Journal of Mid-life Health最新文献

Background: Ovarian carcinoma is the third most common gynecological malignancy among women in India, with a poor prognosis despite advancements in treatment modalities. Immunotherapy, particularly the use of programd cell death ligand 1 (PD-L1) checkpoint inhibitors, has emerged as a promising approach. This study investigates the relationship between PD-L1 expression, mismatch repair (MMR) status, and clinicopathological features in epithelial ovarian carcinoma (EOC).

Materials and methods: A cohort of 50 EOC cases was analyzed for PD-L1 expression in tumor cells and tumor-infiltrating lymphocytes (TILs) using immunohistochemistry (IHC). MMR status was also assessed through IHC. Statistical correlations between PD-L1 expression, MMR deficiency (dMMR), and clinicopathological parameters were evaluated.

Results: PD-L1 expression in tumor cells and TILs was observed in 20% and 14% of cases, respectively. PD-L1 expression in tumor cells was absent in most advanced-stage tumors (stages III and IV) and cases with extraovarian spread. dMMR was identified in 30% (n = 15) of cases, predominantly in higher-stage tumors with extraovarian spread and significant TIL presence (P = 0.007). However, PD-L1 expression in tumor cells and TILs was absent in 86.7% and 80% of dMMR cases, respectively. No significant association was found between dMMR status and PD-L1 expression in EOC.

Conclusion: PD-L1 expression in tumor cells is predominantly observed in early-stage EOC, suggesting its potential as a prognostic marker and therapeutic target. Although dMMR status correlates with advanced-stage disease and TIL presence, it does not significantly influence PD-L1 expression in EOC. These findings highlight the importance of routinely assessing PD-L1 and MMR status to guide immunotherapeutic strategies in ovarian carcinoma.

Two common molecular-targeted drugs used for treating postmenopausal osteoporosis are denosumab (DEN) and romosozumab (ROMO), with the latter being a newly approved drug. The aim of this systematic review and meta-analysis was to compare the efficacy of DEN and ROMO therapy over 12 months for the management of osteoporosis in postmenopausal patients. The percentage increase in bone mineral density (BMD) at the lumbar spine was the primary outcome of interest, while secondary outcomes included bone density changes at the total hip and incidence of clinical or osteoporotic fractures. Two independent reviewers conducted an electronic search on PubMed, Google Scholar, Web of Science, and Cochrane Library until June 2023 to search for randomized controlled trials that studied the clinical efficacy of ROMO or DEN and included those that fulfilled the eligibility criteria. We used Review Manager 5.4 to analyze our data, with an odds ratio for fractures and pooled mean change for BMD. To assess heterogeneity, we used I ² and Chi-square². P < 0.05 was considered for statistical significance. This review analyzed twelve trials with a total of 22,445 participants. ROMO and DEN were associated with a significant percentage change in BMD. Patients who received ROMO had significantly lower rates of clinical and osteoporotic fractures, but this was not true for those on DEN. Both ROMO and DEN are effective treatments for osteoporosis in postmenopausal women, increasing BMD within a year. A decrease in fracture incidence is more prominent for ROMO therapy.

Context: The global incidence of cardiovascular events is on rising trends, especially in young adults. Hypertension via its acceleration of atherosclerotic process is among the most important risk factors for cardiovascular events. In this study, we aim to estimate the cardiovascular event risk among hypertensive patients.

Aims: The aim of this study was to estimate the prevalence of cardiovascular disease (CVD) risk among hypertensive patients in rural field practice areas of Madras Medical College.

Methods: The hypertensive patients attending the outpatient department were included for the study. One hundred and eighty patients from two rural health centers were recruited for the study. The cardiovascular risk of the selected hypertensive patients was assessed by the World Health Organization-International Society of Hypertension chart.

Results: Among the study participants, nearly half (45%) had less than 10% of CVD risk while about 5% had more than 40% risk of CVD. The prevalence of >10% CVD risk significantly increased with age with higher prevalence among the age group of 60-69 years (44.6%) compared to the age groups of 50-59 and 40-49 years (P = 0.0001). The prevalence of >10% CVD risk was higher among nonvegetarians (58.75%), smokers (68.75%), alcoholics (68.3%), and diabetics (67.01%) than those who were taking vegetarian diet, nonsmokers, nonalcoholics, and nondiabetics with statistical significance.

Conclusion: In comparison to a previous study, the higher incidence was due to coincidence of comorbidities. Hence, blood pressure control, comorbidity screening, and regular follow-up are mandated to avoid cardiovascular events among hypertensive patients.

Cutaneous endometriosis, a rare entity, is a type of extra pelvic endometriosis observed in 0.5%-1% of women. The most common sites include the abdominal wall, umbilicus, vulva, and extremities. It mostly occurs following gynecological surgery. Cutaneous endometriosis can mimic suture granuloma, hematoma, abscess, sarcoma, desmoid tumor, and metastasis due to variable presentations. Endometriosis shows a classic triad of epithelial cells, stromal cells, and hemosiderin-laden macrophages. The presence of any of the two features is diagnostic. We present 17 cases of cutaneous endometriosis diagnosed on fine needle aspiration cytology (FNAC) over 12 years (January 2013-December 2024). Cytomorphological features were analyzed and correlated with clinico-radiological findings and histopathology, where available. Age ranged from 22 to 42 years (mean age 32 years). The abdominal wall was the commonest site with 15/17 (88%) cases and a history of prior surgery (cesarean section, laparotomy, and episiotomy) was present in 14/17 (82%) cases. The most common symptom was swelling and cyclic pain together, seen in 13/17 (77%) cases. Cytology revealed the presence of benign epithelial cells and macrophages/hemosiderophages in all 17 (100%) cases and endometrial stromal cells in 11/17 (65%) cases. Epithelial atypia was observed in 6/17 (35%) cases. Histopathology follow-up was available in 6/17 (35%) cases and all were concordant. FNAC is a useful modality in the early diagnosis of endometriosis and helps to rule out other lesions with high accuracy. Epithelial atypia is a potential pitfall and awareness of the clinical presentation is key to prevent overdiagnosis.

Introduction: Menopausal health is vital for low-middle-income countries such as Sri Lanka as the proportion of postmenopausal women is projected to increase with time. However, research into health issues of postmenopausal women is limited in Sri Lanka. The objectives of this study were to describe the menopausal symptoms and noncommunicable diseases (NCDs) in postmenopausal women with an objective to derive recommendations to improve the healthcare delivery.

Subjects and methods: A descriptive cross-sectional study was conducted in sequentially selected public health midwife areas that were randomly selected from Kalutara district, Sri Lanka. The inclusion criterion was postmenopausal women with the exclusion criterion being women on menopausal hormone therapy.

Results: The median (interquartile range) age at menopause was 50 (46-51) years. One or more NCDs were already diagnosed in 280 (65.3%) women. Dyslipidemia was diagnosed in 71.5%, hypertension in 58%, and diabetes in 30.5% of women. There were also 280 (65.3%) women with metabolic syndrome. Cardiovascular disease risk was more than 10% in 28.5% of women. The 10-year major osteoporosis fracture risk was 25.4%, whereas the 10-year mean hip fracture risk was 25.9%. Menopausal symptoms (one or more) were present in 420 (97.9%) women. Urogenital symptoms were present in 172 (40.1%) of women. A Menopause Rating Scale total score ≥4 was seen in 302 (70.4%) women.

Conclusion: A high prevalence of NCDs, osteoporosis-related fracture risk, and menopausal symptoms were observed in the study sample. The burden of NCDs and the hitherto unidentified risk of osteoporosis in postmenopausal women in Sri Lanka will have palpable socioeconomic implications in the future.

In many communities across the globe, sexual health is a sensitive topic due to which people do not find it comfortable to talk or discuss openly about it. The objectives of the current article are to identify the role of social media in creating sexual health awareness, elaborate on the role of social media in influencing sexual health behaviors, identify the risk of misinformation and stigmatization, enumerate the potential challenges in using social media platforms to create awareness and propose measures to overcome these identified challenges. Under these circumstances, social media has emerged as a platform that provides instant access to sexual health resources, making it easier for adults to learn about sexual and reproductive health. Owing to the unregulated content being available across different social media applications, it is quite possible that these platforms can act as a medium to spread misinformation. In conclusion, social media applications have the potential to transform sexual health information and play a vital role in the prevention of sexually transmitted diseases. The need of the hour is to acknowledge their limitations and come out with comprehensive solutions to counter them and optimize the utility of social media platforms in empowering adults to make correct sexual health-related decisions.

Background: While studies focused on the relationships between bone mineral density (BMD) and strength or lean body mass have been conducted, there are not studies that have investigated these relationships for both age groups using the same methodology and population criteria (especially physical activity levels).

Aims and objectives: The aim of this study was to compare the relationships between traditional and regional bone mineral density (BMD) and strength and lean mass values in younger and older women.

Materials and methods: Forty-four younger (18-30 years) and 40 older (65-80 years) healthy females were recruited for this study. All had a physical activity rating of four or lower on the Physical Activity Rating Questionnaire. Muscle strength was tested for hand grip, leg press, and isokinetic knee flexion and extension. Total and regional lean body mass and BMD values were determined using dual-energy x-ray absorptiometry (DXA). Correlations and stepwise regressions were run between traditional (hip, spine, and forearm) and regional (arm and leg) BMD and strength and lean mass values. Significance was determined with P < 0.05.

Results: The relationships for traditional BMD and strength measures for the two groups were quite similar with few significant relationships being identified for either group. The two groups had differing relationships between traditional BMD values and lean mass measures. The relationships between regional BMD and strength and lean mass values had good agreement for the two groups for the arm, but not the leg.

Conclusions: The relationships investigated were most similar between the two age groups for the upper body but did not have good agreement for the lower body. These differences were likely due to greater declines in muscle quality associated with aging that occur more drastically for the lower body.

Encrusted cystitis (EC) is a rare clinical entity, with the first description dating back to 1914 by Francois J. This variety of debilitating and rare cystitis is caused by urea-splitting Corynebacterium urealyticum, especially Corynebacterium type 2B2 (CBGD2). Patients with prior urinary trauma, a history of intravesical bacillus Calmette-Guérin instillation, or chemotherapy are at higher risk for developing EC. Clinical presentation varies from dysuria, pain, hematuria, or passage of mucus or calcified mucopurulent stones. Diagnosis of Encrusted cystitis is done after excluding the other pathologies and is confirmed on isolation of Corynebacterium Type 2B2 organism and its characteristic features on radiotherapy. Medical management involves glycopeptide antibiotics and acidification of urine, either topical or systemic. Surgical treatment is done in rare cases with failed medical management or spontaneous bladder rupture. We report a rare case of morbid EC who required cystectomy and diversion.

Background: Extrauterine leiomyomas (EULs) are rare benign smooth muscle tumors that arise outside the uterus, often leading to diagnostic challenges.

Objective: To evaluate the clinical and pathological characteristics of EULs and their management in a tertiary care setting.

Methods: This retrospective study reviewed 51 cases of EULs over a 5.5-year period. Data on demographics, clinical presentation, tumor location, histology, and treatment were analyzed.

Results: The mean patient age was 41.6 years, with 41.2% aged 40-50 and 15.7% post-menopausal. Abnormal uterine bleeding (AUB) was the most common symptom (66.7%). Tumors were most frequently located in the cervix (72.5%), followed by the broad ligament (11.8%) and ovaries (7.8%). Histologically, EULs resembled uterine leiomyomas, showing spindle-shaped cells and low mitotic activity. Surgical excision was the primary treatment.

Conclusion: EULs, though uncommon, should be considered in differential diagnoses of pelvic masses. Accurate histopathological evaluation is essential to avoid misdiagnosis and unnecessary intervention. This study enhances current understanding of EUL presentation and management.

Objective: The objective of the study was to determine the frequency of sleep disorders and their association with neurocognitive, psychological, or physical alterations in postmenopausal Colombian women.

Materials and methods: A cross-sectional study carried out on postmenopausal women (50-75 years). Participants were surveyed on a general questionnaire, the Jenkins Sleep Scale, the Mini-Mental State Examination tool, the Menopause Rating Scale (MRS), and the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falling scale. Crude and adjusted logistic regression analyses were performed to determine the association between sleep problems (dependent variable) with the neurocognitive, psychological, and physical established impairments (independent variables). The covariates were age, age at menopause, years of being postmenopausal, coffee consumption, smoking habit, and nutritional status.

Results: Among 601 participants, 53 (8.8%) had sleep problems. Bivariate analysis found that overall impairment of quality of life and its domains (somato-vegetative, psychological, and urogenital), and cognitive impairment and its various aspects (memory, language, fixation, and temporal fixation) were found at a higher rate among women with sleep problems. The risk of sarcopenia was similar among those with and without sleep problems. Adjusted logistic regression determined that sleep problems were associated with somato-vegetative (odds ratio [OR]: 3.44, 95% confidence interval [CI]: 1.56-7.59), urogenital (OR: 2.35, 95% CI: 1.00-5.51) and cognitive impairment (OR: 2.20, 95% CI: 1.02-4.71).

Conclusion: 8.8% of this sample of postmenopausal women had sleep problems, which were significantly associated with impairment of quality-of-life aspects and cognition.