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Presentamos un caso clínico de glaucoma conocido como «enfermedad verde¼ y discutimos el reto diagnóstico documentado en la literatura por medio de un reporte de caso clínico. La individualización y evaluación interdimensional de los pacientes tanto con sospecha como con diagnóstico de glaucoma es clave, ya que el uso de diferentes técnicas de examen ayuda a disminuir los diagnósticos erróneos, teniendo en cuenta que las ayudas diagnósticas son un complemento al criterio médico.
We present a clinical case of glaucoma known as the "green disease" and discuss the diagnostic challenge documented in the literature through a clinical case report. The individualization and interdimensional evaluation of patients with both suspicion and diagnosis of glaucoma is key, since the use of different examination techniques helps to reduce misdiagnoses, taking into account that diagnostic aids are a complement to medical criteria.
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Humans , Female , Middle AgedABSTRACT
Background: Estrogen therapy in younger postmenopausal women is associated with a decisive reduction in morbidity and mortality, but estrogen use in this population is low because of risk of side effects. Weekly intermittent therapy is a more patient friendly approach with reduced pill burden increasing compliance and adherence as well as reducing side effects. Therefore, authors wanted to study the effect of weekly intermittent fixed dose estrogen and progesterone (ultra-low dose) supplements in hysterectomised surgically menopaused women.Methods: The present study was prospective and retrospective study. For retrospective study authors records of 100 hysterectomised women up to 45years of age with severe post-menopausal symptoms treated in authors Medicine Department of Hospital with once weekly MALA-D tablets were studied. For prospective study, all consecutive hysterectomised patients with severe post-menopausal symptoms attending medicine OPD were given once weekly MALA-D which contains ethinylestradiol 0.03mg and levonorgestrel 0.15mg tablets and followed up monthly with outcomes measured by Modified Kuppermann Index, visual analogue scale, and women’s health questionnaires.Results: Present retrospective study showed moderate degree of postmenopausal symptoms as indicated by Modified Kuppermann index of 19.57. Prospective study showed significant improvement in postmenopausal symptoms with weekly intermittent hormone replacement therapy as indicated by outcomes measured by Modified Kupperman index and Visual analogue scale. Women’s health questionnaire also showed statistically significant improvement in 6 out of 8 dimensions.Conclusions: Authors concluded that weekly estrogen progesterone hormone replacement therapy with mala-D tablet (ultra-low dose therapy) was 100% effective in relieving vasomotor symptoms and it is very effective in improving psychosomatic symptoms, urinary symptoms and quality of life with no obvious side effects and greater adherence.
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Objective:To explore the factors affecting the pregnancy outcome of frozen-thawed embryo transfer (FET) in endometriosis (EMT) patients in order to provide reference for the clinical selection of FET strategies. Methods:A total of 329 EMT patients who received blastocyst FET at the Reproductive Medicine Center, Department of Obstetrics & Gynecology, The 900th Hospital of the Joint Logistics Support Force, PLA, from Jan. 2015 to Dec. 2017 were analyzed retrospectively. The patients were divided into three groups according to endometrial preparation protocols, ages, and endometrial thickness on the day of progesterone conversion, respectively. By endometrial preparation protocols, the three groups included gonadotropin-releasing hormone agonist (GnRH-a) down-regulation+ hormone replacement therapy (HRT) group (GnRH-a+HRT group, A1 group, n=138), HRT group (B1 group, n=52), and natural cycle (NC) group (C1 group, n=139). By ages, the three groups included 35 years old group (C2 group, n=59). By endometrial thickness on the day of progesterone conversion, the three groups included 12 mm group (C3 group, n=37). The differences in pregnancy outcomes among EMT patients with blastocyst FET were compared under different grouping factors. Results:The endometrium of A1 group was significantly thicker than that of B1 group (P=0.041), the implantation rate and clinical pregnancy rate of B1 group were significantly higher than those of C1 group (P=0.000, P=0.003). Compared with A1 group, the implantation rate of B1 group was significantly higher (P=0.023), while it was significantly lower in group C1 (P=0.027). The abortion rate of A2 group was significantly higher than that of B2 group (P=0.007). Compared with A3 group, the implantation rate of B3 group was significantly higher (P=0.041), while it was significantly lower in C3 group (P=0.026). Conclusion:HRT endometrial preparation protocol for EMT patients with blastocyst FET can improve the implantation rate and clinical pregnancy rate, and reduce the abortion rate and ectopic pregnancy rate, which may be an economical and efficient endometrial preparation protocol in clinical.
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OBJECTIVE: To evaluate the effects of hormone replacement therapy(HRT) on the quality of life in climacteric women. METHODS: The 202 patients were collected and divided into three groups according to whether or not they were treated with HRT: group 1 (not HRT), group 2 (HRT for the first time), group 3 (HRT for more than one year). All patients received follow-up visiting once per three months for one year. They were evaluated by the professionals through Kupperman index(KI), menopause-specific quality of life questionnaire(MENQOL), self-rating anxiety scale(SAS), self-rating depression scale(SDS). All patients were guided to improve the way of life. RESULTS: After a year, KI, MENQOL and SAS in the three groups were improved significantly (P=0.003, 0.007, 0.014). KI and MENQOL were improved earlier than SAS. SDS was improved but not significantly(P=0.109). KI, MENQOL, SAS and SDS of patients in group 1 were improved significantly, but improved more weakly than those in group 2 and group 3. There is negative correlation between HRT and the values of every scale, and there is positive correlation between culture degree and SAS, SDS score values. CONCLUSION: HRT canim prove the quality of life in climacteric women. The improvement in physical symptoms is earlier than that in mental symptoms. Anxiety and depression are more likely to occur in menopausal patients with high degree of education. Traditional Chinese medicine, exercise therapy and physical rehabilitation can be used as an auxiliary treatment for patients who are unable or unwilling to accept the HRT.
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<p>The purpose of this study is to investigate the efficacy of hormone replacement therapy (HRT) and the Kampo medicine saikokeishito before and after treatment in postmenopausal women having various complains followed by a comparison of their effects. From April 2002 to March 2012, thirty-five (35) cases of HRT and eighteen cases of saikokeishito were evaluated by follicle stimulating hormone (FSH), Kupperman index, the self-rating questionnaire for depression (SRQ-D) and also various respective climacteric complaints such as hot flush, sweating, cold sensation, excitation, palpitation, stiffness in the shoulders and insomnia. While HRT was significantly more effective than saikokeishito by Kupperman index, hot flush and sweating (p < 0.05), saikokeishito was more than HRT in excitation, stiffness in the shoulders, insomnia significantly (p < 0.05) and also palpitation (p < 0.01). Although Kupperman index and SRQ-D were decreased significantly by HRT (p < 0.01) and saikokeishito (p < 0.05) over three months, HRT was significantly (p < 0.01) more effective than saikokeishito by Kupperman index and SRQ-D.<br>These results suggested that although HRT and saikokeishito were both effective for climacteric complains, they had many differentiated efficacies in each treatment. Therefore saikokeishito was favorable in women in whom HRT is contraindicated or undesirable. We posit that serious climacteric symptoms with somatic disorders should be treated with HRT. On the other hand, saikokeishito is indicated in psychological disorders.</p>
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AbstractIn southern Brazil, the bottled latex of Synadenium grantii Hook f., Euphorbiaceae, is popularly used as a treatment of all types of cancer. Similarly, Synadenium umbellatum Pax. is used in the central western region of Brazil for the same purpose and in the same manner of use. Both plants are popularly known as janaúba or leitosinha. The objectives of this study were to use pharmacobotanical analysis to verify whether these two species, which are considered to be distinct, are actually the same to determine anatomical markers; to assist in the identification and differentiation of other Euphorbia; and to evaluate the cytotoxic activity of the latex in relation to HeLa and HRT-18 cells. Leaves and stems of the species were collected in Goiânia and Ponta Grossa and were investigated using scanning electron microscopy and optical microscopy techniques. The latex was also collected and analyzed in relation to its cytotoxic effect by employing MTT and NR techniques. The pharmacobotanical study of the specimens in both localities showed that they were the same species, namely Euphorbia umbellata (Pax) Bruyns, which is the scientific nomenclature accepted and confirmed by an expert taxonomist who specializes in Euphorbia. The pharmacobotanical characteristics highlighted in this study can assist in the identification of the taxon and contribute to the control of the quality of this plant drug. The evaluation of the latex in relation to HRT-18 cells demonstrated action after 48 h of experiment. In contrast, in relation to HeLa cells its induced cytotoxicity in all times and a dose-dependent manner. The IC50 values (72 h) observed were 252.58 ± 18.51 µg/ml and 263.42 ± 15.92 µg/ml to MTT experiment and 250.18 ± 19.48 µg/ml and 430.56 ± 19.71 µg/ml to NR experiment for the HeLa and HRT-18 cells, respectively.
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The incidence of open-angle glaucoma has been rising year after year in China, which has caught much at-tention from ophthalmologists.There are various methods to evaluate the disease progression of an open-angle glaucoma pa-tient.These methods can be divided into two classes:functional assessment and structural assessment.We survey these two classes of methods in this paper.
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The symptoms, causes and different risk factors related to ovarian cancer (OC) in Lahore Metropolitan are studied. Information was collected from 52 patients (having mean age 45±10 years) referred to the Institute of Nuclear Medicine and Oncology Lahore (INMOL), Pakistan. The risk was found relevant in the patients having positive family history of any cancer other than OC and that’s why 21.1% patients faced this dilemma. Marital status was not found a cause of OC as unmarried and married patients both were affected. Birth control pills were not a cause of OC as 96.6% patients in Lahore did not used them. High parity and Brest feeding were the cause of OC as 59.6% patients have high parity and 78.8% have breast fed their children for more than one year. Fallopian tube tide (94.2%), hysterectomy (86.5%) and smoking (98.1%) were not the cause of OC. Irregularity in menstrual cycle (30.8%), eating disorders (38.5%), abdominal pain or bloating (90.4%) and natural menopause (50%) were the symptoms of OC. Hormone replacement therapy (HRT) is not found a cause of OC in Lahore as all the selected patients under study never used HRT.
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Um novo produto chamado "fito-hormônio" foi elaborado para substituir a terapia de reposição hormonal (TRH) nos últimos anos. Este desenvolvimento está associado a dois contextos históricos, a saber: o anúncio dos riscos associados à terapia de reposição hormonal (TRH) para mulheres no climatério no ano de 2002, e uma mudança de percepção do público consumidor e laboratórios farmacêuticos a respeito das plantas medicinais. Algumas plantas já utilizadas por comunidades tradicionais para sintomas associados ao climatério foram pesquisadas cientificamente nas últimas décadas e, como resultado, uma nova categoria de medicamento foi constituída. A partir das teorias ator-rede e de translação, de Bruno Latour, analisa-se a construção desta categoria de medicamento, e como a ideia de "natural" foi ressignificada pelos atores envolvidos na rede sócio-técnica.
A new product called "phyto-hormone" was designed to replace the hormone replacement therapy (HRT) in recent years. This development is associated with two historical contexts: the announcement of the risks associated with hormone replacement therapy (HRT) for postmenopausal women in 2002, and a change in public perception of consumers and pharmaceutical companies about medicinal plants. Some plants used by traditional communities for symptoms associated with menopause have been scientifically researched in recent decades and, as a result, a new category of medicine was established. From the actor-network theory and translation, Bruno Latour analyzes the construction of this class of drug, and how the idea of "natural" was re-signified by the actors involved in the socio-technical network.
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Humans , Female , Middle Aged , Plants, Medicinal , Climacteric , Menopause , Women's Health , Hormone Replacement Therapy , PhytotherapyABSTRACT
The present study was carried out on 500 females in the age group of 40-60yrs to find out average age of menopause in rural and urban women and associated menopausal symptoms & its awareness & prevalence by predesigned questionnaire. We found out that , the percentage of all menopausal symptoms is more in urban women as compared to rural cases. Commonly observed symptoms' are hot flushes, joint & muscular discomfort and physical & mental exhaustion. However women don't come out with sexual problem much both in rural and urban.The symptoms are at peak during 45-55 years and after 55 years severity decreases. However the urinary symptoms and heart discomfort are more in > 55 years in urban women. Though the urban women are consulting physician for menopausal problems still percentage is very less. On the other hand rural women don't come out with their problems.
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The present study was carried out on 500 females in the age group of 40-60yrs to find out average age of menopause in rural and urban women and associated menopausal symptoms & its awareness & prevalence by predesigned questionnaire. We found out that , the percentage of all menopausal symptoms is more in urban women as compared to rural cases. Commonly observed symptoms' are hot flushes, joint & muscular discomfort and physical & mental exhaustion. However women don't come out with sexual problem much both in rural and urban.The symptoms are at peak during 45-55 years and after 55 years severity decreases. However the urinary symptoms and heart discomfort are more in > 55 years in urban women. Though the urban women are consulting physician for menopausal problems still percentage is very less. On the other hand rural women don't come out with their problems.
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Background Heideberg retina tomography Ⅱ(HRTⅡ) can offer the quantitative description of optic disc topography and optic nerve fiber layer thickness.The normal optic disc parameter by HRT Ⅱ from Chinese has been reported,but the comparisons between males and females or the left and right eyes are lack.ObjectiveThe goal of this study is to measure the optic disc topography of healthy people with HRT-Ⅱ.Methods Four hundreds eyes from 108 healthy male subjects and 92 healthy female subjects aged 10-72 years were measured with HRT Ⅱ in this study.The parameters of optic disc including disc area,cup area,rim area,cup/disc area ratio,rim/disc area ratio,cup volume,rim volume,cup depth,maximal cup depth,height variation,mean RNFL thickness,and RNFL cross-sectional area were analyzed and compared between the gender or left and right eyes.Oral informed consent was obtained from all of the subjects before this procedure.Results There were no significant differences in measuring parameters by HRTⅡ between female and male subjects (P＞0.05) or between right eye and left eye (P＞0.05).Conclusion The results can be used as a normal reference of optic disc parameters of HRT Ⅱ.
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Objective To compare the changes in optic disc parameters after intraocular pressure (lOP) reduction between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG) eyes, and to determine if there is a difference of lamina eribrosa compliance between POAG and PACG. Design Prospective comparative study. Participants 36 PACG (49 eyes) and 35 POAG (49 eyes). Methods Patients underwent Heidelberg Retina Tomography (HRT Ⅱ) and Humphrey visual field test before IOP reduction. HRT and Humphrey visual field test were repeated one month after the IOP was reduced by laser, anti-glaucomatous medications or surgery treatment. Factors that affected the change in IOP were assessed including age, pretreatment IOP, IOP reduction, initial cup: disc ratio and diagnosis (POAG/PACG). Main outcome measures Changes of HRT parameters including cup area, mean cup depth, cup volume, and rim area after IOP reduction. Results The cup area, mean cup depth and cup volume decreased, and rim area in-creased significantly when the IOP was reduced (P<0.05), but there were no significant differences in the changes between PACG and POAG patients (P>0.05). Changes of these four HRT parameters were related to the amount of IOP reduction and the baseline ratio of cup to disc(P>0.05), but not related to age and pre-treatment IOP (P<0.05). Conclusions The cup became smaller and the rim area in-creased after IOP lowering with treatment in both POAG and PACG, and the magnitude of the change was similar in both groups. The lamina cribrosa compliance may not be different between POAG and PACG. (Ophthalmol CHN, 2009, 18: 264-269)
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O objetivo do presente estudo foi o de determinar os efeitos das isoflavonas sobre o perfil lipídico em mulheres na pós-menopausa. Pacientes e métodos: ensaio clínico aleatório, duplo-cego, comparando o uso de terapia de reposição hormonal convencional (TH) e o de isoflavonas, de acordo com as regras do Consort-Statement. Foram avaliadas 126 voluntárias saudáveis, com idade entre 40 e 76 anos, atendidas no Ambulatório de Ginecologia do Hospital Universitário Regional do Norte do Paraná, da Universidade Estadual de Londrina. As participantes foram, aleatoriamente, divididas em dois grupos de 63 indivíduos cada um. O primeiro fez uso de isoflavona 100 mg e o segundo (controle) de 2 mg de estradiol e 1 mg de acetato de norestiterona. Foram analisados colesterol total, HDL, LDL, triglicérides, estradiol, FSH e LH antes e após o tratamento, em dois e seis meses. Foi utilizada a análise de variância de medidas repetidas. Resultados: não houve diferença estatisticamente significante entre os grupos quanto ao colesterol total, HDL, LDL e triglicérides. Quando os grupos foram analisados individualmente, o controle apresentou diferenças estatisticamente significantes, mostrando uma melhora na diminuição do colesterol total e frações (p < 0,0001) e triglicérides (p = 0,006). Conclusão: o uso de 100 mg de isoflavona parece não ser efetivo na redução do colesterol total, frações e triglicérides quando comparado à terapia de reposição hormonal convencional.
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PURPOSE: To compare the ability of Heidelberg Retina Tomograph (HRT) 2 and the new version, HRT3, to discriminate between glaucoma and non-glaucoma eyes and to evaluate the most useful parameters for glaucoma detection. METHODS: Fifty-two healthy eyes, 62 glaucoma-suspect eyes, and 172 glaucoma eyes (a total of 286 eyes) were studied retrospectively. The discrimination capabilities of healthy and glaucomatous eyes were compared using areas under the receiver operating characteristics (AROCs) curves. Agreement between classifications was defined by kappa analysis. RESULTS: The stereometric parameters that best discriminated between glaucoma and non-glaucoma eyes were cup shape measure at HRT2 (areas under the ROCs curves (AUC) 0.784) and global probability score (GPS) at HRT3 (AUC 0.718). The stereometric parameters that best discriminated between normal and non-normal eyes were cup shape measure at HRT2 (AUC 0.785) and GPS at HRT3 (AUC 0.696). The sensitivity was 95% at HRT3 and 91% at HRT2, and specificity was 61% at HRT2 and 59% at HRT3. CONCLUSIONS: The glaucoma-discriminating ability of the HRT3 software is similar to that of HRT2; however, HRT3 provided results without the need for subjective operator input.
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Discrimination, Psychological , Eye , Glaucoma , Retina , Retrospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
BACKGROUND: According to several recent researches, some reports showed that the hormone replacement therapy in postmenopausal women had no cardiovascular protective effects. Furthermore, some reported that the hormone replacement therapy in postmenopausal women increased the risk of cardiovascular diseases and the high sensitivity C-reactive protein, abbreviated as hsCRP which is a sensitive marker of cardiovascular risk, was increased by hormone replacement therapy. But there are only few studies that investigated the relationship between hsCRP and hormone replacement in postmenopausal women in Korea. The aim of this study was to explore the influence of hormone replacement therapy upon the level of hsCRP, the predictive factor of cardiovascular diseases. METHODS: We recruited 81 postmenopausal women to visit the cardiologic and the climacteric clinic in Gil Hospital, Gachon University of Medicine and Science for hormone therapy since January 2003. Those with diseases which may have influence on the serum levels of hsCRP were excluded. Then, we measured serum hsCRP levels at initial visit and at 6th month after the hormone replacement therapy. RESULTS: The level of hsCRP prior to treatment was 0.1019 mg/dl. After the hormone replacement therapy, the serum level of hsCRP was 0.1826 mg/dl. The level of serum hsCRP was increased significantly after the hormone replacement therapy compared to the baseline (P<0.05). The level of hsCRP in Korean postmenopausal women had been significantly increased from 0.1019 mg/ dl to 0.1826 mg/dl through 6-month hormone replacement therapy (P<0.05). CONCLUSION: The hormone replacement therapy significantly increased the level of serum hsCRP in healthy Korean postmenopausal women. But well controlled prospective investigations should be considered.
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Female , Humans , C-Reactive Protein , Cardiovascular Diseases , Climacteric , Hormone Replacement Therapy , Korea , PostmenopauseABSTRACT
Hormonal replacement therapy (HRT) has been proven for treatment of postmenopausal symptoms such as hot flushes, night sweats and urologic symptoms. HRT became very popular in the 1990's, when there were several reports showing that it also helped with other menopausal complications such as osteoporosis and cardiovascular disease. Recent studies report that the incidence of breast cancer, endometrial cancer, cerebral infarction, coronary artery diseases, deep vein thrombosis and pulmonary thrombembolism could rise after HRT. Among these side effects of HRT, the risk of pulmonary thromboembolism increases 2 to 4 fold after HRT, but can vary with the use of different doses and preparations. Here, we summarize the risk factors and clinical courses for 5 patients who developed pulmonary thromboembolism after postmenopausal HRT.
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Female , Humans , Breast Neoplasms , Cardiovascular Diseases , Cerebral Infarction , Coronary Artery Disease , Endometrial Neoplasms , Incidence , Osteoporosis , Postmenopause , Pulmonary Embolism , Risk Factors , Sweat , Venous ThrombosisABSTRACT
Menopause is very important for women causes of many health problems are related. Hormone Replacement Therapy (HRT) is so common to treat symptoms of menopause. It is important that benefits and harms of HRT based on scientific evidence should be considered when prescribing HRT. The health care workers should prepare themselves for a better dialogue with women including information about alternative treatment. Beneficial effects of HRT on vasomotor symptoms have been supported by various studies, but HRT to treat negative mood is not recommended. Estrogens and androgens have significant beneficial effects on skin collagen, but do not prevent the effect of aging on elastic tissue and have limited use in the prevention and treatment of skin changes of menopause. Short-term benefits have been shown for urogenital atrophy. Recent evidences suggest that benefits of HRT include prevention of osteoporotic fractures, and colorectal cancer while prevention of dementia is uncertain. Harms include Coronary Heart Disease (CHD), stroke, thromboembolic events, and breast cancer, with 5 or more years of use. Active living, alternative therapies and consumption of food rich in phytoestrogens are some areas, which need to be explored in more detail. Patient preferences as well as evidence are important to initiate and/or continue HRT. Treatment choice should be based on up-to-date information and targeted to individual women's needs. HRT still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.
Subject(s)
Female , Humans , Aging , Androgens , Atrophy , Breast Neoplasms , Collagen , Colorectal Neoplasms , Complementary Therapies , Coronary Disease , Delivery of Health Care , Dementia , Elastic Tissue , Estrogens , Hormone Replacement Therapy , Menopause , Osteoporotic Fractures , Patient Preference , Phytoestrogens , Skin , StrokeABSTRACT
Se hace un recuento histórico de cómo la cultura médica occidental ha percibido la menopausia, su transformación de condición fisiológica en una enfermedad y cómo a consecuencia de nuevas publicaciones relacionadas con las terapias de reemplazo hormonal se hace necesario reconsiderar muchas actitudes y prácticas médicas que se desarrollaron en los últimos años.
This article presents a historic review about the recent ways in which medicine conceives menopause, the implications of the Women's Health Initiative Studies and the need to develop a critic attitude before adopting foreign doctrines, technologies and drug therapies
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Menopause , Hormone Replacement Therapy , HistoryABSTRACT
PURPOSE: The purpose of this study was to evaluate whether there is the significant difference in the parameters associated with the optic nerve head between HRT and OCT. We also evaluated the influence of a tilted optic disc, temporal neural rim loss and peripapillary atrophy, in high myopia particularly. METHODS: Two hundred and sixty-eight eyes of 147 patients evaluated HRT and OCT disc analysis, were enrolled retrospectively to evaluate differences in common parameters (e.g., disc area, cup area, CD area ratio, rim area, and rim volume) among the two examination, using a paired t-test. RESULTS: Disc area, cup area and CD area ratio were greater when measured by OCT than HRT. Rim area and volume were smaller by OCT measures than by HRT. There was no difference in disc area and cup area of the high myopia group, but measures of CD area ratio were greater in OCT. Rim area and volume had higher measures in HRT of patients with high myopia. CONCLUSIONS: Because HRT and OCT analyze different optic nerve heads, the common parameters of HRT cannot be applied to OCT. In the high myopia group, tilted optic disc was not different between the two examinations, but OCT was superior in detecting the problem of temporal rim loss and an RPE margin that had been worrisome according to peripapillary atrophy was not a serious problem according to OCT.