Menopausal women have hypofibrinolysis even in subclinical stage of atherosclerosis.

BACKGROUND: PAI-1 is the main inhibitor of fibrinolysis. Increase in PAI-1 levels has been associated with the risk of coronary disease; however, there are few studies on the relationship between subclinical atherosclerosis and PAI-1 levels. OBJECTIVE: The aim of this study was to analyze the relationship between PAI-1 level and carotid intima-media thickness in premenopausal and postmenopausal women without apparent cardiovascular disease. MATERIAL AND METHODS: A cross-sectional study was conducted in 142 women aged 45 to 60 years with no history of cardiovascular disease. Anthropometric and laboratory measurements were performed, including PAI-1 levels. All participants underwent a B-Mode ultrasound to measure intima-media thickness. Subclinical atherosclerosis was considered when intima-media thickness was ≥ 0.7 mm and/or an atheromatous plaque was observed. RESULTS: Postmenopausal women had greater intima-media thickness than premenopausal women (0.688 ± 0.129 vs. 0.621 ± 0.113 mm; p < 0.05). Compared to women with normal intima-media thickness, women with subclinical atherosclerosis had higher PAI-1 levels (23.2 ± 13.7 vs. 30.4 ± 20.7 ng/ml; p < 0.05). In all participants, intima-media thickness correlated with PAI-1 (r = 0.302; p = 0.01) and with age (r = 0.358; p = 0001). CONCLUSIONS: An increase in intima-media thickness was observed in postmenopausal women compared with premenopausal women. Asymptomatic women with increased intima-media thickness had higher PAI-1 levels. These findings suggest that fibrinolytic activity is low in the subclinical stage of atherosclerosis.

[Perinatal complications and serotonin level (5-HT) associated with low birth weight]. / Complicaciones perinatales y concentración de serotonina (5-HT) en recién nacidos asociadas con bajo peso al nacimiento.

BACKGROUND: Studies in human and in experimental models suggest that interaction among the adverse prenatal and postnatal environment increases susceptibility for chronic diseases. This environment could induce changes in the metabolism balance. OBJECTIVE: To analyze how the low birth weight (LBW) influences on the perinatal complications and serotonin serum concentration associated with the possible changes in the alimentary behavior. MATERIAL AND METHODS: A prospective, longitudinal and descriptive study was made during 6 months of the obstetric events to know the frequency and complications of LBW. To evaluate if these complications could have some relationship with the serotonin concentration we measured through their metabolite 5-hidroxitriptamina (5-HT) and the possible chronic illnesses of the adult life. RESULTS: From 1,418 obstetric events attended during the study period, 506 patients with viable pregnancies and met the inclusion criteria were included, 26.8% had LBW and the immediate clinical complications were presented in 52.2% of them and serum concentration 5-HT of 362.2 ± 21.8 vs 82.1 ± 13.6 ng/mL. CONCLUSION: Low birth weight, besides causing perinatal complica- tions, also conditions permanent changes in the expression of satiety neurotransmitters and some tissues, that alter the regulation mechanisms to maintain the energy balance leading to metabolic stability, which is needed to the proper endocrine functioning in the adult life of these individuals.

[Convenience clinic redefine polycystic ovary syndrome (Stein-Leventhal)]. / Conveniencia clínica de redefinir al síndrome de poliquistosis ovárica (Stein-Leventhal).

In 1935 during a medical meeting behalf in New Orleans was presents a study that included seven cases of women that suffered menstrual dysfunctions, hirsutism and sterility, for laparotomy the description of the ovaries had a pearly white color and it was hypertrophic, the cuneiform resection in both ovaries resulted in correction of the menstrual dysfunction and two of them got pregnancy later on, receiving the name of polycystic ovary syndrome (PCOS). The technological advance facilitates the hormonal analyses demonstrating the hyperandrogenism existence and the mechanism of the anovulation, the PCOS showed to be heterogeneous, reason why it was hindered to define it, this advanced the current trend to question the existence of the PCOS and to accept the convenience, either to change the name or to redefine it, leaving it as a simple syndrome with several phenotypes. The endocrine component includes abnormal secretion of insulin and consequently outlying resistance to this hormone, likewise is hyperandrogenism, dislipoproteinemia and obesity. The hormonal exams are unnecessary for the diagnostic and treatment; it is convenient to demonstrate for sonography the ovarian growth. Other dysfunctions like the congenital suprarenal hyperplasia, hyperprolactinemia and hypotiroidism should be discarded. The treatment should be individualized with relationship to the reason of the consultation and the patients age. It has not been demonstrated that the sensibilitizers use to the insulin avoids long term cardiovascular illness and diabetes. Therefore, the phenotype is heterogeneous with a fickle metabolic component and for it has arisen the restlessness of a better definition of the SPO.

[Oral or trandsdermanl hormone replacement therapy reduces interleukine-6 levels]. / La terapia estrogénica de reemplazo, oral o transdérmica, reduce las concentraciones de interleucina-6.

OBJECTIVE: To compare the effect of oral and transdermal estrogen replacement therapy (ET) on circulating interleukin-6 (IL-6) in post-menopausal women. PATIENTS AND METHOD: Prospective open trial study in 55 healthy hysterectomized postmenopausal women with a mean age of 52 years. Twenty-seven women received oral conjugated equine estrogens (0.625 mg daily) and the remaining 28 received transdermal estrogen replacement therapy (50 microg/day) during 6 months. At baseline both groups were similar as to age, body weight, and body mass index as well as serum levels of LH, FSH, 17-beta estradiol (E2) and IL-6. RESULTS: Baseline elevated IL-6 levels decreased significantly (p<0.05) after both oral and transdermal estrogen replacement therapy; this decrement showed no difference between the two groups. After the follow-up there were no differences in body weight and body mass index between groups; however, in the oral group there was a trend to increment this parameters. Serum levels of E2 and IL-6 were negatively correlated in the two groups and IL-6 was positively correlated with body mass index in untreated women and this correlation was the same in women with estrogen replacement therapy. CONCLUSIONS: The decrement of IL-6 after estrogen replacement therapy was similar for both routes of administration; in addition IL-6 had a negative correlation with E2 and a positive correlation with body mass index.

[Endometriosis. Is it a problem of the immunological signs?]. / Endometriosis: es un problema de las señales inmunológicas?

Endometriosis syndrome affects 5% to 35% of women in reproductive age. Many theories have been suggested, but the true importance is the survival mechanism of endometriotic tissue, which seems to be related to a defect of the immunological vigilance from macrophages, which are responsible for secretion of a variety of biochemical substances such as cytokines, prostaglandins and growth factors, which through different ways stimulates the growth of the endometrial cells. This has been observed for the clear interrelation between the homeostasis of the body and the evident association of the hormonal factors with the processes of the immunological system, in whose field many steps are unknown.

Epicardial adipose tissue is associated with visceral fat, metabolic syndrome, and insulin resistance in menopausal women.

INTRODUCTION AND OBJECTIVES: Epicardial adipose tissue has been associated with several obesity-related parameters and with insulin resistance. Echocardiographic assessment of this tissue is an easy and reliable marker of cardiometabolic risk. However, there are insufficient studies on the relationship between epicardial fat and insulin resistance during the postmenopausal period, when cardiovascular risk increases in women. The objective of this study was to examine the association between epicardial adipose tissue and visceral adipose tissue, waist circumference, body mass index, and insulin resistance in postmenopausal women. METHODS: A cross sectional study was conducted in 34 postmenopausal women with and without metabolic syndrome. All participants underwent a transthoracic echocardiogram and body composition analysis. RESULTS: A positive correlation was observed between epicardial fat and visceral adipose tissue, body mass index, and waist circumference. The values of these correlations of epicardial fat thickness overlying the aorta-right ventricle were r = 0.505 (P < .003), r = 0.545 (P < .001), and r = 0.515 (P < .003), respectively. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome than in those without this syndrome (mean [standard deviation], 544.2 [122.9] vs 363.6 [162.3] mm(2); P = .03). CONCLUSIONS: Epicardial fat thickness measured by echocardiography was associated with visceral adipose tissue and other obesity parameters. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome. Therefore, echocardiographic assessment of epicardial fat may be a simple and reliable marker of cardiovascular risk in postmenopausal women.

La grasa epicárdica se relaciona con la visceral, el síndrome metabólico y la resistencia a la insulina en mujeres menopáusicas / Epicardial Adipose Tissue Is Associated With Visceral Fat, Metabolic Syndrome, and Insulin Resistance in Menopausal Women

Introducción y objetivos El tejido adiposo epicárdico se ha asociado con diversos índices de adiposidad y resistencia a insulina. La medición de este tejido por ecocardiografía se considera una herramienta útil y accesible para valorar factores de riesgo cardiometabólico; no obstante, aún no existen suficientes estudios en mujeres posmenopáusicas, que es una etapa en la que se presenta un incremento del riesgo cardiovascular. El objetivo del estudio es analizar la relación entre las mediciones del tejido adiposo epicárdico y tejido adiposo visceral, perímetro de cintura, índice de masa corporal y resistencia a insulina en mujeres posmenopáusicas.MétodosEstudio transversal comparativo en 34 mujeres posmenopáusicas con y sin síndrome metabólico a las que se realizó ecocardiograma transtorácico y análisis de composición corporal.ResultadosSe encontró asociación positiva de las medidas de grasa epicárdica con el tejido adiposo visceral, el índice de masa corporal y el perímetro de cintura; en el surco aortoventricular derecho, las correlaciones fueron r = 0,505 (p < 0,003), r = 0,545 (p < 0,001) y r = 0,515 (p < 0,003) respectivamente. También se observó que las mujeres posmenopáusicas con síndrome metabólico presentaban aumento del tejido adiposo epicárdico en comparación con las que no tienen el síndrome (544,2 ± 122,9 frente a 363,6 ± 162,3 mm2; p = 0,03).ConclusionesEl tejido adiposo epicárdico medido por ecocardiografía se asocia con el tejido adiposo abdominal y corporal en las mujeres posmenopáusicas. Las posmenopáusicas con síndrome metabólico presentan mayor cantidad de grasa epicárdica. La medición del tejido adiposo epicárdico por ecocardiografía puede ser un método de utilidad para evaluar el riesgo cardiovascular en la posmenopausia (AU)

Introduction and objectives Epicardial adipose tissue has been associated with several obesity-related parameters and with insulin resistance. Echocardiographic assessment of this tissue is an easy and reliable marker of cardiometabolic risk. However, there are insufficient studies on the relationship between epicardial fat and insulin resistance during the postmenopausal period, when cardiovascular risk increases in women. The objective of this study was to examine the association between epicardial adipose tissue and visceral adipose tissue, waist circumference, body mass index, and insulin resistance in postmenopausal women.MethodsA cross sectional study was conducted in 34 postmenopausal women with and without metabolic syndrome. All participants underwent a transthoracic echocardiogram and body composition analysis.ResultsA positive correlation was observed between epicardial fat and visceral adipose tissue, body mass index, and waist circumference. The values of these correlations of epicardial fat thickness overlying the aorta-right ventricle were r = 0.505 (P < .003), r = 0.545 (P < .001), and r = 0.515 (P < .003), respectively. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome than in those without this syndrome (mean [standard deviation], 544.2 [122.9] vs 363.6 [162.3] mm2; P = .03).ConclusionsEpicardial fat thickness measured by echocardiography was associated with visceral adipose tissue and other obesity parameters. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome. Therefore, echocardiographic assessment of epicardial fat may be a simple and reliable marker of cardiovascular risk in postmenopausal women (AU)

Algunas consideraciones históricas del diagnóstico de la diabetes mellitus / Historical considerations in the diagnosis of diabetes mellitus

La clasificación de la diabetes mellitus ha sufrido variaciones históricas muy interesantes que contribuyeron al concepto actual, en el que se considera a la enfermedad como un síndrome de variada etiología. Los dos principales tipos de diabetes son: la que requiere de la administración de insulina para su tratamiento y la supervivencia, y la que no es dependiente de insulina. Existe una condición particular: "intolerancia a los carbohidratos" en la que mediante una carga de glucosa se mide la capacidad del páncreas para mantener la glucohomeostasis. Mediante esta prueba se puede predecir la posibilidad de que se desarrolle la diabetes y esta alteración bioquímica tiene una prevalencia variable de 8 por ciento y aumenta con la edad, el sobrepeso y las condiciones de vida

Asma premenstrual: relación con hormonas / Premestrual asthma: relationship sex hormones

Las exacerbaciones de asma previas a la menstruación se conocen como "asma premenstrual". Los efectos de las hormonas sexuales sobre las vías respiratorias no se han estudiado lo suficiente a pesar de existir pruebas que sugieren una estrecha relación entre estas dos. Los trabajos disponibles de asma premenstrual se basan en estudios en los que las pacientes reconocen las exacerbaciones de asma y las relacionan con el periodo premenstrual. A pesar de ello, los mecanismos fisiopatológicos del asma premestrual permanecen desconocidos

La reacción paradójica a la TRH en la enfermedad de Cushing no es una prueba diagnóstica cinfiable / The paradoxical response to TRH in Cushing's disease is not a reliable diagnostic test

En sólo uno de seis pacientes con enfermedad de Cushing dependiente de un tumor de la hipófisis se obtuvo un incremento paradójico de ACTH y cortisol plasmáticos despúes de la administración de TRH. Por lo contrario, todos los pacientes mostraron un incremento normal de los niveles séricos de TSH y prolactina como reacción a la aplicación de TRH. Se presentan las características clínicas y bioquímicas de cada caso. Los datos obtenidos confirman la impresión general acerca de la inutilidad de la prueba de TRH para el diagnóstico de la enfermedad de Cushingg

Características estructurales de la prolactina, la hormona de crecimiento, y sus receptores como determinantes de la acción biológica / Structural characteristics of prolactin, grow hormone and their receptors as determinants of biologic action

En esta revisión se presenta un panorama general de la relación estructural que guardan la prolactina, la hormona de crecimiento y sus receptores. La hipófisis produce entre otras hormonas polipeptídicas, la prolactina (PRL) y la hormona de crecimiento (GH) que están esctructuralmente relacionadas. Ambas hormonas existen en la circulación como una mezcla de formas moleculares que difieren en la secuencia de aminoácidos, por modificaciones postranscripcionales, postransduccionales o producidos por rupturas proteolíticas. La heterogeneidad puede producir una diversidad, de acciones biológicas e inmunológicas; se ha sugerido que cada una de estas formas pueda ser una isohormona con un papel fisiológico diferente. La predominancia de una de ellas en el suero puede modificar la actividad de las hormonas y determinan una acción biológica diferente. Sumando a esto que los receptores presentan homología estructural y la posibilidad de que estas hormonas compartan afinidad de unión a los receptores se explica, que en algunas condiciones especiales se produzcan problemas endocrinológicos

Correlación del nivel sanguíneo de creatin fosfoquinasa con los registros de la frecuencia cardiaca fetal anteparto, como un predictor clínico de hipoxia tisular / Correlation of creatinine phosphokinase blood level with antepartum fetal heart frequency recordings as a clinical, predictor of tisular hipoxia

La presencia de una alta actividad sérica de la enzima Creatin Fosfoquinasa (CPK), puede ser el resultado de un evento hipóxico tisular. Actualmente la presencia de un trazo de frecuencia cardiaca fetal omnoso es una prueba confiable que indica la existencia de un estado hipóxico. Se estudiaron prospectivamente 35 embarazadas entre 34 y 41 semanas con el objeto de correlacionar los niveles CPK y los registros cardiotocográficos con signos de asfixia perinatal. Todas las pacientes fueron sometidas monotoreo electrónico anteparto y su embarazo se interrumpió por vía abdominal dentro de los 7 días del último trazo cardiotocográfico. Recién extraído el bebé, se tomó una muestra de cordón umbilical y otra a las 36 horas de vida extrauterina para medir la actividad de la CPK. Todos los neonatos fueron evaluados neurológicamente, se les tomó electrocardiografía y sonografía cerebral en sus primeras 48 horas de vida. Se formaron dos grupos: El A incluyó 14 neonatos con trazos cardiotocográficos normales (control) y el B con 21 neonatos cuyos trazos fueron anormales (grupo de estudio). Se encontró un incremento estadísticamente significativo de la actividad sérica de la CPK, en las siguientes condiciones: a) en la muestra neonatal de 36 horas comparada con la muestra de cordón en el grupo control, p<0.001. b) en la muestra neonatal tomada a las 36 horas comparada con la muestra de cordón en el grupo de estudio p<0.001,c) en los neonatos del grupo control en la muestra tomada a las 36 horas de vida extrauterino p<0.05. No encontramos diferencia estadística en los niveles de CPK en las muestras de cordón de ambos grupos. Hubo mayor morbilidad perinatal en el grupo de estudio (90 por ciento) que en el control (35 por ciento), y las 2 muertes perinatales ocurrieron en el grupo de estudio. Se concluye que un incremento en la actividad sérica de la CPK, en el periodo neonatal, es un indicador confiable de la presencia de hipoxia perinatal, ya que esta actividad elevada se correlaciona con trazos ominosos de la frecuencia cardiaca fetal.

El sistema de enseñanza de las especialidades médicas en el Instituto Mexicano del Seguro Social / The teaching system in the medical specialities at the Instituto Mexicano del Seguro Social

La especialización busca incrementar en los médicos la capacidad creativa y aumentar sus posibilidades de solucionar los problemas que se presentan en un campo definido de la medicina: los cursos de especialización que se imparten en el Instituto Mexicano del Seguro Social se fundamentan en el perfil profesional que requiere la medicina institucional en cada disciplina; ello constituye la fuente más importante para la determinación de los objetivos educacionales y contenido de los programas de especialización. Los cursos tienen duración de dos a cinco años, se imparten en forma de residencia y consisten en actividades académicas, adiestramiento clínico e instrucción clínica complementaria; se organizan en áreas técnico-médica, de enseñanza e investigación y técnico-administrativa. Para los fines descriptivos de este artículo, de las 38 especialidades que se imparten se escogió a la endocrinología a fin de analizar el modelo educativo general y el plan de estudios de esta especialidad en particular, los cuales por su metodología pueden aplicarse a todas las especialidades