Vaginal Health: Insights, Views & Attitudes (VIVA-LATAM): results from a survey in Latin America.

OBJECTIVE: To investigate awareness in Latin America, knowledge of postmenopausal vaginal atrophy was evaluated in a sample of women from this region. METHODS: A total of 2509 postmenopausal women aged 55-65 years, resident in Argentina, Brazil, Chile, Colombia and Mexico, completed a structured online questionnaire. RESULTS: Over half the surveyed population (57%) reported experiencing symptoms of vaginal atrophy. Only 6% of the overall cohort attributed symptoms of vaginal atrophy directly to the condition, and 71% did not consider the condition to be chronic, resulting in many women not accessing effective therapy. Half the women (49%) affected by vaginal atrophy had used lubricating gels and creams; 36% had used some form of local hormone treatment. To understand symptoms and/or treatment options for vaginal discomfort, the majority of survey participants (92%) were willing to seek advice from health-care professionals; most (61%) felt/would feel comfortable talking to their doctor about this. CONCLUSION: Many women in Latin America lack knowledge of postmenopausal vaginal atrophy, not appreciating the chronic nature of the condition, and may benefit from dialog initiated by health-care professionals to facilitate greater understanding and increased awareness of the availability of effective treatment.

Superior cycle control with a contraceptive vaginal ring compared with an oral contraceptive containing 30 microg ethinylestradiol and 150 microg levonorgestrel: a randomized trial.

BACKGROUND: This trial was conducted to compare cycle control with vaginal ring a combined contraceptive vaginal ring, and a combined oral contraceptive (COC) delivering 30 mug ethinylestradiol (EE) and 150 mug levonorgestrel. METHODS: This open-label, randomized, multi-centre, Phase III study involved adult women from 11 countries. Subjects were treated with either vaginal ring or a COC for 13 cycles (12 months). RESULTS: A total of 1030 subjects (vaginal ring, n=512; COC, n=518) comprised the intention-to-treat (ITT) population. The percentage of women in the ITT population who completed the trial was 70.9% for vaginal ring and 71.2% for the COC group. The incidence of breakthrough bleeding and spotting over cycles 2-13, the primary efficacy parameter, was lower with vaginal ring (range 2.0-6.4%) than the COC (range 3.5-12.6%), and for cycles 2 and 9 the lower incidence with vaginal ring was confirmed as statistically significant (P=0.003 and P=0.002 respectively). The incidence of intended bleeding was significantly higher over all cycles with vaginal ring (58.8-72.8%) than with the COC (43.4-57.9%). CONCLUSIONS: Cycle control with vaginal ring was excellent and superior to that of a COC containing 30 mug EE.

Oral Candida flora from Brazilian human immunodeficiency virus-infected patients in the highly active antiretroviral therapy era

One of the main opportunistic fungal infections amongst immunocompromised individuals is oral candidosis, which has been found in up to 90 percent of human immunodeficiency virus (HIV)-infected patients. This study employed yeasts isolated from the saliva and oral cavities of 114 HIV-infected patients living in Campinas, São Paulo. Of the isolates, 57.8 percent were identified as Candida albicans and 42.1 percent as non-C. albicans. The latter isolates were subsequently identified as C. krusei (7.5 percent), C. lusitaniae (5.2 percent), C. tropicalis (4.6 percent), C. parapsilosis (4.6 percent), C. glabrata (2.8 percent), C. kefyr (1.7 percent), C. guilliermondii (1.7 percent), C. intermedia (1.1 percent), C. norvegensis (0.5 percent), and Rhodotorula rubra (1.7 percent). Susceptibility of the isolates to amphotericin B, fluconazole, miconazole, and itraconazole was also determined by a microdilution method adopted by the National Committee for Clinical Laboratory Standards. The isolates demonstrated various susceptibilities to the antifungal agents. In particular 29 C. albicans and 13 non-C. albicans isolates showed low susceptibility to FLCZ (> 64 æg/ml). This study revealed huge diversity of Candida species, in particular the increasing emergence of non-C. albicans associated with the oral flora of HIV-infected patients.

Oral estradiol-17 beta raises the level of plasma high-density lipoprotein in menopausal women by slowing down its clearance rate.

Plasma lipoprotein composition, plasma kinetics of autologous [125I]HDL and the metabolism of iv administered radioactively labelled artificial chylomicrons were studied in postmenopausal women during a control period and after 4 months of oral estradiol-17 beta treatment (1 mg/m2 body surface per day). Drug treatment significantly raised plasma HDL-cholesterol levels (19%) in the fasting state and total apolipoprotein A-I (16%), but did not interfere with triglyceride, VLDL, LDL or apolipoprotein-B values. As compared with the control period, estradiol-17 beta administration significantly slowed down plasma [125I]HDL clearance by about 82% and reduced the delipidation index of the injected artificial chylomicrons by 47% as a consequence of impaired plasma lipolytic activity.

Aspectos epidemiologicos e clinicos em 1.319 pacientes climatericas / Epidemiological and clinical findings in 1319 pos-menopausal woman

No periodo de junho de 1983 a setembro de 1989, foram estudadas 1319 mulheres climatericas (fase pos-menopausica) cujas idades variaram de 41 a 62 anos (media 51,3 anos), com o objetivo de avaliar, retrospectivamente, os principais parametros concernentes ao climaterio. Os seguintes resultados foram obtidos: a media etaria da menopausa foi 47,8 anos e a duracao media da menacme foi 34,3 anos; nao houve correlacao entre idade da menarca e a idade da menopausa; os sintomas vasomotores presentes em 74,6 por cento prevaleceram sobre todos os sintomas climatericos: queda de cabelo em 13,5 por cento; dor nas mamas 12,0 por cento; cefaleia 10,1 por cento; nervosismo 9,1 por cento; palpitacao 8,7 por cento, e outros. Entre as doencas associadas 28,4 por cento apresentavam hipertensao arterial; 14,1 por cento incontinencia urinaria; 13,8 por cento mioma uterino; 11,1 por cento doencas cardiovasculares; 5,4 por cento doencas osteoarticulares e 4,6 por cento diabetes mellitus. Concluem os autores que houve diferenca significativa quanto a sintomatologia entre as pacientes de peso normal e as obesas, quando comparadas com as pacientes magras, sendo a sintomatologia menos intensa nas pacientes de baixo peso; e, houve diferenca estatistica significativa quanto a sintomatologia entre as pacientes normotensas e hipertensas, pois os sintomas foram mais intensos nas hipertensas.

Ensaio clinico de um novo creme vaginal na terapeutica das colpites. / Clinical trial of a new vaginal cream in colpitis therapy

Os autores avaliaram a eficacia e a tolerabilidade de um novo creme vaginal em 32 pacientes portadoras de vaginitis por monilia e/ou tricomonas e/ou bacterias. A avaliacao da eficacia e da tolerancia foi feita baseada nos dados obtidos por ocasiao dos exames ginecologicos e complementares (bacterioscopia a fresco e apos coloracao pelo Gram), realizados 15 dias apos o final do tratamento. A eficacia foi considerada excelente e boa em 90,91% dos casos avaliados. Nao houve referencias a nenhum efeito colateral. Os autores concluem pela otima eficacia e excelente tolerabilidade deste novo creme vaginal, destacando-se pelo largo espectro de atividade em relacao aos diversos tipos de colpites

Revascularizacao cerebral em obstrucoes de arteria carotida interna e seus ramos. / Cerebral revascularization in obstruction of the internal carotid arteries and their branches

Os autores tentaram demonstrar que lesoes de arteria carotida denominadas inacessiveis, ja nao sao assim consideradas, visto que pela microcirurgia sao corrigidas. A vascularizacao cerebral e feita pela anastomose da arteria temporal superficial com ramos corticais temporais da arteria cerebral

Terapeutica da candidiase vaginal com econazol sob nova forma galenica. / Therapeutic of vaginal candidiasis with econazole in a new galenical form

Os autores avaliaram, em 20 pacientes portadores de moniliase vaginal, a eficacia e tolerancia do econazol na forma de "ovulo mole" com a posologia de um ao dia durante tres dias. O diagnostico da moniliase vaginal foi estabelecido com base no interrogatorio, exame ginecologico e bacterioscopico (a fresco e apos coloracao pelo Gram) de secrecao vaginal. A avaliacao da eficacia, baseada tambem no quadro clinico e bacterioscopico, foi feita sete dias apos o tratamento.Das 19 pacientes que fizeram uso do medicamento por tres dias, 16 (84,21%) foram consideradas curadas. Uma segunda serie de tratamento por tres dias elevou o indice de cura para 100%. Nos casos avaliados nao houve ocorrencia de efeito colateral. A excelente eficacia e tolerancia, alem da posologia de curta duracao dessa nova apresentacao do econazol, levaram os autores a concluir pela sua grande utilidade na pratica clinica diari