Journal of Mid-life Health最新文献

Background: Atherosclerosis is the most common cause of ischemic cardiovascular disease (CVD). However, approximately 20%-40% of cases of acute myocardial infarction (AMI) in patients aged <50 years can be attributed to genetic factors, and coronavirus disease 2019 (COVID-19) is a risk factor for blood clots and AMI. We aimed to describe the clinical, angiographic, and developmental characteristics and COVID-19 severity and vaccination status in patients aged ≤45 years with AMI.

Methods: We retrospectively analyzed 2624 patients with AMI by reviewing the results of coronary angiography and percutaneous coronary intervention and medical reports. The study included patients aged >18 years who met the universal definition of AMI but excluded those with missing medical records or coronary angiograms.

Results: In total, 2624 patients with AMI (aged 18-85 years) were included in the study and divided into two groups based on age: ≤45 (n = 1286) and >45 years (n = 1338). Total cholesterol and triglyceride levels were significantly higher in patients aged ≤45 years (5.6 ± 2.1 and 3.2 ± 2.1 mmol/L, respectively, P < 0.007) than in those aged >45 years (6.3 ± 1.8 and 3.1 ± 2.0 mmol/L, respectively, P < 0.001). Overall, 1745 and 879 patients were unvaccinated and fully vaccinated, respectively; severe and critical COVID-19 infections were more common among unvaccinated patients in both age groups.

Conclusions: Younger patients with AMI were more likely to be smokers with no hypertension, diabetes mellitus, or previous AMI. In contrast, they were more likely to have hypercholesterolemia and hypertriglyceridemia, single-vessel disease, Type C lesions, and a history of drug-eluting stent use.

Genitourinary syndrome of menopause refers to the collection of signs and symptoms associated with decrease in estrogen and other sex steroids involving changes in labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. This term was coined in 2014 to reduce the stigma associated with genital symptoms after menopause. Our patient is a 65-year-old woman, menopausal for the past 15 years, who presented with dribbling of urine for 1 month. On examination, she was diagnosed with complete labial fusion. Diabetes was incidentally detected and antidiabetic treatment was started. Considering dense labial adhesion, the patient underwent surgical separation of labia under anesthesia. Postoperatively, she was put on topical estrogen therapy and was advised to maintain proper hygiene. She was followed up regularly for a month to prevent refusion.

We report the case of a 60-year-old female who presented with postmenopausal bleeding after she underwent investigations followed by a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. A diagnosis of low-grade endometrioid adenocarcinoma admixed with large cell neuroendocrine carcinoma (NEC) was made based on the histomorphology and immunohistochemical profile. NEC of the endometrium is a rare and highly aggressive neoplasm requiring a multidisciplinary approach for its treatment. As treatment strategies are changing over time, preoperating imaging evaluation and histopathological examination with molecular characterization whenever possible are essential to follow, to offer the appropriate information to surgeons and/or oncologists for optimal management in these patients.

Background: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of women.

Materials and methods: It is a prospective study conducted over 40 women of SUI by endovaginal ultrasound on rest and Valsalva preoperatively and 6 months postoperatively for levator hiatus (LH), pubovisceral thickness, urethral length, and bladder neck (BN) position. A 24 h pad test was also performed on all women at the same time for grading of SUI. Treatment given was medical in 4 (10%), Burch colposuspension in 18 (45%), and tension-free obturator tape in 18 (45%).

Results: The mean age, parity, and body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m², respectively. All 40 (100%) patients had SUI with a mean duration of symptoms being 4.04 years. On 24 h pad test, mild SUI was in 4 (10%), moderate SUI in 33 (82.5%), and severe SUI in 3 (7.5%) with mean preoperative 24 h pad test being 36.69 g which significantly reduced to 9.79 g postoperatively (P = 0.001). There was significant change in LH and pubovisceral thickness with treatment of SUI. Overall urethral length increased but there was significant decrease in urethral length on Valsalva after the treatment (0.40 cm vs. 0.28 cm, P = 0.04) and significant reduction in BN descent after Valsalva after treatment (0.41 cm vs. 0.27 cm, P = 0.001).

Conclusion: Endovaginal ultrasound and 24 h pad test are the useful diagnostic modalities for SUI diagnosis and to see the impact of treatment.

Aim: The aim of this study was to study the therapeutic role of hysteroscopy in peri- and postmenopausal women in certain pathological conditions, where it can be done as a single-time procedure to diagnose and operate wherever needed and possible.

Objective: The objective of this study was to measure the diagnostic accuracy of hysteroscopy and its therapeutic efficacy in peri- and postmenopausal women.

Introduction: Hysteroscopy is one of the accurate diagnostic procedures in diagnosing the cause of peri- and postmenopausal bleeding (PMB). It can also be used to treat few benign conditions of peri- and PMB. Here, in our study, we tried to evaluate the accuracy of hysteroscopy in diagnosing the cause of peri- and PMB and its use in treating certain conditions of PMB.

Materials and methods: The study design is a prospective observational study; women with peri- and PMB were recruited for 1 year and followed for consecutive 3 years. Based on hysteroscopic findings and after confirming the histopathological examination report, women were treated. Women who did not need any further surgical procedures after operative hysteroscopy were followed for recurrence in benign conditions. Women with premalignant and malignant lesions underwent simple or radical hysterectomy soon after diagnosis.

Results: A total of 71 women were enrolled in the study who fulfilled the inclusion criteria. There were 20 perimenopausal and 51 postmenopausal women, the mean age was 56.02 years. Most of the women presented with PMB (56.3%) or heavy menstrual bleeding (18.3%). Hysteroscopy has 83.34%, 100%, 100%, 98.46%, and 0.98% of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, respectively, in diagnosing carcinomas. Out of 71 women, 58 were diagnosed with benign conditions, 6 had carcinoma, 7 had premalignant conditions, these 13 women with malignant or premalignant conditions underwent further surgical management as per protocol. 58 women who did not need any further surgical procedure, and hysteroscopy was sufficient to treat their condition were followed up for 3 consecutive years, 4 had recurrence of endometrial polyps, 6 had recurrence of bleeding and needed hysterectomy, thus in our study by means of hysteroscopy we could prevent hysterectomy in 67.7% of women with benign endometrial conditions.

Conclusion: In conditions with benign endometrial polyps and fibroid polyps, hysteroscopy is very much useful for both diagnosis and treatment, which can be performed as a one-time procedure. Although this serves the purpose only in a small segment of women with peri- and PMB, it is needed in the prevention of unnecessary hysterectomies.

Leiomyosarcomas (LMS) arise from smooth muscle cells with more predilection to the uterus, abdomen, retroperitoneum, and blood vessels. LMS of vagina is very rare and usually presents in the early stage as an asymptomatic mobile mass with no clinical features of malignancy and gives the appearance of a benign lesion which can easily be mistaken for a Bartholin's cyst or a vaginal fibroid. The chances of metastasis in LMS are high with poor survival rates. Histopathology confirms the diagnosis and treatment still remains controversial due to less data on this rare malignancy. Even though there is no evidence that leiomyoma can transform into LMS, benign-looking vaginal fibroids need to be resected to avoid misdiagnosis of LMS. We present a case of vaginal LMS which was mistaken to be Bartholin's cyst due to the lack of knowledge of this aggressive tumor and further management.

Endosalpingiosis is a nonneoplastic lesion defined by the presence of tubal epithelium at ectopic sites such as the peritoneum, bladder, appendix, and even uterus. They may be asymptomatic and detected incidentally on ultrasonography. However, cystic endosalpingiosis is also known to be a mimicker of ovarian neoplasms. It is crucial for both the clinician and the pathologist to be aware of this benign lesion so that overdiagnosis and overtreatment can be avoided. We report a case of endosalpingiosis of the uterine serosa in a 45-year-old woman which was misdiagnosed as an adnexal cyst on radiological investigations.

Diabetes mellitus (DM) is a syndrome of chronic metabolic disease which leads to all kinds of complications. Elderly people with DM have significantly higher fear of falling and balance problem scores as compared to those who did not have DM. This literature review aims: (1) to determine the risk factors for balance disorders in the elderly population with DM, (2) to describe valid and reliable balance measurement tools in the elderly population with DM, and (3) to describe the nonpharmacological management in dealing with balance disorders in the elderly population with DM. Several risk factors that cause balance disorders in the elderly with DM are related to complications of the disease they suffer, such as diabetic peripheral neuropathy, decreased sensory abilities, decreased motor skills, and decreased cognitive condition of the elderly with DM. Measuring instruments that can be used in the elderly population with DM to assess balance include the Mini-Balance Evaluation Systems Test, the Berg Balance Scale, and computerized measuring instruments with center of pressure analysis. Several nonpharmacological interventions are suggested in overcoming balance problems in the elderly with DM, including a combination of balance exercise and gait training, strength or resistance training, aquatic exercise, tai chi, yoga, technology-based exercise, electrotherapy, use of insoles, and whole-body vibrations.

Introduction: Colposcopy is important for triaging any abnormal cervical screening test. Scarcity of trained colposcopists and colposcopy centers is a big hurdle to screening programs in low- and middle-income countries.

Objectives of the study: The objective was to assess the performance of the artificial intelligence incorporated into the mobile optical device technologies (ODT) Enhanced Visual Assessment (EVA visual check) against physician colposcopic diagnosis and the gold standard of histopathology.

Materials and methods: It was a cross-sectional observational study conducted on women referred to a colposcopy clinic following an abnormal screening test. Colposcopic examination was performed by colposcopists using the MobileODT EVA system. Physician's impression and Visual Check analysis were compared with the final histopathological analysis or cytology. Cases with normal cytology and normal colposcopy did not undergo biopsy, and these were considered normal.

Results: A total of 2050 women were screened, and 147 screen-positive women were recruited in the study. EVA Visual Check had a sensitivity of 86.8% (75-95), specificity of 28.7% (20-39), positive predictive value (PPV) of 40.7% (32-50), negative predictive value (NPV) of 79.4% (62-91), and diagnostic accuracy of 49.7% (41-58) for diagnosing cervical intraepithelial neoplasia (CIN) 1+ lesions. EVA Visual Check has a sensitivity of 89.3% (72-98), specificity of 26.1% (18-35), PPV of 22.1% (15-31), NPV of 91.2% (76-98), and diagnostic accuracy of 38.1% (30-46) for CIN 2+ lesions.

Conclusion: MobileODT EVA colposcope with AI has sensitivity comparable to physician's diagnosis, whereas specificity, PPV, and NPV were less than that of physician's diagnosis. It could prove valuable for triage of screen-positive women for further management.