Experiencia piloto con el uso extendido de un anticonceptivo oral combinado de baja dosis de estrógeno / Extended use of an oral combined contraceptive pill with low estrogen dose: pilot experience

Objetivo: Evaluar en una experiencia piloto la aceptabilidad y bienestar de la usuaria, después de un periodo de 12 meses de un anticonceptivo hormonal combinado oral de baja dosis estrogénica, con modalidad de uso extendido de 84 píldoras activas consecutivas, seguidas de 7 días de placebo. Método: Se incorporan 25 mujeres voluntarias que usan una combinación de 20 ug de etinilestradiol + 3 mg de drospirenona, con un tiempo de uso de 12 meses. En calendario de registro diario se consignan los días de sangrado o goteo genital así como todo tipo de fármaco ingerido. Al término de los 12 meses se efectúa una encuesta respecto al grado de satisfacción con la posología recibida. Resultados: 13 usuarias (52 por ciento) cumplen los 12 meses de uso. Todas ellas manifiestan un alto grado de conformidad, destacando las ventajas de presentar periodos menstruales ocasionales, mejoría marcada en la sintomatología compatible con el síndrome de tensión premenstrual con el consiguiente incremento del bienestar general. Siete usuarias (28 por ciento) no terminan el estudio por razones médicas, siendo 6 de estas por alteraciones de los flujos rojos y en 5 casos (20 por ciento) se producen retiros no médicos. Conclusión: Esta experiencia, que es la primera con la formulación descrita, confirma en un porcentaje de usuarias las bondades adicionales reportadas en las experiencias previas con otros productos similares, respecto al uso extendido de anticoncepción hormonal oral en un grupo de mujeres que deseaban espaciar sus periodos menstruales.

Objetives: A pilot study designed in order to know about the acceptability of an oral combined contraceptive pill, with low estrogen dose used in an extended way of 84 consecutive days, followed by 7 days of no pills ingestion during a scheduled follow up of 1 year. Methods: 25 volunteers women were recruited among those which wants to use oral combined contraceptive pills and who accepted this extended way of use. Combined contraceptive pills contains each 20 ug of ethinylestradiol plus 3 mg of drosperinone. At admission women were provided with menstrual diary cards in order to check all bleeding days plus any extra pharmaceutical compound received. At the end of the 12 months follow up an interview was done in order to know women experiences and acceptability of this extended way of use. Results: 52 percent of women end the study at the scheduled 12 months use. All of them feel that the main advantages of these extended way of use were to have few menstrual periods and improving premenstrual symtomatology with better quality of life. 7 women (28 percent) did not finish the study because of medical reasons being due in 6 of these for bleeding disturbances. Conclusions: This report is pioneer with the use this hormone combination in this extended type way of use. Results confirm previous positive reports experiences using another similar hormonal compounds with this extended way of use in women who want to reduce the interval of their menstrual periods.

Percepciones, actitudes y conductas de médicos gineco-obstetras, respecto al uso actual de terapia de reemlazo hormonal / Perceptions, attitudes, and behavior of obstetrician-gynecologists for the use of hormonal replacement therapy

Resultados de una encuesta con preguntas específicas contestadas por el 97,6 por ciento de los gineco-obstetras del Departamento de Obstetricia y Ginecología de Clínica Alemana de Santiago, para establecer un diagnóstico de situación sobre el uso de terapia de reemplazo hormonal (TRH). Se enfatizan preguntas sobre la aceptabilidad de las futuras usuarias tanto de TRH como de terapias alternativas; sobre la percepción de los eventuales beneficios desde un punto de vista general, o específicamente cardiovascular; así como las preferencias de hormonas a usar y predilecciones por las vías de administración; las asociaciones del uso y cáncer mamario; las variaciones sobre el uso de TRH pos publicación del Women Health Iniciative Study; los factores que inciden en la discontinuación del tratamiento; la importancia de edad para el uso, factores relacionados con los costos de las terapias y la preferencia o no de productos originales de investigación. Conclusión: Es necesaria una mayor capacitación sobre el uso de TRH en la actualidad tanto de los ginecólogos especialistas en climaterio y menopausia, como de los que no lo son. A falta de información concluyente sobre esta temática en el momento actual se sugiere que el manejo de este tipo de pacientes sea efectuado por los equipos médicos especializados.

In order to set a diagnosis about the use of hormonal replacement therapy (HRT) in peri and postmenopausal women by the obstetricians and gynecologists members of our staff, we did a survey that was answered by 97.6 percent of them. Questions about the future patients desire related to use of HRT or use of natural or alternative medicines were included. There were also questions related to the "risk-benefit" relationship on the use of HRT from an overall point of view as well as from a cardiovascular point of view. The preference of medical doctors (MD) on choice of hormone type in HRT use, in respect to the administration, were also asked. Among others, questions were asked in order to know MD opinions on the relationship with breast cancer, the changes on acceptability use after the WHI study, reasons for the treatment discontinuation, the importance of women's age and the cost of pharmaceuticals produces on HRT use. Conclusions: Are focused on a need of a solid educational program on use of HRT addressed to gynecologists, as well as to general practitioners, cardiologists, oncologists and others related. Educational programs are also quite beneficial to future users as well as women that are currently under treatment. In the absence of conclusive information available at the present moment, we advise that patients considering HRT should seek the counsel of medical teams whose specialties include menopause.

Epidemiología serológica de chlamydia trachomatis en mujeres que asisten a un servicio de planificación familiar / Serologic epidemiology of chlamydia trachomatis infection among fertile women attending a birth control facility

C. trachomatis is an important cause of sexually transmitted diseases, being mainly associated to cervicitis or urethritis among female and male patients, respectively. This study was designed to evaluate the frecuency of C. trachomatis infection among female patients attending a bith control facility using chlamydia IgG and IgM antibody detection, and to correlate this findings with the presence of C. trachomatis at the endocervix. Two hundred fertile women attending a hostital associated birth control facitity were evaluated by indirect microimmunofluorescence (IMIF) to detect circulating antibodies and with direct microimmunofluorescence (DMIF) to detect C. trachomatis in endocervix. C. trachomatis was present in 24 percent (44/200) of endocervical samples. IgG antibodies were equally prevalent in both DMIF positive group had higher antibody titers than the negative group (54,1 vs 32,9 percent, p < 0,05). Moreover, the DMIF positive group was associated with a higher frecuency of chlamydia IgM antibodies than the DMIF negative group. (97,5 vs 4,6 percent, p < 0,0001). These results indicate that C. trachomatis is a frequent agent of infection among women asking to be included in a birth control programm and also suggest that epidemiological surveillance studies are needed

Infección por Chlamydia trachomatis en hombres chilenos asintomáticos y con uretritis: utilidad de la orina de primer chorro / Chlamydia trachomatis infection in asymtomatic men with urethritis: usefulness of first catch urine samples

Background: Chlamydia trachomatis is responsible for 30 to 50 percent of genital tract infections and is present, without symptoms, in 20 percent of men and 60 percent of women. We have little information in Chile about the prevalence of ths infection. Aim: to assess the prevalence of Chlamydia trachomatis in men, using first catch urine samples. Subjects and methods: three hundred and fifty one first catch urine samples of asymptomatic men and 50 samples coming from men with a primary urethritis, were analyzed. Urethral discharge samples from the latter were simultaneously studied. Analysis was performed using an enzyme immunoanalysis (MicroTrak Chlamydia EIA, Syva Co.) and a nested polymerase chain reaction towards the gene that codifies MOMP (PCR/OMP). Results: amoung asymptomatic men, two of 154 teenagers aged 18 to 19 years old (1.3 percent), 10 of 100 university students (10 percent) and eight of 97 adults over 30 years old (8.2 percent), were infected. The global prevalence of infection in these men was 5.7 percent. The prevalence of infection i men with urethritis was 12 percent. Urine EIA had a higher detection frequency than PCR/OMP, but according to another PCR assay, these results were false positives. EIA in first catch urine, had a sensitivity, specificity, positive and negative predictive value of 83.3, 75, 31.3 and 97 percent respectively, for the detection of Chlamydia trachomatis. The figures for PCR/OMP were 100 percent for all these parameters. Conclusions: the prevalence of Chlamydia trachomatis infection in Chilean men is similar to that reported in developed countries. Enzyme immuno assay in first catch urine had a good diagnostic accuracy and could be used in epidemiological studies in asymptomatic men