Obesity is associated with a higher prevalence of musculoskeletal pain in middle-aged women.

Musculoskeletal pain (MSP) has been recently linked with high plasma leptin levels. Our objective was to study if obese women, who have higher leptin levels, could have a higher frequency of MSP. We studied 6079 Latin-American women, 40-59 years old. Their epidemiological data were recorded and the Menopause Rating Scale (MRS), Golberg Anxiety and Depression Scale and Insomnia Scale were applied. MSP was defined as a score ≥2 on MRS11. Women with MSP were slightly older, had fewer years of schooling and were more sedentary. They also complained of more severe menopausal symptoms (29.2% versus. 4.4%, p < 0.0001). Furthermore, they had a higher abdominal perimeter (87.2 ± 12.0 cm versus 84.6 ± 11.6 cm, p < 0.0001) and a higher prevalence of obesity (23.1% versus 15.2%, p < 0.0001). Compared to normal weight women, those with low body weight (IMC <18.5) showed a lower risk of MSP (OR 0.71; 95%CI, 0.42-1.17), overweight women had a higher risk (OR 1.64; 95%CI, 1.44-1.87) and obese women the highest risk (OR 2.06; 95%CI, 1.76-2.40). Logistic regression analysis showed that obesity is independently associated to MSP (OR 1.34; 95%CI, 1.16-1.55). We conclude that obesity is one identifiable risk factor for MSP in middle-aged women.

[Clinical practice guideline for the diagnosis and treatment of hyperprolactinemia]. / Guía de práctica clínica para el diagnóstico y tratamiento de la hiperprolactinemia.

BACKGROUND: Hyperprolactinemia is a common finding within clinical practice in both endocrinology and general practice fields, amongst other specialties. The general practitioner and other specialists must know the indications and serum prolactin determination parameters in order to, once detected, derive the patient for a correct assessment and begin treatment. OBJECTIVE: Formulate a clinical practice guideline evidence-based for the diagnosis and treatment of hyperprolactinemia. METHOD: It took the participation of eight gynecologists, two pathologists and a pharmacologist in the elaboration of this guideline due their experience and clinical judgement. These recommendations were based upon diagnostic criteria and levels of evidence from treatment guidelines previously established, controlled clinical trials and standardized guides for adolescent and adult population with hyperprolactinemia. RESULTS: During the conformation of this guideline each specialist reviewed and updated a specific topic and established the evidence existent over different topics according their field of best clinical expertise, being enriched by the opinion of other experts. At the end, all the evidence and decisions taken were unified in the document presented here. CONCLUSIONS: It is presented the recommendations established by the panel of experts for diagnosis and treatment of patients with high levels of prolactin; also the level of evidence for the diagnosis of hyperprolactinemia, handling drug-induced hyperprolactinemia and prolactinomas in pregnant and non-pregnant patients.

An individualized approach to the management of vaginal atrophy in Latin America.

OBJECTIVE: In the absence of guidelines specific for Latin America, a region where the impact of menopause is becoming increasingly important, an evidence-based specialist opinion on management of vaginal atrophy will help improve outcomes. METHODS: An advisory board meeting was convened in São Paulo, Brazil, to discuss practical recommendations for managing vaginal atrophy in women in Latin America. Before the meeting, physicians considered various aspects of the condition, summarizing information accordingly. This information was discussed during the meeting. The expert consensus is now summarized. RESULTS: In Latin America, given the relatively early age of menopause, it will be beneficial to raise awareness of vaginal atrophy among women before they enter menopause, considering cultural attitudes and involving partners as appropriate. Women should be advised about lifestyle modifications, including attention to genital hygiene, clothing, and sexual activity, and encouraged to seek help as soon as they experience vaginal discomfort. Although treatment can be started at any time, prompt treatment is preferable. A range of treatments is available. By addressing the underlying pathology, local estrogen therapy can provide effective symptom relief, with choice of preparation guided by patient preference. An individualized treatment approach should be considered, giving attention to patients' specific situations. CONCLUSIONS: It is critical that women are empowered to understand vaginal atrophy. Educating women and healthcare providers to engage in open dialogue will facilitate appreciation of the benefits and means of maintaining urogenital health, helping to improve outcomes in middle age and beyond. Women should receive this education before menopause.

[Mixed vaginitis prevalence in Latin-American women, according to physician perception. Preference, effectiveness and security of clindamycin plus ketoconazole]. / Prevalencia de vaginitis mixta en mujeres latinoamericanas según la percepción de los médicos. Preferencia, efectividad e inocuidad de clindamicina más ketoconazol.

BACKGROUND: Vaginitis is an inflammatory process in vaginal mucosa that affects millions of woman worldwide. OBJECTIVE: To evaluate prevalence perception and prescription preference among Latin-American gyneco-obstetricians in mixed vaginitis, and to identify attributes of various active principles. MATERIAL AND METHODS: multicentric and transversal study during January 2008. Close Up was used to poll gyneco-obstetricians prescribing clyndamicin plus ketoconazole. 1,198 gyneco-obstetricians were selected to answer a poll (scales and measuring attributes) to identify differences among various therapeutic schemes to mixed vaginitis. RESULTS: 34% of gyneco-obstetricians consider that 30 to 50% of them patients had mixed vaginitis, 38% consider a 50 to 70% of its prevalence, and 20% a 70% or higher figure. In a bad to excellent scale, 97% had very good to excellent results with antimycotic and antibacterial mix, 73% had a bad to good result with antimycotics alone and 79% with antibacterial alone. Clyndamicin plus ketoconazole had a meaningful difference from mean results (standard), and from the second best mix (metronidazole plus nystatin), with a rapid itch healing, efficacy, and relapse decrease. Metronidazole plus nystatin had the highest score in tolerance and treatment period. CONCLUSION: 90% of polled Latin-American obstetricians prescribe clyndamicin plus ketoconazole as the best available treatment to mixed vaginitis.

Efecto analgésico antiespasmódico y seguridad del clonixinato de lisina y bromuro de L-Butilhioscina en el tratamiento oral de la dismenorrea / Antispasmodic-analgesic effect and safety of Lysene clonixinate and Butylhioscine broide for dysmenorrhea oral treatment

Fue realizado un estudio clínico longitudinal abierto, no comparativo, en 30 mujeres con diagnóstico de dismenorrea primaria o secundaria a dispositivo intrauterino. El objetivo del estudio fue evaluar la eficacia y seguridad del compuesto terapéutico, Clonixinato de lisina y Bromuro de butihioscina 125 y 10 mg respectivamente, en cápsulas, durante un periodo de observación de tres ciclos menstruales. El tiempo de evolución de la dismenorrea primaria fue de 4.46 años; para la secundaria fue de 1.77 años. A la dismenorrea le acompañaron síntomas asociados como: náusea 92 por ciento, vómito 92 por ciento, malestar general 82.1 por ciento, pesantez abdominales 85.7 por ciento y cefalea 46.4 por ciento. Respecto a la intensidad del dolor menstrual, al inicio fue muy severo en el 10.7 por ciento, severo en 42.9 por ciento y moderado 46.4 por ciento. Al final del estudio sólo una paciente de las 28, presentó dolor menstrual de intensidad moderada. Encontramos sólo tres menciones de efectos secundarios de intensidad leve y que no requirieron tratamiento; que correspondieron a dos menciones de gastralgía y una de somnolencia. La conclusión del estudio es que la asociación analgésica espasmolítica del Clonixinato de lisina y Bromuro de butilhioscina en el tratamiento de la dismenorrea primaria o secundaria, reduce y previene el dolor menstrual, así como las manifestaciones asociadas con pocos efectos secundarios. Esta asociación analgésica espasmolítica, es eficaz y segura

Aspectos fisiopatológicos del síndrome de amenorrea galactorrea-normoprolactinémico / The physiopathological aspects of teh normoprolactinemic amenorrhea-galactorrhea syndrome

Para entender en parte la fisiopatología de mujeres con amenorrea-galactorrea-normoprolactinémica (Grupo I: N=5), se establecieron comparaciones Vs. Mujeres con moderada (II; N = 4) y severa hiperprolactinemia y evidencia de tumor (III; N = 4). Se midio PRL y LH en condiciones basales y se valoró la influencia indirecta de dopamina (DA) sobre hipófisis e hipotálamo al emplear un bloqueador a nivel de receptor de DA, metoclopramida (MCP). Fue evidente una mayor disponibilidad de DA a nivel de los lactótropos, ya que después de MCP el grupo I incremento enormemente los niveles de prolactina (PRL), aunque los niveles de PRL basales eran normales. Indirectamente y por la respuesta de LH se detectó una influencia negativa de DA sobre las neuronas productoras de hormona liberadora de gonadotropinas (GnRH) ya que MCP incremento LH en los tres grupos (mayor en I y III) lo cual ha sido relacionado a un mayor recambio de DA a nivel tuberoinfundibular propio de los estados hiperprolactinémicos. La respuesta de LH - PRL a bromocriptina no mostro diferencias que consignar en ninguno de los tres grupos