Rol de la osteocalcina más allá del hueso / Role of osteocalcin beyond bone

Los hallazgos osteológicos se intensi!caron en los últimos años. Se demostró que el esqueleto se comporta, además de sus funciones clásicas, como un órgano de secreción endocrina que sintetiza al menos dos hormonas: el factor de crecimiento de !broblastos 23 (FGF-23) y la osteocalcina (Ocn). La Ocn es un péptido pequeño que contiene 3 residuos de ácido glutámico. Estos residuos se carboxilan postraduccionalmente, quedando retenida en la matriz ósea. La forma decarboxilada en el primer residuo de ácido glutámico (GluOcn) fue reportada por poseer efectos biológicos; la resorción ósea es el mecanismo clave para su bioactivación. La presente revisión se centra en los conocimientos actuales sobre la función hormonal de la Ocn. A la fecha se reporta que la Ocn regularía el metabolismo energético aumentando la proliferación de células ` pancreáticas, y la secreción de insulina y de adiponectina. Sobre el músculo esquelético actuaría favoreciendo la absorción y el catabolismo de nutrientes. La función reproductiva masculina estaría regulada mediante el estímulo a las células de Leydig para sintetizar testosterona; en el desarrollo cerebral y la cognición, la Ocn aumentaría la síntesis de neurotransmisores monoaminados y disminuiría el neurotransmisor inhibidor GABA. Si bien son indispensables mayores evidencias para dilucidar los mecanismos reguladores por medio de los cuales actuaría la Ocn, los resultados enumerados en los distintos estudios experimentales establecen la importancia de este novedoso integrante molecular. Dilucidar su rol dentro de estos procesos interrelacionados en seres humanos abriría la posibilidad de utilizar a la Ocn en el tratamiento de enfermedades endocrino-metabólicas. (AU)

Osteological !ndings have intensi!ed in recent years. The skeleton behaves as an endocrine secretion organ that synthesizes at least two hormones: osteocalcin (Ocn) and !broblast growth factor 23 (FGF-23). Ocn is a small peptide that contains 3 glutamic acid residues. After translation, these residues are carboxylated to make possible its retention into the bone matrix. Decarboxylation on the !rst glutamic acid residue (GluOcn) has been reported to have biological effects. Bone resorption is the key mechanism for its bioactivation. This review focuses on current knowledge on Ocn hormonal function. It has been reported that Ocn regulates energy metabolism by increasing the proliferation of pancreatic ` cells, and the secretion of insulin and adiponectin. On the skeletal muscle, it may act by favoring the absorption and catabolism of nutrients. Male reproductive function might be regulated by stimulating Leydig cells to synthesize testosterone. Regarding brain development and cognition, Ocn would increase monoamine neurotransmitters synthesis and decrease inhibitory neurotransmitter GABA. Although more evidence is needed to elucidate the regulatory mechanisms of Ocn, different experimental studies establish the importance of this novel molecular mediator. Clarifying its role within interrelated processes in humans, might open the possibility of using Ocn in different treatments of endocrine-metabolic diseases. (AU)

Oncofertility: Realizing a Couples’ Dream of Parenthood.

Oncofertility is an emerging fi eld, merging oncology and reproductive endocrinology. Any woman facing a cancer diagnosis is devastated especially if she is young. Young women diagnosed with cancer face an additional burden of compromise of future fertility. Oncofertility aims to explore and expand fertility options to address reproductive concerns of young women with cancer diagnosis. Th is review aims to highlight the available and emerging options for young women diagnosed with gynecological cancers to enable them to realize their dream of parenthood.

Oncofertilidade: opções na manutenção da fertilidade no tratamento do câncer ginecológico / Oncofertility: fertility considerations in the management of gynecological cancer

O diagnóstico do câncer ginecológico ocorre em pacientes cada vez mais jovens e em estadios mais precoces. Muitas dessas pacientes se encontram em idade fértil e desejam prole. A detecção mais precoce e a maior efetividade do tratamento têm propiciado, em casos selecionados, a conservação da fertilidade nesse grupo de paciente, sem prejuízo na cura oncológica. Foi realizada uma revisão da literatura com artigos entre 2004 e 2011, dos quais foram selecionados os mais relevantes. Revisamos as principais opções de preservação da fertilidade no tratamento do câncer ginecológico, abrangendo os tumores do colo uterino, do ovário e do endométrio

The diagnosis of gynecological cancer is increasingly occurring in younger patients and in earlier stages. Many of these patients are fertile and wish to become pregnant. The earlier detection and more effective treatment have allowed the preservation of fertility without prejudice to cure cancer, in selected cases. We conducted a literature review of articles between 2004 and 2011, which we selected the most relevant. We reviewed the main options for fertility preservation in the treatment of gynecological cancers including tumors of the cervix, ovary and endometrium

Moduladores seletivos do receptor estrogênico: novas moléculas e aplicações práticas / Selective estrogen receptor modulators: new molecules and practical uses

Os moduladores seletivos do receptor de estrogênio são moléculas que se ligam ao receptor estrogênico com ações agonistas e antagonistas, em tecidos específicos. Eles apresentam efeitos estrogênicos e antiestrogênicos em vários órgãos, o que lhes permite diferentes atuações clínicas específicas. As diferenças nas estruturas moleculares conferem propriedades diferentes de ligação ao receptor-alvo, resultando em diferenças nos efeitos terapêuticos e adversos. Desde a descoberta dos primeiros compostos, há 50 anos, vários outros têm sido estudados e são usados frequentemente por ginecologistas, oncologistas e mastologistas. O raloxifeno é aprovado para a prevenção e o tratamento de osteoporose na pós-menopausa e para o câncer de mama receptor de estrogênio positivo; o tamoxifeno, para prevenção e tratamento do câncer de mama receptor de estrogênio positivo na pós-menopausa; e o clomifeno, primeiro modulador seletivo com receptor de estrogênio a ser estudado e empregado clinicamente, para infertilidade. Outras moléculas como bazedoxifeno, lasofoxifeno e arzoxifeno vêm sendo estudadas e vêm se mostrando como alternativas eficazes, algumas com menos efeitos colaterais

Selective estrogen receptor modulators are molecules that bind to estrogen receptor with agonistic and antagonistic actions in specific tissues. They exert estrogenic and anti-estrogenic effects in several organs, allowing them to perform differently in specific clinical situations. The differences in molecular structures provide different binding properties to the target receptor, resulting in differences in therapeutic and adverse effects. Since the discovery of the first compounds 50 years ago, several others have been studied and are often used by gynecologists and oncologists, and mastologists. Raloxifene is approved for preventing and treating osteoporosis in postmenopausal women and for treating estrogen receptor-positive breast cancer; tamoxifen is used for preventing and treating estrogen receptor-positive postmenopausal breast cancer; and clomiphene, the first selective estrogen receptor modulator to be studied and clinically employed, is used for infertility treatment. Other molecules such as bazedoxifene, lasofoxifene and arzoxifene have been studied and shown to be effective alternatives, some with fewer side effects

Iranian oncologists' attitude towards fertility preservation in a sample group

Recent advances in cancer treatment have resulted in an increased number of cancer survivors. Fertility might be impaired by cancer itself or through gonadal damage as a consequence of radio-chemotherapy. Damages to reproductive organs are seen in minimally up to 30% of cancer patients. The aim of the present study was evaluate the attitude of Iranian oncologists toward fertility preservation. Thirty oncologists filled an author-designed questionnaire which included five multiple choice questions at Mahak hospital, Tehran in 2009. The data were collected and analyzed by SPSS 11.5 software. More than half of the oncologists believed that radio-chemotherapy has destructive effects on reproductive organs. This study showed that as high as 67% of the respondants believed fertility preservation should be offered to all patients at risk, but 40% of them insisted that the patients should bring up the topic themselves. Only 46% of the oncologist knew about fertility preservation techniques. The greatest barriers for accepting fertility preservation by the parents of children undergoing cancer treatment were: lack of information [41%], hopelessness from treatment prognosis [33%], fear of delay in starting the treatment [15%] and the priority of child survival [11%]. The specific challenges of counseling are time pressure between diagnosis and start of treatment, little knowledge about fertility preservation both by treating oncologists and parents; therefore a team consisting of oncologists, infertility specialists and social workers is recommended in these settings

Inducción de ovulación: conceptos básicos / Ovulation induction: basic concepts

La concepción sin éxito es uno de los trastornos crónicos más prevalentes que involucra adultos jóvenes. Desde el año 1978, cuando nació la primera bebé producto de técnicas de reproducción asistida, el manejo de la infertilidad femenina ha sido transformada por la Fertilizaciòn In Vitro. Los trastornos de la ovulación representan el 15% de las causas de infertilidad en las parejas y el 40% de infertilidad en las mujeres.

Perceptions of Infertility among Undergraduates Students in Kano; Nigeria

Background: Infertility is a global public health problem affecting an average of 8 - 12of couples with severe social implications. The perception of a disease often influences the efficacy of its preventive strategies as well as management outcome. Methods: A cross sectional descriptive study of 289 undergraduates of Bayero University Kano was conducted between January and February 2009 using a multi-stage sampling technique to assess their perception regarding the causes of infertility and its management. Results: Majority of the respondents were between the age of 18 and 29 years; and most (67) were single. Though there was largely high awareness about infertility; the knowledge regarding the causes was poor. There was positive attitude towards infertile couples and infertility in general. Conclusion: Improved health education on the awareness; causes and prevention of infertility among students and the wider public is recommended

The ameriorating effects of grapefruit seed extract on testicular morphology and function of varicocelized rats

Varicoceles are abnormal tortuosity and dilatation of the veins of the pampiniform plexus that drain the testis. The pathophysiology of testicular damage in varicocele has not been completely understood. However there is an increasing body of evidence pointing towards the role of reactive oxygen species and oxidative stress in the pathogenesis of varicocele related subfertility. In the present study we examined the role of proanthocynidin-rich ethanol extract of grapefruit seed as an antioxidant in protecting the testis against damage in experimental varicocele. Three groups of rats were constructed as the first group had intact rats; experimental bilateral varicoceles were established by complete ligation of the left and right main spermatic veins in the later two groups. The third group had in addition daily gavage administration of 1 Omg/ kg body weight ethanol extract of grapefruit seed. Eight weeks after varicocele induction, bilateral testicular weights, bilateral testicular volumes, bilateral caudal epididymal sperm characteristics, and bilateral testicular histology and serum hormone levels were tested. It was found that the testes of grapefruit seed extract treated animals had better functional and histological profiles compared to the untreated varicocelized animals. These results indicated the effectiveness of grapefruit seed extract for preservation of testes function morphology in varicocelized subjects.

Los varicoceles son tortuosidades anormales y dilataciones de las venas del plexo pampiniforme que drenan el testículo. La fisiopatología del daño testicular en el varicocele no se ha entendido completamente. Sin embargo, existe un creciente cúmulo de evidencias que apunta hacia el papel de especies reactivas al oxígeno y al estrés oxidativo, en la patogénesis del varicocele relacionados con subfertilidad. En el presente estudio, se examinó el papel de proantocianidina en el extracto etanólico de semilla del pomelo, como un antioxidante en la protección contra el daño testicular experimental en el varicocele. Tres grupos de ratas fueron seleccionados, un grupo de ratas control y dos grupos experimentales. En estos dos últimos grupos, se provocó varicocele bilateral a través de la ligadura completa de las venas testiculares principales izquierda y derecha. El tercer grupo tuvo además una sonda de administración diaria de 10 mg /kg de peso corporal, de extracto etanólico de semilla de pomelo. Ocho semanas después de la inducción de varicocele, se determinó el peso testicular bilateral, volúmenes testiculares bilaterales, características de los espermatozoides de la cola del epidídimo bilateral, la histología testicular bilateral y los niveles séricos de hormona. Se determinó que los testículos de los animales tratados con extracto de semilla de pomelo presentaban una mayor funcionalidad y mejores perfiles histológicos, en comparación con los animales varicocelizados no tratados. Estos resultados indican la eficacia de extracto de semilla de pomelo para la conservación de la morfología funcional testicular, en sujetos varicocelizados.

O impacto dos fatores ambientais na fertilidade / The impact of environmental factors in fertility

A infertilidade afeta até 15 por cento da população sexualmente ativa e em 50 por cento dos casos o fator masculino está envolvido, como problema primário ou em combinação com causas de origem feminina. Como muitas drogas comumente encontradas e medicações podem ter efeitos deletérios na infertilidade masculina, a avaliação médica deve incluir uma discussão sobre o uso de drogas ilícitas, medicamentos e outras substâncias que podem prejudicar a fertilidade. Com oconhecimento de quais drogas e medicamentos podem ser prejudiciais a fertilidade, talvez seja possível mudar os habitos ou a posologia das medicações para diminuir os efeitos adversos na fertilidade e aumentar as chances de engravidar com sucesso.

Infertility affects up to 15 per cent of the sexual active population and in 50 per cento of cases, a male factor is involved either as a primary problem on in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify a patient's habits or medications regimen to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy.

Endometriose pélvica em adolescentes: novas perspectivas / Adolescent pelvic endometriosis: news perspectives

Endometriose pélvica é a presença de glândulas e/ou estroma endometrial em localizações atípicas. É a principal causa de dor pélvica e infertilidade na mulher em idade reprodutiva. Também é uma causa comum de dor e dismenorréia em adolescentes, afetando cerca de 45 a 70 porcento daquelas com dor pélvica crônica. Há cerca de um quarto de século, a endometriose em adolescentes vem sendo reconhecida como uma causa importante de dor pélvica. Entretanto, ainda hoje, as referências sobre endometriose em adolescentes na literatura são poucas. Estima-se que 4 a 17 porcento das adolescentes pós-menarca possuam endometriose. O reconhecimento de formas atípicas da doença nas adolescentes vem aumentando sua prevalência nos estudos mais recentes. Ainda assim, há grande atraso para diagnóstico da doença em jovens. O tratamento ideal para adolescentes com endometriose ainda é discutível. Deve-se priorizar o alívio da dor e a preservação da fertilidade. O tratamento empírico de dismenorréia pode ser realizado com antiinflamatórios não hormonais e anticoncepcionais hormonais orais. O uso de análogos de GnRH é limitado nesta faixa etária. O cirurgião deve estar atento, na videolaparoscopia, para presença de lesões atípicas, de coloração vermelho-vivas e claras. São lesões mais dolorosas e que normalmente correspondem aos estádios iniciais da doença. Uma abordagem multidisciplinar da dor, mudanças no estilo de vida e terapias alternativas complementares podem auxiliar no alívio dos sintomas. A endometriose pélvica continua sendo uma doença enigmática e as dúvidas nesta faixa etária são ainda maiores.

Reproductive outcome following hysteroscopic lysis of intrauterine adhesions: a result of 65 cases at Ramathibodi Hospital.

We reported the reproductive outcome of 65 patients with varying degrees of IUAs who underwent hysteroscopic adhesiolysis between August 1994 and December 1996 at Ramathibodi Hospital. Of the 65 patients treated, 29 had mild adhesions, 26 had moderate adhesions, and 10 had severe adhesions. Adhesions were lysed with hysteroscopic scissors in 25, with biopsy forceps through hysteroscope in 10, with electrosurgery using a monopolar probe in 22 patients, and with resectoscope in 8 patients. The mean duration of the procedure was 15 +/- 2.1 minutes. The mean follow-up was 12 +/- 1.4 months. Of the 44 patients who originally presented with secondary amenorrhea, 40 (90.9%) have normal menses, 4 (9.1%) have hypomenorrhea. Of the 6 patients who had hypomenorrhea, 5 (83.3%) have normal menses. Cyclic abdominal pain disappeared after treatment in all patients. Of the 45 patients with IUAs and infertility, 16 (35.6%) conceived. Two (20%) of the infertile patients with initially severe adhesions conceived. Of the 5 patients with RPL treated, delivered a full term baby and the other delivered a premature baby at 29 weeks of gestation. All 18 patients who delivered, had live births. Adhesion reformation was absent in patients with initially mild and moderate adhesion but occurred in 2 out of 10 (20%) patients with severe adhesions. These two patients initially suffered from secondary amenorrhea but reported hypomenorrhea after surgery. Both of them had tuberculosis of the genital tract. There were no serious complications occurring in all 65 procedures. All 65 patients were discharged a few hours after the operation.

Role des programmes de SMI/PF dans la lutte contre la fecondite

En Afrique; la plupart des adolescents ne savent pas grand-chose des problemes de sexualite et de reproduction. Or les infections genitales sont la cause majeure des infecondites secondaires dont la prevalence est plus elevee dans nos pays que l'infecondite primaire. Ainsi; tout programme dont l'objectif est la prevention de ces infections doit s'adresser a la population cible chez qui ces facteurs ont un impact important. Cette population n'est evidemment que celle des jeunes. Pour etre efficace; cette education des jeunes qui pourrait se faire directement ou indirectement par les services de planning familial et la sante maternelle et infantile