The metabolic syndrome among postmenopausal women in Ecuador.

BACKGROUND: The prevalence of the metabolic syndrome increases with age and after the onset of menopause, and may explain in part the apparent acceleration of cardiovascular disease in postmenopausal women. OBJECTIVE: To determine the prevalence of metabolic syndrome and related risk determinants among postmenopausal women in Ecuador. METHODS: Postmenopausal women >or=40 years of age, non-users of hormone therapy and with an intact uterus, were asked to participate in a metabolic syndrome screening and educational program at the Institute of Biomedicine of the Universidad Católica of Guayaquil, Ecuador. Sociodemographic data, waist circumference and blood pressure measurements were recorded, and a fasting blood sample obtained for serum glucose and lipid profile determinations. Woman were counseled and managed according to the results. Metabolic syndrome was defined in accordance with the criteria of the Third Adult Treatment Panel (ATP III). RESULTS: Three hundred and twenty-five postmenopausal women entered the program. Mean (+/-standard deviation) age was 55.9 +/- 8.1 years, 53.5% of them were aged >or=54 years (median). The prevalence of metabolic syndrome, according to ATP III criteria, was 41.5%. Using the same criteria, 38.8%, 16.6%, 56.9% and 54.2% of the women presented with hypertension, diabetes, hypertriglyceridemia and abdominal obesity, respectively. More than 40% of women determined to have hypertension or diabetes lacked knowing so. Logistic regression analysis determined that age increased the risk of presenting hypertension and diabetes (odds ratio (95% confidence interval): 2.0 (1.2-3.2) and 1.6 (0.9-3.0), respectively, p < 0.05), entities which in turn duplicated the risk of having high triglyceride levels. Sedentary women with <5 years since menopause onset were at higher risk of having abdominal obesity, which was directly related to diabetes and hypertension. CONCLUSIONS: In this postmenopausal Ecuadorian population the prevalence of the metabolic syndrome was high and its determinant factors related to age, time since menopause onset and sedentary habits. Because of the implications for cardiovascular risk, counseling programs directed toward high-risk populations should be encouraged.

The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study.

BACKGROUND: The unexpected results of the Women's Health Initiative study have decreased the use of conventional hormone therapy (HT), changing physicians' and patients' attitudes towards HT and increasing their interest in alternative options. OBJECTIVE: The present study aimed to evaluate the effect of isoflavones contained in red clover extracts (Trifolium pratense) on menopausal symptoms, lipids and vaginal cytology in menopausal women. METHODS: Sixty postmenopausal women aged >40 years, non-users of HT, with Kupperman index score 15, were double-blindly randomized to receive either a commercially available red clover isoflavone supplement (80 mg/day) or placebo for 90 days. Subsequently, after a 7-day washout period, subjects switched to receive the opposite treatment for a further 90 days. Kupperman index score was determined and fasting blood and vaginal cytologic sampling performed at baseline, 90 and 180 days. RESULTS: Fifty-three women (88.3%) completed the trial. Mean age was 51.3 +/- 3.5 years, 69.7% of the women were aged 50 years or more. There was no significant effect on body mass index, weight or blood pressure after either treatment phase. Baseline Kupperman index score decreased significantly after each treatment phase, with the decrease more pronounced after the isoflavone phase (baseline: 27.2 +/- 7.7; after isoflavone: 5.9 +/- 3.9; after placebo: 20.9 +/- 5.3, p < 0.05). Red clover isoflavone supplementation significantly decreased the rate of menopausal symptoms and had a positive effect on vaginal cytology as expressed by improvement in karyopyknotic, cornification and basal cell maturation indices. Mean total cholesterol, low-density lipoprotein-cholesterol and triglyceride levels also decreased; however, only the latter was significantly lower compared with placebo. CONCLUSIONS: Compared with placebo, red clover isoflavone supplementation in postmenopausal women significantly decreased menopausal symptoms and had a positive effect on vaginal cytology and triglyceride levels.

Measuring climacteric symptoms in an Ecuadorian population with the Greene Climacteric Scale.

OBJECTIVE: Measure climacteric symptoms in a low socio-economic Ecuadorian population with the Greene Climacteric Scale and determine factors involved with higher scorings. METHODS: Women aged 40--65, non hormone therapy (HT) users, with intact uterus and ovaries, attending the Gynecologic Outpatient Service of the Enrique C. Sotomayor Obstetrics and Gynecology Hospital Guayaquil-Ecuador, were selected and asked to fill out the Greene Climacteric Scale. RESULTS: During the study period, 385 women met inclusion criteria and filled out the climacteric scale. Mean age of this sample was 47.6 +/- 5.5 years and 36.6% were aged >or=50 years. Women were classified as: premenopausal 38.9%, perimenopausal 28.8% and postmenopausal 32.3%. The total Greene Climacteric score for postmenopausal was found to be higher than premenopausal total score (18.78 +/- 8.11 versus 16.31 +/- 7.62, p < 0.05). Total, clusters and subclusters scorings maintained an increasing trend from one menopausal status to the next. The most frequently and intensive presenting symptoms of the 21 symptoms composing the scale were: difficulty in concentrating, feeling unhappy or distressed, headaches, and hot flashes (n=385: 87, 82, 83.9 and 82%, anxiety and depression subclusters, and somatic and vasomotor clusters, respectively). Univariate analysis determined that age >or=47 years, parity >or=4 and schooling <12 years were associated to the risk for having a total Greene scoring of >or=18 (OR: [95% CI], 2.5[1.6-3.8]; 1.8[1.1-3]; 1.6[1-2.7], respectively, p < 0.05). Age >or=47 years was associated to increased rates of higher scorings in all clusters except for loss of sexual interest, which was contrarily increased together with vasomotor scoring in women with higher parity (p < 0.05). Women with educational level <12 years were related to higher somatic scorings. Logistic regression analysis confirmed all these associations except for parity, which was excluded as a risk factor for higher vasomotor scorings. CONCLUSION: In this specific population, climacteric symptoms presenting in all menopausal groups, as measured with the Greene Climacteric Scale, resulted to be higher than previously reported standards and age, parity and educational level were independent risk factors.

Obstetrical and neonatal outcome in young adolescents of low socio-economic status: a case control study.

OBJECTIVE: The purpose of this study was to determine obstetrical and neonatal outcome among early adolescent pregnancies (< or =15 years). METHOD: We compared obstetrical and neonatal outcome of early adolescent nulliparas with outcome of nulliparous women aged 20-30 years. RESULTS: Two hundred and one (201) early adolescent nulliparous patients of low socio-economic status were enrolled at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil-Ecuador, and matched for gestational age with 201 low socio-economic nulliparous controls aged 20-30. Mean maternal age of the adolescent group was 14.2+/-0.6 years. The incidence of cervicovaginal infections during current pregnancy was significantly higher among adolescents (trichomoniasis: 11.4% vs. 5% and candidiasis: 27.8% vs. 12.4%, p<0.05). The incidence of eclampsia was higher in adolescents (2.5% vs. 0%, p<0.05). The preterm rate in each group was 4.9%. There were no differences in labor characteristics and the rate of cesarean section, labor complications and abnormal puerperium between both studied groups. Nevertheless, mean neonatal weight was lower and the incidence of low birth weight infants (<2,500 g) and adverse neonatal outcome was significantly higher in the adolescent group (2,837.6+/-454 g vs. 3,017+/-547 g; 19.9% vs. 11.4% [OR=1.92, 95% CI: 1-3.5] and 9.5% vs. 3.5% [OR=2.9, 95% CI: 1.1-7.7] respectively, p<0.05). CONCLUSION: Pregnancy in young adolescents (< or =15 years) of low socio-economic status did not impose adverse obstetrical outcome, however it did increase the risk for low birth weight, adverse neonatal outcome and cervicovaginal infections.

Determinant factors in Ecuador related to pregnancy among adolescents aged 15 or less.

OBJECTIVE: Determine social factors related to pregnancy among young adolescents. METHODS: We obtained socio-demographic data from early adolescent nulliparas aged < or = 15 years. RESULTS: During the study period at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil-Ecuador 201 early adolescent nulliparous patients of low socio-economic status were surveyed and compared with 201 low socio-economic nulliparous controls aged 20 to 30. Mean age of adolescents was 14+/-0.6 years, 58.7% of them were aged 14. Age of menarche and sexual initiation was lower among adolescents (11.8+/-0.9 vs 12.8+/-2 years and 12.6+/-1.1 vs 16.2+/-5 years, respectively, p<0.05). A higher rate of adolescents initiated sexually before menarche onset (18.4% vs 5%, p<0.05). The rate of those who wanted to become pregnant, had adequate prenatal care and had knowledge of conception, used contraception or had knowledge of any contraceptive method prior to pregnancy was significantly lower in adolescents (16.9% vs 86.5%; 37.3% vs 94.5%; 18% vs 70.1%; 6.5% vs 89.5%; 42.8% vs 84.5%, respectively, p<0.05). Age of sexual partner was lower in the adolescent group (20.4+/-3.4 vs 30+/-8 years, p<0.05). Compared to controls, higher rates of adolescents were school dropouts, had problems with the law and were involved in domestic violence (87% vs 9.9%, 7.5% vs 0.5%, 44.7% vs 2.5%, respectively, p <0.05). None of the adolescents were living with mother and father in a complete family structure. Parental illiteracy was higher among adolescents (9% vs 3.5%, p < 0.05). CONCLUSION: In this low socio-economic population, early sexual initiation, poor reproductive health knowledge and the disruption of family structure were the main social factors related to pregnancy among adolescents aged 15 or less.

Management of cervical pregnancy: risk factors for failed systemic methotrexate.

Cervical pregnancy is a rare obstetrical complication. Conservative management with systemic methotrexate has been reported to be successful, obviating the need for surgical treatment which entails a risk for hysterectomy. We report the case of a nulliparous patient with a cervical pregnancy diagnosed at 9 weeks' gestation who after systemic methotrexate treatment necessitated conservative surgical management. This patient highlights the utility of identified risk factors for failure of methotrexate treatment.

Patients' and clinicians' attitudes after the Women's Health Initiative study.

OBJECTIVE: To assess the effect of the publication of the Women's Health Initiative (WHI) study on patients' and physicians' attitudes in relation to hormone therapy (HT). DESIGN: A survey focused on the degree of knowledge and on the reactions to the WHI study was administered to 600 women allocated in two groups according to their socioeconomic status, high (HSES) or low (LSES). Additionally, 283 physicians were surveyed to determine their attitudes regarding HT after the publication of the WHI study. The rates of HT prescription before and after publication of the study were compared. RESULTS: Among patients, HT use and knowledge of the WHI study were less common among women of lower socioeconomic status (LSES 16.7% v HSES 47.3%, and LSES 15.7% v HSES 67.3%; P < 0.0001). Of the women in the LSES group who were HT users and had knowledge on the subject of the WHI study (n = 30), 56.7% contacted their physicians and 6.6% abandoned HT. These rates were similar for women in the HSES group. Among physicians, 97.2% of physicians referred to being aware of the WHI study, and 64.7% modified their clinical approach. The main changes were that 21.5% applied more rigorous risk/benefit assessment, 20.1% lowered hormone dosage, 18.8% decreased continuous-combined therapy use, 12.1% shortened the duration of HT, 7.7% abandoned medroxyprogesterone or conjugated estrogen use, and 5.0% increased the use of transdermal estrogens, tibolone, or other alternatives. As for prescriptions, after the publication of the WHI study, there was an 8.6% drop in the rate of HT prescriptions. This decrease was more pronounced for prescriptions based on conjugated equine estrogen and medroxyprogesterone acetate. In contrast, prescription of transdermal estrogens and tibolone increased 5.2% and 16%, respectively. CONCLUSIONS: There was a significant change in physicians' and patients' attitudes toward HT after publication of the WHI study.

Densidad mineral ósea de columna lumbar en una población de mujeres climatéricas ecuatorianas / bony mineral Densidad of lumbar column in a population of Ecuadorian climacterical women

Objetivos: Determinar en columna lumbar la densidad mineral ósea (DMO), la incidencia de osteoporosis y factores de riesgo asociados, en una población de mujeres climatéricas ecuatorianas. Diseño del Estudio: De manera prospectiva se realizaron 400 densiometrías, usando técnica de doble fotón (DEXA), a nivel de riesgo para el desarrollo de osteoporosis como: ooforectomía, edad, antecedente de fractura, menopausia, edad de la menopausia, edad de la menarquia, antecedente de ingesta de fármacos y de enfermedades crónicas. Se determinó la incidencia de osteoporosis usando la definición de la OMS. Además se comparó la densidad mineral ósea (DMO) entre las mujeres premenopáusicas y posmenopáusicas. Resultados: la DMO promedio (n=400) de columna lumbar fue de 1.034...

A case of leptospirosis and pregnancy.

We present a case of leptospirosis presenting with jaundice at 28 weeks' gestation. We will discuss the clinical course and review the world literature.

Intravenous nitroglycerin in the management of retained placenta.

Thirty patients in the third stage of delivery complicated by retained placenta were prospectively managed with intravenous nitroglycerin. We studied the effect of nitroglycerin on the hemodynamics and characteristics of the procedure, and also analyzed labor and maternal and neonatal data. Intravenous nitroglycerin effectively aided the extraction of the retained placenta in all cases. The average procedure time was 5.3 +/- 1.1 min, and the dose range was 50-200 microg. Systolic and diastolic blood pressure fell significantly from 111 +/- 7.5 to 103 +/- 6 mm Hg and from 74 +/- 6.7 to 67 +/- 6.6 mm Hg, respectively (p<0.05). Although statistically significant, this was not evident clinically and there were no complications. Intravenous nitroglycerin at a dose of 200 microg or less is safe, effective and predictable in the management of retained placenta and could obviate the need of general anesthesia.

Fatal intracranial hemorrhage in a pregnant patient with autoimmune thrombocytopenic purpura.

Thrombocytopenia in pregnancy is a frequent cause of hematological consultation. Autoimmune thrombocytopenic purpura results from platelet destruction due to autoantibodies. Spontaneous intracranial hemorrhage is a rare but devastating complication of these patients. We present a fatal case of intracranial hemorrhage in a 18 week pregnant woman diagnosed with autoimmune thrombocytopenia. The clinical course and treatment of this unusual clinical complication is discussed in relation to the world literature.