Cálculo del Índice de Pearl de etinilestradiol 30 mcg/drospirenona 3 mg (Genesa®)

Objetivo: Calcular el índice de Pearl de Genesa® en mujeres venezolanas. Métodos: Estudio fase IV, prospectivo y abierto. Las pacientes recibieron etinilestradiol 30 mcg / drospirenona 3 mg (Genesa®): un comprimido diario desde el primer día de la menstruación por 21 días; descanso de siete días y reinicio el día ocho. Resultados: Se ingresaron al estudio 115 pacientes, se obtuvo un índice de Pearl de 0,98. Los efectos adversos fueron: un embarazo, incremento de peso, retención de líquidos, náuseas, manchas en la piel. Conclusiones: Etinilestradiol 30 mcg/drospirenona 3 mg (Genesa®) presenta un adecuado índice de Pearl en mujeres venezolanas.

Objective: To calculate the Pearl index of Genesa® in Venezuelan women. Methods: Phase IV prospective and open study. Patients received ethinylestradiol 30 mcg / drospirenone 3 mg (Genesa®): one tablet daily from the first day of menstruation for 21 days; seven-day break and restart the eighth day. Results: 115 patients were admitted to the study, a Pearl index of 0.98 was obtained. Most common side effects: one pregnancy, weight gain, fluid retention, nausea, skin blemishes. One patient discontinued treatment for adverse effects (vomiting and nausea). Conclusions: Genesa® presents an adequate Pearl Index in Venezuelan woman.

Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model.

BACKGROUND: Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, against Human Papillomavirus (HPV) in Venezuelan girls in order to inform decision-makers. METHODS: A previously published Markov cohort model, informed by the best available evidence, was adapted to the Venezuelan context to evaluate the effects of vaccination on health and healthcare costs from the perspective of the healthcare payer in an 11-year-old girls cohort of 264,489. Costs and quality-adjusted life years (QALYs) were discounted at 5%. Eight scenarios were analyzed to depict the cost-effectiveness under alternative vaccine prices, exchange rates and dosing schemes. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Compared to screening only, the bivalent and quadrivalent vaccines were cost-saving in all scenarios, avoiding 2,310 and 2,143 deaths, 4,781 and 4,431 CCs up to 18,459 GW for the quadrivalent vaccine and gaining 4,486 and 4,395 discounted QALYs respectively. For both vaccines, the main determinants of variations in the incremental costs-effectiveness ratio after running deterministic and probabilistic sensitivity analyses were transition probabilities, vaccine and cancer-treatment costs and HPV 16 and 18 distribution in CC cases. When comparing vaccines, none of them was consistently more cost-effective than the other. In sensitivity analyses, for these comparisons, the main determinants were GW incidence, the level of cross-protection and, for some scenarios, vaccines costs. CONCLUSIONS: Immunization with the bivalent or quadrivalent HPV vaccines showed to be cost-saving or cost-effective in Venezuela, falling below the threshold of one Gross Domestic Product (GDP) per capita (104,404 VEF) per QALY gained. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results.

Human papillomavirus in invasive cervical cancer and cervical intraepithelial neoplasia 2 and 3 in Venezuela: a cross-sectional study.

BACKGROUND: This study investigated the distribution of human papillomavirus (HPV) types in invasive cervical cancer (ICC), cervical intraepithelial neoplasia 2 (CIN2) and cervical intraepithelial neoplasia 3 (CIN3) in Venezuela. METHODS: Paraffin-embedded samples from 329 women from 29 medical centers of the 24 states of Venezuela were analyzed to determine the distribution of HPV types for ICC, CIN2, and CIN3, the prevalence of single and multiple infection, and the association of HPV types with severity of lesion, comparing CIN2 versus CIN3+ (CIN3 and ICC). The samples were analyzed with the polymerase chain reaction (PCR) followed by reverse hybridization for the identification of HPV types. RESULTS: HPV was identified in 95/96 ICC specimens (98.9%), in 142/149 CIN3 (95.3%) and in 78/84 CIN2 samples (92.8%). The most common types for ICC and CIN3 were: HPV16, 18, 31, and 33, and for CIN2 were HPV16, 31, 51, 52, and 18. HPV single infection was found in 82.1% of ICC cases, in 79.4% of CIN2 cases, and in 77.4% of CIN3 cases. HPV16 was identified as a single infection more frequently in women with CIN3+ than in those with CIN2 (68.6% versus 46.7%, P=0.002), and HPV16 or HPV18 types were more prevalent in CIN3+ than in CIN2 (73.4% versus 50%, P=0.0006). CONCLUSION: this is the first study of the distribution of HPV types in ICC, CIN2, and CIN3 conducted throughout the territory of Venezuela. HPV16 and HPV18 were the most frequent HPV types identified in single and multiple infections in both ICC and CIN3 groups, and are associated with severity of lesion. The knowledge of the distribution of HPV types would allow organization of an HPV-DNA-based screening test, and consideration of the implementation of prophylactic vaccination in Venezuela.

Follicular fluid antibodies to Chlamydia trachomatis and human heat shock protein-60 kDa and infertility in women.

BACKGROUND: The objective of this study was to establish the relationship between presence of anti-Chlamydia trachomatis and anti-HSP60 antibodies in serum and follicular fluid of infertile women. METHODS: Serum IgG and follicular fluid IgA to Chlamydia trachomatis and human heat shock protein 60 (HSP60) were determined in 41 women undergoing in vitro fertilization (IVF). RESULTS: A significant association was found between presence of bacterial antibodies in serum and IgA anti-HSP60 in follicular fluid. CONCLUSIONS: Chlamydia trachomatis infection might be triggering an autoimmune process that could negatively affect the success of IVF.

Etica y donación del gameto femenino / Ethics and oocyte donation

La donación del gameto femenino (ovocito) se ha convertido, debido a su laboriosa obtención y difícil conservación, en un tema muy controvertido por los aspectos éticos que involucra. Este ensayo evalúa, bajo la racionalidad ética, las implicaciones de las diversas formas de obtención de ovocitos donados y su repercusión sobre el desempeño de la reproducción asistida y los aspectos sociales emanados

Sangrado uterino disfuncional: revisión bibliográfica / Dysfunctional uterine bleeding: bibliografic review

A mediados del siglo, se definía una entidad nosológica caracterizada por "una hemorragia uterina cíclica o acíclica que no responde a un proceso tumoral o inflamatorio definido" (2), a lo que se denominó metritis crónica idiopática, endometritis fungosa, endometritis glandular hiperplásica, metritis hemorrágica, metropatía hemorrágica, metropatía ovarígena, metrorragia funcional o enfermedad de Brecke Schroeder, en honor al ginecólogo que la describió por vez primera (3,4). Actualmente, esta patología se denomina sangrado uterino disfuncional, en correspondencia a la falta de expresión orgánica definida de esta entidad. Lui y Kessel (5) definen una entidad patológica que denominan sangrado uterino anormal, que se manifiesta como sangrado excesivo durante las menstruaciones o trastornos menstruales como sangrado intermenstrual, polimenorrea, menometrorragia y sangrado posmenopáusico, Esta entidad puede ser dividida en dos grandes grupo: el sangrado uterino anormal secundario a causas orgánicas y el sangrado uterino anormal secundario a anovulación, que es lo que se conoce como sangrado uterino disfuncional