasis is usually seen when there is some other coexisting finding. In premenopausal patient and low-risk category, ovarian metastasis is very rare. Early stage adenocarcinoma of cervix can rarely present with ovarian metastasis. Thus, radical surgery with oophorectomy is an aggressive but practical approach in these patients but may not warrant removal in all cases. Ovarian metastasis places these patients at a higher stage. The management of these cases is not standardized, and prognosis is generally good.
  - 2,925 206
ORIGINAL ARTICLES
Socioeconomic and reproductive determinants of waist-hip ratio index in menopausal women
Zahra Rastegari, Mahnaz Noroozi, Zamzam Paknahad
October-December 2017, 8(4):170-173
DOI:10.4103/jmh.JMH_48_17  PMID:29307978
Background: Health evaluation is carried out using various anthropometric methods including waist–hip ratio (WHR) index. This method is applied for estimating body fat distribution. This study was aimed to investigate the socioeconomic and reproductive determinants of WHR index in menopausal women. Materials and Methods: For this cross-sectional study, samples were 278 menopausal women in Isfahan, Iran, who were selected by stratified sampling and invited to ten health centers. The data collection tools were a questionnaire and the standard meter tape. Data were analyzed using descriptive and inferential statistical tests. Results: The mean of WHR index was X̄ = 0.9 ± 7.54. There was a significantly statistical relation between age, job, educational status, number of pregnancies and deliveries, age of the first delivery, and WHR index. Conclusion: Based on the results, body fat distribution of menopausal women is of android (central) type. It is suggested that measuring WHR index should be done in menopausal women and also during the postpartum period in specific intervals. Furthermore, women should be familiarized with related factors to this index, and it is recommended to avoid pregnancy and delivery at early ages and repeated pregnancies.
  - 3,469 326
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