A BSTRACT Background: Postmenopausal bleeding (PMB) is a warning symptom and is associated with endometrial malignancy in 10%–15% of cases. Endometrial thickness (ET) measurement using transvaginal ultrasound (TVS) guides the course of action, with ET >4 mm being ominous. Three-dimensional power Doppler (3DPD) ultrasound raises diagnostic utility with endometrial volume (EV) and vascularity indices-vascularization index (VI), flow Index (FI) and vascularization FI (VFI), while hysteroscopy provides a direct view of uterine lesions. Previous studies have worked on role of 3DPD or hysteroscopy in PMB patients, but none have compared these two. Hence, this study was conducted. Methods: This prospective observational study was conducted at a tertiary center, including 75 women with PMB. They underwent 3DPD ultrasound followed by hysteroscopy and endometrial biopsy. The diagnostic accuracy of Doppler parameters was analyzed using receiver operating characteristic curves. Hysteroscopic results were compared with histopathology, followed by comparison of 3DPD and hysteroscopy. Results: Out of 75 patients, 65 (86.6%) had benign pathologies and 10 (13.4%) had malignancies. 3DPD parameters VI, VFI, and EV were significantly higher in the malignant group. EV had the highest diagnostic performance, with an area under curve (AUC) of 0.88 (cutoff ≥7.34 cm 3 ), yielding 80% sensitivity and 80% specificity. VI, FI, and VFI achieved sensitivity/specificity of 80%/78.5%, 70%/70.8%, and 80%/73.8%, with AUCs of 0.83, 0.69, and 0.82, respectively. Hysteroscopy demonstrated 100% sensitivity and specificity for detecting endometrial malignancy and endometrial polyps. Cohen’s kappa analysis of hysteroscopy and 3DPD showed agreement of 78.67%, 70.67%, 78.67%, and 80% between hysteroscopy and VI, FI, VFI and EV, respectively. Conclusion: 3DPD, particularly EV, is a valuable noninvasive tool in PMB. Hysteroscopy remains a highly sensitive and specific modality for detecting malignancy, showing good correlation with 3DPD.
A BSTRACT Primary malignancies of the fallopian tube are rare, and the simultaneous occurrence of cancers in both the endometrium and fallopian tube is even more uncommon. These synchronous tumors can present with nonspecific symptoms, making diagnosis challenging, especially in postmenopausal women. We describe the case of a 58-year-old postmenopausal woman with a 1-year history of persistent vaginal discharge and repeated episodes of pyometra. Initial evaluations identified an adnexal mass and confirmed endometrial adenocarcinoma through biopsy. Imaging studies did not show signs of myometrial invasion or metastatic disease. The patient underwent comprehensive surgical staging, during which an unexpected diagnosis of high-grade serous carcinoma of the fallopian tube was made, followed by chemotherapy. This case emphasizes the importance of considering synchronous malignancies in postmenopausal women with recurrent pyometra. Early recognition and thorough intraoperative assessment are critical to ensure appropriate surgical management and optimize treatment outcomes.
A BSTRACT Background: Massive ovarian edema (MOE) is a rare benign condition that often mimics ovarian neoplasms both clinically and radiologically, leading to surgical overtreatment. Case Presentation: A 45-year-old multiparous woman (P2L2) presented with intermittent lower abdominal pain and imaging suggestive of an adnexal mass. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathology revealed MOE. Conclusion: Even in mid-life women, MOE should remain a differential for adnexal masses to guide surgical planning and avoid unnecessary radical surgery.
A BSTRACT This study aimed to systematically evaluate the effects of dietary protein intake on metabolic indicators in postmenopausal women, so as to provide scientific evidence for precise nutritional interventions in this population. Four electronic databases, namely PubMed, EBSCOhost, Cochrane, and Web of Science, were systematically searched. A total of 30 studies with 2028 participants were included. Meta-analysis was performed using R software to assess the effects of dietary protein intake on blood glucose, blood lipid profile (triglyceride [TG] and high-density lipoprotein [HDL]), blood pressure, and body composition (body mass index [BMI], waist circumference, and lean body mass [LBM]). Subgroup analyses were conducted according to age, intervention duration, and protein intake level. The results showed that plant protein contributed to reduced fasting glucose, TGs, HDL cholesterol, systolic blood pressure (SBP), and diastolic blood pressure (DBP), but had no significant effect on body composition. Animal protein exerted beneficial effects on reducing BMI, preserving LBM, and lowering SBP and DBP, but showed no significant regulatory effects on core glucose and lipid indicators. Subgroup analysis indicated that younger postmenopausal women were more sensitive to the metabolic effects of plant protein, while older women were more likely to benefit from body composition regulation by animal protein. This study revealed the differential regulatory effects of the two protein sources, providing evidence-based support for the development of individualized dietary protein strategies for postmenopausal women. Future studies should focus on differences in protein subtypes, mechanistic validation, and the supplementation of localized evidence in different ethnic populations.
A BSTRACT Background: Breast and cervical cancer are common cancers among women in India. In Primary health care, gynecological morbidities such as bleeding, vaginal discharge, mental health issues, and the presence of comorbidities need provision of comprehensive care. Methods: We conducted a secondary data analysis of data from the monthly Well Women’s Clinic conducted in an underprivileged area in Bangalore City from 2022 to 2025. Women’s symptoms, clinical presentations, vital signs, anthropometric measurements, depression, anemia, diabetes and hypertension screening, and diabetes and PAP smear reports were analyzed. Results: A total of 313 women have sought the services of the Well Women’s Clinic during the study period. The mean age of the study participants was 44 years (±13) with an average parity of 2 (±1). The mean age at menopause was 46 years (±5). Most of them were married (83.7%). Of the participants, 176 (61.5%) had comorbidities. Overweight was present among 118 (38.7%) and obesity among 102 (33.5%) of the women. Waist circumference indicated a substantial risk among 187 (78.6%) of the women. Of the presenting symptoms, 6 (1.9%) had a breast lump, 40 (12.8%) had irregular cycles, 36 (11.5%) had vaginal discharge, and 38 (12.1%) had genitourinary symptoms. Pap smear report was abnormal in 34 (21.5%) of the women. Of the Pap smear report, one was reported as a precancerous lesion. Conclusion: In primary health care, provision of comprehensive women’s health care includes screening of common noncommunicable diseases, depression, anemia, and cancer. Gender norms in the community prevent women to seek early access to care.
A BSTRACT Background: Sleep deprivation and occupational stress are increasingly recognized as critical determinants of physician well-being, with potential implications for healthcare quality and patient safety. However, data on sleep patterns and their determinants among heterogeneous groups of practicing physicians remain limited. Objective: To assess sleep patterns, lifestyle characteristics, and work-related stressors among practicing physicians and to examine their interrelationships. Methods: This cross-sectional, survey-based study was conducted between January and March 2026 among practicing physicians using an anonymous, self-administered electronic questionnaire. A total of 627 physicians participated. Data collected included demographic and professional characteristics, work patterns, lifestyle behaviors, sleep-related parameters, and perceived stress. Descriptive statistics were used to summarize the data. Results: Among 627 physicians, 54.1% reported sleeping ≤6 h per night, and 51.9% experienced sleep disturbance at least twice per week. Nearly one-third (28.3%) reported working more than 60 h per week. Stress negatively affected sleep in 48.5% of respondents. The most common contributors to sleep disruption were anxiety or stress (44.2%) and patient emergencies (31.9%), while key work-related stressors included poor work–life balance (40.5%), administrative burden (36.5%), and high patient load (32.5%). Despite these findings, most physicians reported low tobacco and alcohol use and moderate levels of physical activity. Conclusions: Sleep deprivation and sleep disturbance are highly prevalent among practicing physicians and are strongly associated with work-related stressors rather than lifestyle factors. These findings highlight the need for system-level interventions targeting workload, scheduling, and workplace stress to improve physician sleep health and overall well-being.
A BSTRACT Background: Menopause is associated with hormonal changes that influence multiple body systems and may affect oral health, thereby impacting overall well-being and quality of life in midlife women. Oral health manifestations during the postmenopausal period often remain under-recognized in routine healthcare. Objective: The objective of this study is to assess the association between duration since menopause and oral health manifestations in postmenopausal women. Methodology: This cross-sectional study included 75 postmenopausal women attending a dental outpatient clinic. Participants were categorized based on duration since menopause into three groups: 1–5 years, 6–10 years, and >10 years (25 participants in each group). Oral health manifestations including xerostomia, burning mouth symptoms, taste disturbances, tongue coating, and periodontal status were assessed using the standard clinical indices. Statistical analysis included Spearman correlation, Kruskal–Wallis test for continuous variables, Chi-square test for categorical variables, and age-adjusted regression analyses (ordinal logistic, binary logistic, and linear regression as appropriate). Results: An increasing trend in oral health manifestations was observed with longer duration since menopause in midlife women. Significant associations were observed in unadjusted analyses; however, none remained statistically significant after adjustment for age. Conclusion: Although oral health manifestations appear to increase with longer duration since menopause, these associations were attenuated after age adjustment and were not independent of age. In this cross-sectional study, the findings should therefore be interpreted as descriptive trends rather than causal relationships. Increased awareness of these manifestations may support improved oral healthcare in postmenopausal women.
A BSTRACT Premature ovarian insufficiency (POI), defined as loss of ovarian function before 40 years with elevated gonadotropins and oligo/amenorrhea, is increasingly recognized as a systemic condition with long-term health consequences. While cardiovascular, skeletal, and neurocognitive risks are well established, the relationship between POI and cancer risk remains less clearly understood. This mini-review summarizes current evidence on site-specific malignancy risks in women with POI and evaluates the influence of hormone replacement therapy (HRT) on cancer outcomes. Available epidemiological studies, cohort analyses, and guideline recommendations addressing cancer incidence in POI were reviewed, with emphasis on breast, ovarian, endometrial, colorectal, and autoimmune-associated malignancies. Women with spontaneous POI generally demonstrate a reduced risk of breast, ovarian, and endometrial cancers, largely attributed to lower lifetime estrogen exposure and fewer ovulatory cycles. However, cancer risk may vary by etiology: autoimmune POI is associated with increased thyroid cancer incidence, while genetic subgroups such as fragile X mental retardation 1 premutation carriers may exhibit altered ovarian cancer susceptibility. Importantly, physiological HRT in POI differs fundamentally from postmenopausal hormone therapy and does not appear to increase overall cancer risk when continued until the average age of natural menopause. POI is typically associated with lower risks of hormone-dependent malignancies, though subgroup-specific variations exist. Individualized counseling, appropriate progestin opposition, and further POI-specific cohort studies are essential to refine cancer surveillance strategies.
Proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders, but emerging evidence suggests they may influence glucose metabolism. This meta-analysis evaluates the effect of PPIs on glycemic control in patients with and without type 2 diabetes mellitus (T2DM). We systematically searched PubMed, Cochrane Library, Embase, and Scopus for randomized controlled trials and observational studies reporting fasting blood glucose (FBG), HbA1c, or insulin resistance with PPI use. Risk of bias was assessed using the Cochrane RoB 2.0 tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Data were synthesized using a random-effects model and expressed as mean differences with 95% confidence intervals (CIs). The review was not prospectively registered in PROSPERO or any other database. Fifteen studies involving 2,038 participants were included in the study. PPI use significantly reduced FBG (mean decrease: 5.32 mg/dL; 95% CI: 2.01-8.63; P = 0.002; 9 studies, n = 1243). HbA1c reductions were observed in some studies (7 studies, n = 1121), but findings were inconsistent. No significant effect was seen on insulin resistance (4 studies, n = 412). Subgroup analyses suggested greater benefits in patients with poorly controlled T2DM. Reported adverse events were mild, including gastrointestinal symptoms and headache. Small sample sizes, study heterogeneity, and moderate risk of bias in some trials limited the certainty of evidence. PPIs may provide modest improvements in glycemic control, particularly among patients with poorly controlled T2DM. While generally safe in the short term, the long-term benefits and risks remain unclear. Regular glucose monitoring may be advisable in diabetic patients on chronic PPI therapy.
Background:Telomeres are protective DNA sequences at chromosome ends that shorten with cell division and regulate cellular lifespan. Dysregulation of telomere maintenance through telomerase activation is implicated in carcinogenesis, including ovarian cancer. This study aimed to systematically review and meta-analyze the association between telomere length and ovarian cancer risk and survival outcomes. Methodology:A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception to the final search date. Studies evaluating measured telomere length in relation to ovarian cancer risk or survival were included. Eligible observational studies reporting effect estimates were pooled using random-effects meta-analysis. Odds ratios (ORs) were synthesized for ovarian cancer risk, while hazard ratios (HRs) were pooled for survival outcomes. Heterogeneity was assessed using Cochran's Q test and the I 2 statistic. Results:Eleven studies were included in the systematic review, of which seven were eligible for meta-analysis (four risk studies and three survival studies). For ovarian cancer risk, the pooled common-effect estimate showed a modest association (OR = 1.17; 95% confidence interval [CI]: 1.02-1.34), but this was not statistically significant under the random-effects model (OR = 1.23; 95% CI: 0.70-2.16) with moderate heterogeneity (I 2 = 66.8%, P = 0.0287). For survival outcomes, the common-effect model showed no significant association between telomere length and survival (HR = 0.98; 95% CI: 0.83-1.16), with substantial heterogeneity (I 2 = 85.2%, P = 0.001). The random-effects estimate also showed no significant association (HR = 1.66; 95% CI: 0.21-12.87). Conclusions:Current evidence does not demonstrate a consistent association between telomere length and ovarian cancer risk or survival. Substantial heterogeneity across studies highlights the need for large, well-designed prospective studies with standardized telomere measurement methods to clarify the role of telomere dynamics in ovarian carcinogenesis.
A BSTRACT Mesonephric adenocarcinoma of the uterine cervix is a rare, human papillomavirus-independent malignancy arising from mesonephric duct remnants and is often underrecognized due to its varied morphology and resemblance to other cervical adenocarcinomas. We report a case of a 35-year-old woman presenting with abnormal uterine bleeding. Imaging revealed a cervical lesion, and biopsy suggested adenocarcinoma. Following radical hysterectomy, histopathology showed an infiltrative tumor composed of glands and tubules with focal retiform architecture and intraluminal eosinophilic secretions. Immunohistochemistry demonstrated positivity for CK7, PAX8, GATA3, and luminal CD10, with nonblock-type p16 staining, confirming mesonephric differentiation. This case underscores the importance of careful morphologic evaluation and appropriate immunohistochemical analysis for accurate diagnosis of this uncommon but clinically significant cervical malignancy.
Periodontitis, a chronic inflammatory disease, causes progressive loss of periodontal tissues. Traditional measures like clinical attachment loss and probing pocket depth fail to quantify the inflammatory burden accurately. The Periodontal Inflamed Surface Area (PISA) quantifies the surface area of bleeding pocket epithelium, offering a better measure of inflammation. This review explores the association between PISA and systemic disorders such as cardiovascular disease, diabetes, dementia, and rheumatoid arthritis (RA). Studies show higher PISA levels correlate with elevated systemic inflammatory markers, including high-sensitivity C-reactive protein and vascular stiffness. In Type 2 diabetes mellitus, PISA is positively associated with HbA1c levels, indicating a dose-response relationship. Additional links have been identified between PISA and conditions like dementia, RA, and diabetic complications. These findings underscore PISA’s value in assessing the systemic impact of periodontitis, advocating for its integration into holistic patient care and further research to standardize its use.
Background:Breast cancer is the most common cancer diagnosed among Indian women due to change in life style, reproductive patterns and rapid urbanization. Methods:A systematic search was conducted for case control studies published between January 2010 and April 2025. Data were extracted from 19 studies. Pooled odds ratios (OR) with 95% confidence intervals (CI) ,heterogeneity was assessed with I² statistics, while publication bias was evaluated using funnel plots and Egger's test. Study quality was appraised using the Newcastle-Ottawa Scale. Results:Sociodemographic risks included unmarried status (OR=1.96; 95% CI: 1.09-3.54) and late age at marriage > 21 years (OR= 2.66; 95% CI: 1.90-3.73). Family history of breast cancer doubled the risk (OR=2.35; 95% CI: 1.73-3.18), and past benign breast disease showed a strong association (OR=4.28; 95% CI: 2.50-7.35). Central obesity (WHR > 0.85) significantly increased risk (OR=2.74; 95% CI: 1.85-4.07), although BMI > 25 kg/m² alone was not significant. Lifestyle factors such as non-vegetarian diet (OR = 1.62; 95% CI: 1.19-2.21), tobacco use (OR=1.67; 95% CI: 1.24-2.24), and high-fat diet (OR=4.20; 95% CI: 2.76-6.42) demonstrated strong associations. Reproductive risk factors-including early menarche (OR =1.95), late menopause (OR=1.92), OCP use (OR=2.01), low parity (OR=1.52), previous abortions (OR=2.48), and breastfeeding <6 months (OR= 4.12)-were all significantly linked to higher risk. Several subgroups exhibited notable heterogeneity and occasional publication bias. Conclusion:Modifiable risks present critical opportunities for prevention.Women with non-modifiable factors warrant targeted screening and risk stratification.
