Improvement in menopausal symptoms with a nutritional product containing evening primrose oil, hop extract, saffron, tryptophan, vitamins B6, D3, K2, B12, and B9.

OBJECTIVE: Safety concerns or contraindications in the use of hormones have resulted in a rise in the use of nutritional medicinal products for the management of menopausal symptoms. The aim of the present study was to demonstrate the efficacy and safety of Exelvit Menopause®. PATIENTS AND METHODS: A prospective, open, observational, and multicentre study was performed, including 156 menopausal women. The patients received the nutritional product containing evening primrose oil 50 mg; hop extract 0.127-0.212 mg; saffron Stigmas Extract 0.6 mg; tryptophan 71.25 mg, vitamins B6, D3, K2, B12, and B9 once per day for 12 weeks. The validated menopausal rating score (MRS) was used for recording symptoms. RESULTS: A decrease in the MRS of all menopausal symptoms was observed after 12 weeks compared to baseline (p < 0. 0001). Overall, hot flashes were reduced by 48.15%, heart discomfort by 33.3%, sleep disturbance by 46.2%, joint and muscular discomfort by 27.8%, depressive mood by 45.0%, irritability by 47.6%, anxiety by 44.4%, physical problems by 36.4%, sexual problems by 30.0%, bladder problems 31.3%, and vaginal dryness by 33.3%. CONCLUSIONS: The nutritional product Exelvit Menopause® significantly reduced menopausal symptoms.

Assessment of Cardiovascular Safety of Anti-Osteoporosis Drugs.

The incidence of osteoporosis and cardiovascular disease increases with age, and there are potentially shared mechanistic associations between the two conditions. It is therefore highly relevant to understand the cardiovascular implications of osteoporosis medications. These are presented in this narrative review. Calcium supplementation could theoretically cause atheroma formation via calcium deposition, and in one study was found to be associated with myocardial infarction, but this has not been replicated. Vitamin D supplementation has been extensively investigated for cardiac benefit, but no consistent effect has been found. Despite findings in the early 21st century that menopausal hormone therapy was associated with coronary artery disease and venous thromboembolism (VTE), this therapy is now thought to be potentially safe (from a cardiac perspective) if started within the first 10 years of the menopause. Selective estrogen receptor modulators (SERMs) are associated with increased risk of VTE and may be related to fatal strokes (a subset of total strokes). Bisphosphonates could theoretically provide protection against atheroma. However, data from randomised trials and observational studies have neither robustly supported this nor consistently demonstrated the potential association with atrial fibrillation. Denosumab does not appear to be associated with cardiovascular disease and, although parathyroid hormone analogues are associated with palpitations and dizziness, no association with a defined cardiovascular pathology has been demonstrated. Finally, romosozumab has been shown to have a possible cardiovascular signal, and therefore post-market surveillance of this therapy will be vital.

Effect of a multi-ingredient based food supplement on sexual function in women with low sexual desire.

BACKGROUND: Studies have demonstrated that women with low desire and low excitement have negative feelings regarding their physical and emotional satisfaction, as well as their happiness. In this study, we evaluate the efficacy of Libicare® - a multi-ingredient food supplement - to improve sexual function in postmenopausal women. METHODS: This was an exploratory, prospective, non-controlled, observational study. Postmenopausal women aged 45-65 with a risk of sexual dysfunction (Female Sexual Function Index (FSFI) < 25.83) were included during routine clinical visits and treated with 2 tablets of Libicare® daily for 2 months. Libicare® is an oral food supplement containing Trigonella foenum graecum, Turnera diffusa, Tribulus terrestris, and Ginkgo biloba dry extracts. Primary endpoint: change vs. baseline in FSFI score. Secondary endpoints: 1) changes in testosterone and serum steroid levels of free testosterone and sex hormone-binding globulin (SHBG) levels and 2) tolerability. RESULTS: A total of 29 patients (mean age: 54.69 years) were included. FSFI mean (SD) score showed a significant increase: 20.15 (4.48) vs 25.03 (6.94), baseline vs final; p = 0.0011, paired t-test. Most patients (86.2%) increased their FSFI score. All FSFI domains, except dyspareunia, showed significant increases. The highest increase was observed in the desire domain (p = 0.0004). Testosterone and SHBG levels were assessed in 21 patients. A significant increase in testosterone level was observed: 0.41 (0.26) vs. 0.50 (0.34) pg/mL, baseline vs. final; p = 0.038, Wilcoxon test. 52.4% of patients increased their testosterone levels. Finally, a significant decrease was observed in SHBG level: 85 (32.9) vs. 73 (26.8) nmol/L, baseline vs. final; p = 0.0001; paired t-test. 95.2% of patients decreased their SHBG levels. CONCLUSION: In this pilot study, a significant improvement in sexual function and related hormone levels was observed with Libicare®. Further studies must be conducted to confirm these exciting results. TRIAL REGISTRATION: Current Controlled Trial ISRCTN12928573 . Date of registration: 28/March/2019. Retrospectively registered.

Coffee consumption and mortality from all causes of death, cardiovascular disease and cancer in an elderly Spanish population.

PURPOSE: The effect of coffee consumption on mortality has been scarcely investigated in the elderly. We assessed the association between coffee consumption and mortality from all-cause, cardiovascular disease (CVD) and cancer, in an elderly population of Spain. METHODS: We studied 903 individuals (511 women) aged 65 years and older from two population-based studies, the EUREYE-Spain study and the Valencia Nutritional Survey. Coffee consumption and diet were assessed using a validated food frequency questionnaire. Information on education, anthropometry, sleeping time, smoking, alcohol intake, physical activity and pre-existing disease was collected at baseline. Deaths were ascertained during a 12-year follow-up period, and Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HR). RESULTS: There were 403 deaths during the 12-year period (40% from CVD), 174 of which occurred during the first 6 years. We observed evidence of a lower CVD mortality among coffee drinkers in the first 6 years of follow-up. Drinkers of ≤1 cup of coffee/day and > 1 cup/day showed lower CVD mortality than non-drinkers of coffee, HR 0.82 (95% CI 0.46-1.44) and HR 0.38 (0.15-0.96), respectively (p trend = 0.04). This association of coffee with CVD mortality attenuated after 12 years of follow-up. No significant association was observed with all-cause or cancer mortality, neither for caffeinated and decaffeinated coffee. CONCLUSIONS: In this study, coffee consumption was associated with lower CVD mortality in elderly. Although this association should be further investigated, coffee consumption appears to be safe for the elderly since no increased mortality was observed in coffee drinkers.

Omega-3 versus isoflavones in the control of vasomotor symptoms in postmenopausal women.

Determine the efficacy and tolerability of omega-3 fatty acids versus soybean isoflavones in reducing the vasomotor symptoms (VMSs) frequency in postmenopausal women. A randomized, prospective, two-arm study was performed in healthy postmenopausal women aged 45-65. The two arms were: two capsules/day of omega-3 (425 mg of omega-3/capsule) administered orally (n = 38) and two tablets/day of soybean isoflavones (54.4 mg of isoflavones/tablet) (n = 30), over 16 weeks. The mean baseline frequency of moderate and severe VMSs per week in the omega-3 group was 24.56 and 23.90, respectively, and 19.65 and 19.51 in the isoflavone group. After 4 months, the reduction in moderate and severe hot flashes with omega-3 was significant (p < .001), whereas in the case of isoflavones, there was a significant difference in severe (p = .02) hot flashes after 4 months, but not in moderate hot flashes (p = .077). Omega-3 did not demonstrate significant efficacy differences versus isoflavones over time. The use of omega-3 has a beneficial effect on hot flash reduction after 4 months of treatment. This is comparable to the benefits found with soybean isoflavones after 3-4 weeks and after 4 months in severe hot flash women, but higher than those found with soybean isoflavones in moderate symptom women.

Factors determining the use of hormonal therapy and phytotherapy in Spanish postmenopausal women.

OBJECTIVE: To identify women's sociodemographic and variables related to health care with the prescription of hormonal therapy (HT) and phytotherapy (PT) in Spanish postmenopausal women. METHOD: The survey consisted of a multicenter, observational, cross-sectional, questionnaire-based investigation and was conducted among 3022 postmenopausal women. RESULTS: Of all the women, 31.8% reported the use of systemic HT or PT sometime in their lives. Hot flushes and information received about menopause were the most important variables that influence HT and PT use, although far more intense symptoms were observed in those who were inclined to use HT. The use of HT or PT was more frequently reported among women with high levels of education, who came from private clinics and lived in urban areas. Women who had primary ovarian insufficiency or surgical menopause were inclined to use HT. CONCLUSION: Hot flushes and information received about menopause are the most important variables that influence HT and PT use.

Inhibition of development, swarming differentiation and virulence factors in Proteus mirabilis by an extract of Lithrea molleoides and its active principle (Z,Z)-5-(trideca-4',7'-dienyl)-resorcinol.

Antibacterial activity of Lithrea molleoides extract against Proteus mirabilis has been previously reported by our group. In the present study, the compound (Z,Z)-5-(trideca-4',7'-dienyl)-resorcinol (1) was isolated as its responsible active principle. The effects of the compound obtained and of L. molleoides extract on P. mirabilis growth and virulence factors were evaluated. Compound 1 showed MIC and MBC values of 4000 µg/ml. It was found that the extract, at four times the MIC, produced complete killing of the uropathogen at 2h from the beginning of the experiment, while the alkylresorcinol, at four times the MIC, produced the same effect after 24 h. Hemolysis was adversely affected in treatments with both products at 8 µg/ml, while hemagglutination was not altered. The whole extract induced complete autoaggregation of P. mirabilis at 2000 µg/ml, while compound 1 at the same concentration did not show this property. Swarming motility was delayed in treatments with the extract and with 1 at 1000 and 8 µg/ml, respectively, at 8h from the beginning of the assay. Complete inhibition of the phenomenon was still observed after 24 h when compound 1 was added at 125 µg/ml. These findings offer the possibility of new classes of antimicrobial medicines to tackle infections caused by P. mirabilis.

Larvicide and oviposition deterrent effects of fruit and leaf extracts from Melia azedarach L. on Aedes aegypti (L.) (Diptera: Culicidae).

Aedes aegypti (L.) (Diptera: Culicidae), the main urban vector of dengue, has developed resistance to various insecticides, making its control increasingly difficult. We explored the effects of Argentine Melia azedarach L. (Meliaceae) fruit and senescent leaf extracts on Ae. aegypti larval development and survival, by rearing cohorts of first instar mosquitoes in water with different extract concentrations. We also analysed oviposition deterrent activity in choice tests with extract-treated ovitraps. The leaf extract showed a strong larvicide activity, with all larvae dying before pupation, and significantly delayed development time. It strongly inhibited oviposition by Ae. aegypti females. The fruit extract showed much weaker effects. This first report of highly effective larvicidal, growth regulating and oviposition deterrent activity of a senescent leaf extract of M. azedarach against Ae. aegypti, suggests that such extract could represent a promising tool in the management of this mosquito pest.

Eficacia terapéutica con el método de Goeckerman en pacientes con psoriasis en placas: Trabajo realizado en el servicio de dermatología del Hospital Carlos Andrade Marín (Ecuador) Agosto-Noviembre de 2001 / Therapeutic efficacy of Goeckerman's method in patients with plaque psoriasis

Se trata de un estudio experimental, longitudinal, prospectivo, simple ciego y controlado aleatoriamente, en el que se propuso demostrar los beneficios del tratamiento con alquitrán de hulla más rayos UVB (Método de Goeckerman ), en comparación con el uso de PUVA en pacientes con psoriasis en el servicio de Dermatología del Hospital Carlos Andrade Marín (HCAM Quito-Ecuador), durante el período de agosto-noviembre de 2001. El estudio trabajó con valores de significancia del 99% y de potencia de un 90%. La selección de la muestra fue intencionada y la asignación de los grupos fue aleatoria mediante el programa de asignación aleatoria PEPI. Se realizó el estudio con 26 pacientes, en quienes se aplicó el regimen de Goeckerman en la mitad de pacientes, mientras que en los 13 restantes se trató con la terapia de PUVA. Se compararon los grupos en base a medias de proporciones, utilizando como prueba de significancia a Kruskar Wallis. Además, los pacientes elegidos tuvieron que cumplir con criterios de inclusión y ser considerados aptos para este estudio. Finalmente se procedió a analizar los datos mediante los programas EPIINFO y EXCELL. La edad media del total de pacientes fue de 44.7 años, correspondiendo a 45.3 años para el grupo PUVA y a 44.1 años para el grupo Goeckerman. La media del PASI de entrada de ambos grupos fue de 22.9 puntos, correspondiendo a 20.27 para PUVA y a 25.69 para Goeckerman. Respecto al sexo 5 fueron mujeres (19.2%) y 21 fueron hombres (80.8%); la distribución en los grupos fue aleatoria con lo cual 1 mujer y 12 hombres pertenecieron al grupo PUVA y 4 mujeres y 9 hombres pertenecieron al grupo Goeckerman. Durante el estudio se obtuvieron algunos efectos adversos, siendo el prurito el más común en ambos grupos con una prevalencia de 62.9% para la terapia PUVA y de 100% en la terapia Goeckerman, seguido del eritema con un 42.2% de prevalencia en PUVA y un 84.6% en Goeckerman. Efectos adversos como naúseas y mareos se presentaron únicamente en la terapia PUVA con porcentajes de 46.2 y de 30.8% respectivamente. El porcentaje de reducción de la escala de PASI fue de 51.16%.

This is an experimental, prospective, double blind, placebo-controlled, experimental study to demonstrate the effects of coal tar plus UVB treatment (Goeckerman's method) compared with PUVA in patients with psoriasis. The study was performed at the Department of Dermatology of the Hospital Carlos Andrade Marín (HCAM Quito-Ecuador) during August - November 2001. The study considered 99% significance levels and a potency of 90%. The selection of the samples was unintentional and subjects were assigned to the treatment groups using PEPI random assignment package. The sample was consisted in 26 subjects equally assigned to both arms of the study (Goeckeremans vs PUVA). The difference among treatment groups were measured using Krusal Wallis tests using EPI-INFO and EXCEL software. Mean age for each group were 45.3 for PUVA, and 44.1 for Goeckerman (average 44.7). The initial PASI score for both groups was 22.9 (PUVA: 20.27, Goeckerman: 25.69). The group was composed by 5 women and 21 men distributed randomly among treatment arms. The adverse events included pruritus (62.9% PUVA, 100% Goeckerman), erythema (42.2% PUVA, 84.6% Goeckerman). Systemic adverse effects included nausea and dizziness only in PUVA 46.2% and 30.8 respectively. The percentage of PASI score reduction was 51.6%.

The dilemma of menopause and hormone replacement--a challenge for women and health-care providers: knowledge of menopause and hormone therapy in Spanish menopausal women.

BACKGROUND: An important goal in menopause research is to develop knowledge and identify interventions that strive to promote, maintain and enhance well-being for women. OBJECTIVE: To evaluate the knowledge of postmenopausal Spanish women about menopause and their knowledge of and trust in hormone replacement therapy (HRT) and to identify their sources of information and how those data are related to compliance with their prescription. STUDY DESIGN: A total of 270 symptomatic postmenopausal women were personally interviewed using a structured questionnaire, which was designed to collect information on their familiarity with medical menopause studies, the menopause and the effects of HRT, their knowledge of alternative therapies, and to identify their sources of information. RESULTS: The most well-known menopausal complaints were hot flushes, sweats, irregular menstruation, cessation of menstruation, irritability and mood changes. Following suggestions of other symptoms by the interviewer, other complaints such as vaginal dryness, insomnia and depression/anxiety were also mentioned. HRT and phytoestrogens were recognized as treatments for the climacteric by most of the women. A woman's decision to seek treatment was initiated in 77% of cases by the gynecologist, in 12% by the general practitioner, in 3% by friends/family and in 3% by books/magazines. The most frequent responses of women to the onset of menopausal symptoms were to talk with their partner (39%), to discuss it with their gynecologist (33%) or with their general practitioner (14%) and to talk with their friends/family or to read books/magazines (10%). CONCLUSIONS: Vasomotor symptoms are recognized as the main complaint during the climacteric and HRT and phytoestrogens as the main therapies. Gynecologists play an important role in assuring compliance with therapies related to the menopause.

Insecticide and antifeedant activity of different plant parts of Melia azedarach on Xanthogaleruca luteola.

In laboratory choice and no-choice bioassays, treatment of elm leaves with extracts obtained from unripe fruits and green or senescent leaves of Melia azedarach at 1-10% concentration significantly deterred feeding by adults of the elm leaf beetle, Xanthogaleruca luteola. Also, in no-choice tests, adults fed on leaves treated with 2, 5 or 10% extract showed a dramatic increase in mortality rates. Extracts from the different plant structures were similarly active, and starvation as a consequence of their strong antifeedant activity could play a significant role in the high mortality values observed.

Sexuality in the climacteric years.

Menopause is a time of anatomic, physiological and psychological changes that often influence in the sexuality of aging female. Being sexual functioning an important aspect of health and well-being, doctors should have an holistic approach reassuring about the possibility of treating the various symptoms. The central nervous system is an important target for sex steroid hormone; estrogen, progestagens and androgens are able to modulate several brain functions, and receptors for gonadal steroids have been identified in several brain areas. Because there is no test that physicians can make to assess sexual function, taking a sexual history is probably the most important aspect in the diagnostic and treatment of sexual problems. Hormonal transition with decreasing levels of estrogen and testosterone produces clinical effects, so women need to make adjustments for this period of life. Testosterone is an important component of female sexuality, and alterations in its circulating levels play an important role in psychological and sexual changes that occur after menopause. This is the reason why the research in identifying women who have a decrease androgen active should be aimed. Treatment may include education about sexuality and medical management of symptoms or problems interfering with sexual activity. Also treatment implications and the diverse aspects that may influence on sexuality in the climacteric years are discussed.

Biochemical and (ultra)structural hepatic perturbations of Brachydanio rerio (Teleostei, Cyprinidae) exposed to two sublethal concentrations of copper sulfate.

The aim of this study was to compare biochemical and (ultra)structural perturbations induced by Cu in the liver of Brachydanio rerio exposed for 14 days to sublethal concentrations of copper and then replaced for 14 days to clean water. Toxicity of Cu was clearly demonstrated: simultaneously to Cu accumulation, the liver developed large lysed areas and hepatocytic alterations. However, the majority of the parenchyma was composed of functional dark hepatocytes displaying typical feature of increased metabolism: development of rough reticulum, increase in size of nucleus and nucleolus, glycogenic depletion. Increase in hepatic protein content and of anti-oxidative defences (glutathione content, catalase and glutathione-S-transferase (GST) activities) indicated that the overall response of the liver was adaptative. In all hepatocytes a cord-like structure of the nucleoli was suspected to be associated to metal deposition. After 14 days depuration, the liver still contained high Cu concentrations and the hepatic alterations were not reversed. Such complementary studies are necessary for a better understanding of the deleterious effects of pollutants and for the development of biomarkers for metal toxicity.