Journal of Mid-life Health Journal of Mid-life Health
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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 11 | Issue 1
Page Nos. 1-50

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EDITORIAL  

Adieu p. 1
Ranu Patni, Annil Mahajan
DOI:10.4103/jmh.JMH_41_20  
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ORIGINAL ARTICLES Top

Comparative study of the effect of resistance exercises versus aerobic exercises in postmenopausal women suffering from insomnia p. 2
Gayatri Karandikar-Agashe, Ronika Agrawal
DOI:10.4103/jmh.JMH_35_19  
Study Objectives: The main objective of the study is to compare the effectiveness of resistance exercises versus aerobic exercises in postmenopausal women suffering from insomnia using the Pittsburgh Sleep Quality Index (PSQI). Materials and Methods: Sixty postmenopausal women with menopause <10 years, suffering from insomnia for >1 month and on no supplementary exercises were recruited and categorized conveniently into two groups of 30 each. Group A received resistance exercises and Group B aerobic exercises. PSQI was used to screen postmenopausal women. Women on hormone replacement therapy, with artificial menopause, with diagnosed osteoporosis (t > 2) were excluded. Group A underwent general strengthening program in the form of closed-chain exercise. Group B received aerobic exercises after calculating target heart rate (HR) using Karvonen's formula in the form of brisk walking three times a week at 30%–60% of HRmax. Results: Paired t-test done to evaluate pre- and postmean values of PSQI for Group A. P < 0.001 which is highly statistically significant. Paired t-test done to evaluate pre- and postmean values of PSQI for Group B. P < 0.001, which is highly statistically significant. Unpaired t-test was carried out to compare the mean difference (pre-post) of PSQI values of both the groups. P < 0.001 which is highly significant. The mean difference of Group A (i.e., 4) is more than the mean difference of Group B (i.e., 2.63) indicating that the intervention of resistance exercises is more effective. Conclusion: Aerobic exercises and resistance exercises, both are effective in reducing insomnia in postmenopausal women, but resistance exercises are more beneficial than aerobic exercises.
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Subclinical hypothyroidism and associated cardiovascular risk factor in perimenopausal females p. 6
Gitanjali Goyal, Lajya Devi Goyal, Heena Singla, Sheenam , Kirti Arora, Harsharan Kaur
DOI:10.4103/jmh.JMH_38_19  
Background: Perimenopause refers to the period around menopause (40-55 years). This includes the period before menopause and the first year after menopause. Perimenopausal age is an important stage in a women's life. Many women are diagnosed with hypothyroidism at midlife. Hypothyroidism - both overt and subclinical are associated with increased risk of CVS diseases. Subclinical hypothyroidism is more important as this stage is usually ignored from treatment point of view and if early intervention is done in SCH worsening of metabolic derangement may be avoided. <bold>Objectives:</bold> The present study was aimed to know the prevalence of subclinical hypothyroidism and associated dyslipidemia in perimenopausal females. <bold>Material and Methods:</bold> In our retrospective study we took 100 perimenopausal females (40-55years) who were investigated for thyroid and lipid profile. Atherogenic indices like TC/HDL-c, LDL-c/HDL-c, TG/HDL-c ratios were calculated from the individual lipid profile parameters. The reference guidelines for lipid profile was according to NCEP ATP III. Result: Subclinical hypothyroidism was found to be present in 18% of perimenopausal females The mean TSH levels were found to be higher in SCH as compared to euthyroid females with a mean value of 7.56±3.54(μIU/ml). Dyslipidemia was seen in patients with SCH. TSH levels were found to be positively correlated with total cholesterol. <bold> Conclusion:</bold> We conclude that subclinical hypothyroidism is present in 18% females of perimenopausal age group. Increased TSH levels are associated with hypertension, hypertriglyceridemia, and elevated TC/HDL-C ratio and non cholesterol HDL. In perimenopausal women the condition is usually underdiagnosed and ignored but subclinical hypothyroidism in these females should be screened and treated timely to decrease the risk of accelerated atherosclerosis and premature coronary artery disease in them.
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Major and minor discordance in dual-energy X-ray absorptiometry diagnosis of osteoporosis – A cross-sectional, population-based, observational study in Indian women p. 12
Tulika Singh, Adarsh Ghosh, Niranjan Khandelwal, Veenu Singla, Madhu Gupta
DOI:10.4103/jmh.JMH_117_19  
Objective: The study objective was to evaluate the presence of major and minor discordance in the diagnosis of osteoporosis in a population-based screening program of Indian women using hip and spine dual-energy X-ray absorptiometry (DEXA). Methods: In this institutional review board-approved study, a population-based screening program was offered to women aged > 40 using a mobile van model. A total of 5708 women underwent DEXA between May 2012 and May 2016 as a population-based, opt-in screening program offered to women as an outreach program. Bone mineral density (BMD) was measured at the hip and spine, which was used to derive T-scores and to determine the prevalence of discordance. Results: The densitometry scores were concordant in 42.50% of the cases, with abnormal bone mineral density, whereas in 54.15% of cases, there was minor discordance and major discordance in 3.35% of cases. Body mass index, weight, age, and postmenopausal status of the patient were important predictors of the presence of discordance. Conclusions: Clinicians and epidemiologists should be prepared for at least five out of every ten women screened to have discordance of the T scores at the two anatomical sites scanned. If there is discordance of BMD in underweight persons or in those with low body mass index, then causes other than physiological discordance should be considered, which may be further evaluated.
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A Prospective study on the incidence of metabolic syndrome in premenopausal and postmenopausal women p. 17
Naina Mehndiratta, Sujata Sharma, Raman Kumar Sharma, Suparna Grover
DOI:10.4103/jmh.JMH_57_19  
Background: Metabolic syndrome is defined as a state of metabolic dysregulation characterized by insulin resistance, a predisposition to Type 2 diabetes mellitus and atherosclerotic vascular disease. The changing hormonal milieu with altered estrogen and testosterone ratio is the cause of metabolic syndrome at menopausal transition. Aims and Objectives: This study was designed to determine the incidence of metabolic syndrome and its various components in premenopausal and postmenopausal women from Punjab. Materials and Methods: This study was conducted on 200 females in the age group of 45–60 years attending outpatient department over a period of 2 years in the Department of Obstetrics and Gynaecology, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar. A detailed history and physical examination were done and recorded on a pro forma. Biochemical assessment comprising fasting blood glucose, triglycerides, and cholesterol was done. Metabolic syndrome was assessed as per the modified NCEP ATP III criteria. Results: Twenty-nine percent women were found to have newly onset metabolic syndrome, the incidence in premenopausal group was 16%, and in postmenopausal group was 42%. Among the components, the incidence of hypertension (58%) was the highest followed by waist circumference (42%). Maximum correlation of metabolic syndrome was found with high-density lipoprotein (odds ratio - 7.250) followed by waist circumference (odds ratio - 7.111). Conclusion: The incidence of metabolic syndrome was found to be higher in postmenopausal women than in premenopausal women. Currently, the need of the hour is lifestyle modification to reduce the emergence of metabolic syndrome and cardiovascular diseases.
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Cardiometabolic risk in pre- and post-menopausal women with special reference to insulin resistance: A cross-sectional study p. 22
Utkarshini Kirtikar, Neha Kajale, Vivek Patwardhan, Vaman Khadilkar, Anuradha Vaman Khadilkar
DOI:10.4103/jmh.JMH_65_19  
Background: Reduced levels of estrogen have been associated with metabolic alterations and increased insulin resistance (IR) in postmenopausal women, thus predisposing them to cardiometabolic risks. The aim of this study was to assess alterations in parameters of cardiometabolic risk in apparently healthy pre- and post-menopausal women and to study the effect of IR on these metabolic parameters. Methods: A cross-sectional study was conducted on randomly selected apparently healthy women (n = 262). These women were categorized as premenopausal (n = 184) and postmenopausal (n = 78). Anthropometric measurements, blood pressure, lipid profile, fasting glucose, and insulin concentrations were estimated on all the participants using standard protocols. Homeostatic model assessment of IR was computed to estimate the level of IR. Results: Most lipid parameters, blood pressure, waist circumference, and fat percentage were significantly higher (P < 0.05) in postmenopausal women than premenopausal women. On subcategorizing women with respect to IR (<3, >3), metabolic parameters (e.g., triglyceride – 104.7 ±53.2 mg/dl, Blood Sugar Level Fasting (BSLF) – 103.3 ± 40.1 mg/dl, and fasting serum insulin – 23 ± 12.3 mIU/L) were also higher (P < 0.001) in premenopausal women having IR >3. Significantly higher low-density lipoprotein (132.7 ± 38.7 mg/dl vs. 114.4 ± 25 mg/dl) and total cholesterol (211.3 ± 40.5 vs. 184.8 ± 29.4 mg/dl) were observed in postmenopausal women with IR >3 (P < 0.05) along with higher BSLF (126.6±54.3 mg/dl**) and fasting insulin levels (22.3 ± 12.1 mIU/L) (P < 0.001). Conclusion: This study reveals that IR may predispose women to increased cardiometabolic risk. Urgent attention needs to be focused toward metabolic health of women.
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Feasibility of laparoscopic hysterectomy in stage iv pelvic endometriosis: Our technique and outcomes p. 27
Devi Balasubramaniam, Kavitha Yogini Duraisamy, Palanivelu Chinnusamy, Swathi Nethaji, Sangeetha Karunanithi
DOI:10.4103/jmh.JMH_69_19  
Context: The definitive surgical treatment of severe endometriosis remains to be hysterectomy whether done by laparoscopy or laparotomy. Aim: The aim of this study was to assess the feasibility and outcome of laparoscopic hysterectomy in severe pelvic endometriosis. Settings and Design: This retrospective study was carried out in a tertiary center over a period of 5 years (January 2013–December 2017). Subjects and Methods: A total of 70 patients who underwent laparoscopic hysterectomy for severe pelvic endometriosis with a score of more than 40, which was defined by the revised American Fertility Society classification, were included in the study. Feasibility of laparoscopic hysterectomy and other clinical parameters such as operative time, blood loss, recurrence of the disease, and need for postoperative medical treatment was analyzed. Results: The mean age of the patients was 43.2 ± 4.56. Majority of the women (62.8%) had dysmenorrhea as the primary complaint, followed by menorrhagia (21.4%). Intraoperatively rectovaginal septum was involved in 95% of the cases with complete obliteration of the pouch of Douglas in 80% of the cases. The ureter was involved in 34% of the cases. The bladder was densely adherent in 71.4% of the patients. There was no conversion to laparotomy in any of these patients and no visceral injuries. The mean duration of surgery was 3 h. The estimated blood loss ranged from 100 to 500 ml. The duration of hospital stay was 2–5 days. There was no recurrence during follow-up in any of these patients. Conclusions: Laparoscopy in experienced hands is feasible and safe even in difficult cases of Stage IV pelvic endometriosis apart from offering superior results.
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BRIEF COMMUNICATION Top

Conservative surgical management of mesh erosion following abdominal sacrocolpopexy p. 34
Shikha Rani, Neha Handa, Poonam Goel, Reeti Mehra
DOI:10.4103/jmh.JMH_41_18  
Abdominal sacrocolpopexy (ASC) provides global support to the prolapsed vault. Hence, it is one of the successful procedures done along with pelvic organ prolapse to prevent future vault prolapse. Mostly, the synthetic mesh is used for the ASC. As, it provides a better strength. However, synthetic meshes are associated with more complications as compared to the autologous graft. Mesh erosion is one of the furious complication with the synthetic meshes. Commonly, these eroded meshes become infected, thus requiring removal. Due to the formation of adhesion and fibrosis around the mesh even the removal of these meshes is difficult. In our institute, we have performed 50 adbominal sacrocolpopexy over the past 9 years. Four mesh erosions had occurred. Two meshes were infected, which responded well to the antibiotics and conservative surgical removal of the mesh.
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CASE REPORTS Top

Incidental finding of microfilariae in cervicovaginal smears on liquid-based cytology - A case report of two cases with review of literature p. 37
Swati Singla, Gaurav Singla, Tanisha Singla, Sachin Kolte
DOI:10.4103/jmh.JMH_17_19  
Filariasis is a vector-borne disease, which is quite common in tropical countries such as India. In India, it is most commonly caused either by Wuchereria bancrofti or Brugia malayi. It can present in any possible site, possibly, because of their ability to migrate along the lymphatics. Very few cases have been reported in the literature where microfilariae have been found in cervicovaginal smears. Most of the cases have been reported on conventional Pap smears. Here, we present two such cases where microfilaria was found as an incidental finding in liquid-based cytology preparation.
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A high-grade undifferentiated endometrial stromal sarcoma presenting as inversion of the uterus: A rare case p. 40
Nalini Sharma, Jaya Mishra, Anusmita Saha, Aranab Kalita
DOI:10.4103/jmh.JMH_75_19  
Endometrial stromal sarcoma (ESS) is a rare malignant tumor that constitutes about 0.2% of all uterine malignancies and 10% of uterine sarcomas. ESS is generally misdiagnosed as leiomyoma or endometrial polyp and typically discovered on histopathological examination postoperatively because of its rarity. Endometrial stromal tumors are composed of cells resembling normal endometrial stroma in its proliferative phase. The histologic diagnosis of the high grade is made if there is a high-grade sarcoma with a high mitotic index and nuclear anaplasia. The mean age of presentation of high-grade endometrial sarcoma is about 61 years with the most common presenting complaint is menorrhagia. The median overall survival for high-grade endometrial sarcoma is 53 months with optimal cytoreduction. A 49-year-old woman P2 L2 presented with nonspecific complaint of discharge and spotting per vaginum. In the present case, the provisional diagnosis by clinical findings as well as imaging was in favor of the inversion of submucous fibroid. Preoperative histopathological examination and immunohistochemistry confirmed the diagnosis of high-grade undifferentiated ESS. Haultain's operation followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. The patient was referred to another center for radiotherapy. From there, she was lost to follow-up. Rarity of endometrial stromal tumor limits the clinician view to diagnose it preoperatively. We were fortunate to have preoperative histopathological diagnosis of ESS. Furthermore, as ESS is rare and undifferentiated stromal sarcoma is even rarer, literature is lacking on its optimal management. Hence, it is important for all clinicians to keep the high degree of suspicion for ESS while working up any case of abnormal uterine bleeding.
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A rare case of grade 1 endometrioid adenocarcinoma of the uterus with omental metastasis with brenner tumor of the ovary in a postmenopausal female p. 45
Rashmi Bagga, Rubina Pandit, Pradip Kumar Saha, Jasvinder Kalra, Tanuja Muthyala, Nalini Gupta, Tulika Singh, Bhavna Rai
DOI:10.4103/jmh.JMH_141_18  
Early-stage endometrial cancer may have microscopic omental metastases which is associated with a poor prognosis. There are no standard guidelines for omentectomy in early-stage endometrial cancer without risk factors. Brenner tumor is a rare ovarian tumor which is usually benign, but rarely, it may be malignant. Some Brenner tumors are endocrinologically active. Various studies have shown an association of Brenner tumor with endometrial hyperplasia, polyp, or early-stage carcinoma, probably due to its estrogen-secreting nature. We report a rare case of well-differentiated endometrioid adenocarcinoma of the uterus with <50% myometrial invasion with omental metastases associated with benign Brenner tumor of the ovary in a postmenopausal female.
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LETTER TO EDITOR Top

Fat necrosis of the breast masquerading as malignancy diagnosed on fine-needle aspiration cytology p. 49
Mona A Agnihotri, Kanchan S Kothari, Leena P Naik
DOI:10.4103/jmh.JMH_60_19  
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