Journal of Mid-life Health Journal of Mid-life Health
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   2014| January-March  | Volume 5 | Issue 1  
    Online since February 24, 2014

 
 
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REVIEW ARTICLES
Obesity: Friend or foe for osteoporosis
Sudhaa Sharma, Vishal R Tandon, Shagun Mahajan, Vivek Mahajan, Annil Mahajan
January-March 2014, 5(1):6-9
DOI:10.4103/0976-7800.127782  PMID:24672199
Osteoporosis and obesity are worldwide health problems. Interestingly, both are associated with significant morbidity and mortality. Both the diseases have common linkage as bone marrow mesenchymal stromal cells are the common precursors for both osteoblasts and adipocytes. Aging may shift composition of bone marrow by increasing adipocytes, osteoclast activity, and decreasing osteoblast activity, resulting into osteoporosis. Adipocytes secret leptin, adiponectin, adipsin, as well as proinflammatory cytokines, that contributes in pathogenesis of osteoporosis. This new concept supports the hypothesis, that the positive correlation of weight and body mass index (BMI) with bone mineral density (BMD) is not confirmed by large population-based studies. Thus, the previous concept, that obesity is protective for osteoporosis may not stand same as bone marrow fat deposition (adipogenesis) seen in obesity, is detrimental for bone health.
  5 3,145 740
Lifestyle and dietary factors determine age at natural menopause
Shilpa Sapre, Ratna Thakur
January-March 2014, 5(1):3-5
DOI:10.4103/0976-7800.127779  PMID:24672198
A literature search was done using PubMed. The age at natural menopause (ANM) depends on various factors like genetic, environmental, socioeconomic, reproductive, dietary, and lifestyle of which some like nulliparity, vegetarian diet, smoking, high fat intake, cholesterol, and caffeine accelerates; while others like parity, prior use of oral contraceptive pills, and Japanese ethnicity delays the ANM. ANM is an important risk factor for long-term morbidity and mortality; and hence, the need to identify the modifiable risk factors like diet and lifestyle changes. Delayed menopause is associated with increased risk of endometrial and breast cancer, while early ANM enhances the risk for cardiovascular diseases and osteoporosis. The correlation between diet and ANM has not been extensively studied; however, whatever studies have been done till now point towards role of high intake of total calories, fruits, and proteins in delaying the ANM, while high polyunsaturated fat intake accelerates it. The role of dietary soy, total fat, saturated fat, red meat, and dietary fiber in determining the ANM has been controversial and needs further studies to substantiate it. The lifestyle factors like current smoking and vigorous exercise have been significantly associated with early menopause, while moderate alcohol consumption delays the ANM. Large prospective studies are needed to study the association of ANM and other modifiable factors like passive smoking fish consumption, soy, and various types of tea. The knowledge of modifiable determinants of ANM can help in setting up menopausal clinics and initiating health programs specially in developing countries.
  3 3,342 854
ORIGINAL ARTICLES
Vaginal pH: A marker for menopause
Subrat Panda, Ananya Das, Ahanthem Santa Singh, Star Pala
January-March 2014, 5(1):34-37
DOI:10.4103/0976-7800.127789  PMID:24672204
Introduction: Menopause is suspected with age, cessation of menstruation for more than a year and presence of symptoms. The diagnosis of menopause is confirmed by follicle stimulating hormone (FSH) levels >40 IU/L. Few studies have focused on vaginal pH for menopausal diagnosis. It is a simple, non-invasive and inexpensive method for this purpose. Aim of the Study: The following study is to correlate the serum follicle stimulating hormone (FSH) level with vaginal pH estimation in menopause. Materials and Methods: This is a cross-sectional descriptive study conducted in 173 women aged 31-60 years with menopausal symptoms who attended the Menopausal Clinic of our hospital from January 2012 to January 2013. Vaginal pH was measured using pH micro-meter strips and serum FSH levels were measured using immunoassay methods. The data obtained was then analyzed using Statistical Package for the Social Sciences software (version 17) and results were evaluated statistically by the Chi-square and Kappa tests. P 0.05 was considered to be statistically significant. Results: According to our study of the 173 women studied, mean FSH level was 46.5 IU/L and mean vaginal pH was 5.3. If the menopausal hallmark is considered to be vaginal pH >4.5 and serum FSH ≥40 IU/L, the sensitivity of vaginal pH for menopausal diagnosis was 84.9% and of serum FSH is 77.4%, respectively. Conclusion: Vaginal pH is a simple, accurate and cost-effective tool that can be suggested as a suitable and better alternative to serum FSH estimation for the diagnosis of menopause.
  2 2,515 355
VIEW POINT
Alzheimer disease in post-menopausal women: Intervene in the critical window period
Nayer Jamshed, Fouzia Firdaus Ozair, Praveen Aggarwal, Meera Ekka
January-March 2014, 5(1):38-40
DOI:10.4103/0976-7800.127791  PMID:24672205
Alzheimer disease (AD) is a crippling neurodegenerative disorder. It is more common in females after menopause. Estrogen probably has a protective role in cognitive decline. Large amount of research has been carried out to see the benefits of hormone replacement therapy with regards to Alzheimer still its neuroprotective effect is not established. Recent studies suggest a reduced risk of AD and improved cognitive functioning of post-menopausal women who used 17 β-estradiol in the critical period. Use of 17 β-estradiol in young and healthy post-menopausal women yields the maximum benefit when the neurons are intact or neuronal stress has just started. Hence intervention in the critical period is key in the prevention or delay of AD in post-menopausal women.
  2 2,038 377
ORIGINAL ARTICLES
Prognosis of vulval cancer with lymph node status and size of primary lesion: A survival study
Pankaj Deka, Debabrata Barmon, Sushrata Shribastava, Amal Chandra Kataki, JD Sharma, M Bhattacharyya
January-March 2014, 5(1):10-13
DOI:10.4103/0976-7800.127784  PMID:24672200
Introduction: Squamous cell cancer of the vulva is a rare disease with an annual incidence of two to three per 100,000 women. Lymph node metastasis is the most important prognostic factor for the recurrence and survival in vulval carcinoma. Materials and Methods: It is a retrospective study of 18 cases, operated in our institute from 2006 to 2009 and followed up till July, 2012. These patients were divided into two group of node positive and node negative and compared for recurrence and survival. Result: Ten patients had lymph node metastasis and eight had no lymph node metastasis. Recurrence rate was 40% and 12.5% in node positive and negative groups, respectively. Adjuvant radiation when given to node negative bulky tumor showed no recurrence compared to one out of two in the non-irradiated group. Survival was only 25% in node positive recurrent cases. Conclusion: Lymph node positivity added a great risk for future recurrence. Prophylactic radiation in node negative, bulky tumor is helpful.
  1 3,018 309
Effect of life-style modification on postmenopausal overweight and obese Indian women: A randomized controlled 24 weeks preliminary study
Vishal R Tandon, Sudhaa Sharma, Annil Mahajan, Shagun Mahajan
January-March 2014, 5(1):23-28
DOI:10.4103/0976-7800.127787  PMID:24672202
Aim: The aim of the following study is to evaluate the effect of life-style modification on postmenopausal (PM) overweight and obese Indian women in a randomized controlled 24 week study. Materials and Methods: Two groups were formed Group I (n = 30) was designated as intervention (dietary and exercise group) and Group II (n = 24) served as control. Comparison of weight, waist circumference (WC) and body mass index (BMI) were made and compared among two groups at 4, 8, 16 and 24 weeks. Results: Mean age at menopause was 48.35 years versus 49.65 years; mean number of menopausal symptoms were 5.70 ± 1.76 versus 5.10 ± 1.56 and mean duration since menopause was 2.70 versus 2.90 years in Groups I and II respectively. When the effect of Group I and control on weight was compared at 4, 8, 16 and 24 weeks, there was no significant difference between them up to 8 week. At 8 weeks Group I caused a significant decrease in weight (P ≤ 0.05) when compared with control arm and which continued throughout the study period (P < 0.05) at both 16 and 24 weeks. Group I produced a significant reduction in WC from 8 weeks onwards up to 24 weeks (P ≤ 0.05). BMI was statistically significant in Group I and the effect started at 4 th week (P ≤ 0.05) and the differences in BMI reduction were highly significant at 16 th and 24 th weeks (P ≤ 0.001). Conclusion: The results of the present study strongly recommend the life-style management to be incorporated in daily style of postmenopausal women under controlled supervision.
  1 1,641 254
First Indian prospective randomized comparative study evaluating adherence and compliance of postmenopausal osteoporotic patients for daily alendronate, weekly risedronate and monthly ibandronate regimens of bisphosphonates
Vishal R Tandon, Sudhaa Sharma, Shagun Mahajan, Annil Mahajan, Vijay Khajuria, Zahid Gillani
January-March 2014, 5(1):29-33
DOI:10.4103/0976-7800.127788  PMID:24672203
Aim: The aim of the following study is to evaluate adherence and compliance of postmenopausal osteoporotic patients for different regimens of bisphosphonates (BP). Materials and Methods: A prospective observational randomized comparative 1 year study was undertaken to evaluate the adherence/compliance rates of most commonly prescribed daily alendronate (ALN), weekly risedronate (RIS) and monthly ibandronate (IBN) BP regimens. Results: Nearly 40% was the 1 year adherence rate with BP and 41.33% of non-compliance. Whereas, 8.66% was interrupted compliance rate and 6% switched over to other anti-osteoporotic treatment. The three treatment arm did not vary significantly. However, numerically maximum adherence rate of 56% was recorded in monthly BP regimen followed by weekly (36%) and daily regimen (32%). Medication possession rate confirmed on a follow-up visit was maximum with monthly regimen as 84.61% followed by daily (62.5%) and weekly (61.11%) respectively. Average time in days for non-adherence was 48, 56 and 92 day with daily ALN, weekly RIS and monthly IBN regimen respectively. Age, mean age at menopause, demographical profile failed to influence the adherence. Concomitant treatment for co-morbid condition (57.14%), unawareness about osteoporosis (OP) (50%), cost of treatment (45.33%), belief that drugs is for their general disability (39.28%), physician's failure to stress the need and necessary calcium + vitamin D daily requirement (23.80%) each were the most prevalent factors responsible for non-adherence. Intolerance and adverse drug reactions were responsible for only 13.09% and 11.90% of non-adherence. Conclusion: Treatment compliance is poor with daily ALN, weekly RIS and monthly IBN regimen along with calcium and vitamin D3 in Indian paramedical workers suffering OP.
  1 1,748 349
CASE REPORTS
Sarcomatoid carcinoma of the cervix with foci of malignant melanoma
Sushruta Shrivastava, Debabrata Barmon, Pankaj Deka, Amal Ch. Kataki, Binoy Kumar Choudhary
January-March 2014, 5(1):41-44
DOI:10.4103/0976-7800.127792  PMID:24672206
Introduction: Sarcomatoid squamous cell carcinoma (SSCC) is a rare malignancy of the cervix. Until date around eighteen cases of SSCC have been reported in the literature. It is an aggressive tumor with poor prognosis. The tumor usually presents at an advanced stage. Similarly, primary melanomas of the uterine cervix are rare tumors with not more than 60 cases reported in the world literature. It also has a poor prognosis. There is no reported case of sarcomatoid carcinoma with malignant melanoma. Here, we are presenting a rare case of cervical carcinoma with histopathology suggestive of SSCC with foci of malignant melanoma proven by immunohistochemistry study. Case Report: The present case report is about a 42-year-old, Mrs. SR, P 5 L 3 D 1 A 1 , presented with the complaints of intermittent bleeding per vaginum since last 3 years and severe pain in the right lower limb since 1 month. On examination, there was a proliferative growth in the cervix. Her magnetic resonance imaging (MRI) showed cervical mass lesion with right parametrial extension invading the right ureter and bladder wall causing hydroureteronephrosis with contiguous bilateral pelvic nodes. There were multiple lesions in the left femur. Diagnosis of carcinoma of cervix International Federation of Gynecology and Obstetrics stage IIIB with distant metastasis was made. Histopathology report was suggestive of sarcomatoid carcinoma with foci of melanocytic melanoma. She was planned to be treated with palliative radiation. Discussion: About 90% of cervical carcinomas are squamous cell carcinoma. Adenocarcinoma constitute about 3-4% of all cervical carcinomas. Other rare pathologies are lymphoma, melanoma, sarcoma and metastatic tumors. Our case is a rare combination of sarcomatoid carcinoma with foci of malignant melanoma of cervix.
  - 1,392 258
Bladder neck leiomyoma presenting with acute retention of urine in an elderly female
Santosh Kumar Agrawal, Pallavi Agrawal, Shweta Paliwal, Chandrajeet Yadav
January-March 2014, 5(1):45-48
DOI:10.4103/0976-7800.127793  PMID:24672207
Acute painful retention of urine in a female is uncommon presentations. Bladder neck tumor presenting as acute painful retentions is rare clinical scenario. We present a case of the urinary bladder neck leiomyoma in a 45-year-old peri-menopausal female who presented with acute painful retention of urine without prior history of lower urinary tract symptoms. Patient was managed with cystoscopy and transurethral endoscopic resection of the tumor.
  - 2,151 224
EDITORIAL
Obesity, sarcopenia and postmenopausal osteoporosis: An interlinked triad!
Rama Vaidya
January-March 2014, 5(1):1-2
DOI:10.4103/0976-7800.127778  PMID:24672197
  - 1,895 492
LETTER TO EDITOR
Commentary on following of Menopausal Guidelines by practitioners in Indian setting
Sagar Borker, Shruthi Bhat
January-March 2014, 5(1):49-50
DOI:10.4103/0976-7800.127795  PMID:24672208
  - 1,156 164
ORIGINAL ARTICLES
Polymerase chain reaction and deoxyribonucleic acid-sequencing based study on distribution of human papillomavirus 16/18 among histopathological types of cervical intra-epithelial neoplasia and primary invasive cervical carcinoma: A scenario in North Bengal, India
Prithwijit Ghosh, Damayanti Das Ghosh, Amita Majumdar (Giri), Sharmila Sengupta, Chandana Das, Indranil Mukhopadhyay
January-March 2014, 5(1):14-22
DOI:10.4103/0976-7800.127786  PMID:24672201
Introduction: Human papillomavirus (HPV) types 16/18 are reportedly most common in cervical cancer (CaCx) with geographical variation of genotypes. HPV16 predominates both in squamous cell carcinoma (SCC) and adenocarcinoma in India, contrary to reported global predominance of HPV18 in the latter. Our study was aimed to determine the occurrence of HPV16/18 among histopathological types of cervical intra-epithelial neoplasia (CIN) and invasive CaCx from North Bengal, India and to identify any major deviation from the known Indian scenario of distribution of HPV16/18 genotypes in cases of SCC and adenocarcinoma. Materials and Methods: This was a retrospective, cross-sectional, case-only type of study, in which 40 cases were histopathologically diagnosed as CIN/CaCx, on which polymerase chain reaction (PCR), deoxyribonucleic acid (DNA)-sequencing and bioinformatics by basic search local alignment tool were performed for HPV-genotyping. Statistical Analysis: The distribution of HPV genotypes among cases of SCC and adenocarcinoma was compared by Fisher's exact-test. Results: HPV was detected in 97.5% (39/40) cases. HPV16-infected cases (32/39; 82.05%) predominated over HPV18-infected ones (7/39; 17.95%). However, HPV18-only infection was significantly (P = 0.0045, one-sided Fisher's exact test) more among adenocarcinoma (3/4; 75%) than SCC (2/26; 7.69%) contrary to HPV16-only infection (SCC = 24/26, 92.31%; adenocarcinoma = 1/4; 25%) whereas both CIN3 cases were HPV16-positive. Conclusion: Predominance of HPV18 over HPV16 in cases of adenocarcinoma in this region was contrasting to that of earlier Indian studies suggesting research on HPV18 related cervical carcinogenesis. PCR and DNA-sequencing could prove to be highly effective tools in HPV detection and genotyping. The study reported HPV16/18 infection in almost 98% of the cases, the knowledge about which might prove useful in future population based studies on HPV genotyping and designing of appropriate HPV-vaccines for this region.
  - 2,413 323
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