Estriol vs estrógenos conjugados de origen equino en el tratamiento del síndrome genitourinario de la menopausia / Estriol vs. Conjugated estrogens of equine origin in the treatment of the genitourinary syndrome of menopause

Resumen OBJETIVO Comparar la efectividad y seguridad del estriol vs estrógenos conjugados de origen equino en el tratamiento del síndrome genitourinario de la menopausia. MATERIALES Y MÉTODOS Ensayo clínico multicéntrico, doble ciego, controlado, con asignación al azar, efectuado en tres clínicas de Colombia entre los meses de julio de 2015 y septiembre de 2017. Criterio de inclusión: mujeres con síndrome genitourinario de la menopausia tratadas con estrógenos tópicos. Las pacientes se asignaron al azar a dos grupos: A (estriol) y B (estrógenos conjugados de origen equino). Variables de estudio: concentraciones séricas de estradiol, testosterona total, globulina fijadora de hormonas sexuales, porcentaje de satisfacción al disminuir los síntomas y tiempo hasta su desaparición. También se consideraron: pH vaginal menor de 4.5, puntuación del índice de maduración vaginal, intensidad de la sequedad vaginal, necesidad de terapia hormonal sistémica, medición del endometrio, comportamiento sexual y coexistencia de efectos secundarios. RESULTADOS Se estudiaron 387 mujeres: 192 del grupo A, que recibió estriol y 195 del grupo B tratadas con estrógenos conjugados de origen equino. El porcentaje de efectividad en el grupo A fue de 90.6% y en el grupo B de 89.2%; (p = 0.507). Las mujeres del grupo A experimentaron menos efectos secundarios (26.5%) que las del grupo B (38.4%). En las otras variables no se encontraron diferencias. CONCLUSIONES El estriol y los estrógenos conjugados de origen equino son igual de efectivos y seguros para tratar el síndrome genitourinario de la menopausia; sin embargo, el estriol ofrece mayores ventajas porque disminuye más rápidamente los síntomas y origina menores efectos secundarios.

Abstract OBJECTIVE To compare the effectiveness and safety of estriol vs. conjugated estrogens of equine origin in the treatment of the genitourinary syndrome of menopause. MATERIALS AND METHODS Multicentric, double-blind, controlled, randomized clinical trial conducted in three clinics in Colombia between July 2015 and September 2017. Inclusion criteria: women with menopausal genitourinary syndrome treated with topical estrogens. The patients were randomly assigned to two groups: A (estriol) and B (conjugated estrogens of equine origin). Study variables: serum levels of estradiol, total testosterone, sex hormone-binding globulin, percentage of satisfaction with decreasing symptoms and time to disappearance. The following were also considered: vaginal pH lower than 4.5, vaginal maturation index score, intensity of vaginal dryness, need for systemic hormonal therapy, measurement of the endometrium, sexual behavior and coexistence of side effects. RESULTS We studied 387 women: 192 of group A, who received estriol and 195 of group B treated with conjugated estrogens of equine origin. The percentage of effectiveness in group A was 90.62% and in group B it was 89.23%; (p = 0.507). In women in group A there were fewer side effects (26.56%) than in group B (38.46%). No differences were found in the other variables. CONCLUSIONS Estriol and conjugated estrogens of equine origin are equally effective and safe in the treatment of the genitourinary syndrome of menopause.

Influence of lipid type on water and fat mobility in fermented sausages studied by low-field NMR.

The effects of diacylglycerols (DAG), pork back fat and sunflower oil on water and fat mobility in fermented sausages were studied with (1)H NMR relaxometry. The added fat affected the physicochemical parameters weight loss, water activity, moisture content and moisture content on a defatted-dry-matter basis of reduced-fat non-acid fermented sausages. The weight losses were the lowest in sausages prepared with DAG and sunflower oil, which resulted in higher water activity compared to sausages prepared with back fat. The relaxation times related to fat mobility differed between fat types and increased in the order: control

Crystal deodorant dermatitis: irritant dermatitis to alum-containing deodorant.

Two patients developed an irritant dermatitis of the axillae shortly after using an over-the-counter "natural deodorant crystal" product containing alum. We discuss this previously unreported, untoward reaction to alum, an ancient agent with newfound popularity as an alternative health product.

Report of an association between discoid lupus erythematosus and smoking.

Smoking has been shown to be associated with many medical disorders, including many involving the skin. While preliminary studies suggest a modest association between smoking and systemic lupus erythematosus, epidemiologic data on discoid lupus erythematosus (DLE) and smoking are lacking. To study this relationship, we examined current smoking habits in two unique patient populations with DLE. One group was compared with matched dermatology patients while the second group was compared with the corresponding statewide population. For both groups, the current smoking prevalence was much higher than that of the comparison population. For the control-matched group of DLE patients, smoking prevalence was found to be significantly greater than that of controls (odds ratio 12.2; p = 0.001). We therefore propose that smoking is a risk factor for development of DLE.

Lichen planus and lichen sclerosus overlap.

Lichen planus and lichen sclerosus share several common features, including lymphocytic infiltration at the dermal-epidermal junction, clinical involvement of both skin and mucosa, erosive disease of mucosal surfaces, and the occasional occurrence of squamous cell carcinoma at the site of chronic, erosive mucosal lesions. In spite of these similarities, there are remarkably few reports of patients who concurrently have evidence of both diseases. We report a patient who had oral lesions of lichen planus and penile lesions of lichen sclerosus and we review possible mechanisms to explain this association.

Leaf water potential and stomatal conductance in Quercus pyrenaica Willd. forests: vertical gradients and response to environmental factors.

Two permanent sampling sites were selected at the two extremes of a rainfall gradient in natural forests of Quercus pyrenaica Willd. located in the Sierra de Gata (Salamanca Province, Spain). During 1991 and 1992, diurnal courses of transpiration rate (E), stomatal conductance (g(s)) and leaf water potential (Psi(l)) were studied at different levels in the tree canopy. Leaf water potential fell from a high value in the early morning to a minimum at midday and then increased again in the afternoon. Values of Psi(l) in the early morning and at midday were lower at Fuenteguinaldo (dry site) than at Navasfrías (wet site) and were related to soil water availability. Stomatal conductance increased during the morning and maximum g(s) occurred about 3 h before Psi(l) was at its lowest value. The highest values of g(s) were found at Navasfrías during July. The lowest Psi(l) values were found in the upper parts of the canopy and differences among canopy levels were greatest when soil water availability was low. In August, minimum values of Psi(l) differed among canopy levels by 1.0 MPa at Navasfrías and by 0.8 MPa at Fuenteguinaldo. The maximum difference in g(s) among canopy levels was about 150 mmol m(-2) s(-1) at Navasfrías and about 300 mmol m(-2) s(-1) at Fuenteguinaldo. The results indicate a nonconservative pattern of water use in Quercus pyrenaica.

Action of intraduodenal ethanol on exocrine pancreatic secretion in chronic alcoholic rats fed with different diets.

The effects of diet composition (equilibrated and fat- and protein-rich) in combination with chronic ethanol ingestion on pancreatic exocrine secretion were studied in rats after a 7-month treatment period, also analyzing under these experimental conditions the acute effects of intraduodenal administration of 20% ethanol. Chronic consumption of ethanol affected pancreatic flow but its acute administration stimulated the secretion of fluid, especially in control rats. Total protein secretion is depressed in all rats receiving ethanol as fluid, but this was increased when rats drank water. Amylase activity depends on carbohydrate levels, decreased with fat and protein-rich diet but not with ethanol ingestion. Diet composition by itself did not affect specific trypsin activity but this increased significantly when a fat- and protein-rich diet was administered together with ethanol. Trypsin activity remained unchanged when ethanol was perfused into the duodenum in animals receiving ethanol chronically.

Effect of acute and chronic administration of ethanol on the pancreatic exocrine response to cholecystokinin in rats fed different diets.

1. The effects of a diet rich in protein and fat, compared with a control diet, with or without chronic ingestion of ethanol on the pancreatic response to cholecystokinin were studied in rats after a 7-month treatment period. The acute effects of intraduodenal administration of 20% (v/v) ethanol were also analysed under these experimental conditions. 2. Animals receiving a diet rich in protein and fat showed a greater percentage increase in pancreatic output in response to cholecystokinin. 3. Chronic ethanol consumption reduced the basal secretion of protein and amylase; and even though the response capacity to cholecystokinin (considered as the percentage secretion on cholecystokinin stimulation with respect to basal secretion) was maintained, this led to hormone-stimulated secretion being decreased in comparison with the animals receiving water. In contrast, a lack of inhibition of basal volume flow and flow after cholecystokinin stimulation was seen after long-term ingestion of ethanol. 4. Acute administration of ethanol generally depressed cholecystokinin-stimulated pancreatic secretion. 5. On stimulation with cholecystokinin, the diet rich in protein and fat combined with long-term ingestion of ethanol led to non-parallel changes in the release of pancreatic enzymes, since an increase in trypsin secretion and a decrease in amylase secretion occurred concomitantly.