Jayashree Joshi

Menopause and metabolic syndrome: A study of 498 urban women from western India

Introduction: Metabolic syndrome (MS) is a cluster of risk factors for future development of type 2 diabetes mellitus and cardiovascular diseases. Menopausal transition with its incidental hormonal changes is considered to contribute to the development of MS. However, age is known to influence MS risk factors. Objective: The present study explores the prevalence of MS in pre- and postmenopausal women from western India. Methods: Four hundred and ninety eight women above 35 years of age, participating in womens health care program were assessed for the prevalence of MS using two criteria- International Diabetes Federation criteria (IDF) and Harmonization (H_MS) criteria. Results: Prevalence of MS amongst postmenopausal women was significantly higher (P < 0.001) than that in premenopausal women by both, IDF (premenopausal 45% and postmenopausal 55%) and H_MS criteria (premenopausal 44% and postmenopausal 56%). However, this significance disappeared when data was adjusted for the confounding variable of age.

Role of cytokines in genesis, progression and prognosis of cervical cancer.

Cytokine research is currently at the forefront in cancer research. Deciphering the functions of these multiple small molecules, discovered within the cell and in intercellular spaces, with their abundance and pleotrophism, was initially a great challenge. Advances in analytical chemistry and molecular biology have made it possible to unravel the pathophysiological functions of these polypeptides/proteins which are called interleukins, chemokines, monokines, lymphokines and growth factors. With more than 5 million women contracting cervical cancer every year this cancer is a major cause of mortality and morbidity the world over, particularly in the developing countries. In more than 95% of cases it is associated with human papilloma virus (HPV) infection which is persistent, particularly in those with a defective immune system. Although preventable, the mere magnitude of prevalence of HPV in the world population makes it a dominating current health hazard. The discovery of cytokine dysregulation in cervical cancer has spurted investigation into the possibility of using them as biomarkers in the early diagnosis of cases at high risk of developing cancer. Their critical role in carcinogenesis and progression of cervical cancer is now being revealed to a great extent. From diagnostics to prognosis, and now with a possible role in therapeutics and prevention of cervical cancer, the cytokines are being evaluated in all anticancer approaches. This review endeavours to capture the essence of the astonishing journey of cytokine research in cervical neoplasia.

Prevalence of premenstrual symptoms: Preliminary analysis and brief review of management strategies.

Objective: To determine the prevalence of premenstrual cyclic symptoms in perimenopausal age. Subjects and Methods: Women attending Bhavans SPARC Maitreyis Health Care Programme (HCP) for women around 40 years of age were included in the study. Last 200 women who attended from April 2002 to October 2004 are included for analysis. Out of these 107 qualified for final analysis as others were post hysterectomy or post menopausal. Thirty five symptoms listed under premenstrual tension syndrome were analysed. Results: Forty one women (38.3%) had 3 or more symptoms whilst 15 (14.0%) had 5 or more cyclic symptoms. Five women (4.7%) reported that the symptoms were severe. Eleven women had seeked treatment for premenstrual tension syndrome (PMTS). The commonest symptom was mastalgia or heaviness of breasts. Next was whilst also was reported by several women. Women reported anger attacks and reported depression. Conclusion: PMTS was common between 36 and 55 years. About half of them have experienced 3 more symptoms and 1 in 20 may require treatment.

Persistence of Cytologic Abnormality After Treatment of Bacterial, Parasitic and Fungal Infections in Older Women with Low Grade Squamous Intraepithelial Lesion

tively) may undergo regression in >30%.1,2 In a large, prospective study by Moscicki et al3 it was observed that 90% of cases with LSIL in the younger age group, 13–22 years of age, show regression on long-term follow-up. We report the effect of treatment of bacterial, parasitic and fungal treatment on Pap smears from women with a report of LSIL. We have outpatient women’s health clinics and a cervical cancer screening program for women. Those with HSIL or suspected cancer are referred to nearby hospitals. A research grant which involved studying the effect of pharmacologic treatment of associated genital infections in women with LSIL (except viral infections) allowed us to screen women from low socioeconomic groups free of cost. Since the majority of women developing cancer or cervical intraepithelial neoplasia (CIN) are over 30 years of age in our population, free Pap tests were offered to this group. About one fourth of the women belong to the higher socioeconomic group and are required to pay for the Pap test. There is no universal governmentor insurance-based screening program. The study was approved by an independent ethics committee. A total of 660 cases were screened by Pap smears from April 2007 to October 2007. More than 80% of patients were over the age of 30 years. Of these there were 3 cases of cervical squamous cell carcinoma, 7 cases of HSIL and 22 cases of LSIL, mostly in the underprivileged group. All abnormal Pap smears, showed evidence of local infections.4,5 None of the women admitted having premarital or extramarital sexual relationships. Two women with HSIL reported that their husbands were polygamous. This letter is restricted to the 15 patients with LSIL who returned for a repeat smear within a period of 8 months after treatment of infections. Since local genital infections act as cofactors for the development of SCC of the cervix, we were interested in finding out the immediate effect of treatment of infections on the cytologic pattern. Out of 15 women with treated LSIL, 8 showed cytologic manifestations of bacterial, parasitic and fungal infections (Table I). Koilocytosis indicating infection by the human papillomavirus (HPV) was associated in 13 of 15 cases. The prevalence of koilocytosis in smears in the general population in our clinics is 8%. All had had 2, 3 or 4 pregnancies. Eight women were postmenopausal, while 7 were premenopausal. Two cases were 30 and 32 years old, and the remainder were between 42 and 67 years of age. All 15 women and their husbands (10 living with husbands) were treated for bacterial, parasitic and fungal infections. Cases were treated with metronidazole or

Single dose metformin kinetics after co-administration of nisha-amalaki powder or mamejwa ghanavati, ayurvedic anti-diabetic formulations: A randomized crossover study in healthy volunteers

Objective: The aim was to study herb-drug interaction of two ayurvedic formulations - DMFN01 (Nisha-Amalaki) powder and DMFN02 (Mamejava) ghanavati with metformin at a single dose in healthy volunteers. Materials and Methods: This was an open-labelled, single dose, crossover, and randomized volunteer study. Healthy volunteers were studied in two groups (6/group). Volunteers were randomized to oral metformin (500 mg single dose) alone or with concurrent DMFN01 (10 g), or DMFN02 (750 mg). Venous blood samples were collected at different time points from 0 to 24 h. Plasma metformin concentrations were measured by high performance liquid chromatography coupled with an ultraviolet detector. Results: Simultaneous administration of DMFN01 with metformin showed a reduction in the mean area under the curve (AUC [0-24 h]) of metformin by 51% (P < 0.002) when compared with metformin alone. However, co-administration of DMFN02 did not show any significant difference in the mean AUC of metformin (P = 0.645). One volunteer had a reduction of 41% in AUC of metformin with DMFN 02. Conclusions: These data raise relevant questions on therapeutic control of hyperglycemia when DMFN01 choorna is given concurrently with metformin. Based on known absorption pattern of metformin an interval of 2 h between the oral doses of metformin and ayurvedic formulations would be advisable to avoid interactions. In reverse pharmacological studies, at an early stage, such interaction studies are desirable.

Reverse pharmacology for antimalarial plants goes global

Sir, A recent issue of the Malaria Journal has been dedicated to the research and development of natural products for treatment of malaria. All the articles in the issue are interesting. The article on Reverse Pharmacology (RP) by Willcox et al[1] is of particular interest, which suggested that this transdiscipline of RP has global appeal. The RP path, as Willcox et al have rightly mentioned in their article, has originated in India for new drug discovery and is based on Ayurveda, India’s ancient traditional system of medicine. However, the statement of Willcox et al supported by the reference of Patwardhan and Mashelkar[2] that “RP still involves classical pathway of isolating compounds for further development” is true only to a certain extent. RP in India focuses mainly on the development of Ayurveda-inspired standardized formulations, the safety, and activity of which is implied through its long history of usage. Several other paths may be considered for the development of drugs from Ayurvedic therapeutics and natural products, one of them is isolation and identification of active compounds.[3]

Serum progesterone and norethisterone levels following injection of norethisterone enanthate in different sites and doses.

Serum progesterone (P) and norethisterone (NET) levels following injection of norethisterone enanthate (NETEN) were studied in 11 regularly menstruating women. In 6 subjects 200 mg NETEN was administered to the gluteal (IG) or deltoid (ID) region sequentially. The serum P levels remained anovulatory (less than 4 ng/mL) up to 12 weeks. Serum NET levels were similar whether injection was given IG or ID (paired t - test, NS). In 5 subjects given a 150-mg dose, serum P levels remained anovulatory up to 11 weeks. Serum NET levels declined faster than with the 200-mg dose, but the difference was not significant (Students t - test, NS). Wide inter-subject variations were seen in both groups. NETEN therefore can effectively be administered in gluteal or deltoid regions. A lower dose of 150 mg may have contraceptive potential on an 8-week schedule.

Cytologic follow up of Low-grade Squamous Intraepithelial Lesions in Pap smears after integrated treatment with antimicrobials followed by oral turmeric oil extract

Cervical cancer is preventable because the carcinogenesis is slow and there are opportunities to detect precancerous lesions by Papanicolaou (Pap) smears, colposcopy, or HPV DNA tests and to treat them by antimicrobials, surgery or cold CO2 vapourization. We have earlier reported on the chemopreventive potential of integrated treatment with antimicrobials therapy followed by a standardized oral Turmeric Oil (TO) extract upto 12 weeks in women who had persistent Low-grade Squamous Intra-epithelial Lesion (LSIL) in their Pap smears. In this communication we report their post-therapy follow up for 36 months (N = 18) with Pap smears. We were also able to follow up for 36 months control cases (N = 10) who had only standard therapy with antimicrobials. During 36 months of follow up none of the cases with integrated treatment, progressed to HSIL or cancer. Out of 15/18 cases which had a regression of Pap smear, all 15 remained free of LSIL from 6 to 36 months post-therapy showing persistent therapeutic effect of integrated therapy. In one case there was recurrence of LSIL in Pap smear, ten months post-therapy, which regressed to mild atypia after a second course of oral TO for 8 weeks. In the control group, persistence of LSIL after antimicrobials was observed in Pap smears in 5/10 cases when followed up by Pap smears up to 36 months. This preliminary report indicates some post-therapeutic benefit with integrative treatment as compared to the use of antimicrobials alone. A large scale controlled study is warranted.