Journal of Mid-life Health Journal of Mid-life Health
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   2018| January-March  | Volume 9 | Issue 1  
    Online since March 14, 2018

 
 
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ORIGINAL ARTICLES
A Cross-Sectional Study to Assess and Correlate Osteoporosis and Periodontitis among Postmenopausal Women: A Dual Energy X-Ray Absorptiometry Study
Vaishali Narayan Mashalkar, Girish Suragimath, Sameer Anil Zope, Siddhartha A Varma
January-March 2018, 9(1):2-7
DOI:10.4103/jmh.JMH_39_17  PMID:29628721
Background: Periodontitis and osteoporosis are two diseases found worldwide and increase in intensity with increasing age of the patients. The severity of osteoporosis and periodontitis are found to be more in women during menopause. The aim of this study was to assess and correlate osteoporosis and periodontal disease among post-menopausal women. Materials and Methods: The study consisted of 94 postmenopausal women in the age range of 45–65 years. All the women underwent dual-energy X-ray absorptiometry (DXA) scan to measure bone mineral density (BMD) and were graded as normal, osteopenic, and osteoporotic based on the T score obtained. Data regarding patient's educational level, socioeconomic status (SES), and body mass index (BMI) was recorded. A detailed periodontal examination was carried out using clinical parameters such as oral hygiene index (OHI), plaque Index (PI), probing pocket depth , and clinical attachment loss to check the level of periodontitis. The level of osteoporosis was correlated with the level of periodontitis. Results: The DXA scan revealed that four women were normal, 44 were osteopenic and 46 were osteoporotic. There was no association found between BMD and OHI, PI, educational status, SES, and BMI. Slight periodontitis was observed in eight women, moderate periodontitis in 62, and severe periodontitis in 24 women. Result suggests that there was a statistical correlation between periodontitis and osteoporosis (P = 0.045). Conclusion: There is a definite correlation found between the severity of periodontitis and osteoporosis among postmenopausal women. A close cooperation between general practitioners and dentists in early diagnosis and treatment of both the diseases will reduce the risk and morbidity among postmenopausal women.
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Prevalence of Postmenopausal Symptoms, Its Effect on Quality of Life and Coping in Rural Couple
Radha Shukla, Jaishree Ganjiwale, Rakhee Patel
January-March 2018, 9(1):14-20
DOI:10.4103/jmh.JMH_34_16  PMID:29628723
Aim: Menopause is a physiological process, with potential to lead to various pathological/psychological complications, leading to change in quality of life (QOL). Although literature suggests the effect of menopause on various aspects of life, there is scarcity of studies from rural setup in this regard. Thus, it is essential to assess extent of menopause-related changes, its awareness, and coping mechanisms in rural couple. This study aimed to find the prevalence of postmenopausal symptoms, its severity, and effect on QOL of rural women and the couples' coping mechanisms. Materials and Methodology: A cross-sectional survey was conducted by approaching 250 families from two villages of Gujarat, India. Inclusion criteria were any woman having attained menopause naturally within last 10 years and having her husband available for data collection. Hundred such couples consenting for participation were included in the study. Data on demographic variables, menopause-specific QOL, personal health of women, and coping of the couple were collected. Results: The prevalence of menopausal symptoms was found to be 47%. Mean (standard deviation) age at menopause was 44.9 (4.9) years. The prevalence of at least one symptom related to vasomotor was 21.3%, physical 91.5%, psychosocial 44.7%, and sexual was 0%. “QOL and Bother” analysis revealed that all those with menopausal symptoms also had their QOL affected from mild-to-moderate extent. The husbands of women with menopausal symptoms were aware of their condition; however, neither of them exhibited use of the active coping mechanism. The avoidant emotional coping strategy appeared to be followed by most. Conclusion: Couples were found to be aware of menopause; however, the symptoms arising as consequence of it seem to be accepted as natural age-related changes. This could possibly account for not taking any active coping strategy despite reporting of mild-to-moderate botheration by women and awareness in both. Rigorous health education and awareness about menopausal changes might be beneficial.
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CASE REPORTS
Squamous Cell Carcinoma Arising in Mature Teratoma of the Ovary Masquerading as Abdominal Tuberculosis
Shreeya Taresh Indulkar, Manisha S Khare, Vinaya B Shah, Archana L Khade
January-March 2018, 9(1):44-46
DOI:10.4103/jmh.JMH_81_17  PMID:29628730
Pure squamous cell carcinoma (SCC) of the ovary is rare. SCC can arise in a mature teratoma (MT), ovarian endometriosis or in a Brenner tumor. SCC is the most common malignant transformation arising in MT and comprises 80% of all cases. Such neoplastic transformations are extremely difficult either to predict or detect early. The mechanism of malignant transformation has not been completely understood. Due to the rarity and the aggressive course, diagnosis and treatment constitute a big challenge. We report a case of SCC arising in MT presenting with a huge abdominopelvic mass and abundant peritoneal collections clinically masquerading as abdominal tuberculosis. A review of literature with special emphasis on prognosis and treatment modalities is also presented.
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ORIGINAL ARTICLES
Yoga as a Therapeutic Intervention in the Management of Dysfunctional Uterine Bleeding: A Controlled Pilot Study
Snehal Pankaj Nalgirkar, Suhas Ashok Vinchurkar, Apar Avinash Saoji, Sriloy Mohanty
January-March 2018, 9(1):8-13
DOI:10.4103/jmh.JMH_76_17  PMID:29628722
Background: Dysfunctional uterine bleeding (DUB) is one of the most common gynecological disorders encountered in women during the reproductive age. Yoga therapy has shown promising benefits in several gynecological disorders. Methods: Thirty women between the ages of 20 and 40 years with primary DUB were randomly assigned to a yoga (n = 15) and a waitlist control group (n = 15). Participants in the yoga group received a 3-month yoga module and were assessed for hemoglobin values, endometrial thickness (ET), pictorial blood loss assessment chart (PBAC), State-Trait Anxiety Inventory, perceived stress scale, and Pittsburgh Sleep Quality Index (PSQI) before and after a 3-month follow-up period. Results: At the end of 3 months of intervention, the yoga group, unlike the control group, reported a significant reduction in the anxiety scores (P < 0.05) and perceived stress (P < 0.05). The PSQI scores indicated a reduction in sleep disturbances (P < 0.001) and the need for sleep medications (P < 0.01) and higher global scores (P < 0.001). However, there were no changes in PBAC and ET in both the groups. Conclusion: The results indicate that yoga therapy positively impacts the outcome of DUB by reducing the perceived stress and state anxiety and improving the quality of sleep. This warrants larger clinical trials to validate the findings of this pilot study.
  2 4,485 464
BRIEF COMMUNICATION
Inositols in Midlife
Sanjay Kalra, Bharti Kalra
January-March 2018, 9(1):36-38
DOI:10.4103/jmh.JMH_52_16  PMID:29628727
This review describes the mechanistic, animal, and clinical data related to the use of inositols in midlife. It covers studies related to the mechanism of action of myo-inositol and D-chiro-inositol and randomized controlled trials conducted in postmenopausal women with metabolic syndrome and supports these data with the results of in vitro and animal studies on inositol in nephropathy and other related conditions. Recent advances related to biochemistry, pharmaceutical science, and genetics are discussed. It concludes that inositols have a potential role to play in maintaining metabolic health in postmenopausal women.
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ORIGINAL ARTICLES
Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration
Pratibha Singh
January-March 2018, 9(1):32-35
DOI:10.4103/jmh.JMH_109_17  PMID:29628726
Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. Materials and Methods: We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn) was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic) were used to retrieve data. Results: One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41–45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C) in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Discussion: Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Conclusion: Endometrial aspiration is a simple, safe, and effective method to sample endometrium in cases of AUB avoiding risk of anesthesia and is less time-consuming. Many similar devices are also available in the market and need to be popularized in all parts of the country.
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CASE REPORTS
Breast Abscess Mimicking Breast Carcinoma in Male
Debasis Gochhait, Priyadarshini Dehuri, Sandyya Umamahesweran, Rohan Kamat
January-March 2018, 9(1):39-40
DOI:10.4103/jmh.JMH_78_17  PMID:29628728
Male breast can show almost all pathological entities described in female breast. Inflammatory conditions of the breast in male are not common; however, occasionally, it can be encountered in the form of an abscess. Clinically, gynecomastia always presents as a symmetric unilateral or bilateral lump in the retroareolar region, and any irregular asymmetric lump raises a possibility of malignancy. Radiology should be used as a part of the triple assessment protocol for breast lump along with fine-needle aspiration cytology for definite diagnosis and proper management.
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Xanthogranulomatous Oophoritis Mimicking an Ovarian Neoplasm: A Rare Case Report
Gireesha Rawal, Sufian Zaheer, Indrani Dhawan
January-March 2018, 9(1):41-43
DOI:10.4103/jmh.JMH_111_17  PMID:29628729
Xanthogranulomatous inflammation of female genital tract is uncommon and is usually seen in endometrium. Only a few cases involving the ovary have been reported. Its clinical manifestations, imaging modalities, and gross features can mimic ovarian malignancy. Thus, a preoperative diagnosis of this entity is important to avoid radical surgical treatment. We report a case of xanthogranulomatous oophoritis in a 24 years female, which was clinically and radiologically misdiagnosed as ovarian neoplasm. The approach to such a case and the differential diagnosis has also been discussed.
  - 2,520 201
Myofibroblastoma of the Breast: A Rare Cause of Breast Lump in a Postmenopausal Woman
Yasmeen Khatib, Vinita Pandey, Archana L Khade, Rahul Pandey
January-March 2018, 9(1):47-49
DOI:10.4103/jmh.JMH_59_17  PMID:29628731
A breast mass in a postmenopausal age woman is treated with a high index of clinical suspicion for malignancy. Myofibroblastoma (MFB) of the breast is a very rare benign stromal tumor, predominantly occurring in menopausal women and older men. Owing to its rarity, nonspecific radiology, cytomorphology, and many variants, it can be confused with other malignant and benign breast lesions and hence can be a source of diagnostic pitfall. We present a case of an MFB of the breast in a 55-year-old female, which was detected on a routine screening mammography. Fine-needle aspiration cytology was inconclusive. Final diagnosis was made by histopathology and immunohistochemistry examination. We report this case as the likelihood of encountering MFB has increased in recent years due to routine mammographic screening, and this lesion should be kept in the differential diagnosis of spindle-cell lesions of the breast.
  - 2,654 245
EDITORIAL
Dyslipidemia and Breast Cancer
Neelam Aggarwal, Sudhaa Sharma
January-March 2018, 9(1):1-1
DOI:10.4103/jmh.JMH_24_18  PMID:29628720
  - 2,757 339
ORIGINAL ARTICLES
Magnitude and Correlates of Anemia in Elderly Women of a Resettlement Colony of Delhi
Tulika Singh, S Nagesh, TK Ray
January-March 2018, 9(1):21-25
DOI:10.4103/jmh.JMH_57_17  PMID:29628724
Background: Anemia of any degree contributes significantly to morbidity and mortality and has a significant effect on the quality of life of elderly women. Despite its clinical importance, anemia in the elderly women is underrecognized. Objectives: The objective of this study was to assess the magnitude and correlates of anemia in elderly women of a resettlement colony of Delhi. Materials and Methods: A community-based, cross-sectional study for the duration of 1 year was conducted among 512 geriatric women (≥60 years). Demographic characteristics, dietary assessment, and behavioral risk factors were determined by interview, and the participants underwent physical examination followed by hemoglobin estimation by HemoCue. Anemia was defined using the WHO criteria of hemoglobin <12 g/dl. Chi-square test was employed to study the association between sociodemographic factors and anemia followed by multivariate regression analysis. Results: The prevalence of anemia was 79.9% according to the WHO criteria of hemoglobin <12 g/dl in females. Age, education, marital status, financial dependence, diagnosed chronic disease, diet, calorie intake, history of worm infestation, and body mass index (BMI) were significantly associated with anemia on univariate analysis. In multivariate analysis, age, marital status, financial dependence, diagnosed chronic disease, diet, calorie intake, and BMI were significant explanatory variables for anemia. Conclusion: Our study points out high prevalence of and some of the major factors associated with anemia in elderly women. The need of the hour is to include our elderly women under the gamut of National Anemia Prophylaxis Program.
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Robotic-assisted Sacrocolpopexy with versus without Concomitant Midurethral Sling: A 2-year Follow-up of Urinary Symptoms and Quality of Life
Jeffrey S Schachar, Kathryn S Williams, Harvey A Winkler
January-March 2018, 9(1):26-31
DOI:10.4103/jmh.JMH_64_17  PMID:29628725
Objective: The objective of this study was to assess long-term postoperative urinary incontinence (UI) symptoms and quality of life (QOL) in patients after robotic-assisted sacrocolpopexy (RASC) with or without concomitant midurethral sling (MUS). Materials and Methods: This is a cross-sectional survey of patients comparing long-term postoperative urinary symptoms and QOL measurements in women who underwent RASC with or without MUS. We included all patients from 2011 to 2014 who had RASC with or without MUS. All patients had preoperative urodynamic testing (UDS). Patients who demonstrated stress UI on UDS underwent MUS at the time of RASC. Urinary symptoms and QOL were assessed through the validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) patient questionnaires. Results: Sixty-eight patients met inclusion criteria, 46 patients completed follow-up questionnaires, and were included in the final analysis. Average length of time to follow-up from surgery was 24 months (range: 6–36 months). A statistically significant difference in UDI-6 scores between the two groups (RASC vs. RASC + MUS) was observed. Median (25th and 75th percentiles) scores for UDI-6 were 22.92 (8.33 and 32.29, respectively) for the RASC group and 4.17 (0 and 13.54, respectively) for the RASC + MUS group (P = 0.0017). Median scores for IIQ-7 were 0 (0 and 29.73 for the 25th and 75th percentiles, respectively) for the RASC group and 0 (0 and 0, respectively) for the RASC + MUS group (P = 0.1691). Conclusion: Patients who underwent RASC + MUS scored significantly lower on the UDI-6, indicating fewer urinary distress symptoms. Although not statistically significant, patients in the RASC + MUS group had lower IIQ-7 scores, indicating less negative impact on QOL, compared to the RASC-only group.
  - 2,802 266
RETRACTION
Retraction: Current Concepts in Voiding Dysfunction and Dysfunctional Voiding: A Review from a Urogynaecologist's Perspective

January-March 2018, 9(1):50-50
DOI:10.4103/0976-7800.227258  PMID:29628732
  - 2,068 194
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