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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

In benign prostatic hyperplasia (BPH) there will be a sudden impact on overall quality of life of patient. This disease occurs normally at the age of 40 or above and also is associated with sexual dysfunction. Thus, there is a need of update on current medications of this disease. The presented review provides information on medications available for BPH. Phytotherapies with some improvements in BPH are also included. Relevant articles were identified through a search of the English-language literature indexed on MEDLINE, PUBMED, Sciencedirect and the proceedings of scientific meetings. The search terms were BPH, medications for BPH, drugs for BPH, combination therapies for BPH, Phytotherapies for BPH, Ayurveda and BPH, BPH treatments in Ayurveda. Medications including watchful waitings, Alpha one adrenoreceptor blockers, 5-alpha reductase inhibitors, combination therapies including tamsulosin-dutasteride, doxazosin-finasteride, terazosin-finasteride, tolterodine-tamsulosin and rofecoxib-finasteride were found. Herbal remedies such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSP), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa Repens, pumpkin extract and Lepidium meyenii (Red Maca) have some improvements on BPH are included. Other than these discussions on Ayurvedic medications, TURP and minimally invasive therapies (MITs) are also included. Recent advancements in terms of newly synthesized molecules are also discussed. Specific alpha one adrenoreceptor blockers such as tamsulosin and alfuzosin will remain preferred choice of urologists for symptom relief. Medications with combination therapies are still needs more investigation to establish as preference in initial stage for fast symptom relief reduced prostate growth and obviously reduce need for BPH-related surgery. Due to lack of proper evidence Phytotherapies are not gaining much advantage. MITs and TURP are expensive and are rarely supported by healthcare systems.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objective: To determine the prevalence of premenstrual cyclic symptoms in perimenopausal age. Subjects and Methods: Women attending Bhavan's SPARC Maitreyi's Health Care Programme (HCP) for women around 40 years of age were included in the study. Last 200 women who attended from April 2002 to October 2004 are included for analysis. Out of these 107 qualified for final analysis as others were post hysterectomy or post menopausal. Thirty five symptoms listed under premenstrual tension syndrome were analysed. Results: Forty one women (38.3%) had 3 or more symptoms whilst 15 (14.0%) had 5 or more cyclic symptoms. Five women (4.7%) reported that the symptoms were severe. Eleven women had seeked treatment for premenstrual tension syndrome (PMTS). The commonest symptom was mastalgia or heaviness of breasts. Next was whilst also was reported by several women. Women reported anger attacks and reported depression. Conclusion: PMTS was common between 36 and 55 years. About half of them have experienced 3 more symptoms and 1 in 20 may require treatment.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Bladder outlet obstruction in females remains a poorly understood condition and is much rarer as compared to males. More difficult is the objective diagnosis of this condition. There is no general agreement on the Urodynamic parameters to define the condition with certainty. A number of conditions are involved particularly in urinary retention in females are not completely understood. Besides, external sphincter dysfunction and post surgical retentions add another group of conditions which are distinct from retentions seen in the males. This article takes a review of various aetiological factors of Bladder outlet obstruction in women. An attempt is made to standardise the Urodynamic parameters for use in females, based on our data and experimentation on the models of the bladder and urethra. This article also takes a review of uncommon conditions such as Fowler's syndrome which often complicate evaluation of this condition.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Background: Dual-energy X-ray absorptiometry is presently considered the gold standard for measuring bone mineral density (BMD). The International Osteoporosis Foundation and World Health Organization have recommended National Health and Nutrition Examination Survey III database values for women aged 20-29 years to be followed as reference BMD values worldwide. However, the BMD may differ for different populations. Objective: The objective of the present study was to plot BMD values in the hip (neck) and lumbar spine (L1-L4 AP view) in Indian women aged 20-80 years. Also, BMD values in the 20-60-year-old females were compared with reference American/European population. Result: It was found that the BMD of Indian females was 1.5-2 standard deviation (SD) s lower than that of the reference Western population in all the comparative age groups. Conclusion: It is reasonable to conclude that BMD values of the hip and spine among comparative Indian and Western female age groups show significant differences. Hence, different normals should be followed for each population.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Urogenital infections are one of the most common causes for a woman to visit a gynecologist or a urologist. The well-known association between abnormal vaginal microbial flora and its formidable risk in the increased incidence of urinary tract infection underscores the importance of understanding the microbial flora and the efforts needed to maintain it, for ensuring urogenital health. Surprisingly in spite of the increased incidence urogenital infections receive very less attention from the medical fraternity. Growing awareness among people and newer advances in the medical field has brought them into the limelight. The importance of replenishing these depleting commensals with 'probiotics' has resurfaced in a big way. As the days go by science and medicines will touch new milestones, which will include probiotics. The value of a probiotics cannot be taken at face value. Probiotics must not be considered a panacea for treating urogenital infections. However, the available data promises that it will be a strong option in improving and maintaining urogenital health.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Brenner tumor is a rare ovarian tumor that is a part of the surface epithelial group of ovarian neoplasm. It is usually asymptomatic and most of the times it is an incidental pathological finding. Here we present a case of benign Brenner tumor of ovary treated surgically.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

The prevalence of osteoporosis in India is high and osteoporotic fractures are thought to occur early in Indian women. The aim was to study the prevalence of osteopenia and osteoporosis in women aged above 40 years. Women aged above 40 years attending the out patient department of this hospital were offered bone densitometry. A significant positive correlation was found between age and time since menopause and bone mineral density (BMD). Differences in the prevalence of osteoporosis were noted on the basis of socioeconomic strata. There was no statistically significant difference observed in BMD for many of the other accepted risk factors such as age at menarche, lactation, and exercise.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Aim: The present observational, cross-sectional prospective study was conducted during the period of 1 year in one of the rural health centers to study prevalence of conventional cardiovascular disease risk factors (CVRFs) in postmenopausal women. Materials and Methods: Five hundred consecutive postmenopausal women were screened for detailed information regarding common menopausal symptoms, the presence or absence of conventional CVRFs. Physical activity was measured, and dietary lifestyle was also assessed. Use of hormone replacement therapy (HRT) and other drugs were also noted. Knowledge regarding their menopause was also evaluated. Results: Mean age at menopause was 49.35 years, Mean number of menopausal symptoms was 6.70 ± 5.76, and mean duration since menopause was (MDSM = 4.70 years)). Fatigue, lack of energy (70%), cold hand and feet, rheumatology-related symptoms (60%) cold sweats, weight gain, irritability, and nervousness (50%), palpitation of heart, excitable/anxiety (30%) each were common complaints. Hypertension was diagnosed or a person was a known hypertensive (56%). Diabetes was diagnosed or a person was known diabetic in 21%, and BMI was found to be 25 kg/m ² in 78%. Truncal obesity with waist-hip ratio >0.8 in 68% females, whereas abdominal obesity with waist size >88 cm was in 60% women. Dyslipidemia was seen in 39%. It was defined by the presence of high TC (=200 mg/dL) in 30%, high LDL-c (=130 mg/dL) in 27%, low HDLc (<40 mg/dL) in 21% or high TG (=150 mg/dL) in 31%. Metabolic syndrome was present in 13% of cases. CRP was found positive in 12 out of 39 total evaluated women, and serum uric acid was found >6.5 mg/dL in 4%. Smoking (0.5%), alcohol (0%,), tobacco chewing (4%), and family history of premature heart disease (9%) were recorded. Lifestyle was active in 35%, hectic in 10%, and sedentary in 55% of postmenopausal women (PMWs). Only 5% of women were receiving HRT, 0.5% isoflavone-containing phytoestrogens, 0.4% tibolone, 24% anti-HT, 9% anti-diabetic, 8% lipid-lowering drugs, and only three patients were on anti-obesity along with dietary and lifestyle management. Out of 68 patients, who were advised for electrocardiography (ECG), 23 were found positive for ischemic changes on ECG and out of 12 women advised for treadmill test (TMT), only four were found positive for ischemic heart disease (IHD). Risk factor count of more than four was found in 11%. Over all 96% of women were affected by menopause or related problems. Only 9% were aware about their menopause, 3% for importance of lifestyle modification, weight and dietary management programs to ameliorate menopause or menopause-compounded CVRFs. Conclusion: This study showed alarmingly high prevalence of most of the conventional CVRFs, especially diabetes, hypertension, dyslipidemia, obesity, and other risk factors in postmenopausal women from rural areas.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Objectives: This study was designed to assess the effectiveness of self-administered osteoporosis risk score sheet, body mass index (BMI), and bone mineral density (BMD) (ultrasound) in screening females with low bone mass, and how the results of the tools correlate with each other. Materials and Methods: The study was conducted on 536 postmenopausal women, who attended public awareness camps on Midlife Women Health held at the Menopause Research Unit, MGMCH, Sitapura, Jaipur. At these camps, in addition to several informational sessions on issues related to menopause, ultrasonic measurement of BMD was conducted on each participant. A broad questionnaire to identify midlife health problems was developed, and osteoporosis specific score sheet was designed to be self-administered. Patients were required to complete the osteoporosis specific risk score sheet and women health questionnaire (WHQ). BMI was determined. Statistical analysis was carried out to find the correlation between various variables. Sensitivity and specificity of the each risk score ascertained and cutoff risk score for identifying osteopenia was derived by comparing area under curve of each risk score on drawing receiver operational curve (ROC). Results: Sensitivity of risk score system was calculated to be 78.33% with 95% confidence interval being 73.24-82.86% and specificity was 27.12% with 95% confidence interval being 21.56-33.27%, keeping the cutoff point at nine. There was statistically significant inverse relationship between risk score and BMD values with Pearson correlation coefficient of (-) 0.22 and positive relationship between BMD and BMI with correlation coefficient of 0.192. Conclusion: By noting down the risk factors and BMI, we can screen out the women who require further evaluation and management, thus, it is an effective tool, particularly in developing countries like India, where most of the patients cannot afford expensive DEXA scans, although considered as the gold standard for BMD assessment. With the help of such scoring systems, health resources can be judiciously utilized.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Lipoleiomyomas are uncommon benign neoplasms of uterus and are considered to be a variant of uterine myomas. Their reported incidence varies from 0.03 to 0.2%. Lipoleiomyoma consists of variable proportion of mature lipocytes and smooth muscle cells. These tumors generally occur in asymptomatic obese perimenopausal or menopausal women. We report this case of uterine lipoleiomyoma because of its rarity.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Introduction: Metabolic syndrome (MS) is a cluster of risk factors for future development of type 2 diabetes mellitus and cardiovascular diseases. Menopausal transition with its incidental hormonal changes is considered to contribute to the development of MS. However, age is known to influence MS risk factors. Objective: The present study explores the prevalence of MS in pre- and postmenopausal women from western India. Methods: Four hundred and ninety eight women above 35 years of age, participating in women's health care program were assessed for the prevalence of MS using two criteria- International Diabetes Federation criteria (IDF) and Harmonization (H_MS) criteria. Results: Prevalence of MS amongst postmenopausal women was significantly higher (P < 0.001) than that in premenopausal women by both, IDF (premenopausal 45% and postmenopausal 55%) and H_MS criteria (premenopausal 44% and postmenopausal 56%). However, this significance disappeared when data was adjusted for the confounding variable of age.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

We report a case of a 48-year old lady, who presented with complaints of lower abdominal pain and menorrhagia for the last four months. The patient had undergone bilateral salpingectomy four years back by the Pomeroy technique. Ultrasonography revealed an ovarian cyst on the right side. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and the specimen was sent for histopathological examination. It revealed that the normal mucosa of the tubectomy stump was completely replaced by endometrial tissue. Tubal endometriosis remains an under-recognized entity, due to less extensive routine sampling of the fallopian tubes, and they may be also be associated with other pathologies, as was in the present case.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Introduction: The World Health Organization has declared India as the "diabetic capital" of the world. In controlling of such chronic, mostly asymptomatic disease, patients' role can't be overemphasized. Aims : To assess the level of compliance to anti-diabetic therapies and to ascertain the determinants of non-compliance, if any. Materials and Methods : A cross-sectional observational study was conducted for 3 months in a diabetic clinic of R G Kar Medical College and Hospital, Kolkata. Data were collected by interviewing the patients, examining their prescriptions and laboratory reports and anthropometry after obtaining informed consent. Results : Blood report at the point of data collection revealed controlled glucose homeostasis in 38.93% patients but evaluation of past 3 months report showed only 24.3% had control over hyperglycemia. Glycemic control was seen to be positively related to short duration of disease, compliance to therapies, and high knowledge about diabetes. Compliance to therapies found in 32.22% of study subjects was in turn associated with short duration of disease. House-wives showed poor compliance; insulin treatment with or without oral-anti-diabetic agent showed better compliance. Knowledge of diabetes was significantly high among higher educated; poor among women, house-wives, and rural people. Conclusion : Patient-providers collaboration is to be developed through a patient-centered care model based on the mutual responsibility of both so that each patient is considered in the mesh of his/her other goals of life and helped to promote empowerment to take informed decision for behavioral change conducive to control the disease.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Premature Ovarian Failure (POF) is an important cause of amenorrhoea and infertility. However some women may spontaneously ovulate and conceive. Primary ovarian insufficiency (POI) is thus the preferred term. POF / POI is multifactorial in etiology. Autoimmunity is an important mechanism for accelerated destruction of ovarian follicles. The present review focuses on the role of autoimmunity in the pathophysiology of POI. Antibodies to multiple ovarian antigens have been proposed as markers of ovarian autoimmunity. However, there has been lack of clinically proven sensitive and specific serum tests to confirm autoimmune involvement in POI. The review details recently developed specific test for antiovarian antibodies (AOA) that has enabeled identification of different molecular antigenic targets in the ovary. The application of this specific test for AOA has brought to light the need for screening for autoimmunity prior to patients undergoing IVF technique.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

With increased life expectancy, today, women spend one-third of their life after menopause. Thus more attention is needed towards peri- and post-menopausal symptoms. Estrogen replacement therapy is the most effective treatment, however, it has its own limitations. The present need is to explore new options for the management of menopausal symptoms. Yogic life style is a way of living which aims to improve the body, mind and day to day life of individuals. The most commonly performed Yoga practices are postures (asana), controlled breathing (pranayama), and meditation (dhyana). Yoga has been utilized as a therapeutic tool to achieve positive health and control and cure diseases. The exact mechanism as to how Yoga helps in various disease states is not known. There could be neuro-hormonal pathways with a selective effect in each pathological situation. There have been multiple studies that have combined the many aspects of Yoga into a general Yoga session in order to investigate its effects on menopausal symptoms. Integrated approach of Yoga therapy can improve hot flushes and night sweats. There is increasing evidence suggesting that even the short-term practice of Yoga can decrease both psychological and physiological risk factors for cardiovascular disease (CVD). Studies conclude that our age old therapy, Yoga, is fairly effective in managing menopausal symptoms

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Background: Business executives' lives have become a never-ending race against time, technology, and targets. This race creates tension, which leads to dissatisfaction and frustration and eventually manifests itself as psychological and physiological stress with mental and emotional drain. This modern lifestyle intensifies the stress leading to "excessive tension" and consequent deterioration in "executive efficiency." Objective: To assess emotional intelligent quotient (EQ) in managers undergoing yoga-based Self Management of Excessive Tension (SMET) program. Materials and Methods: 72 managers participated in this study which is of "single group pre-post design." The EQ test developed by Prof N. K. Chadha from University of Delhi was administered as pre and post the 5 days of SMET program. Statistical Analysis: Means, standard deviations, Kolmogorov-Smirnov test, and Wilcoxon signed rank test were used to analyze the data. Results: The data analysis showed 72.02% significant increase (P<0.001) in EQ. Conclusion: The results suggest that participation in a SMET program was associated with improvement in EQ and may have implications for "executive efficiency."

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

The objective of the study was to evaluate the effects of raloxifene and estrogen progesterone (E + P) combination on symptoms, endometrium, and lipid profile in postmenopausal women. Ninety healthy postmenopausal women were enrolled and allocated to three groups namely E + P, raloxifene, and controls. These groups were given 0.625 mg conjugated estrogen and 2.5 mg medroxyprogesterone, 60 mg raloxifene and no therapy, respectively. Symptomatology and lipid profile were evaluated at 3, 6, and 12 months. Endometrial thickness was evaluated at 6 and 12 months, and endometrial biopsy was repeated at 12 months. The demographic profile of the women in the three different groups was comparable. In addition, the symptomatology, lipid profile, mean endometrial thickness, and endometrial biopsy categorization were comparable. E + P and raloxifene were equally effective in improving the postmenopausal symptoms and lipid profile. E + P had stimulatory effect on the endometrium, whereas raloxifene was found to be neutral.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]