Journal of Mid-life Health Journal of Mid-life Health
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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 10 | Issue 4
Page Nos. 163-215

Online since Thursday, December 26, 2019

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EDITORIAL  

Low back pain and menopause p. 163
Annil Mahajan, Ranu Patni, Somnath Verma
DOI:10.4103/jmh.JMH_176_19  PMID:31942150
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REVIEW ARTICLE Top

Weight management module for perimenopausal women: A practical guide for gynecologists p. 165
Sakshi Chopra, K. Aparna Sharma, Piyush Ranjan, Anita Malhotra, Naval K. Vikram, Archana Kumari
DOI:10.4103/jmh.JMH_155_19  PMID:31942151
Menopause has been identified as a high-risk stage for weight gain in a woman's lifecycle. Menopause-related weight gain is a consequence of low circulating estrogen levels due to progressive loss of ovarian function. Moreover, the changes in the hormonal milieu, chronological aging, decline in physical activity coupled with westernized dietary pattern, and recurrent emotional eating episodes associated with psychological distress also contribute to the increase in total body fat and waist circumference. Higher waist circumference is an independent risk factor for cardiovascular and metabolic disease in menopausal women. These obesity-related cardiometabolic risk factors and menopausal symptoms can be effectively managed by achieving clinically significant weight loss through lifestyle modification. Behavioral lifestyle intervention uses behavioral techniques for counseling corrective dietary and physical activity practices in achieving sustainable weight loss outcomes. Majority of menopausal women seek this counseling from gynecologist, especially in primary care settings due to nonavailability of multidisciplinary teams. Thus, the aim of the review is to understand the menopause-obesity link, associated risk factors, and its health-related burden in perimenopausal women to devise a practical women-centric weight management module based on lifestyle modification techniques to address the burden of menopausal obesity in regular gynecological practice.
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ORIGINAL ARTICLES Top

Assessment of quality of life of the elderly living in rural and urban areas of Ambala District: A comparative study p. 173
Anshu Mittal, Anisha Aggarwal, Shefali Nayyar, Ankita Thakral, Harsimranjit Kaur Natt, Arundeep Singh
DOI:10.4103/jmh.JMH_128_19  PMID:31942152
Context: Aging is a natural process which universally affects all the human beings in the society. As the geriatric population is quiet vulnerable, They might suffer from mental and physical disabilities which consequently threatens their independence. Quality of life among the geriatric population is a global concern as it reflects the status of health and of well being among the set population. Aims: To assess the quality of life of elderly living in rural and urban areas and compare the role of socio-demographic factors influencing the quality of life of elderly. Settings and Design: It is a Community based Cross sectional study conducted in urban and rural field practice areas of MMIMSR, Mullana. Methods and Material: Convenience sampling was used. A total of 200 elderly were included in the study. A pretested semi structured questionnaire was used. Statistical Analysis: Data was analysed using SPSS 20.0. Results: According to the sex of the participants, male participants had a higher mean score for QOL as compared to the female participants. Higher mean score was found in each domain for the participants living with their spouses. Conclusions: The quality of life is better among the individuals who do not suffer from any chronic illness'. The health care services should be strengthened to provide for better healthcare to the elderlies for their morbid conditions.
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A clinicopathological evaluation of postmenopausal bleeding and its correlation with risk factors for developing endometrial hyperplasia and cancer: A hospital-based prospective study p. 179
Jasmina Begum, Rupal Samal
DOI:10.4103/jmh.JMH_136_18  PMID:31942153
Objective: The aim of this study is to investigate the clinical data from history and endometrial pathology by endometrial sampling in patients with postmenopausal bleeding and to identify risk factors associated with future development of endometrial cancer (EC). Methods: We prospectively studied 76 postmenopausal women with vaginal bleeding and endometrial thickness (ET) >5 mm undergoing endometrial biopsy or dilatation and curettage. Patient characteristics and endometrial assessment of women with or without EC and hyperplasia were compared. Univariate and multivariate logistic regression identified factors associated with risks of endometrial neoplasia. Results: In this study, the mean age at the time of presentation was 57.17 ± 7.11 years, mean menopausal age was 49.18 ± 3.69 years, and mean thickness of endometrial was 11.13 ± 6.37 mm. The histopathological analysis showed atrophic endometrium (30.3%), proliferative endometrium (27.6%), EC (15.8%), endometrium hyperplasia (11.8%), disordered proliferative endometrium (9.2%), and endometrial polyp (5.3%). Women of EC and hyperplasia group were more likely to be multiparous, diabetic, hypertensive, obese or overweight, has a history of recurrent bleeding episodes or thick endometrium. Using multivariate logistic regression, we found ET (adjusted odds ratio [AOR] = 17.76, confidence interval [CI] 1.91–165.02, P < 0.011, criterion ≥11 mm), recurrent episode of bleeding (AOR = 13.21, CI 1.10–158.91, P < 0.042), diabetes (AOR = 8.03, CI 1.15–55.78, P < 0.035) the best predictors of EC. Conclusion: As clinical characteristics are possible predictors of EC, these should also be taken into account in risk estimations and in the formulation of management plans. This not only has benefit in the process of disease detection but also may result in improved the efficiency of care.
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The role of lifestyle in developing and maintaining vasomotor symptoms: A cross-sectional study among Iranian postmenopausal women p. 184
Mozhgan Hashemzadeh, Afsaneh Keramat, Leila Mollaahmadi, Ashraf Ghiasi, Arezoo Haseli
DOI:10.4103/jmh.JMH_64_19  PMID:31942154
Objective: Lifestyle patterns are not only related to healthy life but also could be related to modifying menopausal symptoms. Considering the lack of data, the present study aimed to evaluate the relationship between lifestyle and vasomotor symptoms among Iranian postmenopausal women. Materials and Methods: The present cross-sectional questionnaire-based study was conducted among 302 eligible postmenopausal women referring to Shahroud health centers (Shahroud, Iran) during June 2017 and October 2018. The Iranian standard questionnaire on women health project (Saba questionnaire) was used for data collection. Our data were analyzed using the SPSS software (version 18). Descriptive statistics, Chi-square test, Fisher's exact test, and multiple logistic regression were used to address sociodemographic characteristics among our participants and the relations between lifestyle and vasomotor symptoms. Results: We found a significant relation between daily dairy units (P = 0.05), daily vegetable units (P = 0.01), weekly use of solid oils (0.01), and hot flush. The relation between daily vegetable units and urinary incontinence was also statistically significant (P = 0.02). When we use multiple logistic regression, we found significant predictive relations between daily vegetable unit status (P = 0.01), weekly use of solid oils (P = 0.04), body mass index (P = 0.03), and hot flush. Conclusion: The study provided findings to support the probable relation between some of lifestyle-related variables and vasomotor symptoms in postmenopausal women.
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Assessment of diagnostic value of Serum Ca-125 and risk of malignancy index scoring in the evaluation of adnexal masses p. 192
Kavita Khoiwal, Anupama Bahadur, Ranjeeta Kumari, Namrata Bhattacharya, Shalinee Rao, Jaya Chaturvedi
DOI:10.4103/jmh.JMH_84_19  PMID:31942155
Introduction: Adnexal masses have a wide spectrum with respect to the age of presentation, signs and symptoms, imaging findings, and histopathology report. Materials and Methods: This is a cross-sectional diagnostic study, conducted at All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. The data were collected from department of gynecology over a period of 1½ years from June 2017 to December 2018. All women who were diagnosed to have an adnexal mass irrespective to age, parity, and menopausal status were included in the study. Ultrasonography of the abdomen with the pelvis was ordered in all patients followed by contrast-enhanced computed tomography or magnetic resonance imaging in selective patients. Tumor markers such as Ca-125 was measured, and risk of malignancy index (RMI) was calculated for each tumor. The clinical and imaging findings were correlated with intra-operative findings and finally with the histopathology examination report. Results: A total of 171 women were included in the study who were diagnosed to have adnexal mass. A total of 137 women (80.1%) had benign tumor (Group B), whereas 34 women (19.9%) were found to have malignant tumor (Group M). Mean age in Group B was 35.85 ± 12.46 and in Group M was 46.12 ± 13.46 (P = 0.001). Ca-125 was significantly higher in Group M (1350 U/ml) than Group B (175 U/ml) (P = 0.008). The RMI score was also found to significantly increased in Group M than Group B (P = 0.007). Conclusion: With respect to adnexal masses, both Ca-125, as well as RMI scoring, are important diagnostic tools. RMI scoring has a better overall diagnostic performance than Ca-125 in predicting malignancy.
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Comparative efficacy and safety of clonazepam versus nortriptyline in restless leg syndrome among forty plus women: A prospective, open-label randomized study p. 197
Roshi , Vishal R. Tandon, Annil Mahajan, Sudhaa Sharma, Vijay Khajuria
DOI:10.4103/jmh.JMH_26_18  PMID:31942156
Aims and Objectives: The aim of this study is to compare the effect of clonazepam and nortriptyline on rate, frequency, and severity of restless leg syndrome (RLS) in above 40 years women suffering from RLS. Materials and Methods: A prospective, randomized, open-label comparative study was conducted at a tertiary care teaching hospital for 1 year. Restless legs syndrome (RLS) diagnosis was based on four essential clinical criteria established by the International RLS Study Group in 2003. Patients were randomized into two groups. Group 1 received tablet clonazepam 0.5 mg bedtime orally daily. Group 2 received tablet nortriptyline 25 mg bedtime orally daily. The primary efficacy endpoints by the International Restless leg Syndrome Scale (IRLS) were evaluated at 0, 4, and 8 weeks. Adverse drug events and safety assessment for vital signs such as blood pressure, pulse, heart rate, waist circumference, and body mass index were compared between two groups. Results: Effect on mean IRLSS was statistically more in clonazepam group in comparison to nortriptyline group with comparable results at 8 weeks (P < 0.001), but at 4 weeks, nortriptyline showed less improvement (P < 0.01) versus P < 0.001 in nortriptyline group. Thus, nortriptyline reported relatively more improvement on IRLSS numerically in comparison to clonazepam. Nortriptyline proved to be statistically better in improving the frequency of RLS with comparison to clonazepam, whereas the results were comparable with regard to rate and the severity of RLS. Both the groups were relatively safe and did not produce any change in biochemical parameters and were free from any serious or severe adverse events and overall, both the treatments were well tolerated. Conclusion: Both the drugs provided clinically and statistical significant effect on RLS when compared with their respective baselines. However, nortriptyline proved to be statistically better in improving the frequency of RLS in comparison to clonazepam, whereas the results were comparable with regard to rate and the severity of RLS on intergroup comparison. Both the drugs were well tolerated.
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CASE REPORTS Top

An unusual presentation of vaginal leiomyoma p. 204
Rahul R. Patil, Nikita R. Vijay, Sulbha Joshi
DOI:10.4103/jmh.JMH_40_19  PMID:31942157
Leiomyomas are classified as benign mesenchymal neoplasms and consist of smooth muscle cells with variable amounts of fibrous stroma. The tumors occur most frequently in the uterus, affecting 20%–30% of women of reproductive age, but vaginal leiomyomas are rare with only around 300 cases reported since the first case was described in 1733. These tumors are thought to arise from Müllerian smooth muscle cells in the subepithelium of the vagina. Here, we present a case of vaginal leiomyoma who presented as left vaginal wall mass.
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Xanthogranulomatous endometritis: A benign uncommon masquerader of malignancy p. 206
Vipra Malik, Debajyoti Chatterjee, Bharti Goel, Navneet Takkar
DOI:10.4103/jmh.JMH_6_18  PMID:31942158
Xanthogranulomatous endometritis is an uncommon benign lesion characterized by the destruction of endometrium and replacement by the sheets of foamy histiocytes, lymphocytes, plasma cells, multinucleated giant cells, fibrosis, calcification, and accompanying polymorphonuclear leukocytes. It is commonly mistaken for malignancy clinicoradiologically, and therefore, histopathological examination is of utmost importance. We report the case of a 61-year-old postmenopausal female who presented with pyometra, bulky uterus, and cervical stenosis, and histopathology revealed XGE.
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A case of high-grade endometrial stromal sarcoma: A poignant allegory p. 209
Shashank Shekhar, Charu Sharma, Poonam Elhence, Shavina Bansal, Neha Garg
DOI:10.4103/jmh.JMH_8_19  PMID:31942159
Endometrial stromal sarcomas (ESS) are rare tumors of endometrial stromal origin that account for approximately 1% of all uterine malignant neoplasms and are responsible for a significant proportion of mortality due to uterine malignancies. There are immense case reports on low-grade ESS, but there is a paucity of data on high-grade ones, probably, because these cases generally present in advanced stages and have a high case fatality rate. Moreover, there have been several refinements in the classification of these tumors. We, herein, provide an update on this topic and discuss the poignant outcome of a case of high-grade ESS.
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An uncommon cause of postmenopausal bleeding p. 213
Geetika Garg, Anju Singh, Bharti Goel, Ranjeev Bhagat
DOI:10.4103/jmh.JMH_17_18  PMID:31942160
A 65-year-old multiparous female was evaluated for postmenopausal bleeding. Imaging was strongly suggestive of malignancy. However, hysteroscopic-guided endometrial biopsy revealed tuberculous endometritis. The patient responded to antitubercular therapy and recovered completely. Genital tuberculosis is typically considered a disease of young women presenting with infertility. However, tuberculous endometritis should be considered in a patient of postmenopausal bleeding, particularly in developing countries. It is a rare, but curable cause of postmenopausal bleeding.
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