Does the menopausal status of female gynecologists affect their prescription of menopausal hormone therapy?

OBJECTIVE: To evaluate whether menopausal status and symptoms among female gynecologists would influence their clinical behavior related to menopausal hormone therapy (MHT). METHODS: Female gynecologists of 11 Latin American countries were requested to fill out the Menopause Rating Scale and a questionnaire containing personal information and that related to MHT use. RESULTS: A total of 818 gynecologists accepted to participate (86.4%). Overall, the mean age was 45.0 ± 10.7 years, 32.2% were postmenopausal, and 17.6% worked in an academic position; 81.8% reported that they would use MHT if they have symptoms, regardless of menopausal status. Academic gynecologists favor personal MHT use at a higher rate (p = 0.04) and have a higher MHT prescription rate as compared to non-academic ones (p = 0.0001). The same trend was observed among post- as compared to premenopausal ones (p = 0.01) and among those who had hysterectomy alone as compared to those experiencing natural menopause (p = 0.002). The presence of menopausal symptoms did not influence their MHT prescription. Current use of MHT and alternative therapy was higher among post- than premenopausal gynecologists (both, p = 0.0001) and among those who had undergone hysterectomy than those experiencing natural menopause. A 38.5% perceived breast cancer as the main risk related to MHT, and a high proportion prescribed non-hormonal drugs (86.4%) or alternative therapies (84.5%). CONCLUSION: Most female gynecologists in this survey would use MHT if menopausal symptoms were present. Postmenopausal physicians use MHT and prescribe it to their symptomatic patients at a higher rate than premenopausal physicians.

Phytoestrogens possess a weak antioxidant activity on low density lipoprotein in contrast to the flavonoid quercetin in vitro in postmenopausal women.

BACKGROUND: Phytoestrogens are a family of plant-derived compounds with weak estrogenic and antiestrogenic properties. The antioxidant capacity of phytoestrogens has been proposed as one of the important mechanisms that explain their health benefits. OBJECTIVE: To determine the in vitro potency of three phytoestrogens, ubiquitous in food, (biochanin A, daidzein and genistein) as antioxidants of low density lipoprotein (LDL) and to compare them with the well-established antioxidant actions of estradiol and quercetin, an ubiquitous flavonoid which is found in high concentration in onions, tea and berries. METHODS: LDL was isolated by ultracentrifugation from the plasma of ten healthy postmenopausal women who were not on hormone therapy. Aliquots containing 0.5 mg of protein were incubated for 4 h with CuSO4 15 micromol/l to induce oxidative stress and with one of the five compounds studied: estradiol, quercetin, biochanin A, daidzein, and genistein, in doses of 0, 5, 15, 50, 500, 1000 and 2000 micromol/l. In addition, we studied the combined effect of estradiol 1 micromol/l plus quercetin 1 micromol/l, comparing their antioxidant action with that of each compound separately. Malonaldehyde (MDE nmol/ mg protein) was measured as a marker of LDL oxidation. RESULTS: Estradiol and quercetin induced a dose-dependent decrease in MDE concentration (p < 0.01). Comparing the areas under the curve, the antioxidant effect of quercetin was 8 times higher than the one observed with estradiol (p < 0.01). A 50% decrease in MDE was reached by quercetin at a concentration of 3.4 micromol/l, estradiol at 29 micromol/l, genistein at 280 micromol/l, biochanin at 1312 mmol/l and daidzein at 8007 mmol/l. Estradiol 1 micromol/l and quercetin 1 micromol/l did not modify MDE generation separately, but, when incubated combined, there was a significant decrease of MDE (p < 0.02). CONCLUSION: The phytoestrogens studied showed a weak antioxidant activity in vitro. The flavonoid quercetin, in contrast, showed the most potent antioxidant activity in vitro, higher than estradiol. Estradiol and quercetin showed additive antioxidant activity. We speculate that different compounds with variable antioxidant effects could amplify their antioxidant capacity when acting combined.

[Cushing syndrome by ectopic ACTH secretion: analysis of the physiopathologic mechanism of hypokalemia. Report of two cases]. / Síndrome de Cushing por secreción ectópica de ACTH: análisis del mecanismo fisiopatológico de la hipokalemia. Comunicación de dos casos.

We report a 42 years old male and a 66 years old female with a Cushing syndrome caused by ectopic ACTH secretion secondary to a carcinoid tumor. These patients had both severe hypokalemia, resistant to medical treatment and that subsided with bilateral adrenalectomy and supplementation with dexametasone. Cushing syndrome caused by ectopic ACTH secretion is characterized by a severe and rapidly evolving hypercortisolism. Hypokalemia is present in 90% of cases and is probably caused by a defect in 11 beta hydroxysteroid dehydrogenase, that limits the binding of cortisol to aldosterone receptor, metabolizing it to cortisone. Therefore, this alteration will increase the mineralocorticoid action of cortisol.

[Dissolution velocity of different calcium preparations used in the clinical field]. / Velocidad de disolución de diferentes preparados de calcio utilizados en clínica.

BACKGROUND: Prescription of calcium supplements is a frequent practice, considering that diet is insufficient to cover daily requirements of this mineral. AIM: To study the dissolution velocity in an acid solution, of different commercial calcium supplements. MATERIAL AND METHODS: Hydrochloric acid was added to distilled water in increasing amounts to obtain a final pH of 6.9, 3.0, 2.5, 2.0 and 1.5. Eighteen commercial calcium preparations were incubated in these solutions for 60 min and dissolution velocity was measured as the percentage of elemental calcium found in solution after this incubation period. RESULTS: Calcium carbonate preparations had a pH dependent dissolution velocity, ranging from 0.67 +/- 0.8% at pH 6.9 to 77.15 +/- 17.5% at pH 1.5. Using the solution with pH 1.5, the dissolution velocity of different preparations varied widely from 56 to 100%. Calcium acetate, followed by calcium citrate and dicalcic phosphate were the salts in tablets with better dissolution velocities. Among powders and effervescent preparations, those containing calcium lactogluconate and citrate had the better dissolution velocities (95 to 115%), that were independent of the solution's pH. A studied preparation with integral bone had a very low dissolution velocity, not surpassing 33 mg of calcium per tablet. CONCLUSIONS: The dissolution velocity of different calcium carbonate preparations varies greatly and, in conditions of achlorhydria, it is negligible. Calcium lactogluconate and citrate dissolution velocities are independent of the solution's pH.

Effect of oral potassium supplements on urinary Kallikrein excretion in Sheeha's syndrome

La excrexión urinaria de Klicreína (UKE) es modificada por mineralocorticoides, glucocorticoido del potasio (independiente de su acción sobre aldosterona) sobre la UKE no ha sido evaluado. Para investigar tal acción, se estudió a cuatro pacietnes con síndrome de Sheehan, adecuadamente suplementadas con cortisol y tiroxina, quienes recibieron captopril hasta alcanzar concentraciones muy bajas o no detectables de aldosterona urinaria. Posteriormente, todas ellas recibieron una carga oral de potasio de 30 mmol de KCl dos veces al día, durante dos días consectutivos. La carga oral de potasio no modificó la UKE(F3,9=1,24; p>0,05). El estudio se repitió mientras las pacientes estaban sin cortisol; nuevamente la carga de potasio no cambió la UKE (F3,9 = 2,25; p>0,05). La excreción urinaria de aldosterona no se elevó con la carga oral de potasio, dada bajo el régimen de aporte de cortisol (F3,9 = 1; p>0,05). Sin embargo, cuando la carga de potasio se administró estando suspendido el cortisol, la excreción de aldosterona se elevó significativamente (p<0,025). Estos resultados sugieren que la carga oral de potasio no modifica la UKE, independientemente si la aldosterona es estimulada o no

Effect of oral potassium supplements on urinary Kallikrein excretion in Sheehas syndrome

La excrexión urinaria de Klicreína (UKE) es modificada por mineralocorticoides, glucocorticoido del potasio (independiente de su acción sobre aldosterona) sobre la UKE no ha sido evaluado. Para investigar tal acción, se estudió a cuatro pacietnes con síndrome de Sheehan, adecuadamente suplementadas con cortisol y tiroxina, quienes recibieron captopril hasta alcanzar concentraciones muy bajas o no detectables de aldosterona urinaria. Posteriormente, todas ellas recibieron una carga oral de potasio de 30 mmol de KCl dos veces al día, durante dos días consectutivos. La carga oral de potasio no modificó la UKE(F3,9=1,24; p>0,05). El estudio se repitió mientras las pacientes estaban sin cortisol; nuevamente la carga de potasio no cambió la UKE (F3,9 = 2,25; p>0,05). La excreción urinaria de aldosterona no se elevó con la carga oral de potasio, dada bajo el régimen de aporte de cortisol (F3,9 = 1; p>0,05). Sin embargo, cuando la carga de potasio se administró estando suspendido el cortisol, la excreción de aldosterona se elevó significativamente (p<0,025). Estos resultados sugieren que la carga oral de potasio no modifica la UKE, independientemente si la aldosterona es estimulada o no (AU)