Application of a new ultrasound criterion for the diagnosis of polycystic ovary syndrome.

Objective: To define which ultrasound criteria could replace the classic Rotterdam criteria as the best indicator of the risk of developing endocrine-metabolic changes in women with polycystic ovary syndrome (PCOS). Materials and methods: This multicenter cross-sectional study included 200 women with PCOS and one control group of 111 women without PCOS. The primary outcomes to be considered were follicular count, hirsutism, total testosterone levels, free androgen index (FAI), and insulin sensitivity (HOMA-IR), and the secondary outcome was the anti-Müllerian hormone (AMH) level. Results: The main finding in this study points toward a different ultrasound criterion-23 or more follicles of any size in at least one ovary, which is postulated as an alternative to the classic criterion described in the Rotterdam consensus. This criterion correlates better with the other two PCOS criteria and also identifies women at increased risk of hirsutism (Ferriman-Gallwey score: 6.08 ± 3.54 vs. 4.44 ± 3.75, p < 0.0001), total testosterone levels (2.24 ± 0.298 vs. 1.42 ± 1.530, p = 0.0001), FAI (4.85 ± 0.83 vs. 2.12 ± 1.93, p < 0.001), and insulin resistance (HOMA-IR: 1.74 ± 0.182 vs. 1.504 ± 0.230, p = 0.001) more accurately. Regarding AMH, large differences in their mean values were observed between the groups (7.07 vs. 4.846 ng/ml, p = 0.000). However, these differences depended on age. Conclusion: The ovarian ultrasound examination with 23 or more follicles of any size in any of the ovaries constitutes a powerful tool to accurately diagnose PCOS and to associate it with metabolic-endocrine processes such as hyperandrogenism and insulin resistance.

Effects of raloxifene on bone metabolism and serum lipids in postmenopausal women on chronic hemodialysis.

BACKGROUND: Premature amenorrhea and hypoestrogenism and lack of hormone replacement therapy after menopause have been frequently reported in uremic women on dialysis. Therefore, in addition to renal osteodystrophy, postmenopausal women on dialysis could be at risk of osteoporosis. In addition, these patients are at higher risk for hyperlipidemia, arteriosclerosis, and subsequent coronary heart disease and stroke. Recent evidence has suggested that hormone replacement therapy (HRT) in postmenopausal women could have several beneficial effects as well as potentially serious risks. Great efforts have been made to identify therapeutic alternatives that would have the benefits of estrogen on brain and bone without its adverse effects on breast and endometrium. In the present study, we evaluated the effect of raloxifene, a selective estrogen receptor modulator (SERM), on bone metabolism and serum lipids in postmenopausal women on chronic hemodialysis. METHODS: We performed a prospective, blind, placebo-controlled, and randomized study. Fifty postmenopausal women on chronic hemodialysis with proven severe osteopenia or osteoporosis by bone densitometry were selected. After a written informed consent, patients were randomized into two groups: 25 women on placebo and 25 women on the study drug, raloxifene hydrochloride, at a dose of 60 mg/day. In all patients, we performed a baseline bone mineral density (BMD) analysis and simultaneously evaluated different biochemical parameters, serum lipids (total low-density lipoprotein [LDL] and high-density lipoprotein [HDL] cholesterol and triglycerides) and serum markers of bone resorption (pyridinoline crosslinks). BMD was reassessed after 1 year of therapy. Bone resorption markers were determined every 3 months for 1 year. RESULTS: After 1 year on raloxifene therapy, lumbar spine BMD (trabecular bone) significantly improved, whereas femoral neck BMD (cortical bone) did not change significantly. No changes in BMD were observed at trabecular or cortical sites in the placebo group. Serum pyridinoline levels showed a significant decrease after 6 months on raloxifene that persisted thereafter. Low-density lipoprotein (LDL)-cholesterol decreased significantly in the raloxifene group with no changes in serum triglycerides, total cholesterol, or HDL cholesterol. No significant side effects were observed in the raloxifene group. CONCLUSION: The study demonstrates that after one year on raloxifene, postmenopausal women on hemodialysis have a significant increase in trabecular BMD, decrease in bone resorption markers and LDL-cholesterol values, suggesting that SERMs could constitute a therapeutic alternative to improve bone metabolism and control of hyperlipidemia in these patients. The possible long-term effects of raloxifene remain to be determined.

Dislipidemias en infección por virus de inmunodeficiencia humana en diferentes estados de la enfermedad: estudio prospectivo en 41 pacientes / Hyperdipilemia in infection by human inmunodeficiency virus in differents stades of the desease: study in 41 patients

Las anormalidades de los lípidos han sido descritas especialmente con síndrome de inmunodeficiencia adquirida, especialmente en los episodios de infecciones oportunistas. El presente trabajo tiene como finalidad estudiar los niveles de triglicéridos, colesterol total y HDL colesterol, en diferentes estadios de la enfermedad y con la presencia de infecciones oportunistas. Se evaluaron 50 individuos sanos normolipemicos (Grupo control: G1), y un total de 41 pacientes que fueron subdivididos en tres grupos según el contaje de CD4 en: Grupo 2 (G2) formado por 12 pacientes HIV positivos sin evidencia de infección con una media de CD4 de 401.08 +/- 111,4, Grupo 3 (G3) con 17 pacientes con SIDA C3 con infección oportunísta con media de CD4 de 69.4 +/-52.52 y Grupo 4 (G4) con pacientes con SIDA C3 sin tratamiento retroviral convalencientes por 2 meses de infección oportunísta con una media de CD4 de 69.18 +/- 69.77. Así mismo se evaluaron los niveles de triglicéridos, colesterol total y HDLc (método enzimático Ciba Corning), y su correlación con el contaje de CD4+ e índice de masa corporal. La media del índice de masa corporal fue: G1: 23,69+/- 1.17 por ciento, G2: 24.12 +/- 1.80 por ciento, G3 21.11 +/- 1.96 por ciento y G4 20.42 +/- 3.92 siendo en G1 y G2 significativamente diferente de G3 y G4 (ANOVA, T de Bonferroni) (p<0.0001). El valor de triglicéridos fue: G1 103 +/- 28.3 mg/dl, G2: 170+/- 49, G3: 177+/-30 y G4: 180 +/-55 siendo diferente G1 Vs G2, G3 y G4 con una p<0.0001. El valor de colesterol fue: G1: 188+/- 15mg/dl, G2:210.8 +/- 57.62, G3: 129 +/- 41 y G4:123 +/- 62 siendo diferente solo G1, G2, G3 Vs G4 con p<0.05. El valor de HDL fue: G1 52 +/- 10 mg/dl, G2: 30+/- 2, G:3 29+/- 1.9 y G:4 25 +/- siendo diferente G1 vs G2, G3: G4 con p<0.0001. La hipertrigliceridemia y el ascenso del HDL en estos pacientes está presente desde los primeros estadios de la enfermedad, pudiendo ser esto por un descenso de la aclaración de triglicéridos y por un aumento de la lipogénesis hepática, ambas producidas por las citoquinas que median la respuesta inmune. Se ha descrito hipocolesterolemia, pero en nuestro grupo de pacientes sólo se encontró en el G4, no teniendo relación con el grado de hipertrigliceridemia

Piroxicam en el tratamiento sintomático de la dismenorrea primaria: un estudio multicéntrico venezolano / Piroxicam in the symptomatic treatment of primary dysmenorrhea: a multicenter Venezuelan study

Se evaluó la actividad analgésica y tolerancia del Piroxicam (P) en 69 pacientes con diagnóstico de dismenorrea primaria en un diseño multicéntrico abierto no-comparativo. Luego de un período basal sin droga activa se administró P a la dosis de 40 mg/día x 2 días seguidos de 20 mg/día x 2 días durante dos ciclos menstruales consecutivos. A 42 pacientes se les administró un tercer ciclo de tratamiento con P. La administración de P se tradujo en un significativo descenso de la intensidad del dolor (62.2% a 72.8% p < 0.001) en los diferentes días del ciclo menstrual. Un 79.1% de los pacientes manifestaron sentirse asintomáticos al cabo de 2 ciclos de tratamiento con P. No hubo cambios significativos en la reducción del dolor durante el tercer ciclo de tratamiento con P en comparación con el segundo ciclo. Piroxicam fue bien tolerado. Se observaron efectos secundarios en solo 7 pacientes (10.1%), 2 de ellos presentaron rash cutáneo que obligó a la suspensión del tratamiento. La evaluación global de la terapia con P fue excelente y buena en el 92% de los pacientes tratados. Piroxicam es útil en el tratamiento sintomático de la dismenorrea primaria administrado en dosis única diaria