Phaeoacremonium krajdenii, a cause of white grain eumycetoma.

We describe the first case of white grain pedal eumycetoma caused by Phaeoacremonium krajdenii in a 41-year-old man from Goa, India. Based on histological examination of biopsy tissue showing serpentine granules, a culture of the granules yielding phaeoid fungal colonies, and morphological characteristics and sequence comparison of the partial beta-tubulin gene with the ex-type isolate of P. krajdenii, the causal agent was identified as P. krajdenii.

Effects of transdermal and oral estrogen replacement on lipids and glucose metabolism in postmenopausal women with type 2 diabetes mellitus.

OBJECTIVE: To compare the effects of oral and transdermal estrogen replacement on lipid and glucose metabolism in postmenopausal women with diabetes mellitus type 2. DESIGN AND METHODS: In an open, randomized, cross-over study, 21 diabetic postmenopausal women were treated with transdermal 17beta-estradiol 50 microg or oral conjugated equine estrogens (CEE) 0.625 mg daily, both associated with 300 mg/day of oral micronized progesterone for 12 days monthly during 6 months each. After a 12-h overnight fasting period, blood glucose, insulin, glycosylated hemoglobin (HbA1c) and lipoprotein profile were evaluated, at baseline and after 6 months of each schedule of hormone replacement therapy (HRT). Insulin sensitivity was determined by homeostasis model assessment (HOMA). RESULTS: HRT had no negative influence on glucose metabolism. After 6 months of CEE treatment, there was a significant increase in high-density lipoprotein (HDL) cholesterol, but also in triglycerides, of 9.0% and 20.7%, respectively (p = 0.04). The levels of total cholesterol and low-density lipoprotein (LDL) cholesterol were unaffected. Transdermal estradiol did not affect the lipid profile. CONCLUSIONS: Hormone replacement therapy with either oral or transdermal estrogen plus micronized progesterone has no harmful influence on glucose metabolism in type 2 diabetic postmenopausal women; whether the increase in HDL cholesterol, but also in triglyceride levels, makes oral CEE the better choice remains an open question.

[Information on advances in sciences and technology. Advances in contraceptive technology]. / Informacoes sobre avancos em ciencia e tecnologia. Avancos da tecnologia anticonceptiva.

PIP: Hormonal contraceptives include oral pills with lower steroid concentrations such as the triphasic gestodene. A dose of less than 20 mcg of ethinyl estradiol in the combined pill is effective. The use of RU-486 or mifepristone to inhibit ovulation or as a postcoital method is still being investigated. The vaginal rings that release 20 mcg of levonorgestrel (LNG) have a 97% rate of efficacy. There are newer types that release 30 mcg of LNG or desogestrel. A progesterone-releasing ring used during lactation is being studied. Among implants Norplant has been approved in many countries, including by the US Food and Drug Administration, with excellent results. In Brazil it continues to be banned. Studies have been initiated about implants, such as Norplant 11 and UNIPLANT. The studies conducted by the World Health Organization on injectables such as Cyclofem (which contains 5 mg of estradiol cypionate and 25 mg of medroxyprogesterone acetate) as well as Mesigyna (5 mg of estradiol valerate and 50 mg of norethindrone enanthate) are awaited. These two monthly injectables have minor side effects, produce regular cycles, and are highly effective. The use of GnRH analogues for ovulation inhibition are held back because of cost, dosage, and routes of administration The hormonal IUD releasing 20 mcg of LNG holds promise for high efficacy, probable protection against inflammations, and pronounced reduction of menstrual bleeding, particularly in long-term use. The frameless IUD, called Flexigard, consists of 6 fixed copper cylinders placed in the myometrium, which causes less endometrial irritation and less incidence of inflammation, pain, and bleeding. It has been in an experimental testing phase for some years. The female condom helps prevent STDs and is under the woman's control. Among male contraceptives, a hormonal method awaits development, while gossypol with the ability to inhibit HIV proliferation and the Chinese method of scalpel-free vasectomy are effective methods.^ieng

Menstrual blood loss and body iron stores in Brazilian women.

Menstrual blood loss (MBL) studies are relevant for developing world women as this could be an important cause of anemia. Whenever a contraceptive method is to be used by such women, consideration should be given to the method which least affects the volume of MBL. In 309 women considered as clinically healthy, MBL, serum ferritin, serum iron and hemoglobin levels were measured: a mean MBL of 23 ml was found. Age, weight, height and previous oral contraceptive use did not affect MBL. Higher parity women may have higher MBL levels but their hematologic indices are not altered. While body iron stores (as judged by serum ferritin levels) are depleted in women who bleed more than 60 ml per cycle, clinical anemia may not be present until their blood loss exceeds 80 ml per menstruation. Brazilian women who lose more than 60 ml of menstrual blood associated with multiple pregnancies without adequate iron supplementation may have a depletion of their body iron stores.

[Menstrual blood loss and body iron stores: comparative study between a Multiload-375 IUD and a levonorgestrel vaginal ring]. / Perda sanguinea menstrual e estoques de ferro do organismo -- estudo comparativo entre o DIU Multiload-375 e o anel vaginal de levonorgestrel.

PIP: 107 users of vaginal rings and 74 users of Multiload-375 (ML-375) IUDs aged 18-40 years with more than 1 parity were studied. In the city of Santiago, Chile, 57 patients and at the University of Juiz de Fora, Brazil, 124 users were enrolled. The vaginal ring releases about 20 mcg/day of levonorgestrel (LNG). It was used continuously for 12 months with replacement every 3 months. The ML-375 was used continuously for 24 months or more. Menstrual blood loss (MBL) was determined before insertion; 3, 6, 9 and 12 months after insertion in both groups; and after 24 months in the IUD users. Serum ferritin measurement was done before use: 6 and 12 months after use in the vaginal ring group and 6, 12, and 24 after IUD insertion. Hemoglobin also was measured. It was observed that MBL always increased with IUD use and decreased with vaginal ring use. The measurements concerning IUD were significant in Santiago up to 24 months with a value of MBL of + 17.9 +or- 7.8 ml, while in Juiz de Fora they were significant up to 12 months returning to the value of preinsertion at 24 months (+ 3.1 +or- 4.6 ml). In vaginal ring users a small decrease of MBL was ascertained, but the only statistical difference occurred up to 12 months in Santiago (- 9 +or- 4.4 ml). In IUD use, in inverse correlation to MBL, serum ferritin dropped significantly at 6 months in Chile (- 7.7 +or- 2.9 ng.ml) and 6, 12, and 24-month follow-ups in Brazil (-5.2, -6 and-7.7 ng/ml, respectively). With the vaginal ring serum ferritin did not change significantly. These findings confirm previous research that ML IUDs increased MBL much less than other IUDs causing less change in iron stores even in patients with ferritin lower than 15 ng/ml, considered under the normal value. Yet for users in developing countries, the use of vaginal rings with LNG would be more suitable than the IUD ML-375 because of slighter alterations in the iron balance of the system.^ieng

Perda sanguínea menstrual e estoques de ferro do organismo: estudo comparativo entre o DIU Multiload-375 e o anel vaginal de Levonorgestrel / Menstrual blood loss and body iron stores: comparative study with the use of a Multiload-375 IUD and a Levonorgestrel vaginal ring

Setenta e quatro usuárias do DIU Multiload-375 foram estudadas comparativamente com 107 usuárias de anel vaginal de Levonorgestrel (20 micra g/dia) no Brasil e Chile, relativamente à sua perda sanguínea menstrual (PSM) e estoques de ferro do organismo através de medidas da hemoglobina (HGB) e ferritina sérica (FS). As medidas foram feitas antes e após a inserçäo do DIU por 24 meses e do anel vaginal por 12 meses. Enquanto näo houve alteraçöes com o uso do anel vaginal nas medidas de PSM, HGB e FS, as mulheres que usaram o DIU tiveram o aumento significativo na PSM por pelo menos um ano depois da inserçäo e uma queda também significativa da FS até 24 meses depois da inserçäo. Em conclusäo, sugere-se que dos dois métodos estudados, o anel vaginal seria o mais adequado para indivíduos com baixos estoques de ferro do organismo.