Older women do not have seasonal variations of vitamin D levels: a study from a southern country.

OBJECTIVE: The aim was to study whether the seasonal variation of vitamin D [25(OH)-D or calcidiol] is similar or different in younger and older women living in a southern country. METHODS: Measurement of serum 25(OH)-D concentration in 739 Chilean women aged 20 to 87 years, residents of Santiago (latitude: 33.4° South) who, during a routine gynaecological checkup, agreed to be evaluated. RESULTS: The mean serum concentration of 25(OH)-D for the group was 24.1 ±â€Š10.5 ng/mL. In women 20 to 39 years, the mean was significantly different from the mean of the ≥60 years old group (25.8 ±â€Š10.6 ng/mL vs 23.9 ±â€Š11.1 ng/mL; P < 0.02). Globally, 38.4% of participants had vitamin D deficiency and 36.1% insufficiency. A deficiency was present in 28.4% of the 20 to 39 years old, and in 43.9% in the ≥60 years old group (P < 0.004). In the whole group, a lower proportion (P < 0.0001) of vitamin D deficiency cases in the youngest women occurred during the summer (23.7%) in comparison to the winter (47.7%). It was observed that the proportion of participants in the 20 to 39 years old group with vitamin D deficiency fell from 48.9% in winter to 4.9% in summer (P = 0.0001). In the older groups, this change (less deficiency) is progressively smaller, 51.2% to 27.6% (P = 0.0020) in women 40 to 59 years old, and it does not happen in women ≥60 years (40% with vitamin D deficiency). CONCLUSIONS: Serum vitamin D deficiency [25(OH)-D or calcidiol] is highly prevalent in Santiago, especially in older women (≥60 y) throughout the year. In contrast, in younger women (<40 y), the vitamin D deficiency tends to disappear during summer. More epidemiological studies and targeted prevention actions on vitamin D deficiency are warranted.

[Digestive and Kidney Complications by indomethacin and ibuprofen in extreme preterm infants with patent ductus arteriosus]. / Complicaciones digestivas y renales por indometacina e ibuprofeno en prematuros extremos con ductus arterioso permeable.

The symptomatic patent ductus arteriosus (sPDA) is common in extremely premature infants (EPI). In order to decrease the hemodynamic repercussion and avoid complications it is necessary to close it. Indomethacin or ibuprofen are used for this purpose with its associated risks. OBJECTIVE: Characterize digestive and renal complications in EPI who received indomethacin or ibuprofen as sPDA treatment. PATIENTS AND METHOD: Retrospective study on EPI between January-2004 and December-2013. Three groups were compared: treated with indomethacin or ibuprofen and a non-treated group. EPI with other serious complications were excluded. The primary outcomes on each group were digestive and/or renal complications. Statistical significance was p < 0.05. RESULTS: 599 EPI were included, 33.1% with PDA received treatment and 66.9% did not need it. A statistical association was found between sPDA and lower gestational ages, neonatal depression and respiratory distress. In the non-treated group, 5% presented enterocolitis and 0.25% renal failure; on the treated group, 2.5% presented enterocolitis and 1.0% renal failure. No significant differences were found between the treated and non-treated groups in relation to complications considering enterocolitis (p = 0.11) or renal failure (p = 0.33) alone, or combined (p = 0.17). No difference were detected either between those treated with indomethacin or ibuprofen. CONCLUSIONS: The results show that in absence of other clinical complication, medical treatment of sPDA with indomethacin or ibuprofen, do not increase the risk of serious digestive or renal disorders. There were no advantages of using indomethacin or ibuprofen over the other.

Complicaciones digestivas y renales por indometacina e ibuprofeno en prematuros extremos con ductus arterioso permeable / Digestive and Kidney Complications by indomethacin and ibuprofen in extreme preterm infants with patent ductus arteriosus

El ductus arterioso permeable sintomático (DAPs) es frecuente en prematuros extremos (PE), siendo importante su cierre para disminuir la repercusión hemodinámica. Para ello se usa indometacina o ibuprofeno con los riesgos subyacentes. OBJETIVO: Caracterizar las complicaciones digestivas y renales en PE tratados por DAPs. PACIENTES Y MÉTODO: Estudio retrospectivo en PE nacidos entre enero de 2004 y diciembre de 2013. Según diagnóstico se distribuyeron en 3 grupos: sin DAPs, con DAPs tratados con indometacina y con ibuprofeno. Se excluyeron PE con otras complicaciones graves. Se evaluaron complicaciones digestivas y renales graves. Se usó significación estadistica con p ≤ 0,05. RESULTADOS: Se enrolaron 599 PE; 33,1% recibió tratamiento por DAPs, 66,9% no lo requirió. Hubo asociación estadística entre DAPs y menor edad gestacional, depresión neonatal y distrés respiratorio. Del grupo no tratado, el 5% presentó enterocolitis y el 0,25% falla renal; entre los tratados el 2,5% presentó enterocolitis y el 1,0% falla renal. No hubo diferencias estadísticas significativas considerando ambas complicaciones (p = 0,17), sólo enterocolitis (p = 0,11) o sólo falla renal (p = 0,33) entre tratados y no tratados; tampoco las hubo al comparar complicaciones entre tratados con indometacina o ibuprofeno. CONCLUSIONES: Los resultados en nuestra población demuestran que el tratamiento médico del DAPs, en ausencia de otras complicaciones clínicas, no representa un mayor riesgo de complicaciones graves digestivas o renales. No se demostraron ventajas entre la indometacina e ibuprofeno.

The symptomatic patent ductus arteriosus (sPDA) is common in extremely premature infants (EPI). In order to decrease the hemodynamic repercussion and avoid complications it is necessary to close it. Indomethacin or ibuprofen are used for this purpose with its associated risks. OBJECTIVE: Characterize digestive and renal complications in EPI who received indomethacin or ibuprofen as sPDA treatment. PATIENTS AND METHOD: Retrospective study on EPI between January-2004 and December-2013. Three groups were compared: treated with indomethacin or ibuprofen and a non-treated group. EPI with other serious complications were excluded. The primary outcomes on each group were digestive and/or renal complications. Statistical significance was p < 0.05. RESULTS: 599 EPI were included, 33.1% with PDA received treatment and 66.9% did not need it. A statistical association was found between sPDA and lower gestational ages, neonatal depression and respiratory distress. In the non-treated group, 5% presented enterocolitis and 0.25% renal failure; on the treated group, 2.5% presented enterocolitis and 1.0% renal failure. No significant differences were found between the treated and non-treated groups in relation to complications considering enterocolitis (p = 0.11) or renal failure (p = 0.33) alone, or combined (p = 0.17). No difference were detected either between those treated with indomethacin or ibuprofen. CONCLUSIONS: The results show that in absence of other clinical complication, medical treatment of sPDA with indomethacin or ibuprofen, do not increase the risk of serious digestive or renal disorders. There were no advantages of using indomethacin or ibuprofen over the other.

Estudio PIENSA: efecto de la asesoría sobre la elección de anticonceptivos hormonales combinados en mujeres chilenas / PIENSA study: effect of advice on the choice of combined hormonal contraceptives in Chilean women

Objetivos: Evaluar la asesoría acerca de los anticonceptivos hormonales combinados de auto administración por parte de profesionales de la salud y cómo influye en el cambio o elección del método a utilizar. Método: Durante la consulta ginecológica habitual, se registra la elección del método anticonceptivo (MAC) combinado de auto administración (píldora, anillo o parche transdérmico) previa a la asesoría del médico y posterior a esta. El registro se realiza por medio de una encuesta que debe llenar la paciente y otra a completar por el médico. Resultados: Luego de la asesoría, de las 867 mujeres participantes un 11,6 por ciento variaron su opción de MAC elegido previamente. La píldora, originalmente el método más elegido, disminuyó en las preferencias, aunque continuó siéndolo y las otras opciones aumentaron. La píldora anticonceptiva bajó en un 13,4 por ciento desde su elección inicial, el anillo vaginal y el parche transdérmico incrementaron su elección en un 63,6 y 56,7 por ciento respectivamente. Conclusión: Las píldoras son el MAC hormonal combinado preferido por las mujeres participantes. Sin embargo entregándo una información estandarizada se produce un impacto en la elección anticonceptiva, favoreciendo los métodos menos tradicionales y de uso prolongado como son el anillo vaginal y parche transdérmico.

Objectives: To evaluate the impact of health care professional counseling in the choice of combined self-administered contraceptive method. It also assesses how such advice influences in the final contraceptive choice or how it changes from the original. Method: During routine gynecological consultation, the patient's self-administered contraceptive method (pill, vaginal ring and transdermal patch) preference was registered. This was done before and after physician counseling, through a survey filled by both the patient and the physician. Results: After counseling, of the 867 women who participated, 11.6 percent changed their previously chosen contraceptive. The pill, originally the chosen method of the majority of women, decreased in terms of preference; although the pill continued to be the preferred contraceptive method, preference for other methods increased. The contraceptive pill decreased 13.4 percent in the preference rating, while the choice of the vaginal ring and the transdermal patch increased by 63.65 and 56.7 percent respectively. Conclusion: The pill is women's preferred combined self-administered contraceptive method. Nevertheless during counseling, a standardized information impacts in the contraceptive choice increasing the preference of less conventional methods as transdermal patch and vaginal ring.

Climacteric symptoms in Quechua and Mestizo women from the Andean region of Cusco, Peru: effects of altitude and ethnicity.

BACKGROUND: Latin-American women present a greater severity of climacteric symptoms than women from other parts of the world. Previous studies suggest that this could be due to either its Amerindian crossbreeding or the altitude in which a huge proportion of the Latin-American population lives. OBJECTIVE: To answer this question, climacteric symptoms between Peruvian women ("Hispanic-Mestizas" and "Quechuas") living in similar altitude (around 3000 MASL) were compared. METHOD: This is a cross sectional descriptive study of healthy women of 40-59 years of age living in Departamento de El Cusco, Peru. Using the MRS questionnaire climacteric symptoms were assessed in 395 "Hispanic-Mestizas" (Quechua-Spaniard breeding) and 376 pure "Quechuas". RESULTS: The "Quechuas" compared with "Hispanic-Mestizas" have comparable similar age, but less: obesity, schooling years, cigarette smoking, use of hormonal therapy, diabetes and hypertension; and a greater: proportion of postmenopausal women and number of children. "Quechuas" showed a greater prevalence in ten of the eleven symptoms evaluated by the MRS scale, except for insomnia. The total MRS score was 14.54±7.51 vs. 9.87±6.26 (p<0.0001), respectively. As a consequence of this, 46.5% of the "Quechuas" had a deteriorated quality of life due to severe climacteric symptomatology, compared to only 14.2% of "Hispanic-Mestizas" women (p<0.0001). After adjusting for confounding variables menopause was associated with increased risk of severe menopausal symptoms (OR: 5.86, 95% CI: 3.93-8.75), followed by lack of partner (OR: 3.52, 95% CI: 1.91-6.48), arterial hypertension (OR: 2.62, 95% CI: 1.28-5.39) and Quechua being (OR: 2.38, 95% CI: 1.27-4.45). CONCLUSIONS: Peruvian "Quechuas" women have severer climacteric symptoms than the Peruvian "Hispanic-Mestizas" who live in a comparable altitude. This could suggest that the ethnicity could be one of the factors that could explain the augmented symptoms in Latin-American climacteric woman.

[Official position of the Chilean Society of Climacteric on the management of climacteric women]. / Posición oficial de la Sociedad Chilena de Climaterio para el manejo clínico de la mujer climatérica.

The health of many women is affected in the climacteric period, either by symptoms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most efficient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed according to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.

Effects of tibolone and continuous combined hormone therapy on mammographic breast density and breast histochemical markers in postmenopausal women.

OBJECTIVE: To compare changes in mammographic density and the expression of markers of proliferation (Ki67) and apoptosis (Bcl-2) after 1 year of treatment with tibolone and continuous conjugated equine estrogens combined with medroxyprogesterone acetate (CEE-MPA). DESIGN: Comparative, randomized, evaluator-blinded study. SETTING: City research hospital. PATIENT(S): Thirty-seven postmenopausal women. INTERVENTION(S): Tibolone (2.5 mg; n = 18) or continuous conjugated estrogens (0.625 mg) combined with medroxyprogesterone acetate (5 mg; n = 19) for 1 year. MAIN OUTCOME MEASURE(S): Mammographic density (BI-RADS density score), expression of immunohistochemical markers Ki67 and Bcl-2. RESULT(S): Mean breast density score decreased significantly from 2.22 to 1.67 in the tibolone group, compared with a significant increase in the CEE-MPA-treated group from 1.84 to 2.63. Ki67 expression decreased in 12 of 15, increased in 2 of 15, and remained unchanged in 1 of 15 subjects in the tibolone group, compared with 1 of 19, 15 of 19, and 3 of 19 subjects, respectively, in the CEE-MPA group. Bcl-2 expression decreased in 12 of 15, increased in 2 of 15, and remained unchanged in 1 of 15 subjects in the tibolone group, compared with 5 of 19, 9 of 19, and 5 of 19 subjects, respectively, in the CEE-MPA group. CONCLUSION(S): One-year treatment with tibolone induced a decrease in breast density, with a reduction in proliferation and a stimulation of apoptosis, whereas 1-year treatment with CEE-MPA induced an increase in breast density, with stimulation of proliferation and inhibition of apoptosis, indicating that tibolone effects on the breast are different from those of CEE-MPA.

Use of hormone replacement therapy among Chilean women: a comparison between socioeconomic levels.

OBJECTIVE: To compare the use of hormone replacement therapy (HRT) among Chilean women according to their socioeconomic level. METHODS: A total of 540 women between 50 and 79 years of age were interviewed in Santiago, Chile. Women were allocated into two groups (H, high; L, low), according to their socioeconomic status. RESULTS: Each group consisted of 270 women. The mean age and percentage of menopausal women were similar in both groups. Of the interviewed women, 47% had taken HRT at some time; marked differences between the two groups were observed (L, 15%; H, 79%; < 0.0001). In group H, the percentage of women who had been advised about HRT was close to 88%, whereas, in group L, the percentage was only 24%. Among the women who were informed about HRT, 83% ( = 253) had used it at some time. The percentage of women who used HRT for >2 years was similar in both groups. The main reason for not taking HRT in group H was fear of adverse effects, whereas the main reason for not taking it in group L was the lack of medical advice. CONCLUSIONS: The percentage of women in the low socioeconomic group who use HRT is low. Medical advice is fundamental to increasing HRT use in this group.

Estudio clínico multicéntrico con implantes anticonceptivos de levonorgestrel / Multicenter clinical study with levonorgestrel contraceptive implants

Se presentan los resultados de un estudio pre-introductorio clínico multicéntrico destinado a evaluar la eficacia, inocuidad y conducta de los nuevos implantes anticonceptivos Norplant en programas de salud pública de planificación familiar en Chile. El estudio fue realizado en seis clínicas (3 de Santiago y 3 de diferentes regiones) durante el período septiembre 1985 a junio 1988. Incluye 1.679 aceptantes con un total de 19.703 meses-mujeres de uso. Se realizó un total de 8.273 visitas de seguimiento con un promedio de 4,9 controles y 11,8 meses de observación por usuaria. Las tasas acumuladas de pérdida de seguimiento fueron bajas, 4,5% y 6,9% para el primer y segundo año de uso, respectivamente. Se registraron 6 embarazos, todos ellos durante el segundo año de uso. La eficacia anticonceptiva fue excelente y la tasa acumulada de embarazo fue de 0,0 a 12 meses y de 0,5 a 24 meses. La alteración de los patrones menstruales constituyó el efecto más frecuente y también la causa más importante de terminación. Fueron cerrados un total de 246 casos, 64 de ellos por problemas menstruales. Hubo 92 cierres por otras causas médicas. Un 31,2% de las usuarias no tuvo ningún problema o queja durante el período de observación. Las tasas acumuladas de continuación después de uno y dos años de uso fueron de 92,4 y 78,7 por cien mujeres, respectivamente. Los resultados sugieren que Norplan es un método anticonceptivo eficaz e inocuo, siempre que sea utilizado por personal de salud bien entrenado en consejería y en las técnicas de inserción y extracción

Monitorización electrónica fetal: valor pronóstico de la prueba no estresante / Fetal electronic monotoring: predictive value of non stress test

Se analizan sensibilidad y valor predictivo de la prueba no estresante en 547 embarazadas en control en el Servicio de Obstetricia y Ginecología, Hospital Barros Luco-Trudeau. Se relaciona la última prueba no estresante, relizada dentro de un lapso menor o igual a siete días del parto, en el Apgar a los 5 minutos en el recién nacido. Se comprueba alto valor de predicción (98%). El referido valor de predicción es bajo (2,9%), y por tanto, frente a una prueba no estresante reactiva debe complementarse la vigilancia mediante otras pruebas (ultrasonografía y otras). En caso de embarazo prolongado debe prestarse especial atención a la presencia de desaceleraciones