Relación entre perímetro abdominal, nivel socioeconómico y presión arterial / Relation of abdominal circumference and socio-economic status to blood pressure

Objetivos: Relacionar perímetro abdominal y condición socioeconómica con presión arterial (PA) en comunidad urbana de Concepción. Métodos: Se midió el perímetro abdominal (PeA) de 8472 residentes mayores de 15 años de edad, proporcionados por edad, género y nivel socioeconómico. La PA fue medida con normas estandarizadas, realizando dos visitas en diferentes días, la segunda si la PA era mayor de 140/90 mm Hg. Los Pe A se distribuyeron en cuartiles, relacionando cada cuartil con los respectivos promedios de presión sistólica y diastólica y se establecieron coeficientes de correlación lineal mediante "r" de Pearson entre PeA y PA. Además, se estableció la frecuencia de cada cuartil de Pe A por nivel socioeconómico. Resultados: Los Pea tuvieron la siguiente distribución (cm): 1er cuartil, < 78; 2º cuartil, 78- 87; 3er cuartil, 88-96 y 4º cuartil, > 96. La prevalencia de hipertensión para niveles socioeconómicos alto, medio y bajo fue 17,9 por ciento, 19,5 por ciento y 24,5 por ciento, respectivamente. La PA promedio (mmHg) en hombres y en mujeres del 1er cuartil de PeA fue 112 y 109; en el 2º cuartil 118 y 118; en el 3er cuartil 123 y 122 y en el 4º cuartil 129 y 129, respectivamente. Los coeficientes de correlación entre PeA y presión sistólica y presión diastólica resultaron significativos en ambos géneros: r = 0,343, p<0.00001 y r = 0,281, p<0.00001, respectivamente. La distribución ( por ciento) de PeA fue inversa al nivel socioeconómico: en el nivel social bajo, el 22 por ciento estaba en el 1er cuartil de PeA, y el 28,8 por ciento en el 4º cuartil. En el nivel social alto se observó lo inverso: 38,9 por ciento estaba en el 1er cuartil de PeA, y sólo el 15.5 por ciento en el 4º cuartil (p<0.0001). Conclusiones: Hubo correlación positiva entre PeA y PA en ambos géneros. La frecuencia de mayor PeA en el nivel socioeconómico bajo podría explicar la mayor prevalencia de hipertensión en este grupo.

Aim: To correlate abdominal circumference (AC) and socio-economic status with blood pressure( BP) in an urban community of Concepción, Chile Methods: AC was measured in 8472 subjects above 15years of age, stratified by age, gender and socio-economic status. BP was measured by standard procedures, with a repeat recording when the initial value was > 140/90mmHg. BP was compared in quartiles of abdominal circumference and according to socio-economic status. Pearson "r" was used to correlate BP and AC Results: Cut points for quartiles of AC were 78, 87, and 96 cm. Prevalence of hypertension in high, medium and low socio-economic status was 17.9 percent, 19.5 percent and 24.5 percent, respectively Mean systolic BP was 112 - 109 mmHg (males - females) in the first AC quartile, 118 - 118, 123-122 and 129-129 in the second, third and fourth quartiles, respectively. A significant correlation between AC and BP (systolic and diastolic) was observed in both genders (r 0.345 and 0.281 for males and females, respectively, p<0.00001). 22 percent of low socio-economic subjects belonged in the first AC quartile compared to 28.8 percent in the 4th quartile. In contrast 38.9 percent of high socio-economic subjects belonged in the first AC quartile while 15.5 percent did so in the 4th quartile (p<0001). Conclusion: A positive correlation of AC and blood pressure was shown in both genders. A greater AC in low socio-economic subjects maybe related to a higher prevalence of hypertension in this group.

Hipertension arterial y menopausia: epidemiología, mecanismos fisiopatológicos y tratamiento / Hypertension and menopause: epidemiology, physiopathology and treatment

Las enfermedades cardiovasculares constituyen la primera causa de muerte en las mujeres mayores de 50 años, edad en que se inicia el periodo de la menopausia. A pesar de la controversia existente del aumento de la prevalencia de hipertensión en mujeres post menopausia, existe evidencia de que en este estadio de la mujer se genera un ambiente pro hipertensivo. La hipertensión es considerada como uno de los principales factores de riesgos cardiovasculares. Aunque la hipertensión arterial es un problema médico mayor; su diagnóstico oportuno y tratamiento eficaz se alcanza en la minoría de las mujeres. Es necesario un tratamiento integral de los diferentes factores de riesgo cardiovasculares para lograr disminuir la mortalidad en este grupo de pacientes.

Cardiovascular diseases are the first cause of dead in women older than 50 years, age where menopause period begins Although the in crease of hypertension in postmenopausal women is controversial, there exists strong evidence that this state generate a pro hypertensive environment is considered one of the main cardiovascular risk factors. Although high blood pressure is a major medical problem the minority of women have a proper diagnose and effective, treatment. It is necessary an integral treatment of the different cardiovascular risk factors to diminish the mortality of this group of patients.

Análisis epidemiológico de los suicidios registrados en el Servicio de Salud Concepción - Arauco (1994-1998) / Epidemiological analysis of the suicides registered in the Concepción - Arauco Health Service (1994-1998)

Se realizó un estudio estadístico de todos los suicidios ocurridos en el Servicio de Salud Concepción-Arauco de Chile entre los años 1994-1998. Para ello se revisó el 100 por ciento de los Certificados de Defunción que contenían tal diagnóstico y fueron emitidos en ese período de tiempo. Se trabajó con un universo que alcanzó a 549 sujetos, con un promedio de edad de 41,2 en un rango que va desde los 15 a los 97 años. Entre las variables estudiadas se encuentran la edad, el género, el lugar y hora de ocurrencia, método usado, nivel de instrucción, ocupación del fallecido y estación del año y mes. A través de este análisis se demuestran una vez más todas las limitaciones y riesgos propios de este tipo de estudio retrospectivo. Esto plantea la necesidad de realizar estudios prospectivos que permiten acercarse con más detalle al fenómeno del suicidio, especialmente en relación alos factores asociados.

[Epidemiological study of Chlamydia trachomatis infection in a sample of women requesting voluntary termination of pregnancy, treated with rokitamycin]. / Studio epidemiologico sull'infezione da Chlamydia trachomatis in un campione di donne che richiedono l'IVG trattate con rokitamicina.

BACKGROUND: Infection with Chlamydia trachomatis usually involves the cervix uteri, causing no symptoms, and may easily be unrecognised and untreated until troublesome symptoms arise, such as pelvic inflammatory disease, which can affect fertility and reproductive life. Therapies include the macrolide antibiotics, and in this class rokitamycin offers marked lipophilia, excellent intracellular penetration, and bactericidal activity at concentrations close to the MIC. The present study was therefore designed to establish the frequency of intracervical infection with Chlamydia trachomatis in women applying for termination of pregnancy, and to assess the efficacy and safety of this drug in this indication. METHODS: Women aged 18-40 years were admitted for termination of pregnancy, with a positive cervical swab for Chlamydia trachomatis. The study was conducted in accordance with the Declaration of Helsinki and amendments. Patients were given one oral tablet of 400 mg rokitamycin in the morning, and one in the evening, for two weeks. Treatment started ten days before the termination, within 48 h of taking the swab. Partners were to receive the same treatment. RESULTS: 292 women requiring termination of pregnancy, on average at the 9th week of pregnancy, were assessed. Of these, 24 (8.2%), mean (+/- SD) age 27.1 +/- 6.1 years, range 18-39, with a positive cervical swab for Chlamydia trachomatis, were treated with rokitamycin; 22 of their partners were treated too. Forty days after the start of treatment 22 patients (92%) gave negative results; these were all the cases whose partners had received treatment. No adverse events were reported and the acceptability of the treatment was considered good or excellent in 91% and fair in 9% of the cases. CONCLUSIONS: The findings confirm that rokitamycin is one of the most useful and effective macrolides for the treatment of infections caused by intracellular microorganisms; it is extremely well tolerated and has marked microbiological efficacy.

Chronic pelvic pain: oral contraceptives and non-steroidal anti-inflammatory compounds.

A correct classification of female pelvic pain originating from gynaecological disorders is essential if the most appropriate therapy is to be chosen. Certain types of non-steroidal anti-inflammatory drugs and oral contraceptives reduce the production of prostaglandins, which are responsible in large part for primary dysmenorrhoea. Oestroprogestin formulations become the drugs of choice if the patient also requests contraception. Secondary dysmenorrhoea and chronic pelvic pain may require combined medical and surgical treatment. Oral contraceptives can also be used as post-treatment agents in endometriosis, one of the most common causes of pelvic pain, whereas more specific compounds (GnRH-analogues and Danazol) are used to produce anatomical regression of endometriosis.

Felodipino en el tratamiento de la hipertensión arterial esencial de adultos mayores / Felodipine in the treatment of essential arterial hypertension in elders

Felodipine is a calcium channel inhibitor with high vascular selectivity. To studu the effectiveness of felodipine in the treatment of essential hypertension in subjects older than 64 years old, 50 subjects were studied. After a washout period of 4 weeks, subjects received a placebo for 2 weeks followed by the active drug given in an initial dose of 5 mg/day, adjusted to 10 and 20 mg every 21 days if normal blood pressure levels were not attained. Compared to the placebo period, Felodipine treatment reduced blood pressure from 173ñ7.5/102ñ3.3 mm Hg to 158ñ6.3/91ñ4.4 mm Hg. There was no orthostatic reduction of blood pressure and 87 percent of subjects attained systolic and diastolic pressure levels below 140 and 90 mm Hg respectively. Adverse reactions (edema, cephalea and flushing) were reported by 38 percent of subjects and in 3, the drug was discontinued. There were no changes in laboratory parameters during the treatment period. Quality life improved during treatment in the items of concentration, health status perception, mood, physical condition, depression, effects of hypertension on life evets and initiative. Felodipine is effective in the treatment of elders with essential hypertension

Treatment of endometriosis with goserelin depot, a long-acting gonadotropin-releasing hormone agonist analog: endocrine and clinical results.

Thirty-two patients with laparoscopic diagnosis of endometriosis were treated for 6 months with the gonadotropin-releasing hormone agonist goserelin depot. Hormonal and clinical evaluations were conducted during treatment and for a 6-month follow-up period. Serum 17 beta-estradiol levels were sharply suppressed. Luteinizing hormone was also decreased, whereas follicle-stimulating hormone, after an initial fall, gradually rose to pretreatment levels. Ovarian androgenic production was less inhibited, total testosterone being the only significantly suppressed hormone. There was a marked improvement of signs and symptoms of endometriosis and a 47.3% reduction of laparoscopic score. The results of this study suggest that goserelin depot provides a very good suppression of ovarian estrogen production and is highly effective in decreasing the symptoms of endometriosis with an acceptable compliance by the patient.

Endocrine, metabolic, and clinical effects of gestrinone in women with endometriosis.

The effect of oral gestrinone, 2.5 mg twice weekly for 6 months, was studied in 11 women with mild or moderate endometriosis laparoscopically confirmed. The mean laparoscopic score decreased from 17.18 to 9.09 (P greater than 0.005). Painful symptoms were relieved in all patients within 2 months from start of therapy. Gonadotropins, prolactin (PRL) 17 beta-estradiol (17 beta-E2), estrone (E1), progesterone (P), androstenedione (A), and dehydroepiandrosterone sulfate (DHEA-S) remained in the follicular phase range. Total testosterone (TT) and sex hormone-binding globulin (SHBG) decreased, whereas free testosterone (FT) slightly increased. Metabolic studies showed a decrease of total triglycerides, very low-density lipoprotein (VLDL) triglycerides, and high-density lipoprotein (HDL) and VLDL cholesterol, parallel to the decrease of associated apoproteins. Low-density lipoprotein cholesterol and apoprotein B increased during therapy. The results suggest that gestrinone possesses antiestrogenic, androgenic, and progestigenic effects at therapeutic dosages both by acting on central and peripheral steroid receptors. For its efficacy and good tolerance, gestrinone may be considered an option for treating endometriosis.

Suppression of puerperal lactation by terguride. A double-blind study.

Clinical efficacy, prolactin (PRL)-lowering effect and tolerance of terguride (an 8-alpha-ergoline derived from Lisuride which acts as a partial dopaminergic agonist) were investigated in a double-blind study on inhibition of puerperal lactation using three different daily doses of the drug (0.25, 0.5 and 1.0 mg). With 0.5 and 1.0 daily therapeutical regimens PRL levels were suppressed in a dose-dependent manner and lactation was prevented. Terguride was highly well tolerated.

Ultrasonic evaluation of cervical incompetence.

Ultrasound can provide important information for the assessment of cervical incompetence (C.I.) and for the follow-up of pregnant women submitted to a cervical cerclage. Attention must be paid to the technical problems involved in the examination and the physiological variations in anatomical configuration must be taken into account.

Effect of terguride on prolactin levels in normal, puerperal and hyperprolactinaemic women.

Terguride, is an 8 - alpha - ergoline derived from lisuride, acts as a partial dopamine (DA) agonist. The effect and tolerance of terguride has been investigated by an acute administration of 0.2 mg p.o. to 8 normal women, 8 patients with hyperprolactinaemia and 8 women with puerperal hyperprolactinaemia. Prolactin (PRL) levels were markedly suppressed in all subjects, with no significant differences between the groups. Treatment for 5 days with terguride 0.4 mg/day or 0.8 mg/day was studied as an inhibitor of lactation. PRL levels were suppressed in a dose-related manner. No untoward side-effects were noted.