Cystic degeneration of submucous uterine leiomyoma after an incomplete course of ulipristal acetate treatment

@#Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) indicated for the medical treatment of myoma. Several theoretical mechanisms help explain how it induces apoptosis and cystic degeneration of a submucous myoma, leading to its expulsion. This paper presents the case of a young nulligravid diagnosed with heavy menstrual bleeding secondary to submucous myoma, who was started on UPA treatment but with very poor compliance. Despite the very short and incomplete course of treatment, degenerative changes still took effect, which led to the expulsion or prolapse of the pedunculated submucous myoma.

Criterios Médicos de elegibilidad para el uso de anticonceptivos de la OMS / Medical eligibility criteria for the use of WHO contraceptives

Introducción: Los "Criterios Médicos de Elegibilidad para el Uso de Anticonceptivos" de la Organización Mundial de la Salud (OMS) son una guía para la correcta elección y uso de los métodos anticonceptivos en variadas condiciones de salud. En este documento revisaremos las principales modificaciones en su quinta y última edición publicada en inglés el año 2015. Desarrollo: Las modificaciones de la quinta edición son fundamentalmente la adición de nuevos métodos y la modificación de la categoría de recomendación para algunas condiciones de salud. Se agregan el acetato de medroxiprogesterona de depósito vía subcutánea, el anillo vaginal de progesterona, el implante anticonceptivo subcutáneo sinoimplant(II)® y el método anticonceptivo de emergencia acetato de ulipristal. Se modifican las recomendaciones para las mujeres en lactancia, permitiendo el uso de algunos métodos de progestágeno solo desde el posparto inmediato, salvo el acetato de medroxiprogesterona de depósito por entregar una dosis elevada del esteroide y el dispositivo intrauterino (DIU) con levonorgestrel, el cual sigue las normas de los DIU con cobre. También hay modificación en las recomendaciones en cuanto al uso de anticonceptivos combinados en el puerperio, con más restricciones para mujeres sin lactancia. Por último, sobre el uso de terapia antiretroviral, cambian algunas categorías y se amplía el listado de fármacos detallados. Conclusión: Es necesario que los profesionales de salud conozcan estas modificaciones para poder entregar una atención de calidad a las usuarias de anticoncepción.

Introduction: The "Medical Eligibility Criteria for Contraceptive Use" published by the World Health Organization (WHO) is a guide for the correct choice and use of the contraceptive methods in many different health conditions. In this document we will review the main changes made in the fifth and last edition of this guide published in English in 2015. Development: The modifications of this last edition are the addition of new contraceptive methods and the modification of the category of the recommendation for some health conditions. It adds the medroxiprogesterone acetate subcutaneous injection, the progesterone vaginal ring, the subcutaneous contraceptive implant sinoimplant(II)® and ulipristal acetate as emergency contraception. There are modifications of the recommendations for breastfeeding women, allowing the use of some progestin only methods since the immediate postpartum, with the exception of medroxiprogesterone acetate because it delivers a high dose of the steroid and the levonorgestrel intrauterine device that follows the same recommendations as the copper intrauterine device. There are also modifications in the recommendations for the use of combined contraceptives in the first 42 days postpartum, with more restrictions for non-breastfeeding women. Finally, on the use of antiretroviral therapy drugs, there were changes of some categories and a detailed categorization for each drug. Conclusion: It is necessary for health care providers to know these changes in order to deliver a quality care to contraception users.

Acetato de ulipristal en el diagnóstico diferencial de carcinoma de endometrio / Ulipristal acetate in the differential diagnosis of endometrial carcinoma

Los miomas uterinos son las tumoraciones genitales más frecuentes cuyo tratamiento más habitual es el quirúrgico. Actualmente existe un tratamiento médico eficaz para reducir su volumen y la clínica asociada que es el acetato de ulipristal (AU), que es un modulador selectivo de los receptores de la progesterona. A nivel endometrial puede ocasionar cambios histológicos que cuando son muy marcados plantean dudas diagnósticas. Se presenta el caso de una paciente con útero miomatoso sintomático bajo tratamiento con AU, la histología en las muestras de biopsia planteó el diagnóstico diferencial con adenocarcinoma de endometrio.

Uterine fibroids are the most common genital tumors and the most common treatment is surgery. Actually there is an effective medical treatment to reduce its volume and the symptoms. It is ulipristal acetate (UA), a selective progesterone receptor modulator. In the endometrium it can cause some peculiar histological changes. We present a patient with symptomatic uterine fibroid with UA, and it was difficult to make differential diagnosis with endometrial cancer.

La anticoncepción de emergencia es menos efectiva en mujeres con obesidad / Emergency contraception is less effective in women with obesity

La anticoncepción de emergencia se refiere al uso de medicación o a la inserción de un dispositivo intrauterino de cobre para prevenir el embarazo luego de una relación sexual no protegida o del fallo de un método anticonceptivo, en una mujer que no desea el embarazo. De entre las alternativas farmacológicas del método, se estima que el uso de levonorgestrel prevendría el 50% de los embarazos. A partir de una viñeta clínica, en la cual se describe el caso de una paciente obesa que resultó embarazada luego de utilizar anticoncepción hormonal de emergencia tras una relación sexual no protegida, se realizó una búsqueda bibliográfica para establecer la efectividad del método en pacientes con esta característica (obesidad). La búsqueda identificó un metaanálisis que relacionó al triple la probabilidad de embarazo en pacientes con índice de masa corporal superior a 30 kg/m2 que utilizaron anticoncepción de emergencia hormonal. (AU)

Emergency contraception refers to the use of medication or the insertion of a copper intrauterine device to prevent pregnancy after the occurance of unprotected sex intercourse or failure of a contraceptive method in a woman who does not desire pregnancy. Among the pharmacological alternatives of the method it is estimated that the use of levonorgestrel prevents 50% of pregnancies. From a clinical vignette, in which the case of an obese patient who became pregnant using hormonal emergency contraception after unprotected sex intercourse is described, a literature search was conducted to establish the effectiveness of the method in patients with this feature (obesity). The search identified a metaanalysis that shows an incresed probability (threetimes) of pregnancy in patients with body mass index greater than 30 kg/m2 that used hormonal emergency contraception. Emergency contraception is less effective in women with obesity. (AU)

Reversal of nomegestrol acetate on multidrug resistance in drug-resistant human breast cancer cell line MCF7/ADR / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the reversal effect of nomegestrol acetate (NOM) on mutidrug resistance (MDR) in MCF7/ADR and its mechanism.</p><p><b>METHODS</b>Using tetrazolium dye assay, effects of various concentrations of NOM on sensitivity to ADR in MCF7/ADR was studied. Expression of MDR related genes MDR1, glutathoine S-transferase Pi (GSTpi), Topoisomerase II alpha (Topo II alpha) and MDR related protein (MRP) were assayed by reverse transcription-polymerase chain reaction (RT-PCR) and immunocytochemistry assay. Using flow cytometry (FCM), intracellular ADR concentration effects on cell cycle were observed.</p><p><b>RESULTS</b>NOM significantly reversed MDR in MCF7/ADR. After NOM 20, 10 and 5 micromol/L treatment, the chemosensitivity to ADR increased to 21, 12 and 8 times. The reversal activity of NOM was stronger than that of the precursor compound megestrol acetate, and was comparable to that of verapamail. After treatment with NOM 5 micromol/L both MDR1 and GSTpi mRNA genes expression began to decline on D2 (P < 0.05, & P < 0.01) and reached the lowest level on D3 (both P < 0.01), but the expression levels began to rise on D6 again (both P < 0.05). The expression of MRP and Topo II alpha gave no significant change. Changes of P-gp and GSTpi protein expressions were similar to those of their mRNA expressions, showing early decline and late rise. Two hours after NOM 20, 10, and 5 micromol/L treatment, intracellular ADR concentration increased 2.7, 2.3 and 1.5 times, respectively. FCM data showed that after forty-eight hours, combined administration of NOM (20 micromol/L) and ADR (from low concentration to high concentration), MCF7/ADR cells showed gradual arrest in the G(2)M phase with the increase of ADR dose.</p><p><b>CONCLUSION</b>NOM has strong reversal effects on MDR in MCF7/ADR. The reversal takes place via different routes, i.e. down regulating mRNA and protein expression levels of MDR1 and GSTpi, increasing intracellular drug concentration, and enhancing the arrest of ADR in cells at G(2)M phase.</p>

O uso da tibolona para tratamento do climatério: efeitos sobre sintomatologia, perfil lipídico e endométrio / The use of org od 14 in the treatment of climateric: effects of syntomathology, lipid profile and endometrium

OBJETIVOS: Avaliar a resposta clínica do tratamento do climatério com tibolona em relaçao à sintomatologia, efeitos sobre o perfil lipídico e o endométrio. METODOLOGIA E CASUISTICA: Avaliaram-se prospectivamente 11 pacientes atendidas no Ambulatório de Menopausa do CAISM/UNICAMP, que utilizaram tibolona para o tratamento do climatério na dose de 2,5mg/dia por um período de seis meses. A média etária das pacientes foi de 49,2 anos (ñ5,2). RESULTADOS: Observou-se melhora dos sintomas vasomotores, psicológicos, libido e cefaléia. Os sintomas urogenitais nao foram afetados durante o tratamento. Nao houve alteraçao na maioria dos parâmetros do perfil lipídico e houve adequada proteçao endometrial. CONCLUSOES: A tibolona representa mais uma opçao terapêutica para o climatério, com poucas alteraçoes no perfil lipídico e proteçao endometrial adequada.