Are women living with HIV prone to osteoporosis in postmenopause? A systematic review.

BACKGROUND: Some researchers have suggested that HIV infections can increase the cytokines, which might interfere with the bone metabolism and increase the risk of bone mass loss. However, this issue has yet to be consolidated in postmenopausal women. OBJECTIVE: To analyze studies that evaluated the loss of bone mass through DEXA in women living with HIV. MATERIALS AND METHODS: A systematic review was conducted following the PRISMA guideline. The MEDLINE, EMBASE and Cochrane databases were consulted from January 1987 to March 2017. Studies assessing bone mineral density (BMD) in postmenopausal women living with HIV were included. The secondary outcome was to evaluate the impact of antiretroviral on BMD. RESULTS: Sixty percent of the manuscripts suggested that women living with HIV had more bone loss than women in the control group, mainly in the lumbar spine. Forty percent did not observe any difference between groups. One study reported the influence of antiretroviral drugs on bone mass but did not find any difference between groups. CONCLUSION: Our data suggest that HIV infections may have a negative influence on bone mass loss in women. Further studies on the mechanism of this HIV consequence are necessary to clarify the connection as well as the impact of the antiretroviral action on BMD in postmenopausal women.

Are women living with HIV prone to osteoporosis in postmenopause? A systematic review

SUMMARY BACKGROUND Some researchers have suggested that HIV infections can increase the cytokines, which might interfere with the bone metabolism and increase the risk of bone mass loss. However, this issue has yet to be consolidated in postmenopausal women. OBJECTIVE To analyze studies that evaluated the loss of bone mass through DEXA in women living with HIV. MATERIALS AND METHODS: A systematic review was conducted following the PRISMA guideline. The MEDLINE, EMBASE and Cochrane databases were consulted from January 1987 to March 2017. Studies assessing bone mineral density (BMD) in postmenopausal women living with HIV were included. The secondary outcome was to evaluate the impact of antiretroviral on BMD. RESULTS Sixty percent of the manuscripts suggested that women living with HIV had more bone loss than women in the control group, mainly in the lumbar spine. Forty percent did not observe any difference between groups. One study reported the influence of antiretroviral drugs on bone mass but did not find any difference between groups. CONCLUSION Our data suggest that HIV infections may have a negative influence on bone mass loss in women. Further studies on the mechanism of this HIV consequence are necessary to clarify the connection as well as the impact of the antiretroviral action on BMD in postmenopausal women.

Alternativas para o tratamento não hormonal de mulheres no climatério / Alternatives to non-hormonal treatment of climacteric women

Objetivo: Analisar as opções de tratamento não hormonal da mulher climatérica. Material e método: Estudo e análise dos trabalhos e capítulos de livro que mostrem avaliação adequada das opções de tratamento não hormonal das mulheres climatéricas, considerando as indicações, benefícios e tolerabilidade com os diferentes tratamentos. Resultados e conclusões: A revisão apresentou evidências de que medidas gerais (dieta, atividade física e ocupacional) são recomendáveis para todas as mulheres climatéricas. Para alívio dos sintomas vasomotores, o tratamento com mais índices de sucesso é realizado com antidepressivos, outras opções como cinarizina ou hipotensores podem beneficiar secundariamente as mulheres que devam utilizá-los por indicações clínicas. A fitoterapia, acupuntura e homeopatia ainda não apresentam evidências conclusivas...

Microperforated hymen: a case of delayed diagnosis.

Although the incidence of microperforated hymen (MH) is unclear, this hymenal subocclusive anomaly is considered a rare entity. Differently from imperforated hymen, MH may be asymptomatic until puberty when the women's quality of life is jeopardized. Depending on the size of the microperforation, MH's clinical features me be very similar to those found in imperforated hymen cases. However, MH may present infectious complications since the accumulated secretion retained in the vaginal canal has contact with the external environment and therefore represents a source of entry for infectious agents. The authors report a case of a 28-year-old woman who sought the gynecologist complaining of inability to have vaginal intercourse. She referred normal menses, but in fact, although regular, bleeding was filiform and was exteriorized only through the right side of the vagina. Physical examination and imaging disclosed a microperforation of the hymenal membrane at 10 o'clock position. Hymenotomy under general anesthesia was undertaken. Outcome was favorable and the patient could thenceforth have a normal life. We conclude that this anomaly may be overlooked, interfering on its incidence determination. The delayed onset of symptoms and psychological embarrassing aspects, which postpone gynecological consultation, may contribute for misdiagnoses. We call attention to a mandatory detailed anamnesis and thorough physical examination to diagnose this anomaly before the puberty, when complications are less frequent and treatment is advisable.

Tratamento hormonal no climatério / Climacteric hormonal treatment

Objetivo: Analisar os aspectos relevantes do tratamento hormonal no climatério, orientado por monitorização adequada, para aumentar benefícios e reduzir riscos.Material e métodos: Análise de trabalhos e livros relevantes pertinentes ao tema, que em conjunto favoreçam a monitorização clínica, laboratorial e a individualização das mulheres climatéricas, conduzindo assim para a melhor opção de tratamento hormonal.Resultados e conclusões: As evidências da literatura e os dados observados em publicação do Setor de Ginecologia Endócrina e Climatério da Clínica Ginecológica da FMUSP mostram que a individualização das mulheres climatéricas, de acordo com suas condições clínicas, possibilita tratamento hormonal individualizado para cada mulher, oferecendo maiores benefícios e segurança.

Tratamento hormonal da acne baseado em evidências / Hormonal treatment of acne based on evidence

Este trabalho de revisão apresenta o tratamento hormonal da acne baseado em evidências. O trabalho resume a clínica, a classificação, a fisiopatologia e a etiologia da acne. A avaliação de estudos selecionados mostrou que o tratamento hormonal da acne deve ser complementado por tratamento cosmiátrico, e não está indicado para gestantes ou mulheres com planos de engravidar. A primeira escolha para esse tratamento são os contraceptivos hormonais orais, pois são efetivos e seguros para tratamento da acne e também para anticoncepção. Após tempo estabelecido, se o resultado for insatisfatório, outro medicamento, como acetato de ciproterona ou espironolactona, deve ser adicionado. A finasterida é o medicamento indicado para acne de origem idiopática, e a flutamida apresenta efeitos colaterais significativos, não constituindo indicação segura até o momento.

This review shows the hormonal treatment of acne. The review summarizes the clinical aspects, classification, physiopathology and etiology of the acne. The evaluation of selected papers showed that hormonal treatment of acne with hormones has to be complemented by esthetics treatment and is not prescribed for pregnant women or those who want to get pregnant. The first choice of treatment is the hormonal oral contraceptive one, because it is effective and safe for treatment of acne and also for contraception. After an established period with unsatisfactory results, other medicines, such as ciproterone acetate or spironolactone, can be added. The finasteride is prescribed for idiopathic acne and flutamide has many relevant side effects and is also not safe.

Terapia estrogênica no climatério: qual a melhor via? Uma resposta baseada nas melhores evidências / Estrogen therapy in climacteric: what is the best route? An answer based on the best evidences

Foi realizada uma pesquisa abrangente acerca de revisões sistemáticas, trabalhos randomizados e controlados, utilizando o banco de dados, Medline, Pubmed, Scielo e Biblioteca Cochrane com descritores apropriados para avaliar os efeitos das diferentes vias de administração dos estrogênios nas principais indicações da terapia estrogênica para o controle dos sintomas atribuídos à deficiência estrogênica do climatério (sintomas vasomotores e atrofia urogenital). Concluiu-se que, para os sintomas vasomotores, a administração de estrogênios pelas vias oral ou não-oral são eficientes. No caso da atrofia urogenital, a administração de estrogênios pela via vaginal parece ser mais eficaz do que a sistêmica

To evaluate the influence of different forms of estrogens delivery on the primary indication of estrogen therapy in postmenopausal women for the control of symptoms attributed to estrogen deficiency (vasomotor symptoms and urogenital atrophy) a comprehensive literature search was conducted using the database Medline, Pubmed, Scielo and Cochrane Library with appropriate key words for systematic reviews and controlled randomized trials on the subjects. It was concluded that, for vasomotor symptoms, oral or non-oral routes of estrogens administrations are safe and effective, and for urogenital atrophy, the vaginal route has showed to be better than systemic route