[Usefulness of a clinical questionnaire for screening osteopenia and osteoporosis in post-menopausal women]. / Utilidad de un cuestionario clínico en la detección de osteopenia y osteoporosis en la posmenopausia.

BACKGROUND: The prevalence of osteoporosis in post-menopausal women (PMW) is 30 %, and bone densitometry (BD) is the gold standard. This is not recommended as a screening test because of its cost. Instead, the SCORE index (Simple Calculated Osteoporosis Risk Estimation) is proposed. The objective is to determine the sensitivity and specificity of this test in the population and the optimization of BD. METHODS: The SCORE Index is a pre-screening questionnaire; it was used in PMW to compare with BD, registering the total score of the questionnaire, densitometry diagnosis, the fracture risk and the site of osteoporosis. The sensitivity and specificity of SCORE Index and chi(2) of Mantel-Hanszel were calculated. RESULTS: We studied 201 patients, mean age 55.70 years. Osteoporosis was recognized in 22.8 %, osteopenia in 68.3 % and 8.9 % was normal. The sensitivity of the SCORE index was 87 % (95 % CI = 77-97) and specificity was 34.6 % (95 % CI = 27-42) with p = 0.000. A positive probability quotient of 1.33 (95 % CI = 1.1-1.7). CONCLUSIONS: Osteoporosis is a frequent disease in PMW. It is mandatory to have cheap and easy-tools which can detect osteoporosis cases.

[Estrogen therapy effect in arterial tension in postmenopausal women]. / Efecto del tratamiento con estrógenos en la tensión arterial de mujeres posmenopáusicas.

INTRODUCTION: Experimental studies have shown that estrogens prevent deposit of cholesterol in arteries, have effect upon the endothelial function (to prevent contraction of smooth muscle), and enlarge the vascular tone or vasodilatation. OBJECTIVE: To determine changes in arterial pressure before and after use of estrogen-therapy. MATERIAL AND METHODS: A descriptive study was carried out follow-up during 8 weeks in Obstetric and Gynecologic Hospital (No. 3), Instituto Mexicano del Seguro Social. We included 250 postmenopausal women with prescribed estrogen-therapy. Arterial tension was determined before and after therapy; descriptive statistics and student t test (value, p < 0.05) was employed. RESULTS: Menopause was present in a mean of age of 46 +/- 4.2 years (M +/- SD); height was 1.53 +/- 0.6 m; corporal weight, 60.9 +/- 10.2 kg, and hip-waist index was 81.3 +/- 5.4. Mean arterial tension before estrogen-therapy was 90.2 +/- 10.0 mmHg, and after, 85.7 +/- 9.6 mmHg (p < 0.05). CONCLUSIONS: There is evidence of estrogen-therapy vasodilatation and hypotension effects, with clinical changes statistically significative; however is recommendable that such estrogenic therapy must be individualized and attended in slender form. Hormonal therapy (estrogens) has benefits in arterial tension of postmenopausal women.

[Elaboration and validation of an index for preeclampsia diagnosis]. / Elaboración y validación de un indice para el diagnóstico de preeclampsia.

OBJECTIVE: To build a consistent and valid preeclampsia diagnosis index (IDP) for its Spanish acronyms. PATIENTS AND METHOD: The study was done in a Gyneco-Obstetrics Hospital and a Family Medicine Unit from March 2000 to February 2001. Fifty items were chosen from the literature, with a design to validate diagnostic tests, which were assessed by family doctors and gyneco-obstetricians in regard to their appearance and content validity. Concurrent criterion validity. Golden standard: Two gyneco-obstetricians diagnosed pre-eclampsia (hypertension and proteinuria). Simultaneously a family doctor (in an independent and blinded way) questioned, examined and recorded laboratory data of 219 preeclamptic patients and 251 non preeclamptic patients. RESULTS: Preeclampsia diagnosis index is an additive index with 21 clinical and paraclinical parameters weighted according to their individual diagnostic capacity. It has two parts: The first one with 82% (95%CI 80-84) sensitivity; 93% (95%CI 91-95) specificity; the second one with 86% (95%CI 83-89) sensitivity; 75% (95%CI 65-85) specificity. CONCLUSIONS: Preeclampsia diagnosis index is easily applied and has immediate results, which makes easier the physician's decisions.

[Depression prevalence and risk factors found in women attended by a family physician]. / Prevalencia de depresión y factores de riesgo en mujeres atendidas en medicina familiar.

OBJECTIVES: Determine the prevalence of depressive symptoms in adult woman who was attended by family physician, to explore risk factors for depression and estimate how often depression is registered as a diagnosis by the family physician. MATERIALS AND METHODS: We did a prospective, analytic, and transversal study with simple randomized sampling at a Mexico City Family Medicine Clinic from March to December 2004. The size of the study was 384 patients. It includes women from 20 to 59 years of age. We excluded women without a clinical file for at least 1 year of reliable information. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Family Apgar Scale were applied. RESULTS: The survey included a total of 400 patients with the following characteristics: average age, 39 +/- 11 years; married, 74%; homemakers, 68%, and women with education level of high school or less were 79%. Prevalence of depressive symptoms was 52% (95% confidence interval [95% CI], 47-57). In women between 20 and 39 years of age, there was an association between depression and family dysfunction; the average number of healthcare appointments for the year prior to the study was significantly higher in patients 40 years old or more. CONCLUSIONS: There is a high prevalence of depressive symptoms in adult women, and depression diagnosis is frequently omitted. Depression-associated factors differ according to chronological age. In young women, family dysfunction is the main risk factor.

[Analysis of trends in maternal mortality during a 10 year-follow up in a urban region]. / Análisis de la tendencia de mortalidad materna durante 10 años de seguimiento en una región urbana.

BACKGROUND: Maternal mortality is considered a worldwide health problem, since the WHO has estimated that there are 500,000 maternal deaths annually and that the highest percentage of these deaths occurs in developed countries. It was not until 1970 that this problem became important, by revising the birth's registrations and the maternal causes of morbidity and mortality, and that the mortality committees study began. OBJECTIVE: To determine the epidemiological profile and the trend of the maternal mortality in a urban hospital. MATERIAL AND METHODS: This retrospective and descriptive study was carried out at the Reproductive Health Coordination of the Centro Medico Nacional La Raza, through the registrations of the maternal deaths reported from 1993 to 2002 by the local committees of maternal mortality. Maternal mortality was defined as an event occurred during pregnancy or within 42 days after delivery, by any associated cause and aggravated by the same pregnancy. We used analytic and descriptive statistics, with central trend measurements, as well as chi square test. RESULTS: During the 10 years of analysis, 244 deaths were shown, with mean per year of 24.4 +/- 5.2 deaths. Preeclampsia-eclampsia, hypovolemia and sepsis represented 71.7% of the cases. The highest number of deaths ranged from 30 to 34 years, with 64 deaths. Women with the first pregnancy had the highest number of deaths, with incidence of one maternal death for each 664.7 +/- 135.6 new born in each year. DISCUSSION: The main maternal deaths per year corresponded to direct obstetric causes, with percentages from 53.3 to 86.9% annually, where preeclampsia-eclampsia syndrome maintains these high percentages, with a death average within the international standard parameters considered adequate.

[Incidence of infected surgical wound and prophylaxis with cefotaxime in cesarean section]. / Incidencia de herida quirúirgica infectada y profilaxis con cefotaxima en cesárea.

BACKGROUND: Surgical wound infection after cesarean section varies from 2.5 to 16.1%, thus the utilization of antibiotic prophylaxis has increased routinely and irrationally. Despite this, we can still see cases of infections. OBJECTIVE: To determine if the antibiotic prophylaxis with cefotaxime is associated with the decreased incidence of wound infection in patients submitted to cesarean section without risk factors. PATIENTS AND METHODS: This study was carried out as a randomized clinical trial in patients submitted to cesarean section. Two groups were formed: in the first group we administered cefotaxime and the other one did not receive prophylaxis. The follow-up lasted 30 days to evaluate clinical data of infection. RESULTS: We performed 3,300 cesarean in the studied period; 1,000 patients had the inclusion criteria to participate in the study. A surgical wound infection was observed in 31 (0.96%) patients without risk factors. In 14 of these patients we administered cefotaxime, and in 17 patients we did not use prophylaxis. The highest frequency of infection was observed in the group of 24 to 30 years old, with 16 patients (51.6%). The clinical data of infection were: dehiscence in 29 patients (93.5%), pus secretion in 23 (74.2%), and fever in only 3 (9.7%) of them. The hospital stay after the infection was of five days in 75% of the cases. When the use of cefotaxime as prophylaxis was analyzed in both groups we had an odds ratio of 0.82, which was not significant. DISCUSSION: The use of cefotaxime in patients operated of cesarean does not have great transcendence since it does not reduce the infection incidence. The use of antibiotics in an irrational way implies a high cost, since the majority of the post-operation infections are not complicated, involving exclusively the skin and cellular subcutaneous tissue. Then, the cases with risk factors should be analyzed carefully for the cefotaxime administration.

[Hormonal replacement therapy and breast cancer. A case-control study]. / Terapia de reemplazo hormonal y cáncer de mama. Estudio de casos y controles.

AIMS: Breast cancer is the second more frequently neoplasia in the woman and the first cause of mortality after 35 years old. It is considered a multifactorial illness, since is influenced for genetic, dietary and endocrine factors. Among these, hormonal replacement therapy (HRT) have been assigned benefits effect, as well as risks to increase the breast cancer incidence, because presence of estrogens receptor in the neoplasia cells makes think that the estrogens and other sexual hormones constitute a factor promoter of this cancer. OBJECTIVE: The objective of this study was to determine the association of HRT as risk factor in the incidence of breast cancer, in women from oncology-gynecological service. PATIENTS AND METHOD: Was carried out this descriptive study in patients that used HRT, considering as cases patients with breast cancer confirmed by hystophatological study and controls the patients without breast cancer. To statistical analysis took mean occurrence using the momios reason (MM), with confidence interval of 95% (CI), and chi2 test of Mantel-Haenszel, for a significant value of p < 0.05. RESULTS: Were included successively 250 patients, in 100 of these were confirmed diagnosis of breast cancer, 60 patients (37.5%) used HRT with mean of 3 years and 40 patients (44.4%) did not use HRT (Cases), the other 150 patients did not have breast cancer, 100 of these used HRT and 50 patients did not use HRT (Control). The statistical analysis showed that the HRT had a MM 0.75 (IC 95% 0.62-1.15) p=0.28, the maternal nursing with MM 0.68 (IC 95% 0.59-1.08) p=0.05, the multiparity with MM 0.42 (IC 95% 0.16-1.87) p=0.26, obesity MM 1.67 (IC 95% 0.99-1.54) p=0.05, familial history with MM 1.23 (IC 95% 0.83-1.54) p=0.05. CONCLUSIONS: These results show that does not exist a direct association between HRT and breast cancer. Therefore, whenever takes the decision to use the HRT should be considered the possible risks and benefits individualizing the patient, also the mammography should be present in mind, same that frequent physical examination, autoexploration and the use of HRT smaller to 5 years.

[Clinical experience with chemotherapy of the malignant tumor of germinal cells (dysgerminoma) of the ovary]. / Experiencia clínica con el tratamiento a base de quimioterapia del tumor maligno de células germinales (disgerminoma) del ovario.

OBJECTIVE: To evaluate two alternative plans of chemotherapy with EP (etoposide, platinum) and BEP (bleomycin, etoposide, platinum) after oncological surgery. MATERIAL AND METHODS: A clinical, longitudinal and descriptive study was done, where the cases with pure dysgerminoma diagnosed in the gynecology-oncology service during the years from 1992 to 2003 were included. Information was recollected in a precoding survey that included sociodemographic characteristics, tumor size, free survival of disease, general survival, recurrence index and the index of fertility. RESULTS: The age of the group studied was of 22.1 +/- 6.5 years, with stratification to 9 patients in phase I (50%), phase III in 7 patients (38.9%) and phase IV in 2 patients (11.1%). Histological study confirmed the pure dysgerminoma, with a mean duration of the symptoms of 5.2 months, the free survival of disease was of 39.6 months and general survival was of 49.5 months. It was administered early chemotherapy in 11 patients, from which 7 received EP and the other 4 received BEP. Eight patients were found in advanced phases and with metastasis. There were 4 (22.2%) recurrences, of which 3 corresponded to phase III and a case to phase IV with tumors all of them over 15 cm. There were 3 patients rescued with chemotherapy of second line and a patient with radiotherapy to central nervous system. The statistical analysis showed that size of tumor among the recurrent group (24.2 cm) and the group without recurrence (14.5 cm) had significant differences (p = 0.018), the size of the tumor and the free survival of disease did not have significant correlation (p = 0.99), but upon comparing the general survival with the phase of the disease, a significant correlation was found (p = 0.03), where the survival to 5 years was observed in 6 cases (33.3%), of which a case was treated with surgery and without chemotherapy, 4 cases with EP and a case with BEP. Out of the 11 cases treated with conservative surgery, two patients got pregnancy in three occasions.

[Maternal and perinatal surgical complications in low platelet count for HELLP syndrome in severe preeclampsia-eclampsia in intensive care]. / Complicaciones quirúrgicas maternas y perinatales en pacientes con plaquetopenia por síndrome de HELLP, en preeclampsia severa-eclampsia en terapia intensiva.

The preeclampsia is the first cause of maternal morbility, with increase in the obstetric complications when it is associated to HELLP syndrome, for the low platelets that even involves to the neonate. This study was carried out in the patients accepted in the intensive Adults Cares Unit in the period of one year, surgical complications and the perinatal results were determined in women with low platelet count for HELLP syndrome in preeclampsia-eclampsia. Three groups were formed according to the platelets account and then were analyzed using chi square to determine association among these groups of patients, as well as mean and standard deviation (M +/- DE) to describe results. Forty patients were studied with low platelets by HELLP syndrome in preeclampsia-eclampsia, where the distribution for the group with platelets < 50,000 were 12 patients (30%), in the group among 51,000-100,000 of 18 cases (45%), and of 101,000-150,000 were of 10 cases (25%). The mean of gestas was of 2.3 +/- 1.2, more frequent delivery was for cesarean section in 39 cases (97.5%) and a single case for vaginal via (2.5%), a maternal death was presented (8.3%). The surgical reintervention was observed with more frequency in the group of < 50,000 platelets, the most frequent cause in these reinterventions was the hipovolemic shock. Also in this group the perinatal mortality was presented in 3 cases (25%) and the asphyxia at the birth with Apgar < 6 was presented in 5 cases (41.7%). A bigger morbility was observed inversely proportional to the account platelets, being the renal failure the cause most frequent of this morbility in the three groups. The low platelets account contribute in a direct way in the obstetric complications, since there are more surgical reinterventions, with bled in the transsurgical and increase in the days of intrahospitalary stay. Also with smaller account platelet, there are bigger prematural index, asphyxia and perinatal mortality in the newborn of mothers with HELLP syndrome.