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).

Transmission study of Andes hantavirus infection in wild sigmodontine rodents.

Our study was designed to contribute to an understanding of the timing and conditions under which transmission of Andes hantavirus in Oligoryzomys longicaudatus reservoir populations takes place. Mice were caged in test habitats consisting of steel drums containing holding cages, where seronegative rodents were exposed to wild seropositive individuals by freely sharing the same cage or being separated by a wire mesh. Tests were also performed for potential viral transmission to mice from excrement-tainted bedding in the cages. Andes virus transmitted efficiently; from 130 attempts with direct contact, 12.3% resulted in virus transmission. However, if we consider only those rodents that proved to be infectious, from 93 attempts we obtained 16 infected animals (17.2%). Twelve of them resulted from intraspecies O. longicaudatus encounters where male mice were differentially affected and 4 resulted from O. longicaudatus to Abrothrix olivaceus. Experiments using Abrothrix longipilis as receptors were not successful. Transmission was not observed between wire mesh-separated animals, and mice were not infected from excrement-tainted bedding. Bites seemed not to be a requisite for oral transmission. Genomic viral RNA was amplified in two out of three saliva samples from seropositive rodents, but it was not detected in urine samples obtained by vesicle puncture from two other infected rodents. Immunohistochemistry, using antibodies against Andes (AND) hantavirus proteins, revealed strong reactions in the lung and salivary glands, supporting the possibility of oral transmission. Our study suggests that AND hantavirus may be principally transmitted via saliva or saliva aerosols rather than via feces and urine.

Sperm binding to the human zona pellucida and calcium influx in response to GnRH and progesterone.

In this study the effect of the sequential exposure of spermatozoa to progesterone and gonadotrophin-releasing hormone (GnRH) upon zona binding and the intracellular free Ca2+ concentration was evaluated. Sperm aliquots were treated as follows: (a) 0.7 micro mol l(-1) progesterone or 0.1% DMSO (progesterone solvent) followed by 50 nmol l(-1) of GnRH; (b) 50 nmol l(-1) of GnRH or distilled water (GnRH solvent) followed by 0.7 micro mol l(-1) of progesterone. Additional aliquots were incubated with DMSO or distilled water (controls) and with 0.7 micro mol l(-1) of progesterone or 50 nmol l(-1) of GnRH. All treatments were for 5 min. Motile spermatozoa were incubated in modified Tyrode's medium, at 37 degrees C, 5% CO2, 10 x 10(6) spermatozoa ml(-1), for 4.5 h. Intracellular Ca2+ concentration and sperm-zona binding was evaluated using fura 2 and the hemizona assay, respectively. GnRH and progesterone increased sperm-zona binding and the Ca2+ concentration. Regarding zona binding, the effect of GnRH was significantly greater when the spermatozoa had been previously treated with progesterone (progesterone-->GnRH=185 +/- 116 zona-bound spermatozoa versus DMSO-->GnRH=99 +/- 15, P < 0.001). On the other hand, previous treatment with GnRH did not modify their subsequent response to progesterone (GnRH-->progesterone= 114 +/- 19 zona-bound spermatozoa versus distilled water-->progesterone=108 +/- 22, NS). The results regarding intracellular Ca2+ showed a similar pattern. These findings suggest a priming effect of progesterone upon a GnRH-induced increase in sperm-zona binding and intracellular Ca2+.

Gonadotropin-releasing hormone-stimulated sperm binding to the human zona is mediated by a calcium influx.

The mechanism by which GnRH increases sperm-zona pellucida binding in humans was investigated in this study. We tested whether GnRH increases sperm-zona binding in Ca(2+)-free medium and in the presence of Ca(2+) channel antagonists. We also examined the GnRH effect on the intracellular free Ca(2+) concentration ([Ca(2+)](i)). Sperm treatment with GnRH increased sperm-zona binding 300% but only when Ca(2+) was present in the medium. In Ca(2+)-free medium or in the presence of 400 nM nifedipine, 80 microM diltiazem, or 50 microM verapamil, GnRH did not influence sperm-zona binding. GnRH increased the [Ca(2+)](i) in the sperm in a dose-dependent manner. The maximum effect was reached with 75 nM GnRH. The GnRH-induced increase in [Ca(2+)](i) was fast and transient, from a basal [Ca(2+)](i) of 413 +/- 22 nM to a peak value of 797 +/- 24 nM. The GnRH-induced increase in [Ca(2+)](i) was entirely due to a Ca(2+) influx from the extracellular medium because the increase in [Ca(2+)](i) was blocked by the Ca(2+) chelator EGTA and by the Ca(2+) channel antagonists nifedipine and diltiazem. These antagonists, however, were not able to inhibit the progesterone-activated Ca(2+) influx. On the contrary, T-type calcium channel antagonists pimozide and mibefradil did not affect GnRH-activated Ca(2+) influx but inhibited the progesterone-activated Ca(2+) influx. Finally, the GnRH-induced Ca(2+) influx was blocked by two specific GnRH antagonists, Ac-D-Nal(1)-Cl-D-Phe(2)-3-Pyr-D-Ala(3)-Arg(5)-D-Glu(AA)(6)-GnRH and Ac-(3,4)-dehydro-Pro(1),-p-fluoro-D-Phe(2), D-Trp(3,6)-GnRH. These results suggest that GnRH increases sperm-zona binding via an elevation of [Ca(2+)](i) through T-type, voltage-operated calcium channels.

Gonadotrophin-releasing hormone antagonists inhibit sperm binding to the human zona pellucida.

Previous work from our laboratory indicated that gonadotrophin-releasing hormone (GnRH) increases human sperm-zona pellucida binding. Here we present evidence that GnRH antagonists inhibit sperm-zona pellucida binding in humans. Motile spermatozoa (10(7) cells/ml) were incubated in modified Tyrode's medium at 37 degrees C, in 5% CO(2) in air. After 4.5 h, aliquots of spermatozoa were treated with saline (control) or with different concentrations of GnRH antagonists (test). Each sperm aliquot was then tested in the hemizona binding assay. In this assay, the control aliquot was incubated with half a human zona pellucida (hemizona) and the test aliquot was incubated with the matching half. After 20 min, the hemizonae were withdrawn and the number of zona-bound spermatozoa counted using phase-contrast microscopy. In addition, the effect of GnRH antagonists upon the pattern of sperm movement, frequency of sperm-zona pellucida collisions, and percentage of living and acrosome-reacted spermatozoa was determined. The results indicated that treatment with GnRH antagonists decreased the number of zona-bound spermatozoa and did not change the pattern of sperm movement, frequency of sperm-zona collisions, and percentage of acrosome-reacted spermatozoa. We suggest that this action of GnRH antagonists may be due to an effect on zona receptors on the sperm plasma membrane.

Valor nutritivo da silagem de milho adicionada de uréia e carbonato de cálcio e do roläo de milho. I - Consumo de digestibilidade aparente da matéria seca e da proteína bruta e balanço de nitrogênio / Nutritive value of maize silage or maize silage with urea and calcium carbonate, and dried whole maize plant. I - Dry matter and crude protein intake and aparent digestibility, and nitrogen balance

Estudou-se o uso de aditivo em silagem de milho e sua comparaçäo com o roläo de milho sobre o consumo, a digestibilidade aparente de matéria seca e da proteína bruta e o balanço de nitrogênio, usando planta integral de milho, em três silos subterrâneos , revestidos de cimento, com capacidade média de 24t, vedados com plástico. Os tratamentos constituíram-se de: I- Silagem de milho com 0,5 por cento de uréia e 0,5 por cento de carbonato de cálcio; II-Silagem de milho com 0,5 por cento de uréia; III- Silagem de milho pura; IV - Roläo de milho. Os aditivos foram adicionados secos, em porcentagem do material verde, no momento da ensilagem. Utilizaram-se oito carneiros castrados, com aproximadamente três anos de idade, distribuídos em um delineamento de quadrado latino quatro por quatro, com uma repetiçäo. A adiçäo de uréia dobrou o teor de proteína bruta e aumentou o pH das silagens. A silagem tratada com uréia apresentou menor conteúdo de matéria seca que a tratada com uréia e carbonato de cálcio, mas ambas foram semelhantes à silagem pura. Houve melhora nos consumos de matéria seca e proteína digestível das silagens com o uso da uréia, mas esses valores foram ainda maiores com adiçäo conjunta de carbonato de cálcio. Os consumos de matéria seca e proteína digestível da silagem sem aditivos foram iguais aos do roläo. As digestibilidades da proteína e da matéria seca do roläo foram iguais às da silagem sem aditivos. A retençäo de nitrogênio no caso desta última mostrou-se igual à do roläo, sendo melhorada com a adiçäo de uréia e de carbonato de cálcio. O roläo de milho, de forma geral, apresentou características comparáveis às da silagem de milho sem aditivos

Valor nutritivo de silagem de milho, adicionada de uréia e carbonato de cálcio, e do roläo de milho. II - Consumo de digestibilidade de energia / Nutritive value of maize silage with urea and calcium carbonate, and dried whole maize plant. II - Energy intake and digestibility

Estudou-se o uso de aditivos em silagens de milho e sua comparaçäo com o roläo de milho sobre o consumo e a digestibilidade aparente da energia, usando planta integral de milho, em três silos subterrâneos, revestidos de cimento. Os tratamentos foram: I- Silagem de milho com 0,5 por cento de uréia e 0,5 por cento de carbonato de cálcio; II - Silagem de milho com 0,5 por cento de uréia; III - Silagem de milho pura; IV - Roläo de milho. Os aditivos foram adicionados secos, em porcentagem do material verde, no momento da ensilagem. Utilizaram-se oito carneiros castrados, com aproximadamente três anos de idade, distribuídos em um delineamento de quadrado latino quatro por quatro, com uma repetiçäo. A adiçäo de uréia melhorou os consumos de matéria seca e energia digestíveis da silagem, mas a adiçäo de uréia mais carbonato de cálcio tornaram esses valores ainda melhores. O uso de uréia pura ou junto com carbonato de cálcio também aumentou a digestibilidade da energia bruta da silagem. Os consumos de matéria seca e de energia digestíveis da silagem sem aditivos foram semelhantes aos do roläo. A digestibilidade da energia do roläo foi maior que a da silagem sem aditivos. O uso de uréia sozinha ou com carbonato de cálcio teve efeito positivo sobre o consumo de matéria seca e de energia

[Chlamydia trachomatis infection in asymptomatic Chilean men and with urethritis. Usefulness of first catch urine samples]. / Infección por Chlamydia trachomatis en hombres chilenos asintomátícos y con uretritis. Utilidad de la orina de primer chorro.

BACKGROUND: Chlamydia trachomatis is responsible for 30 to 50% of genital tract infections and is present, without symptoms, in 20% of men and 60% of women. We have little information in Chile about the prevalence of this infection. AIM: To assess the prevalence of Chlamydia trachomatis in men, using first catch urine samples. SUBJECTS AND METHODS: Three hundred and fifty one first catch urine samples of asymptomatic men and 50 samples coming from men with a primary urethritis, were analyzed. Urethral discharge samples from the latter were simultaneously studied. Analysis was performed using an enzyme immuno analysis (MicroTrak Chlamydia EIA, Syva Co.) and a nested polymerase chain reaction towards the gene that codifies MOMP (PCR/OMP). RESULTS: Among asymptomatic men, two of 154 teenagers aged 18 to 19 years old (1.3%), 10 of 100 university students (10%) and eight of 97 adults over 30 years old (8.2%), were infected. The global prevalence of infection in these men was 5.7%. The prevalence of infection in men with urethritis was 12%. Urine EIA had a higher detection frequency than PCR/OMP, but according to another PCR assay, these results were false positives. EIA in first catch urine, had a sensitivity, specificity, positive and negative predictive value of 83.3, 75, 31.3 and 97% respectively, for the detection of Chlamydia trachomatis. The figures for PCR/OMP were 100% for all these parameters. CONCLUSIONS: The prevalence of Chlamydia trachomatis infection in Chilean men is similar to that reported in developed countries. Enzyme immuno assay in first catch urine had a good diagnostic accuracy and could be used in epidemiological studies in asymptomatic men.

[Ultrasonography: a complement to sialography in recurrent chronic childhood parotitis]. / L'échographie: un complément à la sialographie dans les parotidites récurrentes chroniques infantiles.

The objective of this research is to compare the ultrasonographic (USG) and sialographic contributions for the diagnosis of Recurrent Parotitis in Childhood (RPC). Bilateral USG of the parotid gland was performed among 16 children with RPC and 16 healthy children. The image of the normal parotid glands was compared with the image of the parotid gland with RPC. A pathologic USG pattern for RPC was obtained which consisted in a homogeneous, micronodular parenchyme with a diffuse increase density, sometimes with multiples hypoechogenous areas, that were considered solid hypoechogenous nodules suggesting inflammatory nodes. A glandular contour finely granulated was described with normal peri-parotidareas and with aponeurotic-muscular planes. Then 16 USG of the parotid gland of the children with RPC were compared with 16 Sialography previous obtained. The possibilities of diagnosis of the disease with both techniques was not different (p > 0.05). When the clinic was correlated with the USG it was possible to obtain parameters of severity of the glandular damage and to visualise the degree of changes of the parenchyma of each child with RPC. In some cases, bilateral damage was observed in children with clinical unilateral symptoms. The USG was performed in children in the acute phase of disease, visualising the microabscess in the gland and confirming the previous diagnosis. Finally, it was possible to conclude the utility of USG in the study of the disease. Being a not invasive exam, harmless, unpainfully echography, was easily accepted by the child. Also, we obtain information not only about the diagnosis of the disease, but also about the severity, prognosis, treatment and follow-up of the infant patients.

[Menstrual blood loss and body iron stores: comparative study between a Multiload-375 IUD and a levonorgestrel vaginal ring]. / Perda sanguinea menstrual e estoques de ferro do organismo -- estudo comparativo entre o DIU Multiload-375 e o anel vaginal de levonorgestrel.

PIP: 107 users of vaginal rings and 74 users of Multiload-375 (ML-375) IUDs aged 18-40 years with more than 1 parity were studied. In the city of Santiago, Chile, 57 patients and at the University of Juiz de Fora, Brazil, 124 users were enrolled. The vaginal ring releases about 20 mcg/day of levonorgestrel (LNG). It was used continuously for 12 months with replacement every 3 months. The ML-375 was used continuously for 24 months or more. Menstrual blood loss (MBL) was determined before insertion; 3, 6, 9 and 12 months after insertion in both groups; and after 24 months in the IUD users. Serum ferritin measurement was done before use: 6 and 12 months after use in the vaginal ring group and 6, 12, and 24 after IUD insertion. Hemoglobin also was measured. It was observed that MBL always increased with IUD use and decreased with vaginal ring use. The measurements concerning IUD were significant in Santiago up to 24 months with a value of MBL of + 17.9 +or- 7.8 ml, while in Juiz de Fora they were significant up to 12 months returning to the value of preinsertion at 24 months (+ 3.1 +or- 4.6 ml). In vaginal ring users a small decrease of MBL was ascertained, but the only statistical difference occurred up to 12 months in Santiago (- 9 +or- 4.4 ml). In IUD use, in inverse correlation to MBL, serum ferritin dropped significantly at 6 months in Chile (- 7.7 +or- 2.9 ng.ml) and 6, 12, and 24-month follow-ups in Brazil (-5.2, -6 and-7.7 ng/ml, respectively). With the vaginal ring serum ferritin did not change significantly. These findings confirm previous research that ML IUDs increased MBL much less than other IUDs causing less change in iron stores even in patients with ferritin lower than 15 ng/ml, considered under the normal value. Yet for users in developing countries, the use of vaginal rings with LNG would be more suitable than the IUD ML-375 because of slighter alterations in the iron balance of the system.^ieng

Itraconazol: evaluación de su seguridad y eficacia en el tratamiento de vulvovaginitis por candida / Itraconazol: evaluation of it security and efficacy in the treatment of vulvovaginitis by candida

La vulvovaginitis constituye una patología muy frecuente en la mujer en edad fértil, siendo Candida spp uno de los principales agentes. Existen numerosos tratamientos tópicos y orales, señalándose las ventajas del tratamiento oral y siendo lo más utilizados los derivados azólicos. El objetivo de este trabajo es evaluar la eficacia y seguridad de itraconazol, una nueva droga triazólica en vulvovaginitis por Candida (VVC). Se estudiaron 111 pacientes con diagnóstico de vulvovaginitis. Se incorporaron al estudio 25 pacientes en las que se estableció el diagnóstico clínico y microbiológico de VVC. Se inició terapia con itraconazol (200 mg cada 12 h) por un día, realizándose control clínico y microbiológico a los 7 y 30 días. Un 60% (15/25) demostró mejoría clínica con erradicación microbiológica a los 7 días. Al resto de los pacientes (10) se les indicó un 2- esquema terapeútico con Itraconazol (200 mg diarios) por 3 días. Todas estas pacientes presentaron mejoría clínica a la 1ª semana postratamiento. Sin embargo, en sólo 5 de ellas se obtuvo la erradicación microbológica. Por lo tanto, 100% (25/25) de las pacientes presentaron curación clínica, en 80% (20/25) se logró erradicación microbiológica de Candida spp. Según estos resultados itraconazol demuestra eficacia y seguridad en el tratamiento de VVC. Se recomienda el primer esquema para las primoinfecciones y el 2- esquema a pacientes con VVC recurrente

Perda sanguínea menstrual e estoques de ferro do organismo: estudo comparativo entre o DIU Multiload-375 e o anel vaginal de Levonorgestrel / Menstrual blood loss and body iron stores: comparative study with the use of a Multiload-375 IUD and a Levonorgestrel vaginal ring

Setenta e quatro usuárias do DIU Multiload-375 foram estudadas comparativamente com 107 usuárias de anel vaginal de Levonorgestrel (20 micra g/dia) no Brasil e Chile, relativamente à sua perda sanguínea menstrual (PSM) e estoques de ferro do organismo através de medidas da hemoglobina (HGB) e ferritina sérica (FS). As medidas foram feitas antes e após a inserçäo do DIU por 24 meses e do anel vaginal por 12 meses. Enquanto näo houve alteraçöes com o uso do anel vaginal nas medidas de PSM, HGB e FS, as mulheres que usaram o DIU tiveram o aumento significativo na PSM por pelo menos um ano depois da inserçäo e uma queda também significativa da FS até 24 meses depois da inserçäo. Em conclusäo, sugere-se que dos dois métodos estudados, o anel vaginal seria o mais adequado para indivíduos com baixos estoques de ferro do organismo.

Consequences of uterine blood loss caused by various intrauterine contraceptive devices in South American women. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction.

Increased menstrual blood loss (MBL) associated with intrauterine device (IUD) use may precipitate or aggravate iron deficiency anaemia, adversely affecting the health of women particularly those from developing countries. Studies were conducted to define the association of MBL and iron status in South American women; to determine the level of MBL induced by IUD use which would result in iron depletion, the length of time for this depletion to occur and, comparing various IUDS, to determine if any currently tested IUDs are suited to long-term use in South American women. A total of 395 women received one of 5 types of IUDs in Santiago, Chile, and Juiz de Fora, Brazil: Lippes Loop, Multiload-250 and Multiload-375 were used in both centres; in Santiago some subjects received the Copper-7 or ProgestasertR devices and in Juiz de Fora, the TCu 200 and the T-Chloroquin IUDs were also tested. MBL and haemoglobin (HGB) were measured for 3 menstrual cycles before insertion, and following insertion, at one, two, four, six, nine, twelve, eighteen and twenty-four months in the majority of cases. Serum ferritin was measured before insertion and at intervals of six months. Mean values of MBL prior to IUD insertion in both centres varied from 21-30 ml. As with previous publications, the use of the Lippes Loop was associated with the greatest increase in MBL which was sustained throughout the 24 months of observation. Women who had one of the two types of Multiload devices inserted also had increased MBL and reduced ferritin for at least 12 months of use. TCu 200 and Copper-7 IUD users had an initial increase in MBL of 1 to 17 ml in the first six months of observation returning to normal levels beyond six months. Serum ferritin levels were lower for one year and then returned to admission values. ProgestasertR users confirmed previous reports of a reduction of 40-50% in MBL and an increase in serum ferritin. Few significant changes in haemoglobin (HGB) concentrations were found. Serum ferritin levels on admission ranged from 7.1 to 16.4 ng/ml in Santiago and from 15.8 to 23.2 ng/ml in Juiz de Fora. Many women were in a marginal state of iron balance as evidenced by lower serum ferritin values. Changes in serum ferritin were very closely related to those in MBL.(ABSTRACT TRUNCATED AT 400 WORDS)

A comparative study of the effect of the Progestasert TM and Gravigard IUDs on dysmenorrhoea.

Data obtained from questionnaires on the occurrence of dysmenorrhoea in women using IUDs inserted randomly (146 of them Progestasert and 149 Copper 7) are analyzed. In both groups a reduction in the intensity of menstrual cramps was observed over 12 months of use. Although these reductions are significant in each group, they are slightly higher in Progestasert users. However, on comparing the reduction tendencies of both groups, the difference between them is not significant. No significant differences become apparent either when comparing premenstrual and intermenstrual camps. The usefulness of simple questionnaires directed at detecting the nature of pain in currently used family planning forms for IUD users is discussed.

PIP: A study was conducted at the Family Planning Centre of the Hospital Jose Joaquin Aguirre, Chile, involving 146 patients who had a Progestasert TM IUD inserted and 149 patients who had a Copper 7 IUD, Gravigard TM, inserted to determine the occurrence of dysmenorrhea. All patients completed questionnaires concerning habitual pelvic or genital pain prior to IUD insertion as well as at 1, 3, 6, and 12 months after insertion. Results indicated a reduction in menstrual cramps over 12 months of use. The Progestasert TM group showed a slightly higher reduction of menstrual cramps than Copper 7 users; however, the reductions are not significant. There were no significant differences between premenstrual and intermenstrual cramps. With the use of a questionnaire and the subjective condition of pain, it is difficult to ascertain whether the IUD produced any change in menstrual cramps or whether the reduction of pain originated in the patients; therefore, the technique of questioning the occurrence of pain may not be reliable enough.