bluuebunny/crossref_metadata_2025 huggingface dataset:
Forgotten Memory of Numerous Synchronous Grammar Editions?
Authors: Smolej Mojca
Published: September 2019

The contribution focuses on the historical overview of the publication of Slovenian grammars and on the emergence of the “one-grammar” state of affairs in grammatography. The turning point in writing and publishing grammar books is 1854. It was then that Anton Janežič’s Slovenska slovnica s kratkim pregledom slovenskega slovstva ter z malim cirilskim in glagoliškim berilom za Slovence was published and introduced to grammar writing, at least on the level of grammatography, the concept of monopoly and with it the primacy of the one and only grammar. Janežič’s grammar maintained its influence until as late as 1916 (more than half a century), when Breznik’s Slovenska slovnica za srednje šole was published. The latter had the role of the leading (and only) grammar until as late as 1956, when the so-called grammar of the four was published. From 1976 to today, again nearly half a century, the role of the one and only grammar has been performed by Jože Toporišič’s grammar. Prior to 1854 the situation was entirely different. In some ways it was much freer or more plural in the sense of the number of published grammars. In the first half of the 19th century, a teacher of Slovenian could pick from as many as ten different grammars. The contribution focuses, then, on the occurrence of the transition from a (forgotten) state of grammar numerousness to today’s predominant state of the “one and only correct” grammar.
Ovidij: Heroide 1 - Penelopino pismo Odiseju
Authors: Gantar Kajetan
Published: September 2019

To, Odisej, ti zamudnežu piše Penelopa tvoja.Nič ne odpiši nazaj! Rajši mi pridi ti sam!Troja, odurna danajskim ženám, poteptana na tleh je!Priam in Troja tegà sploh nista vredna bila.O, da takrat, ko s svojim brodovjem je plul proti Šparti,bedno vlačugar končal v divjih bi morskih vodáh!V postelji ne bi prezebala zdaj, zapuščena in sama,tarnala ne bi, kako dnevi počasi teko,tuhtala ne bi, kako noči naj predolge si krajšam,ne bi ob statvah bedé vdova si utrujala rok.
Enej Silvij Piccolomini in sveti Maksim Grek – razumevanje humanističnega individuuma
Authors: Zajc Neža
Published: September 2019

Prispevek prek primerjalne analize biografskih dokumentov, nazorov, literarnih in teoloških del obravnava dva kompleksna renesančna načina za razumevanje humanističnega individuuma, kot se odražata v delih svetega Maksima Greka in Eneja Silvija Piccolominija. Primerjava dveh teologov, ki sta precejšen del življenja preživela v stiku z renesančno mislijo, pokaže, kako je slednja zaznamovala tudi njuna teološka sistema ter zaostrila njuno ortodoksnost v nepopuščanju tedaj aktualnemu antropocentrizmu. Obema avtorjema so skupne: osebna raba jezika (idiolekt); odprto in ustvarjalno sprejemanje tako vzhodnega kot tudi zahodnega krščanstva; nasprotovanje krivoverskim ločinam; poudarjen kristološki teocentrizem; zavedanje ogroženosti krščanskega sveta; avtobiografskost njunih del. Prav v združevanju vzhodnih in zahodnih krščanskih elementov ter v izpostavljenem in prepoznavno osebnem interpretiranju svetopisemskega sporočila je mogoče utemeljiti podobnost primerjanih nazorov. Povečana avtobiografskost njunih spisov priča o močni vezi z renesančnim humanizmom.
Ovidijeva poezija ob soočenjih z Avgustovim režimom
Authors: Gantar Kajetan
Published: September 2019

Ovidij je nedvomno med vsemi avgustejskimi pesniki eden najbolj izrazitih oporečnikov v odnosu do avtokratskega režima cesarja Oktavijana Avgusta. Medtem ko je na primer Vergilij na Avgustov ukaz spremenil zaključni del druge knjige Georgik, tako da je izbrisal iz nje laudes Galli, ki ga je zadela damnatio memoriae, pa se Ovidij niti v svoji mladostni zbirki Amores niti v žalostinkah iz izgnanstva (Tristia) ni bal proslavljati tragično preminulega pesnika, ki velja za začetnika rimske elegije. Zato se ne smemo čuditi, da je tudi Ovidija zadela nekaka damnatio memoriae, saj so morale biti vse njegove pesniške zbirke, ne le spotakljiva Ars amatoria, odstranjene iz rimskih javnih knjižnic (Tristia, 3.1.63–80). Tudi v največjo umetnino, Metamorfoze, je Ovidij zasejal nekaj domiselnih in iskrivih protiavgustovskih bodic. Tako je na primer že v eni prvih epizod, v zgodbi o preobrazbi Likaona, še izraziteje pa v zadnji epizodi, kjer katasterizmu, tj. preobrazbi Julija Cezarja v zvezdo in podobni preobrazbi, ki po smrti čaka Avgusta, dodal za sklep še zaostreno poanto, da bo njegovo ime po smrti povzdignjeno še višje, visoko nad (super!) zvezde (torej še višje kot Cezarjeva in Avgustova zvezda): super alta perennis / astra ferar (Metamorfoze, 15.875–6).
Effects of Fish Cage Culture on Water and Sediment Quality in the Gorge Area of Lake Volta in Ghana: A Case Study of Lee Fish Cage Farm
Authors: Osei L. K. , Asmah R. , Aikins S. , Karikari A. Y.
Published: September 2019

The study determined the impacts of fish cage farming on the gorge area of Lake Volta. Water and sediment samples were collected from six sites in the Lee Cage Farm; four from sections with cages and two from about 1300 m upstream of the farm which served as the control. Water quality variables monitored were pH, temperature, dissolved oxygen, nitrate-nitrogen, ammonia-nitrogen, orthophosphate, faecal coliforms and total coliforms. Variables monitored in the sediment were organic matter, total carbon, total nitrogen and total phosphorus. There were variations in water quality between the farmed and control sites but the differences were not significant (p > 0.05). The mean counts of total coliform in the water ranged from 940 - 3318 cfu/100 ml while faecal coliforms ranged from 113 - 552 cfu/100 ml at the farmed site. The mean total coliform count at the control site ranged from 837 - 6960 cfu/100 ml while the faecal coliforms ranged from 48 - 120 cfu/100 ml. Therefore, there was significant variation between the faecal coliforms count at the two sites (p = 0.046). The results suggest that the general microbiological quality of the water at the study area was unacceptable.
Karl Marx's thoughts on functional income distribution: a critical analysis from a Keynesian and Kaleckian perspective
Authors: Herr Hansjörg
Published: September 2019

In Marx's explanation of functional income distribution, wages are given as a basket of goods needed for the reproduction needs of the working class. Profits are then the remaining part of income creation. Marx's explanation of functional income distribution has several theoretical and practical shortcomings. The Keynesian paradigm in the traditional works of Keynes and Kalecki provides alternative explanations of functional income distribution. Here the profit rate is given by processes in the financial market and the degree of financialisation. Also the degree of monopoly influences functional income distribution. The Keynesian and Kaleckian approach allows a plausible interpretation of the changes in functional income distribution during recent decades.
An update on Kalecki–Minsky modelling
Authors: Stockhammer Engelbert
Published: September 2019

Within post-Keynesian macroeconomics, the Kaleckian streams analysing demand regimes and the Minskyan streams analysing financial instability have proceeded relatively independently. To develop a comprehensive alternative to mainstream economics, post-Keynesians will have to integrate Kaleckian and Minskyan arguments with an analysis of the supply side. This paper gives a partial update on advances in Kalecki-Minsky modelling. First, theoretically, it discusses the notion of pseudo-Goodwin cycles. Second, it presents empirical findings on endogenous debt cycles. Third, it reviews evidence of the relative size of distributional and financial effects on demand. Fourth, it reports results on the drivers of household debt.
Study of Intravenous Ferric Carboxymaltose in Iron Deficiency Anemia in Women attending Gynecological Clinic: Safety and Efficacy
Authors: Roy Priyankur , Mishra Vineet , Aggarwal Rohina , Gandhi Khushali , Hokabaj Shaheen
Published: September 2019

Introduction

Several intravenous iron preparations are available for the treatment of iron deficiency anemia (IDA). Some of these require multiple small infusions to prevent labile iron reactions, while iron dextran (DEX) is associated with a risk of potentially serious anaphylactic reactions. Ferric carboxymaltose (FCM), a non-DEX intravenous iron, is an effective and a safe option, which can be administered in high single doses without serious adverse effects.

Objective

The objective of the study was to evaluate the efficacy and safety of FCM in the treatment of IDA in gynecological patients.

Materials and methods

It was an open, single-arm study including 442 women of age more than 18 years with definitive diagnosis of IDA and hemoglobin (Hb) between 4 and 11 gm% from December 2013 to November 2016. Out of these, 25 women were lost to follow-up and were excluded from the study. Intravenous FCM (500—1500 mg) was administered and the improvement in Hb levels and iron stores was assessed after 3 weeks of total dose infusion.

Results

Out of the 442 women, 417 women were included in the analysis. Most of the women were in the age group of 30 to 39 years. Most of the women had mild anemia as per the World Health Organization (WHO) guidelines. Mean Hb levels significantly increased over a period of 3 weeks after FCM administration. Other parameters like total iron-binding capacity (TIBC), ferritin, and iron also had a significant improvement after FCM administration. No serious life-threatening adverse events were observed after FCM administration.

Conclusion

Intravenous FCM is an effective and a safe treatment option for IDA and has an advantage of single administration of high doses without serious adverse effects.

How to cite this article

Mishra V, Roy P, Gandhi K, Hokabaj S, Aggarwal R. Study of Intravenous Ferric Carboxymaltose in Iron Deficiency Anemia in Women attending Gynecological Clinic: Safety and Efficacy. J South Asian Feder Menopause Soc 2017;5(2):71-74.
Treatment Dilemma of Simple Cyst in Menopausal Women
Authors: Nasreen Shaikh Zinnat Ara , Shahreen Safinaz , Huq Saleheen , Huq Sabereen
Published: September 2019

Objective

Can we offer conservative treatment for the menopausal women who are having simple cysts?

Study design

It is a prospective cross sectional study carried out in ZHSikder medical college & hospital, Medinova and Popular hospital. The study period was from january 2011 to January 2016.

Materials and methods

500 menopausal women with simple cysts were enrolled after counseling and taking written consent. Inclusion criteria was cysts size should not be more than 5 cm, they should be unilocular, without having any solid component or any debris. Exclusion criteria was women with family history of cancer of ovary, breast, or colon or women with HRT therapy. Thorough history taking, clinical examination, and some investigation like CA125, TVS with Color Doppler was carried out for all the women. CT Scan.MRI, and PET Scan were reserved for selected cases. All the patients were followed up every 3 monthly for 3 to 5 years. Surgery was done if the patient developed any symptoms, or increment of sizes of cysts or there was any sonographic changes were evident. MRI1 (malignancy risk index ) was calculated for each patient. Data were analyzed by SPSS where all calculation rate of less than 0.05 was considered significant.

Results

Among 500 cysts, 285 (57%) cysts resolved spontaneously which is highly significant( p = < 0.05), 165 (33%) cysts needed surgery and only 50(10%) cysts remained without significant changes. Histopathology of surgical specimen revealed all were benign except 4 cysts, i.e., < 1% became malignant or malignant potential.

Conclusion

Menopausal women with simple cysts not more than 5cm,which are unilocular, unilateral, without having any solid component and with normal Doppler study are rarely malignant. So if MRI1 is below 200 we may avoid unnecessary surgery and assure the menopausal women for the conservative treatment with regular follow up.

How to cite this article

Nasreen SZA, Shahreen S, Huq S, Huq S. Treatment Dilemma of Simple Cyst in Menopausal Women. J South Asian Feder Menopause Soc 2017;5(2):75-80.
To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse
Authors: Bhalerao Krutika , Bhalerao Anuja V , Garg Richa
Published: September 2019

Introduction

Vaginal vault prolapse can be prevented by supporting the vaginal cuff, which is an essential part of hysterectomy, whether done abdominally or vaginally. The American Association of Gynecologic Laparoscopists (AAGL) has recommended for future research, specifically, a randomized trial comparing McCall's culdoplasty (with uterosacral ligament plication) with vaginal high uterosacral ligament suspension (HUSLS) (without plication), since both procedures are accessible to gynecological surgeons without urologic background. Hence, this study was carried out.

Aim

To compare both anatomic and functional outcomes of patients undergoing vaginal HUSLS or McCall's culdoplasty at the time of vaginal hysterectomy.

Materials and methods

This hospital-based prospective comparative study was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining Ethical Committee approval. All women attending gynecological outpatient department having symptom of mass coming out of vagina were subjected to detailed history, examination, and later underwent either HUSLS (43) or McCall's culdoplasty (42), for vault suspension with concomitant hysterectomy. The effectiveness of both the procedures was assessed by preoperative and postoperative pelvic organ prolapse quantification (POP-Q) and both were compared.

Observations

There was statistically significant improvement in all the sites of POP-Q points by HUSLS and McCall's culdoplasty as a method of vault suspension except in total vaginal length (TVL). Vault suspension by HUSLS is better than McCall's culdoplasty. All the points of POP-Q showed better results but the point C was significantly placed at a higher level by HUSLS (p = 0.000) as compared with McCall's culdoplasty. The time required for HUSLS was statistically more as compared with repair by McCall's culdoplasty (81.55/74.53 minutes, T: 1.981, p: 0.05). Complications, such as hemorrhage and ureteric injuries were more in HUSLS (2/43, 4.8%) as compared with McCall's culdoplasty (0/42); this is statistically significant.

Conclusion

High uterosacral ligament suspension provides excellent suspensory support to vaginal vault. Vagina is suspended over the levator ani with normal axis toward sacrum. By doing HUSLS, the vagina is symmetrically supported directed toward the hollow of sacrum. High uterosacral ligament suspension is highly recommended for young women with POP as vaginal length is not altered at all and so is the quality of life.

How to cite this article

Bhalerao AV, Bhalerao K, Garg R. To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):81-86.
A Study of the Age of Menopause and Menopausal Symptoms among Women in a Rural Area of Tamil Nadu, India
Authors: Ganitha G , Premalatha PB , Kannan Iyanar
Published: September 2019

Aim

The aim of this study is to determine the age and symptoms of menopause, and attitude and perception of postmenopausal women toward menopause in a rural area of Tamil Nadu.

Materials and methods

This is a cross-sectional observational study of 500 women in a rural area of Tamil Nadu. Women aged 40 to 55 years who had attained natural menopause and had cessation of menses for at least 1 year were included in the study. Women who had attained surgical menopause or menopause secondary to medical illness were excluded from the study. A self-structured questionnaire was used to collect information.

Results

The mean age of attaining menopause was 45.75 ± 3.83 years; 87% women were symptomatic with at least one symptom. Majority of women (78.2%) had psychosomatic symptoms followed by vasomotor symptoms (55.8%); 68.4% women welcomed menopause with positive attitude; 19.4% women were indifferent and 12.2% women had negative attitude toward menopause. About 24% women felt that the symptoms of menopause were distressing; 23.2% women availed some form of treatment for their symptoms.

Conclusion

Many women are affected by menopausal symptoms. Some women are affected severely by these symptoms. Lack of awareness, economic factors, sociocultural factors, myths, and inaccessibility to health services can negatively affect the attitude of women toward menopause.

Clinical significance

Menopause is an important transitional phase of life in all women. The waning ovarian hormone level causes several symptoms, some of which can be distressing to some women. Age and symptoms of menopause are influenced by several factors. Attitude and perception of women toward menopause reflect the awareness and health care accessibility in the community. Creating awareness of menopausal symptoms can improve utilization of health services and the quality of life of postmenopausal women.

How to cite this article

Ganitha G, Premalatha PB, Kannan I. A Study of the Age of Menopause and Menopausal Symptoms among Women in a Rural Area of Tamil Nadu, India. J South Asian Feder Menopause Soc 2017;5(2):87-91.
To Compare the Effectiveness of Traditional Anterior Colporrhaphy, Posterior Colpoperineorrhaphy with Site-specific Anterior and Posterior Repair for Pelvic Organ Prolapse
Authors: Bhalerao Krutika , Bhalerao Anuja V , Garg Richa , Vora Amishi
Published: September 2019

Background

Pelvic organ prolapse (POP) is a common health problem affecting 40% multiparous women above 35 years of age. Lifetime risk of women requiring surgery for recurrence is 10%. The POP is intricious due to complex pelvic anatomy, and difficulty increases due to tissue weakness, lack of evidence-based surgical guidelines, and lack of standardized definition for surgical success, which results in highly variable estimates of success.

Aim

To compare the effectiveness of traditional anteroposterior repair with site-specific repair with concomitant vaginal hysterectomy with respect to anatomical considerations by POP-Q and functional or symptomatic considerations, complications, duration of surgery, and recurrence.

Materials and methods

This hospital-based randomized controlled trial was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining ethical committee approval. All women attending the gynecological outpatient department having symptoms of mass coming out of vagina were subjected to detailed history and examination and 51 women underwent traditional anterior and posterior repair and 44 women underwent site-specific repair with concomitant hysterectomy, with random sampling according to computerized sheet. The effectiveness of both the surgeries was assessed and compared.

Observations

There was statistically significant improvement in all the sites of POP-Q points using traditional repair and site-specific repair. When compared, site-specific repair by POP-Q was better than traditional method.

Conclusion

Site-specific repair of decussated natural tissue has great curative potential, and success is attributable to site-specific repair, rather than nonspecific scar formation by traditional method. Thus, it is important to properly quantify the repair to be done, whether anterior or posterior, and perform site-specific repair.

How to cite this article

Bhalerao AV, Vora A, Bhalerao K, Garg R. To Compare the Effectiveness of Traditional Anterior Colporrhaphy, Posterior Colpoperineorrhaphy with Site-specific Anterior and Posterior Repair for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):92-98.
Effect of Menopause on Pulmonary Functions: An Analysis!
Authors: Kedar Kshama V , Munje Radha P , Karia Amar K
Published: September 2019

Introduction

Sex hormones play an important role in women's health. There is a close relationship between female sex hormones and lung function in postmenopausal women. Deterioration of lung function is observed more after menopause. Estrogen deficiency after menopause accelerates the adverse effects of biological aging on lung mechanics in postmenopausal women. Our study uses a spirometer to analyze and evaluate these effects of menopausal aging.

Objective

To study the effects of menopause on pulmonary function tests in women of perimenopausal age group.

Materials and methods

This study was carried out in the Department of Obstetrics and Gynecology in Indira Gandhi Government Medical College & Hospital (IGGMC) Nagpur, India. Totally 50 women each in premenopausal and menopausal age groups were included in our study. Venous blood was collected under aseptic precautions on 10 to 14 and 18 to 23 days corresponding to follicular and luteal phase of menstrual cycle in premenopausal and postmenopausal women. Serum estrogen and progesterone levels were estimated by microparticle enzyme immunoassay. The pulmonary function of all subjects was measured with digital microspirometer and data collected. The peak expiratory flow rate (PEFR), forced expiratory flow (FEF)25-75, forced expiratory volume (FEV1), and forced vital capacity (FVC) were studied and correlated with symptoms. Data analysis was done using Student's unpaired t-test and chi-squared test.

Results

The mean percentages of predicted values of FEF25-75 and PEFR were lower in postmenopausal women compared with premenopausal women. Mean serum estrogen levels were significantly lower in postmenopausal women as compared with premenopausal women. Progesterone levels were lower in postmenopausal women and in proliferative phase of premenopausal women as compared with luteal phase of menstrual cycle.

Conclusion

As menopause sets in, decrease in hormonal levels leads to decreased lung capacity as evident by pulmonary function tests. Decreased pulmonary function test can be attributed to lower levels of sex hormones estrogen and progesterone in postmenopausal women.

How to cite this article

Karia AK, Kedar KV, Munje RP. Effect of Menopause on Pulmonary Functions: An Analysis! J South Asian Feder Menopause Soc 2017;5(2):99-101.
Evaluation of the Role of Ormeloxifene in Abnormal Uterine Bleeding
Authors: Sharma Ritu , Singhal Savita R
Published: September 2019

Aim

This is a prospective study to find the effect of ormeloxifene on menstrual blood loss and its side effects in patients with abnormal uterine bleeding (AUB).

Materials and methods

Fifty women in the age group of 30 to 52 years with AUB were enrolled in the study. After baseline assessment, each patient was given 60 mg of ormeloxifene orally twice a week for first 3 months, then once a week for the next 3 months. The patients were followed up after 1, 3, and 6 months. The effect of ormeloxifene was evaluated by a change in the pictorial blood loss assessment chart (PBAC) score, passage of clots during menstruation, hemoglobin level, endometrial thickness (ET), and dysmenorrhea. Side effects of the drug were also noted at each visit; p-value < 0.05 was taken as significant.

Results

There was statistically significant reduction in median PBAC score from baseline 360 to 113, 73, and 41.5 after 1, 3, and 6 months. There was significant reduction in ET, passage of clots, and dysmenorrhea at each visit. Mean hemoglobin level increased significantly by 1.56 gm% after 6 months treatment. Adverse effects included amenorrhea (28%), ovarian cyst (11.3%), nausea (4.5%), headache (2%), and weight gain (4.5%). There was no major side effect requiring termination of treatment.

Conclusion

Ormeloxifene is a safe and efficacious alternative for medical therapy in the management of AUB.

Clinical significance

Ormeloxifene can be used in women with AUB to avoid the side effects of hormonal treatment and unnecessary hysterectomies.

How to cite this article

Sharma R, Singhal SR. Evaluation of the Role of Ormeloxifene in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):107-110.
Osteoporosis in Black South African Women: Myth or Reality
Authors: Matsela Lineo , Towobola Olakunle , Mokgokong Ephraim T
Published: September 2019

Aim

The study was conducted to ascertain the severity of the occurrence of osteopenia and osteoporosis among black South African women during their transition from premenopause to postmenopause.

Materials and methods

Sixty-eight black South African women, aged between 32 and 77 years, residents of three districts of Pretoria, South Africa, constituted the participants in the study. Following informed consent, the women were randomly recruited and assessed for age, medical history, and lifestyle data. Each woman was classified as being premenopause, perimenopause, or postmenopause based on her menstrual history within the preceding 12 months to the study. Bone mineral density (BMD) of the L1-L4 vertebrae and the hip vertebrae was measured using dual-energy X-ray absorptiometry (DEXA) method and the results were expressed as T-scores based on World Health Organization (WHO) classifications for osteopenia and osteoporosis.

Results

Osteopenia was found in 2 of the 8 (25%) premenopausal women aged 37 and 38 years. Similarly, 2 perimenopausal women out of the 28 (7.1%), aged 45 and 49 years, also had evidence of osteopenia. Among 32 postmenopausal women, 11 (34.4%) had osteopenia and 8 (25%) were diagnosed with osteoporosis. There was no statistical significant difference (p = 0.0832) for osteopenia between premenopausal and perimenopausal women. However, the incidence of osteopenia became statistically significant between premenopausal and postmenopausal women (p = 0.0137), and between perimenopausal and postmenopausal women (p = 0.0218).

Conclusion

Even from this small cohort study, it is apparent that osteoporosis does afflict postmenopausal black South African women. The need to institute screening strategies and appropriate guidance to prevent osteoporosis in these women is strongly advocated.

Clinical significance

The study draws special attention to the necessity to investigate black South African women for early detection of osteopenia and osteoporosis.

How to cite this article

Matsela L, Towobola O, Mokgokong ET. Osteoporosis in Black South African Women: Myth or Reality. J South Asian Feder Menopause Soc 2017;5(2):111-116.

Source of support

The authors herewith express their gratitude to both MSD (South Africa) and the South African Menopause Society for their financial donations, which enabled the DEXA evaluations of participants in this study.
Knowledge and Attitudes of Black South African Women toward Menopause: Impact of Culture and Traditions
Authors: Matsela Lineo , Towobola Olakunle , Mokgokong Ephraim T
Published: September 2019

Introduction

Vasomotor symptoms of menopause could affect the quality-of-life of most women. The understanding of menopause by African women and the coping mechanisms of these women are essential factors that may be influenced by culture and traditions. This study has evaluated the psychosomatic and sociodemographic profiles of menopausal black South African women in order to ascertain the role played by their culture and traditions during the menopausal years.

Materials and methods

The study was carried out at three periurban districts close to the city of Pretoria, South Africa. A qualitative, prospective, community-based, cohort study was conducted over a 2-year period. The targeted population included women between 40 and 80 years, and each woman was interviewed using a structured questionnaire. Data on sociodemographic, psychosomatic profiles of the women as well as cultural and traditional beliefs relating to menopause were documented. The data from the study were analyzed by descriptive statistics.

Results

Totally, 450 women were interviewed: 250 (perimenopausal) and 200 (postmenopausal). The ages of the women ranged between 42.5 and 50.8 years (perimenopausal) and between 51.5 and 68.4 years for postmenopausal women. Only 20% of the women interviewed for the study had no formal education and 78% of them were financially independent. The percentage of the women who had an understanding of menopause and expressed cultural explanations for it was 96%. The women explained the impact of support systems on which they relied and by which their attitudes toward menopause were greatly influenced. Knowledge of hormone replacement therapy (HRT) and its importance in the alleviation of vasomotor symptomatology ranged between 80 and 84%, yet the women were reluctant to seek medical remedy for their vasomotor symptoms.

Conclusion

The study provides insight into the impact that traditions and culture of black South African women have on their capacity to cope with menopause.

How to cite this article

Matsela L, Towobola O, Mokgokong ET. Knowledge and Attitudes of Black South African Women toward Menopause: Impact of Culture and Traditions. J South Asian Feder Menopause Soc 2017;5(2):117-122.
Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding
Authors: Chandrashekar Nikhitha , GS Jyothi , Shetty Prasanna
Published: September 2019

Aim

The objective of this study was to assess the adequacy of the sample aspirated in order to make a definite diagnosis of endometrial disease in abnormal uterine bleeding (AUB) and to draw comparisons between the histopathological findings of Pipelle endometrial aspiration biopsy and dilatation and curettage (D&C).

Materials and methods

Pipelle endometrial biopsy and D&C samples were collected from 100 patients with AUB in the Department of the Obstetrics and Gynecology and sent to the Department of Pathology of a tertiary care hospital for adequacy of the sample and for histopathological analysis.

Results

The Pipelle sample was adequate in 73% of the cases and inadequate in 27% compared with D&C, which showed 85% and 15%, respectively. About 53% of cases were comparable between D&C and Pipelle and 37% were discordant. For endometrial hyperplasia using Pipelle aspirator, the sensitivity was 58.8%, specificity was 91.6%, positive predictive value (PPV) was 58.8%, negative predictive value (NPV) was 91.6%, and concordance was 86%. For detection of endometrial carcinoma using Pipelle, the sensitivity was 50%, specificity was 99%, PPV was 50%, NPV was 99%, and concordance rate was 98%.

Conclusion

It is more convenient and cost-effective for patients to undergo pipelle biopsy to confirm normalcy and rule out endometrial hyperplasia rather than undergoing D&C initially. Out of the 27% of inadequate samples, 14.8% had fibroids and 11.1% had polyps, thus showing that tumors localized to a polyp or a small area of endometrium went undetected with Pipelle.

Clinical significance

Due to the high specificity and NPV and low sensitivity and PPV in diagnosing endometrial lesions and carcinomas, pipelle is suitable for women with a low risk of cancer. In cases where the diagnosis is hyperplasia on Pipelle, the patients are advised to undergo hysteroscopic-guided D&C following pipelle to confirm the diagnosis. This is also applicable for cases of polyps and fibroids.

How to cite this article

Chandrashekar N, Jyothi GS, Shetty P. Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):123-128.
Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases
Authors: Rajput Disha A , Valecha Shalini M , Sarwade Manisha , Dhumale Shrikant
Published: September 2019

Introduction

Urinary incontinence (UI) is more common than any other chronic disease with the prevalence of approximately 23 and 55%. Among the various forms of UI, stress incontinence (SUI) is the most common (49%), with urgency incontinence (UUI) representing 21% and mixed type (MUI) at 29%. As it affects the quality-of-life of women, the restoration of urinary continence is one of the greatest challenges.

Aim

To review the cases of genuine SUI treated surgically by Burch retropubic urethropexy.

Results

We have managed surgically eight cases of genuine SUI by Burch retropubic urethropexy. On 1-year follow-up, none of the patients had any urinary complaints. All had responded well to surgery and patient's satisfaction index was good.

Conclusion

Since SUI is the commonest among incontinences, it is a challenge to diagnose and treat to improve quality-of-life of patients. Burch retropubic urethropexy is the gold standard treatment for SUI, especially if other indications exist for abdominal surgery. Even in the present era of less invasive vaginal procedures, results are comparable.

How to cite this article

Rajput DA, Valecha SM, Sarwade M, Dhumale S. Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases. J South Asian Feder Menopause Soc 2017;5(2):129-132.
Evaluation of Incompletely Staged Ovarian Malignancy: A Study in Western India
Authors: Kamath Anusha , Dave Pariseema , Mankad Meeta
Published: September 2019

Introduction

Incomplete initial surgery complicates subsequent management of ovarian tumors. This study aimed to study demographic and clinical factors associated with incompletely staged ovarian tumor patients.

Materials and methods

Twenty five patients who had undergone incomplete staging surgery for ovarian tumors outside Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India, were included in this study. Their demographic and clinical features were studied in detail. Patients were either subjected to restaging or were referred for chemotherapy initially.

Results

Mean age of patients was 42 years (23—60 years); 64% of patients had abdominal pain as initial complaint; 64% patients were operated initially using a transverse incision. Only four patients were managed laparoscopically initially, others by laparotomy. Single/part of one ovary was removed in 60% of patients as part of initial surgery. Infundibulopelvic ligament was tied distally in 40% of patients. Omentectomy (Om) and lymphadenectomy were not done in most of the patients. Nineteen patients were found to have malignancy on final histopathological examination; 3 borderline malignancy; 1 granulosa cell tumor; and 2 benign tumors; 52% (n = 13) patients were subjected to chemotherapy; 4% (n = 1) were observed, and rest underwent restaging procedures.

Conclusion

Incompletely staged ovarian tumor patients, especially those with malignant histopathology, should be managed by gynecologic oncologists. The management needs to be individualized and cannot be a blanket therapy.

How to cite this article

Kamath A, Dave P, Mankad M. Evaluation of Incompletely Staged Ovarian Malignancy: A Study in Western India. J South Asian Feder Menopause Soc 2017;5(2):133-137.
Endometrial Metastasis from an Occult Colonic Primary presenting with Massive Ascites
Authors: Mathew John , Komaranchath Ashok S , Gopalakrishnan Sindhu , John Shirly , Mahadevan Pushpa , Kumar Lijesh
Published: September 2019

In most developed nations, endometrial cancer is the most common gynecological malignancy. However, the endometrium is an extremely rare site for metastasis from an extragenital site. Also, the most common presentation of such metastasis is with uterine bleeding, similar to primary endometrial cancers. We present an unusual case of a 38-year-old female who presented with abdominal pain and distension. Evaluation revealed an endometrial mass lesion with bilateral adnexal masses and massive ascites. An endometrial biopsy was done, which revealed a mucinous adenocarcinoma with signet ring cells. Immunohistochemistry showed cells positive for CK20 and CDX2 and negative for CK7, which was in favor of a colonic primary. A colonoscopy was attempted, but failed due to extrinsic compression at the rectosigmoid junction. There was no evidence of supradiaphragmatic disease. She was started on palliative chemotherapy. This case report highlights the indispensability of histological correlation and immunohistochemistry in the diagnosis of pelvic malignancies.

How to cite this article

Komaranchath AS, Gopalakrishnan S, John S, Mahadevan P, Mathew J, Kumar L. Endometrial Metastasis from an Occult Colonic Primary presenting with Massive Ascites. J South Asian Feder Menopause Soc 2017;5(2):138-141.
Papillary Squamotransitional Cell Carcinoma Cervix: A Rare Variant
Authors: Singh Amrita , Anant Monika , Singh Vandita Y
Published: September 2019

Papillary squamotransitional cell carcinoma (PSTCC) is a lesser known histological subtype of the most common type of cervical “squamous cell carcinoma (SCC).” Papillary carcinomas of the uterine cervix with transitional or squamous differentiation often resemble transitional cell carcinomas of the urinary tract. In the literature, PSTCC is underdiagnosed, has late presentation, is more common in postmenopausal age group, and has a late recurrence. Here we report a case of a 52-year-old lady presenting with postmenopausal bleeding, whose cytological evaluation reported atypical squamous cells of undetermined significance (ASCUS) and cervical biopsy as high-grade squamous intraepithelial lesion (HSIL). She underwent laparoscopic hysterectomy to be diagnosed with PSTCC mixed type. With an 18-month follow-up, she has shown no locoregional recurrence. A high index of suspicion on the part of the clinician and an awareness of PSTCC subtype of cancer cervix by the histopathologist are required to make an accurate diagnosis.

How to cite this article

Anant M, Singh A, Singh VY. Papillary Squamotransitional Cell Carcinoma Cervix: A Rare Variant. J South Asian Feder Menopause Soc 2017;5(2):142-144.
Surgical vs Natural Menopause: Cognitive Issues
Authors: Henderson VW , Sherwin BB
Published: September 2019

Objective

Women who undergo both natural and surgical menopause experience the loss of cyclic ovarian production of estrogen, but hormonal and demographic differences distinguish these two groups of women. Our objective was to review published evidence on whether the premature cessation of endogenous estrogen production in women who underwent a surgical menopause has deleterious consequences for cognitive aging and to determine whether consequences differ for women if they undergo natural menopause. Studies of estrogen-containing hormone therapy are relevant to this issue.

Design

We reviewed evidence-based research, including the systematic identification of randomized clinical trials of hormone therapy with cognitive outcomes that included an objective measure of episodic memory.

Results

As inferred from very small, short-term, randomized, controled trials of high-dose estrogen treatment, surgical menopause may be accompanied by cognitive impairment that primarily affects verbal episodic memory. Observational evidence suggests that the natural menopausal transition is not accompanied by substantial changes in cognitive abilities. For initiation of hormone therapy during perimenopause or early postmenopause when the ovaries are intact, limited clinical trial data provide no consistent evidence of short-term benefit or harm. There is stronger clinical trial evidence that initiation of hormone therapy in late postmenopause does not benefit episodic memory or other cognitive skills.

Conclusion

Further research is needed on the long-term cognitive consequences of surgical menopause and long-term cognitive consequences of hormone therapy initiated near the time of surgical or natural menopause. A potential short-term cognitive benefit might be weighed when a premenopausal woman considers initiation of estrogen therapy at the time of, or soon after, hysterectomy and oophorectomy for benign conditions, although data are still quite limited and estrogen is not approved for this indication. Older postmenopausal women should not initiate hormone therapy to improve or maintain cognitive skills.
Subclinical Thyroid Disorders
Authors: LNU Stuenkel , Cynthia A
Published: September 2019

Symptoms of the menopause transition-altered cycle length, change in amount of bleeding, sleep disruption, fatigue, mood swings, forgetfulness, heat intolerance, and palpitations can also reflect thyroid dysfunction, common in midlife women. Although many clinicians are familiar with diagnosis and management of overt thyroid disorders, subclinical thyroid disease adds an entirely new dimension to this arena.
Combined Estrogenic and Antiestrogenic Properties of Estetrol on Breast Cancer may provide a Safe Therapeutic Window for the Treatment of Menopausal Symptoms
Authors: Gérard Céline , Mestdagt Mélanie , Tskitishvili Ekaterine , Communal Laudine , Gompel Anne , Silva Elisabete , Arnal Jean-François , Lenfant Françoise , Noël Agnès , Foidart Jean-Michel , Pequeux Christel
Published: September 2019

Increased risk of breast cancer is a critical side-effect associated with the use of a menopausal hormone therapy (MHT). Estetrol (E4) is a natural estrogen produced by the human fetal liver and is a promising compound for clinical use in MHT. However, its impact on breast cancer is controversial and poorly defined. In this preclinical study, we show that E4 acts as a weak estrogen by stimulating the growth of hormone-dependent breast cancer only at concentrations exceeding menopausal therapeutic needs. Estetrol (E4) presents also an antitumor activity by decreasing the strong proliferative effect of estradiol (E2). While estrogen receptor alpha (ERá) is the predominant receptor mediating its effects, the dual weak-estrogenic/antiestrogenic feature of E4 results from differential signaling pathways activation. Both nuclear and rapid extranuclear signaling pathway are necessary for a complete estrogenic effect of E4. However, the antitumor action of E4 is not due to a capacity to antagonize E2-induced nuclear activity. Altogether, our results highlight that E4 has a limited impact on breast cancer and may offer a safe therapeutic window for the treatment of menopausal symptoms.
Influence of Selected Reproductive Factors and Smoking on Age at Menopause
Authors: Rumianowski B , Rotter I , Brodowska A , Adler G , Kowalski J , Karakiewicz B , Laszczyñska M
Published: September 2019

Introduction

Early menopause may be associated with serious health risks resulting from, e.g. decreased estrogen levels. This may occur despite hormone replacement therapy.

Aim

The aim of this study was the determination of the effect of selected reproductive factors and smoking on age at the onset of menopause in women from Szczecin and surrounding areas.

Materials and methods

Three hundred and five women after natural menopause were asked to complete a questionnaire, and blood samples were collected from them to test for the levels of follicle stimulating hormone (FSH) andoestradiol (E2).

Results

Smoking women experienced menopause on average more than a year earlier than non-smokers, but this difference was not statistically significant. There was no statistically significant effect of age at menarche or first birth on age at the last menstrual period.

Conclusion

Age at menarche and first birth were not related to age at menopause. In smoking women, menopause occurred earlier but the difference was not statistically significant.
The Association between Menopause Symptoms and Risk of Postmenopausal Breast Cancer among nonusers of Hormone Therapy
Authors: Tricia Li , Han Jiali , Chunyan He
Published: September 2019

Background

Hot flashes are a common symptom among women during their menopause transition, likely due to the changes of endogenous hormone levels. Previous research suggested that hot flashes symptoms were associated with a reduced risk of cardiovascular diseases. Few studies have investigated the association of hot flashes symptoms with the risk of breast cancer. Furthermore, the confounding effect by hormone use has not been sufficiently addressed in previous studies.

Methods

We investigated the association between hot flashes symptoms and risk of postmenopausal breast cancer in the Nurses’ Health Study (NHS). In order to eliminate the confounding by hormone use, we investigated the association only among women who never used hormone therapy. We calculated relative risk of breast cancer using a multivariate Cox model, adjusting for potential confounders, including age, race, family history of breast cancer, age at menarche, age at menopause, parity, age at first birth, body mass index, smoking, alcohol use, and education. We further investigated the severity of hot flashes symptoms in association with risk of postmenopausal breast cancer.

Results

We documented 1079 incidence of breast cancer during 396,166 person-years of follow-up. Hot flashes symptoms were not associated with risk of postmenopausal breast cancer after adjustment for potential confounders (RR = 1.02, 95% CI, 0.90- 1.15) among non-users of hormone therapy. Relative risk of breast cancer across symptom severity categories (mild, moderate, severe) were 1.01 (95% CI, 0.87-1.17), 1.04 (95% CI, 0.88-1.22), and 1.05 (95% CI, 0.75-1.46), respectively.

Conclusion

These data suggested that menopausal symptoms were not associated with risk of postmenopausal breast cancer.
Sleep-disordered Breathing and the Menopausal Transition Among Participants in the Sleep in Midlife Women Study
Authors: Mirer Anna G , Young Terry , Palta Mari , Benca Ruth M , Rasmuson Amanda , Peppard Paul E
Published: September 2019

Objective

Menopause is widely believed to be an established cause of sleep disorders, but evidence for this theory is inconclusive. Attributing any sleep problem to normal processes of menopause may lead to underdiagnosis of treatable sleep disorders in midlife women. This study uses detailed longitudinal data on sleep and menopausal health from participants in the Sleep in Midlife Women Study to investigate whether risk and severity of sleep-disordered breathing increase with progression through menopause, accounting for changes in age and body habitus.

Methods

A total of 219 women aged 38 to 62 years were recruited from participants in the Wisconsin Sleep Cohort Study. Menopause status was determined from daily diaries in which participants reported menstrual flow, hot flashes, and use of hormonal medications. Each participant underwent in-home polysomnography studies every 6 months, to measure the apneahypopnea index (AHI) (N = 1,667 studies). Linear models with empirical standard errors were fit for logarithm of AHI on menopause status and years in menopause, adjusting for age, body mass index, waist girth, and neck girth.

Results

Compared with women in premenopause, AHI was 21% higher among participants in perimenopause (95% CI, −4 to 54), 31% higher among participants in postmenopause (95% CI, 2-68), and 41% higher among participants whose menopausal stage could not be distinguished between peri- and postmenopause (95% CI, 8-82). Among women who had begun perimenopause, each additional year in menopause was associated with 4% greater AHI (95% CI, 2-6).

Conclusions

Progression through menopause is associated with greater sleep-disordered breathing severity. This association is independent of aging and changes in body habitus.
Healthy Heart Matters for Midlife Woman Health
Authors: Mazhar Syeda Batool
Published: September 2019

How to cite this article

Mazhar SB. Healthy Heart Matters for Women. J South Asian Federation Menopause Societies 2017;xx(xx):xx-xx.
The Consolidated Medium-Term Income and Expenditure Framework
Authors:   International Monetary Fund
Published: September 2019

This paper updates the Fund’s consolidated income and expenditure outlook from the projections in January 2011. The paper incorporates and extends the income and budget projections in the companion papers, Review of the Fund’s Income Position for FY 2011 and FY 2012 (4/7/11) and FY 2012–FY 2014 Medium-Term Budget (3/31/11).

The paper also provides an update on the projected accumulation of precautionary balances over the medium term. This responds to a request made during the September 2010 discussion of the adequacy of precautionary balances that progress towards targets be assessed also in the context of the annual income discussion.