Journal of Mid-life Health Journal of Mid-life Health
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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 10 | Issue 2
Page Nos. 55-107

Online since Wednesday, July 3, 2019

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EDITORIAL  

Menopause and cardiovascular disease p. 55
Annil Mahajan, Ranu Patni, Varun Gupta
DOI:10.4103/0976-7800.261983  
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REVIEW ARTICLE Top

Vitamin D status in women with pelvic floor disorders: A meta-analysis of observational studies Highly accessed article p. 57
Zinat Ghanbari, Maryam Karamali, Naghmeh Mirhosseini, Maryam Akbari, Reza Tabrizi, Kamran B Lankarani, Tahereh Eftekhar, Maryam Deldar Pesikhani, Shokoofeh Borzabadi, Zatollah Asemi
DOI:10.4103/jmh.JMH_9_19  
The current evidence regarding the association between vitamin D status and pelvic floor disorder (PFD) are inconclusive. This meta-analysis was aimed to summarize existing data demonstrating the association between Vitamin D status and PFD using published observational studies. All national and international databases including Web of Science, PubMed, Google Scholar, and Scopus were searched up until January 30, 2018, and related published studies retrieved for meta-analysis. The effect sizes of Vitamin D status were presented as standardized mean difference (SMD) with 95% confidence interval (CI), using random-effect models and inverse variance method. The Cochran Q statistic and I2 tests were used to evaluate the heterogeneity across included studies. Seven studies with 3219 women were included our meta-analysis. There was heterogeneity existing among included studies (I2 = 96.4%, P < 0.001), so a random-effect model was used. The findings of this meta-analysis revealed that the mean serum Vitamin D levels in women with PFD were significantly lower than healthy women (SMD −0.60; 95% CI, −1.06, −0.13; P = 0.01). This meta-analysis demonstrates lower levels of serum Vitamin D in women with PFD rather than healthy women. Additional prospective studies regarding the association between Vitamin D status and PFD are required to confirm our findings.
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ORIGINAL ARTICLES Top

Quality of life after hysterectomy and uterus-sparing hysteroscopic management of abnormal uterine bleeding or heavy menstrual bleeding p. 63
Sushma Selvanathan, Neema Acharya, Sonakshi Singhal
DOI:10.4103/jmh.JMH_15_19  
Study Objective: To compare the effect on quality of life (QOL) of uterus-sparing hysteroscopic targeted therapy with that of hysterectomy as therapeutic surgical procedure for heavy menstrual bleeding (HMB). Methods/Methodology: This was a prospective observational study. Setting: Endoscopy unit, Department of Obstetrics and Gynecology, Datta Meghe Institute of Medical Sciences Wardha, Maharashtra, India. Patients: A total of 354 women meeting inclusion and exclusion criteria were included in the study, of which 178 women had undergone hysteroscopic targeted therapy while 176 women had undergone abdominal hysterectomy as surgical treatment for HMB. Interventions: Group I – Hysteroscopic surgical procedure – polypectomy, endometrial resection, myomectomy. Group II – Hysterectomy – abdominal hysterectomy, vaginal hysterectomy, laparoscopic hysterectomy.) Results: Health-related QOL assessed by Short Form 36 questionnaire response score was significantly better for women who underwent hysteroscopic targeted therapy was significantly better at both short-term and long-term follow-up. Conclusions: Both hysteroscopic procedures and hysterectomy when used as therapeutic modality for abnormal uterine bleeding/HMB (AUB/HMB) improve the quality of life when used as therapeutic option, and the improvement in QOL is significantly different at 6 months and 1 year while the improvement in QOL 1 week after surgery is better in hysteroscopy group when compared to hysterectomy group suggesting early improvement in QOL when hysteroscopic therapies are used as treatment modality for surgical management of HMB/AUB.
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Sexual health of postmenopausal women in North India Highly accessed article p. 70
Neelam Jain, Reeti Mehra, Poonam Goel, BS Chavan
DOI:10.4103/jmh.JMH_38_18  
Background: Sexual health is the most important aspect of person's well being, self-esteem and quality of life. Sexual pleasure leads to enhanced conjugal relationships and an overall healthy psychological state. There is paucity of data on sexual health of postmenopausal women. Aims and Objectives: To assess the prevalence and determinants of sexual health in postmenopausal women of North India. Materials and Methods: The study was conducted over a period of 18 months, from January 2016 to June 2017. Standard FSFI-6 questionnaire and various socio-demographic factors were used to analyse the sexual health of 110 menopausal women. Results: 80.9% postmenopausal women reported sexual dysfunction (SD). We found more sexual dysfunction in postmenopausal women with increasing age and increasing duration of menopause. Satisfied past sexual experience, joint family structure, low socioeconomic and education status were found to be important determinants of sexual health of postmenopausal females. Parity, substance use and past medical and gynaecological history of participants and various partner's factors like medical disorders, substance use and sexual disorders showed no association with sexual health in postmenopausal females. Conclusion: Sexuality varies with cultural and social differences across the globe. The prevalence of female sexual dysfunction in our study is much higher because Indian women are suppressed, self conscious, inhibited and hesistant to talk about their sexual problems with health care professionals. Also revalidation of the FSFI tool for Indian population is required. Further studies are needed to evaluate the sexual health in postmenopausal women.
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Study of the efficacy of pipelle biopsy technique to diagnose endometrial diseases in abnormal uterine bleeding p. 75
C Raja Ilavarasi, GS Jyothi, Nanda Kishore Alva
DOI:10.4103/jmh.JMH_109_18  
Background: Pipelle biopsy is ideal for obtaining endometrial sample in outpatient department. It samples only 4% of the endometrial surface and has sensitivity up to 97%. A positive biopsy can avoid inconvenience to a patient, but a nonspecific finding should be interpreted with caution. Thus, the objectives of this study were to analyze the efficacy of pipelle biopsy by adequacy of the sample obtained and also to establish the reliability by comparing the histopathology report obtained by pipelle biopsy with that of the hysterectomy specimen. Materials and Methods: A prospective study conducted at a tertiary care hospital on 104 women with abnormal uterine bleeding (AUB). They were scheduled for pipelle endometrial sampling before hysterectomy. The sensitivity, specificity, negative and positive predictive values, and accuracy of pipelle biopsy in diagnosing various endometrial pathologies were analyzed. The validity of pipelle biopsy was studied for endometrial hyperplasia and carcinoma and their statistical significance was tested. Results: The overall concordance rate was 63.8%. The sensitivity, specificity, positive and negative predictive values, and accuracy of pipelle biopsy for endometrial hyperplasia was 64.2%, 88.8%, 94.1%, 85.5%, and 47.3% and for endometrial carcinoma was 75%, 100%, 100%, 97.9%, and 98%, respectively. The P value for endometrial hyperplasia and carcinoma was 0.001 (statistically significant). Conclusion: Pipelle biopsy is valuable in diagnosing endometrial pathology of AUB cases. It has very high sensitivity and specificity for endometrial malignancies. A hysteroscopic dilatation and curettage is required for definitive diagnosis in cases of polyps and focal endometrial lesions.
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Evaluation of quality of life in type 2 diabetes mellitus patients using quality of life instrument for indian diabetic patients: A cross-sectional study p. 81
Reeni John, Sanjivani Pise, Leena Chaudhari, Prasanna R Deshpande
DOI:10.4103/jmh.JMH_32_18  
Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease with major impact on the quality of life (QoL) in terms of various domains such as social, physical, and mental well-being. Aim: This study aimed to study the factors determining the QoL in T2DM patients. Materials and Methods: A prospective, observational study was conducted in a tertiary care hospital for 6 months. Patients of age ≥18 years and diagnosed with T2DM for ≥6 months (with and without comorbidities) were enrolled for the study. The sociodemographic and clinical characteristics were noted in the self-designed pro forma. The QoL was assessed by the Marathi-translated version of QoL Instrument for Indian Diabetes Patients questionnaire of 34 items and 8 domains. The reliability was validated by Cronbach's alpha. The differences were analyzed by Mann–Whitney U-test and Kruskal–Walis test. Results: Out of 153 T2DM patients, majority were elderly males with mean age of 61.23 ± 11.4 years, married (83%), lower-middle income (57%), urban (51.6%), primary education (46.4%), had diabetes for 5 years or less (42.5%), had positive family history of diabetes (32.6%), and were treated by intensive therapy mainly insulin (41.2%). Statistically significant (P < 0.05) association was found between different domains of QoL and family history, hypertension, body mass index, educational status, marital status, income status, treatment, and complications. The domains of diet satisfaction and general health with the least mean estimates of 7.70 ± 2.62 and 8.25 ± 3.08, respectively, were predominantly affected. Conclusion: QoL is an important parameter in diabetes treatment modality. Different factors affected QoL in diabetics in our study. Further studies are definitely needed for better data generation at national level.
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Comparative diagnostic accuracy of frozen sections and scrape cytology in ovarian neoplasms p. 89
Swati Bhardwaj, Charanjeet Ahluwalia, Amit Kumar Yadav, Sufian Zaheer, Sachin Kolte, Rashmi Arora
DOI:10.4103/jmh.JMH_114_18  
Introduction: Frozen section is a well-established method for providing rapid and accurate intraoperative diagnosis. Cytological techniques such as imprint and scrape cytology and intraoperative fine-needle aspiration cytology are conventionally considered as less accurate alternatives to the frozen section. However, inexperienced hands, scrape cytology has been shown to provide remarkably accurate results comparable to the frozen section. Aims: The aims of this study are as follows: (1) To evaluate the diagnostic utility of scrape cytology in the intraoperative diagnosis of ovarian neoplasms. (2) To compare the accuracy of scrape cytology with frozen section in the intraoperative diagnosis of ovarian neoplasms. Materials and Methods: This study was conducted over a period of 3 years from 2014 to 2017. A total of 60 cases of clinically and radiologically suspected ovarian masses were included in the study. Thirty cases were evaluated using frozen section and 30 cases using scrape cytology alone. The intraoperative diagnosis of both was compared with the final paraffin section histopathology. Results: The diagnostic accuracy of scrape cytology and frozen section in determining a benign and malignant nature of neoplasm was 96% and 100%, respectively. In 93% of cases, scrape cytology enabled correct categorization of the tumor as surface epithelial, germ-cell tumor, sex cord-stromal, or others. Conclusion: Scrape cytology is an adjunct to frozen section for providing an intraoperative diagnosis; however, in resource-poor settings, it can be used as a stand-alone method for aiding intraoperative decision-making.
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CASE REPORTS Top

Capillary hemangioma: A concurrent presentation in ovary and fallopian tube p. 93
Chitra Kalaivanan, Devi Subbarayan, N R. Rajesh Kanna, Sushma Nayar
DOI:10.4103/jmh.JMH_51_18  
Hemangioma of the female genital tract is very uncommon. Histologically, these are predominantly cavernous type, with few capillary and mixed type reported in the literature. Hence, we report a case of concurrent occurrence of capillary hemangioma of the ovary and fallopian tube, an incidental finding.
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Amebic infection of the female genital tract: A report of three cases p. 96
Naga Bharati Musthyala, Shreeya Indulkar, Vinitha Reddy Palwai, M Babaiah, Mirza Athar Ali, Prabhakar Marriapam
DOI:10.4103/jmh.JMH_152_18  
Amebiasis is a common protozoan disease with a worldwide distribution. It is endemic in tropical developing countries, and cases are being detected in subtropical countries as well. It usually presents with intestinal manifestations. An extraintestinal manifestation of this disease, amebic vaginitis and amebic cervicitis, is rare and often misinterpreted clinically as vaginal and cervical carcinoma because of its overall ulcerated and necrotic appearance. Awareness of this rare manifestation is important for preventing unnecessary interventions and for effectively managing the patients with antiamebic treatment. Herewith, we report three cases of amebic vulvovaginitis and cervicitis in elderly women clinically masquerading as carcinomas.
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An unusual case of defecation syncope p. 99
Maureen P Tigga
DOI:10.4103/jmh.JMH_2_19  
Syncope is a common cause for emergency room visitations. The common attributable causes are cardiac or orthostatic factors in a majority of cases; however, situational syncope is a lesser known phenomenon and infrequently described in the literature. Here, we present an unusual case of a 55-year-old woman with recurrent hypotension and bradycardia related to defecation due to an unexpected cause.
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Multifocal superficial rapidly growing postirradiation sarcoma mimicking metastatic carcinoma p. 101
Debasis Gochhait, Priyadarshini Dehuri, Vidhyalakshmi Rangarajan, Neelaiah Siddaraju
DOI:10.4103/jmh.JMH_24_19  
Radiation induced sarcomas (RIS) on cytology is rare however need to be reported as they are histologically distinct from the primary tumor and arise years after completion of the radiotherapy. Fine needle aspiration cytology is mostly indicated in cancer patients suspected of recurrence/metastasis and rarely in secondary tumors post therapy or irradiation. Depending on the morphology and site of occurrence of RIS they can cause diagnostic difficulty with the primary carcinoma or sarcoma that was irradiated. Here we discuss a 49 yr old lady, known and treated case of carcinoma cervix who presented with multiple nodular swellings in the lower back and gluteal region and had clinical impression of metastatic carcinoma. The fine needle aspiration cytology smears revealed pleomorphic spindle shaped cells with abundant mitotic figures. Extensive immunocytochemical work up was done on the smear and cell block which helped to make a final conclusion of radiation induced pleomorphic sarcoma. The diagnosis of a tumor in a proven case of previous malignancy needs consideration of tumors secondary to therapy as well, along with the diagnostic differentials of metastasis or recurrence.
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Angiomyofibroblastoma of the vulva: A rare case report with brief review of literature p. 105
Prita Pradhan, Nageswar Sahu, Kanakalata Dash, Pranati Misra, Urmila Senapati, Sudhanshu Kumar Rath
DOI:10.4103/jmh.JMH_156_18  
Angiomyofibroblastoma is an unusual tumor of pelvic and vulval region. It is often diagnosed in the middle-aged women. Although benign owing to its location and morphology, it has a few benign and malignant mimics. Here, we present such a case where a 42-year-old female presented with a vulval mass.
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