RESUMO
OBJECTIVE: To evaluate the systemic effect of therapy with conjugated equine estrogen (CEE) vaginal cream on bone turnover markers in postmenopausal women. METHODS: This study was conducted in 40 spontaneously menopausal women aged 40-60 years who complained of vulvovaginal symptoms. Subjects were instructed to self-administer 1 g CEE vaginal cream (CEE 0.625 mg) once daily for 12 weeks (continuous phase), then twice weekly for the next 12 consecutive weeks (intermittent phase). Serum levels of bone turnover markers and estradiol and the vaginal maturation index were evaluated at baseline, 12 and 24 weeks after treatment initiation. RESULTS: Levels of C-terminal cross-linked telopeptide of type I collagen (CTx) were significantly decreased at 12 weeks and 24 weeks when compared to baseline values (median (range) 0.435 (0.171-0.859) and 0.391 (0.122-0.714) vs. 0.562 (0.250-1.290) ng/ml (p < 0.001 and < 0.001), respectively), but there was no significant difference between the levels at 12 and 24 weeks. Levels of procollagen type I N-terminal propeptide (P1NP) and osteocalcin levels were significantly decreased after 24 weeks when compared to pretreatment levels (mean (standard deviation) 41.74 (11.76) vs. 50.02 (17.71) ng/ml (p = 0.002) for P1NP and 23.91 (7.11) vs. 27.54 (8.67) ng/ml (p < 0.001) for osteocalcin, respectively). Estradiol levels were significantly increased and the vaginal maturation index was significantly improved after 12 and 24 weeks when compared to baseline. CONCLUSIONS: CEE vaginal cream significantly decreased the bone resorption marker (CTx) in postmenopausal women after completion of the continuous-treatment phase. There was no significant further decrease after the intermittent phase. The effects on the markers of bone formation and bone turnover (P1NP and osteocalcin) were apparent only at 24 weeks. The two treatment phases moderately increased serum estradiol levels and significantly improved the vaginal maturation index.
Assuntos
Remodelação Óssea/efeitos dos fármacos , Colágeno Tipo I/sangue , Estrogênios Conjugados (USP)/farmacologia , Estrogênios/farmacologia , Peptídeos/sangue , Pós-Menopausa/sangue , Vagina/patologia , Adulto , Análise de Variância , Atrofia/tratamento farmacológico , Biomarcadores/sangue , Estradiol/sangue , Estrogênios/uso terapêutico , Estrogênios Conjugados (USP)/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Osteocalcina/sangue , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Estatísticas não Paramétricas , Tailândia , Vagina/efeitos dos fármacos , Cremes, Espumas e Géis Vaginais/farmacologia , Cremes, Espumas e Géis Vaginais/uso terapêuticoRESUMO
An infected ovarian cyst in a thalassemic patient is rarely reported. We describe the case of a 22-year old woman with splenectomized homozygous beta-thalassemia who developed high fever and was diagnosed as having an infected ovarian cyst. The mechanisms which beta-thalassemia might predispose to infection and considered to be immunocompromized are discussed. She was given an intravenous antibiotic regimen and the infected ovarian cyst was removed. The difficulties in the diagnosis of an infected ovarian cyst is because of its rarity and the paucity of information on it in the literature. Therefore, the triad of ovarian cyst, immunocompromized host, and signs of infection with failure to identify any other source of infection should raise the suspicion of an infected ovarian cyst.