Journal of Mid-life Health Journal of Mid-life Health
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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 10 | Issue 3
Page Nos. 111-162

Online since Tuesday, September 17, 2019

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EDITORIAL  

Genitourinary syndrome of menopause p. 111
Ranu Patni
DOI:10.4103/jmh.JMH_125_19  
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LETTER TO EDITOR Top

A letter to the editor p. 114
Lalit K Kothari
DOI:10.4103/jmh.JMH_126_19  
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ORIGINAL ARTICLES Top

Office cervicoscopy versus stationary colposcopy in suspicious cervix: A randomized controlled trial p. 115
Atef Mohammad Darwish, Momen Ahmad Kamel, Kamal Zahran, Mostafa Aboulela
DOI:10.4103/jmh.JMH_135_18  
Study Objective: The objective of the study was to estimate the diagnostic accuracy and doctor satisfaction of small caliber office cervicoscopy versus stationary colposcopy in diagnosis of ectocervical as well as endocervical lesions in women clinically presented with suspicious cervix. Patients and Methods: Eligible 112 cases with clinically suspicious cervix were randomized into Group A (56 cases) and Group B (56 cases) who were subjected to small caliber office cervicoscopy and stationary colposcopy, respectively. The outcome was the diagnostic accuracy and safety of both tools for detection of ectocervical and endocervical cervical lesions. Results: There was no statistically significant difference between both groups regarding parity, previous abortion, age at marriage, duration of marriage, and age at menarche and menopause. On unaided naked eye examination of the cervix (UNEE), there were no statistically significant differences between both groups. Diagnostic indices were similar in both groups apart from the finding that office cervicoscopy was more sensitive for detection of endocervical abnormalities. Doctors were significantly more satisfied with stationary colposcopy than office cervicoscopy. Conclusions: Office cervicoscopy is a good complementary tool added to stationary colposcopy for detection of cervical lesions in cases with suspicious cervix as an example of high-risk group for cervical cancer. Due to its small caliber, cervicoscopy offers a better evaluation of the endocervical canal, especially in cases of Type 2 and 3 transformation zone with a possibility of examination of the endometrial cavity.
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Assessment of poor functional status and its predictors among the elderly in a rural area of West Bengal p. 123
Jayeeta Burman, Sembagamuthu Sembiah, Aparajita Dasgupta, Bobby Paul, Neeraj Pawar, Adrija Roy
DOI:10.4103/jmh.JMH_154_18  
Context: Functional ability considered a proxy for healthy aging, not only related to mental and physical health but it also determines social well-being. Eliciting the determinants of functionality components among the elderly will assist in evolving with appropriate plans at both domiciliary and facility level to eliminate their sufferings and disabilities. Aim: The aim of this study is to find out the magnitude of poor functional status among the elderly and its predictors. Materials and Methods: This is a community-based cross-sectional study conducted among 246 geriatric people in a rural area of West Bengal from August 2017 to December 2017; data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Logistic regression analysis was performed to find out the factors associated with poor functional status (activities of daily living [ADL] and instrumental ADL [IADL]). Results: The study concluded that 32.4% and 59.3% were dependent for basic ADL and IADL, respectively. Binary logistics showed people aged >70 years, female gender, less than primary level education, widowed/separated, who lived in the joint family, poorest percentile of economic status, who were depressed and who suffered from multimorbidity had increased odds of dependency for ADL and IADL. In multivariate logit regression, age >70 years and depression remained significant for ADL; in addition, marital status, education, and family type remained significant for IADL. Conclusion: There should be a provision for community-based comprehensive geriatric health and disability assessment, as it enables older people to avert the illness at the early stage, to delay the onset of disabling diseases. This will ensure their participation in the upliftment of the society, and they thus will be less dependent on their progeny.
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Urogynecology service at a district general hospital in the United Kingdom – Changing needs or a better understanding? p. 131
Farah Wali Lone, Ainharan Raveendran
DOI:10.4103/jmh.JMH_50_18  
Context: The urogynecological problems in women increase with age. The National Health Services (NHS) is experiencing an increase in the demand for and costs of health and social care for women in midlife. It is a relatively new subspecialty which requires a holistic approach to a patient symptoms and expert skills to overcome demands from aging female population and fulfilling patient expectations. Aims: The aim of the study was to analyze the referral pattern in relation to urogynecological symptoms referred to district general hospital in the United Kingdom and in turn to understand the gravity of the situation for improving the care of these women. Subjects and Methods: This was a retrospective study of case notes of women attending the gynecological outpatient clinic led by an urogynecology subspecialist at district general hospital in the United Kingdom having attended the clinic with symptoms suggestive of pelvic floor dysfunction. Results: We identified 777 women who attended the clinic with symptoms of pelvic floor dysfunction. The most frequently stated reason for referral was pelvic organ prolapse, followed by primary urinary incontinence. Majority of the patients (44%) had prolapse at diagnosis and 26% of the patients had multiple symptoms related to pelvic floor dysfunction after a urogynecologist's consultation, 5% of the patients had combined symptoms diagnosed at urogynaecology clinic. Majority of the referrals were from the general practitioners (43%). Conclusions: The study revealed that health practitioner referring the women needs better understanding of the urogynecological symptoms and with a better understanding and a thorough symptom treatment can be initiated for various symptoms at the same time. This allows patients' multiple symptoms improvement, avoids repeat referrals from primary care, avoids repeat visits to the clinics, avoids repeat interventions, and improves patients' satisfaction and therefore saves NHS resources.
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Utility of trucut biopsy in diagnosing phyllodes tumor p. 135
Dimple Chaudhary, Vishal Singh, Varuna Mallya, Shramana Mandal, Nita Khurana, Rajdeep Singh
DOI:10.4103/jmh.JMH_146_18  
Breast phyllodes are rare fibroepithelial neoplasms. Various classifications adopted to grade them into benign, borderline and malignant but the presently used one is the WHO classification of 2012. Trucut biopsy is a sensitive prediagnostic tool to grade phyllodes. But features can sometimes be overlapping making it difficult to grade it. In this study, an effort has been made to compare the morphology of trucut and histolopathology specimens. Sensitivity of the trucut bopsy in diagnosing benign and malignant phyllodes is calculated and is being compared with other studies. Hence due to varied morphological features sole diagnosis should not be based on trucut biopsy.
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Comparative efficacy and safety of escitalopram versus desvenlafaxine in postmenopausal women with depression and anxiety: A randomized, open-label, comparative trial p. 141
Sonia Shinde Mahajan, Vishal R Tandon, Manu Arora, Annil Mahajan, Suman Kotwal
DOI:10.4103/jmh.JMH_139_18  
Aims and Objectives: The aim was to evaluate the comparative efficacy and safety of escitalopram versus desvenlafaxine in postmenopausal women with depression and anxiety in our study cohort. Materials and Methods: A randomized, open-label, intention-to-treat, comparative study was conducted over a period of 1 year. Group 1 (n = 20) patients received tablet escitalopram 10 mg once daily orally which was increased to 20 mg/day when needed at the first follow-up. Group 2 (n = 20) patients received tablet desvenlafaxine 50 mg once daily orally which was increased to 100 mg/day when needed at the first follow-up. Patients were followed at 3 and 6 weeks. Primary endpoints were change in baseline scores (recorded as mean ± standard deviation) of Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), and safety was also assessed and compared. Results: Forty patients completed the study. Escitalopram was statistically better than desvenlafaxine in reducing depression after 6 weeks of treatment (P < 0.05). Both the drugs were found to be equally effective in treating anxiety. Furthermore, they showed comparable safety and tolerability. Conclusion: Escitalopram appears to be more effective on short-term basis in treating depression, and both the drugs appear equally effective in combating anxiety. Furthermore, they appear to be equally safe and well tolerated in postmenopausal women with depression and anxiety.
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A clinicopathological correlation of international federation of gynecology and obstetrics's PALM–COEIN classification of abnormal uterine bleeding: Indian scenario p. 147
Kanika Singh, Charu Agarwal, Mukta Pujani, Sujata Raychaudhuri, Nimisha Sharma, Varsha Chauhan, Raina Chawla, Rashmi Ahuja, Mitasha Singh
DOI:10.4103/jmh.JMH_128_18  
Background: Abnormal uterine bleeding (AUB) is a common problem affecting the women of reproductive age group and may also have a significant impact on their physical, social, and emotional aspects directly affecting their quality of life. The International Federation of Gynecology and Obstetrics (FIGO) devised a universally acceptable system of nomenclature and classification, namely PALM–COEIN classification of AUB in the year 2011. The objective of the present study was to analyze the structural (PALM) and functional (COEIN) component of FIGO system in the Indian scenario. Materials and Methods: Three hundred patients with complaints of AUB were taken. A clinical diagnosis according to PALM–COEIN system was made after thorough history and clinical examination. Additional investigations if required were done, and endometrial sampling or hysterectomy was done whichever indicated. A histological diagnosis was made, and each case was allocated a category according to PALM–COEIN classification. A clinicopathological correlation was done in the hysterectomy cases for structural causes (PALM). Results: Leiomyoma (30%) was the most common cause of AUB closely followed by adenomyosis (29.66%) overall. The clinicopathological correlation in hysterectomy cases was good with concordance rate of 85.03%. The concordance between clinical and pathological diagnoses for AUB-L, AUB-A, AUB-M, and AUB-A, L was statistically significant with P < 05 in positive cases. However, additional finding of adenomyosis was diagnosed in 48.2% of the cases apart from primary clinical diagnosis. Conclusion: A good clinicopathological correlation was seen in the cases when classified according to PALM–COEIN classification. The system also provides for consideration of multiple etiologies contributing toward AUB both clinically and histopathologically. However, histopathology remains the cornerstone in establishing the accurate diagnosis as the cases without specific symptoms can be missed clinically.
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CASE REPORTS Top

Microfilaria infection in metastatic node in a case of breast carcinoma p. 153
Subrata Chakraborty, Maitrayee Saha, Sunipa Ghosh Pradhan, Sanchita Biswas
DOI:10.4103/jmh.JMH_5_19  
Filariasis is a major public health problem in tropical and subtropical countries such as India. It is caused by nematodes, principally Wuchereria bancrofti and Brugia malayi and is transmitted by the Culex mosquito. W.bancrofti accounts for 90% of cases of lymphatic filariasis. Filaria of the breast with axillary lymphadenopathy and lymphedema, mimicking breast carcinoma has been previously reported. Microfilariae have also been previously observed as coincidental findings with various inflammatory and neoplastic lesions. Few examples are hemangiomas of the liver, meningiomas, intracranial hemangioblastomas, uterine cervix, pharyngeal, urinary bladder, preputial and metastatic carcinomas, melanomas, and leukemia.Here, we report an unusual case of filarial infection of a metastatic axillary node in a case of invasive breast carcinoma, observed in a modified radical mastectomy specimen. Previous cases reported in literature have reported microfilaria in metastatic axillary node detected on cytology specimens; histological diagnosis, though reported, is rare.
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Pure transitional cell carcinoma of the ovary presenting as bilateral complex cystic masses in a premenopausal woman – Case report and review of literature p. 156
Garima Yadav, Vrushti Solanki, Jyotsna Naresh Bharti, Sushma Bharti, Pratibha Singh, Meenakshi Gothwal
DOI:10.4103/jmh.JMH_66_19  
The understanding of ovarian malignancy pathogenesis has greatly increased with identification of varied genomic mutation profiles, which directs the clinical behavior of the tumors. The present case describes the rare subtype of pure transitional cell carcinoma which is no more included in the newer World Health Organization (WHO) classification as the WHO labels it as a type of high-grade serous ovarian cancer with transitional cell differentiation, although in our case no serous component was identified. Hence, with revised classification of ovarian malignancies, it is important to report all rare subtypes in order to understand their biology and behavior.
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Gossypiboma – A nightmare for surgeon: A rare case with review of literature p. 160
Meenakshi Gothwal, Mahaveer Rodha, Binit Surekha, Pratibha Singh, Garima Yadav, Priyanka Sethi
DOI:10.4103/jmh.JMH_105_18  
Gossypiboma is an uncommon but avoidable condition, which is mostly asymptomatic initially and difficult to diagnose but can cause serious postoperative complications. It is a mass lesion due to surgical sponge or swab if retained in the body after the surgery. Gossypiboma has a vague presentation, and it is difficult to diagnose. In patients with a prior history of surgery having soft-tissue masses or localized pain abdomen, gossypiboma should be included in the differential diagnosis. We are reporting a case of a 33-year-old woman referred to our center with a complaint of vague abdominal pain, mild distension for the past 7 days, and discharge from the stitch line for the past 1 day. After investigation, diagnosis of gossypiboma was made and an exploratory laparotomy was performed to remove the retained surgical mop.
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