With a significant number of women belonging to the status of menopause and beyond, it is imperative to plan a comprehensive health program for them, including lifestyle modifications. Exercise is an integral part of the strategy. The benefits are many, most important being maintenance of muscle mass and thereby the bone mass and strength. The exercise program for postmenopausal women should include the endurance exercise (aerobic), strength exercise and balance exercise; it should aim for two hours and 30 minutes of moderate aerobic activity each week. Every woman should be aware of her target heart rate range and should track the intensity of exercise employing the talk test. Other deep breathing, yoga and stretching exercises can help to manage the stress of life and menopause-related symptoms. Exercises for women with osteoporosis should not include high impact aerobics or activities in which a fall is likely. The women and the treating medical practitioner should also be aware of the warning symptoms and contraindications regarding exercise prescription in women beyond menopause. The role of exercise in hot flashes, however, remains inconclusive. Overall, exercising beyond menopause is the only noncontroversial and beneficial aspect of lifestyle modification and must be opted by all.

Stress urinary incontinence (SUI) has a significant impact on the quality of life for many women. Most women do not seek medical attention for this condition. Treatment for this problem includes initial conservative therapies and then surgery is an option. More than 200 surgical procedures have been described in the literature for the treatment of stress incontinence. The gold-standard surgical treatment of SUI in patients with a mobile bladder neck and normally functioning urethra has been accomplished through a retropubic approach using either a Burch or Marshall-Marchetti-Krantz procedure. By the absolute success of Trans obturator tape (TOT) application in treatment of SUI and the niche it has created for itself in the maze of treatment modalities available for SUI, there seems to be little doubt that TOT is all set to become the new Gold Standard for treatment of SUI in times to come. It is difficult to imagine any further improvements in the midurethral sling procedures or surgeries for SUI. However 10 years ago, no one could have imagined the progress and development that has been seen over these few short years in the treatment of SUI. The future may hold promise in technologies such as stem cells that may be injected in or around the urethral support structures and provide regeneration of the lacking support structures. What so ever, it's definitely time to provide millions of women with knowledge that empowers them to make lifestyle changes to decrease their risk of SUI and to understand the reality that they are not alone if they have SUI.

Background: Limitations in spinal mobility can interfere with the attainment of important functional skills and activities of daily living and restrictions in spinal mobility are usually the earliest and reliable indicator of diseases. Objective : The aim of this study was to determine the differences of lumbar spinal mobility among healthy adults with advancing age. Materials and Methods : The modified Schober's method was used to measure anterior flexion. The guideline of the American Academy of Orthopaedic Surgeons was adapted to measure lateral flexion and extension. Results : The results of this study indicate that spinal mobility decreases with advancing age. The most significant (P < 0.05) differences occurred between the two youngest and the two oldest age categories. Conclusion : Using these data, we developed normative values of spinal mobility for each sex and age group. This study helps the clinicians to understand and correlate the restrictions of lumbar spinal mobility due to age and differentiate the limitations due to disease.

Background: Both hyperglycemia and obesity are known to cause oxidative stress, which leads to many complications associated with diabetes mellitus. A large number of diabetic patients are obese. Glutathione peroxidase (GPx) is an important indicator of level of oxidative stress. Materials and Methods: In the present study, we assessed GPx levels in 20 healthy controls, obese, and nonobese diabetic patients (n=20 each) and analyzed the effect of insulin treatment for 24 and 48 weeks on GPx activity. GPx activity was measured using biochemical method. The GPx activity was also correlated with glycemic status of obese and nonobese diabetic patients [fasting plasma glucose (FPG) levels] after insulin therapy. Statplus software was used for statistical analysis. Results: We found that there is suppression of GPx activity in diabetic patients as compared to healthy controls (70.9 ± 9.6 U/mg protein) and suppression is more in case of obese (23.4 ± 3.8 U/mg protein) than nonobese diabetics (41.5 ± 3.5 U/mg protein). Both obese (26.05 ± 4.03 U/mg protein) and nonobese (48.7 ± 4.8 U/mg protein) diabetics had increase in GPx activity after 24 weeks of insulin treatment. Further, insulin treatment led to improvement in oxidative stress after 48 weeks in both obese (28.4 ± 6.4) as well as nonobese diabetics (51.8 ± 5.4). The nonobese group showed extremely significant (P<0.001) increase in GPx activity after 24 and 48 weeks both, while obese group showed significant (P value<0.05) increase in GPx activity with insulin treatment only after 48 weeks. A negative correlation was found between postinsulin GPx levels and FPG of obese and nonobese diabetics. The correlation was more strong in case of nonobese than obese diabetics. Conclusion: Higher levels of oxidative stress in obese diabetics even after control of hyperglycemia by insulin treatment reflect the importance of obesity in contributing to oxidative stress.

Background: Sexual activity is an important part of the human being's life but this instinct could be influenced by some factors such as diseases, drug using, aging, and menopause. But information about that is limited. Aim: The aim of this study is to determine the status of sexual activity among married menopausal women in Amol, Iran. Materials and Methods: This descriptive analytical study was conducted to describe the sexual activity and sexual dysfunction of women after menopause. Data were collected from health centers in Amol from 280 married women using a questionnaire (self-completed or by interview). Finding: Mean age of subjects were 55.9 ± 6.02 years. 23.4% of subjects reported that their sexual intercourse had been low. 70% of subjects reported a decrease in their sexual activities after menopause. Sexual dysfunctions includes sexual desire disorder 80% arousal dysfunction 80%, orgasmic dysfunction 25%, dyspareunia 55.6%, and lack of sexual satisfaction 43.2%. Conclusion: Findings revealed high percentage of sexual desire disorder and sexual arousal disorder in menopausal women. Therefore, we should have emphasis on counseling and education about sexual activities during the menopause period.

Aim: We undertook this study involving 200 peri- and postmenopausal women to determine the prevalence of osteoporosis, and in turn increase the awareness, education, prevention, and treatment of osteoporosis. Setting and Design: Postgraduate Institute of Medical Education and Research, UT Chandigarh, India, and a clinical study. Materials and Methods: A detailed medical, obstetrical, menstrual, and drug history was recorded in a proforma designated for the study. Height and weight was measured, weight-bearing exercise was assessed, and sunlight exposure per day for each woman was recorded. Food intake was estimated by using the 24-hour dietary recall method, and calcium and vitamin D consumption pattern was assessed. Bone mineral density (BMD) at postero-anterior lumbar spine and dual femurs was assessed by densitometer. Women were classified according to the WHO criteria. Statistical Analysis Used: Student's t-test, multiple logistic regression analysis. Results: The prevalence of low BMD was found in more than half of this population (53%). The mean age in group I (normal BMD) was found to be 50.56 ± 5.74 years as compared to 52.50 ± 5.94 in group II with low BMD (P=0.02). The two groups were similar with respect to parity, education, socioeconomic status, family history of osteoporosis, hormone replacement therapy, and thyroid disorders. 46.8% of the women in group I and 33% of the women in group II had low physical activity and there was no statistically significant difference in sunlight exposure between the groups. Parity or the number of children and type of menopause was not seen to have much association with low BMD in our study. Lack of exercise and low calcium diet were significantly associated with low BMD. Multiple logistic regression analysis showed that age, exercise, menopause, and low calcium diet acted as significant predictors of low bone density. Conclusion: The findings from the study suggest the need for large community-based studies so that high-risk population can be picked up and early interventions and other life style changes can be instituted if there is delay in implementing national or international health strategies to tackle this increasing global health problem. Strategies to identify and manage low BMD in the primary care setting need to be established and implemented.

A 52-year-old patient presented with complaints of menorrhagia. Endometrial biopsy revealed simple hyperplasia of the endometrium. Total abdominal hysterectomy with bilateral oophorectomy was carried out. The ovaries looked grossly normal, but histopathology reported granulosa cell tumor of the right ovary. Granulosa cell tumors belong to the sexcord stromal category and account for approximately 2% of all ovarian tumors. We review the features and treatment of granulosa cell tumors and the importance of screening for ovarian tumors in a case of endometrial hyperplasia and delayed menopause.

Basal cell carcinoma (BCC) of the breast is a rare occurrence. To the best of our knowledge, only 34 cases of this rare malignancy have been reported worldwide. We report the case of a 48 year old lady who presented with history of rapid enlargement of a nevus over breast since three months. On initial examination a diagnosis of melanoma was considered. However the histopathology showed features suggestive of BCC. This case report highlights an atypical presentation of BCC.

Pressure ulcers (PUs) are an important aspect of geriatrics and palliative care that amplifies morbidity of the chronically bed-ridden patients posing a threat to health-care economy and resources. PUs can interfere with functional recovery, may be complicated by pain and infection and can prolong hospital length of stay. Their presence may be a marker of poor overall prognosis and premature mortality. The pathogenesis and progress in the management of PUs is discussed.