Insuficiencia ovárica primaria en adolescentes: revisión de la literatura a propósito de un caso clínico / Primary ovarian insufficiency in adolescents: review of the literature regarding a clinical case

El objetivo de este manuscrito es realizar una revisión y actualización de la literatura de la insuficiencia ovárica primaria (IOP) en población adolescente, a partir del diagnóstico, manejo y seguimiento de un caso clínico. La insuficiencia ovárica primaria se define como la menopausia en una mujer antes de los 40 años, acompañada de amenorrea, hipogonadismo hipergonadotrópico e infertilidad. Su prevalencia varía entre 1 a 2%, y en mujeres menores de 20 años su prevalencia es un caso de cada 10,000. Aunque se sabe que muchas afecciones pueden llevar a una IOP, la más común es la causa idiopática. La presentación clínica es diversa, y varios trastornos diferentes pueden también, llevar a esta condición. CASO CLÍNICO: Se presenta el caso de una adolescente de 17 años, previamente sana, con historia de amenorrea secundaria, no embarazada, con examen físico general y ginecológico normal. Se solicita estudio analítico complementario resultando con niveles de hormona folículo estimulante (FHS), estradiol (E2) y hormona antimülleriana (AMH) compatibles con una insuficiencia ovárica como la observada en la posmenopausia. Se inicia terapia hormonal (TH) clásica con estradiol y progesterona, siendo posteriormente reemplazada por anticoncepción hormonal combinada (AHC) oral, coincidente con el inicio de vida sexual, con respuesta favorable y sangrados regulares. La IOP tiene graves consecuencias para la salud incluyendo trastornos psicológicos como angustia, síntomas depresivos o depresión, infertilidad, osteoporosis, trastornos autoinmunes, cardiopatía isquémica, y un mayor riesgo de mortalidad. La enfermedad de Hashimoto es el trastorno autoinmune más frecuente asociado a la IOP. Su tratamiento y diagnóstico deben establecerse de forma precoz para evitar consecuencias a largo plazo. La terapia con estrógenos es la base del tratamiento para eliminar los síntomas de la deficiencia de estrógenos, además de evitar las consecuencias futuras del hipogonadismo no tratado. También el manejo debe incluir los siguientes dominios: fertilidad y anticoncepción, salud ósea, problemas cardiovasculares, función psicosexual, psicológica y neurológica, informando a los familiares y a la paciente sobre la dimensión real de la IOP y la necesidad de tratamiento multidisciplinario en muchos casos. CONCLUSIÓN: El caso presentado, pese a ser infrecuente, permite abordar de manera sistematizada el diagnostico de IOP y evaluar alternativas de manejo plausibles para evitar graves consecuencias en la salud, así como conocer respuesta clínica y de satisfacción de la adolescente.

The objective of this manuscript is to review and update the literature on primary ovarian insufficiency (POI) in an adolescent population, based on the diagnosis, management and follow-up of a clinical case. Primary ovarian insufficiency is defined as menopause in a woman before the age of 40, accompanied by amenorrhea, hypergonadotropic hypogonadism, and infertility. Its prevalence varies between 1 to 2%, and in women under 20 years of age its prevalence is one case in every 10,000. Although it is known that many conditions can lead to POI, the most common is the idiopathic cause. The clinical presentation is diverse, and several different disorders can also lead to this condition. CLINICAL CASE: The case of a 17-year-old adolescent, previously healthy, with a history of secondary amenorrhea, not pregnant, with a normal general physical and gynecological examination is presented. A complementary analytical study is requested, resulting in levels of follicle stimulating hormone (FHS), estradiol (E2) and anti-müllerian hormone (AMH) compatible with ovarian insufficiency such as that observed in postmenopause. Classic hormonal therapy (HT) with estradiol and progesterone was started, later being replaced by combined hormonal contraception (CHC), coinciding with the beginning of sexual life, with a favorable response and regular bleeding. POI has serious health consequences including psychological disorders such as distress, depressive symptoms or depression, infertility, osteoporosis, autoimmune disorders, ischemic heart disease, and an increased risk of mortality. Hashimoto's disease is the most common autoimmune disorder associated with POI. Its treatment and diagnosis must be established early to avoid long-term consequences. Estrogen therapy is the mainstay of treatment to eliminate the symptoms of estrogen deficiency, in addition to avoiding the future consequences of untreated hypogonadism. Management should also include the following domains: fertility and contraception, bone health, cardiovascular problems, psychosexual, psychological and neurological function, informing family members and the patient about the real dimension of POI and the need for multidisciplinary treatment in many cases. CONCLUSION: The case, although infrequent, allows a systematic approach to the diagnosis of POI and evaluate plausible management alternatives to avoid serious health consequences, as well as to know the clinical response and satisfaction of the adolescent.

Menopausia y terapia hormonal de la menopausia. Las recomendaciones 2018 de la Unidad de Endocrinología Ginecológica de Clínica Alemana de Santiago -Sociedad Italiana de la Menopausia y la Sociedad Chilena de Endocrinología Ginecológica / Menopause and menopausal hormone therapy. The 2018 recommendations of the Gynecological Endocrinology Unit of Clínica Alemana de Santiago -Italian Society of Menopause and the Chilean Society of Gynecological Endocrinology

ABSTRACT In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these Recommendations is to provide a simple and updated reference on postmenopausal MHT. The term MHT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential (Seq) when progestogen is added to ERT for 10-14 days a month, or continuous combined (CC) when progestogen is administered continuously every day along with a fixed amount of estrogen. MHT also includes Tibolone and the Tissue Selective Estrogen Complex (TSEC).

At 10 years of chlormadinone use in Latin America: a review.

Chlormadinone acetate (CMA) is a progesterone derivative (17α-acetoxy-6-chloro-4,6-pregnadiene-3,20-dione), first synthesized in 1961. It was used as progestin-based hormone replacement therapy; since 1999 it was first used for oral contraception combined with ethinyl estradiol (EE). CMA exerts a potent progestagenic effect, about one third higher than that observed with endogenous progesterone. CMA is also an anti-estrogen, showing no androgenic effects (at birth control dose). Unlike progesterone, it has a mild glucosteroidal effect with no anti-mineralocorticoid effect at all. These biological actions have allowed CMA to have a role for therapeutic use in dysmenorrhea, hyperandrogenism, and as a contraceptive agent. In addition, CMA has exhibited beneficial neuroendocrine effects on women's mood. CMA-EE combination has shown excellent contraceptive efficacy, high tolerability, and compliance due to its risk-benefit profile, having additional benefits on skin and hair, such as reduction of seborrhea and acne. Metabolic tolerance of CMA has been demonstrated in several clinical studies. Currently, CMA is formulated to be taken as oral caplets in a 21 caplets package containing 0.03 mg/EE and 2 mg CMA per pill with/without seven placebo additional pills. Another presentation has 24 caplets containing 0.02 mg/EE and 2 mg CMA plus four placebo pills.

Diferencias en antioxidantes plasmáticos según nivel socioeconómico en mujeres chilenas / Differences in plasma antioxidants according to socioeconomic level in chilean women

Background: Free radical-mediated oxidative damage is a known initial event in atherogenesis. Cardiovascular disease is frequent in the Chilean population showing differences in the prevalence of risk factors of the disease according to socioeconomic level (SEL). Aim: To determine levels of antioxidants and lipid peroxides in Chilean women from different SEL. Patients and methods: Blood samples were taken from 81 women for measurements of plasma ascorbic acid, ß-carotene, a-tocopherol, licopene, ubiquinol, glutathione, total plasma antioxidant capacity, and lipid peroxides (TBARS). Results:Individuals in the lower SEL showed reduced levels of plasma ß-carotene, ascorbic acid, a-tocopherol, and ubiquinol compared to women in the higher SEL. There were no differences between groups in the plasma levels of glutathione, total antioxidant capacity, or TBARS. Conclusions: The results could be explained in part by the higher consumption of fruits and vegetables in women from the upper SEL

Food of the gods: cure for humanity? A cultural history of the medicinal and ritual use of chocolate.

The medicinal use of cacao, or chocolate, both as a primary remedy and as a vehicle to deliver other medicines, originated in the New World and diffused to Europe in the mid 1500s. These practices originated among the Olmec, Maya and Mexica (Aztec). The word cacao is derived from Olmec and the subsequent Mayan languages (kakaw); the chocolate-related term cacahuatl is Nahuatl (Aztec language), derived from Olmec/Mayan etymology. Early colonial era documents included instructions for the medicinal use of cacao. The Badianus Codex (1552) noted the use of cacao flowers to treat fatigue, whereas the Florentine Codex (1590) offered a prescription of cacao beans, maize and the herb tlacoxochitl (Calliandra anomala) to alleviate fever and panting of breath and to treat the faint of heart. Subsequent 16th to early 20th century manuscripts produced in Europe and New Spain revealed >100 medicinal uses for cacao/chocolate. Three consistent roles can be identified: 1) to treat emaciated patients to gain weight; 2) to stimulate nervous systems of apathetic, exhausted or feeble patients; and 3) to improve digestion and elimination where cacao/chocolate countered the effects of stagnant or weak stomachs, stimulated kidneys and improved bowel function. Additional medical complaints treated with chocolate/cacao have included anemia, poor appetite, mental fatigue, poor breast milk production, consumption/tuberculosis, fever, gout, kidney stones, reduced longevity and poor sexual appetite/low virility. Chocolate paste was a medium used to administer drugs and to counter the taste of bitter pharmacological additives. In addition to cacao beans, preparations of cacao bark, oil (cacao butter), leaves and flowers have been used to treat burns, bowel dysfunction, cuts and skin irritations.

Vino y salud: estudios epidemiológicos y posibles mecanismos de los efectos protectores / Wine and health: epidemiological studies and possible mechanisms for protective effect

Epidemiological studies show that moderate alcohol consumption, particularly wine, is associated to a decreased risk of ischemic heart disease death. A series of in vitro observations also support this association. Low density lipoproteins (LDL) oxidation apparently plays a key pathogenic role. Wine contains compounds with antioxidant capacity that could account for its postulated stabilizing effect on LDL. Furthermore, in human volunteers wine increases plasma total antioxidant capacity. Other additional effects also contribute to decrease the risk of ischemic heart disease: increased HDL cholesterol, and decreased blood coagulation. In another series of observations, moderate alcohol consumption has been associated with decreased physical and mental deterioration in elderly people. However, it is still under analysis if exaggerated alcohol consumption does increase the incidence of some cancers. On the whole, the presently available evidences clearly indicate that the posittive effects associated to moderate wine or alcohol consumption, predominate over the negative effects. In fact, it seems reasonable to reassure moderate alcohol consumers that their cardiovascular death risk is lower; yet there are not enough studies to recommend moderate drinking to non-drinkers

Efecto de la preñez y la lactancia en el estado nutricional de los ácidos grasos esenciales en la rata / Effect of pregnancy and lactation in nutritional state of essential fatty acids in rats

To study the effect of pregnancy and lactation on red blood cell phospholipids percentual fatty acid composition of virgin, pregnant and lactating rats,,24 pregnant rats of 50ñ1 days of age were supplement with soy and 24 with fish oil during 21 days. Twelve rats of each group were sacrificed after 18 days of lactation, 24 non pregnant rats received soy oil and acted as controls of pregnant and lactating rats. Red blood cell phospholipid fatty acid composition was analized by gas chromatography. The percentage of total w-6 fatty acids of red blood cell phospholipid was 37.8ñ5.9, 32,6ñ0.6 and 38.3ñ3.5 percent in non pregnant, pregnant and lactating rats respectively (p<0.001). The figures for total w-3 fatty acids were 6.33ñ1.52, 4,31ñ0.39 and 2.7ñ0.46 respectively (p<0.001). There was no change in eicosatrienoic fatty acid percentage. Supplementation with fish oil reverted the decrease in w-6 and w-3 fatty acid percentage of pregnant and lactating rats. In conclusion, pregnancy and lactation decrease the capacity to transform precursors of essential fatty acids in long chain polyunsaturated fatty acids

[Honduran experience with the control of acute infantile respiratory infections]. / Experiencia hondureña en el control de las infecciones respiratorias agudas infantiles.

The Honduran Ministry of Public Health and Social Welfare, in consultation with the HEALTHCOM Project of the Academy for Educational Development, conducted a national study that examined the characteristic patterns of acute respiratory infections (ARI) in children, as well as the measures being used to control them. Following an ethnographic analysis of the entire population, a pilot intervention program was developed to teach mothers how to recognize ARI symptoms and take appropriate measures in the case of mild, moderate, and severe episodes. The intervention consisted of teaching health workers (HW) in eight rural towns the most important aspects of ARI control and instructing them in a methodology for transmitting these concepts to the community through oral presentations in local health centers. The methodology included behavior modification techniques and incentives. Three observation instruments were used to compare the effectiveness of the health workers' presentations before and after their training, as well as the knowledge acquired by those who attended the presentations and the community at large. The results indicated that the techniques used both to train the HW and by them in their presentations helped the mothers and other members of the community to respond more effectively when children came down with acute respiratory infections of varying degrees of severity.

Enterocolitis necrotizante en el Hospital General de Medellin / Necrotizing enterocolitis in the General Hospital of Medellin

Se realizo un estudio retrospectivo y prospectivo en el Hospital General de Medellin, en pacientes menores de un ano con diagnostico de Enterocolitis Necrotizante, en un periodo de 2 anos y medio (Enero 1985-Junio 1987). Se encontro una incidencia del 1,27% del total de ninos nacidos vivos, con una mortalidad del 32.5%. Durante el ultimo ano se realizaron corpocultivos a 30 pacientes, obteniendose un 26,6% positivo para E. coli Enteropatogeno; 3,3% positivo para Clostridium Perfringens, Clostridium Difficile y Klebsiella, respectivamente. Los hallazgos clinicos mas frecuentes fueron: distension abdominal, retencion gastrica, diarrea y vomito. Los hallazgos radiologicos mas frecuentes fueron: distension de asas intestinales, neumatosis y edema de pared intestinal