CALIDAD DE VIDA RELACIONADA CON EL CLIMATERIO EN UNA POBLACIÓN CHILENA DE MUJERES SALUDABLES

Objetivo: Aplicar una versión chilena de la escala MRS para evaluar calidad de vida de mujeres climatéricas. Métodos: Aplicación de la versión chilena de la escala MRS a mujeres de 45-64 años inscritas en el SSMO: Grupo 1, concurrentes a controles preventivos de salud (n=844) y Grupo 2, concurrentes a ginecólogo (n=360). Resultados: El adecuado comportamiento del instrumento fue confirmado porque el análisis de confiabilidad interna, que presentó un alfa de Crombach >0,86; la confiabilidad externa mostró una correlación en re-encuesta del Grupo 1 y 2 con coeficiente de Pearson pObjective: To apply a chilean version of the MRS scale to evaluate quality of life in climacteric women. Methods: Application of chilean version of the MRS scale in 45-64 year-old women registered at Metropolitan Health Service (MHS) of Chile. Group 1, women attending programmed health preventive controls (n=844); and Group 2, women who require attention by gynecologist (n=360). Results: The suitable behavior of the used instrument was confirmed because the analysis of internal reliability showed Crombach's alpha >0.8; external reliability showed correlation in re-test of both group with Pearson's coefficient p<0.01 for the 11 items under study and for the somatic, psychological and urogenital domains; the validity of content was confirmed because in the 2 groups in study 3 domains in the contents could be found (psychological, somatic and urogenital) as seen in other countries; and the discriminative validity of the chilean version of the MRS scale demonstrated that both group of informed scores orient to a deterioration of quality of life in relation to the climacteric, being significantly greater the deterioration into the group 2. Conclusion: The Chilean version of the MRS scale is comparable methodologically to the original version of Heinemann and it allowed to evaluate as the quality of life in relation to the climacteric in a Chilean population is affecte

FUNDAMENTOS DEL USO DE ESTROGENOS EN DOSIS BAJA CON PROGESTINA PERIODICA EN THR ORAL PARA MUJERES POSTMENOPAUSICAS

Los estudios clínicos recientes (WHI, HERS) demostraron que la terapia hormonal oral de reemplazo combinada continua (THRCC), de estrógeno y progestina, no resultó útil como prevención cardiovascular primaria ni secundaria en las mujeres post menopáusica. Esto ha desencadenado confusiones tales como pretender que otras modalidades y dosis de THR oral deberían tener esos mismos resultados. Frente a esta situación se desarrolla una revisión crítica en relación al empleo de la THRCC y los posibles efectos indeseables de la progestina. Además, se revisa el accionar del estrógeno y de la progestina usados en dosis reducidas; destacándose las evidencias moleculares y clínicas que muestran una mayor seguridad junto con buenos efectos clínicos. Se concluye que una modalidad de THR oral, con dosis baja de estrógeno, puede lograr los objetivos metabólicos buscados para las mujeres post menopáusicas. Y la progestina periódica se agregaría con la única finalidad de protección endometrial<br>The recent clinic studies (WHI, HERS) demonstrated that oral combined continuous hormonal replacement therapy (CCHRT) with estrogen and progestin, was not useful as primary or secondary cardiovascular prevention in the postmenopausal women. This results should not be extended to other modalities of treatments or different oral doses of HRT. We review critically the evidence in relation CCHRT and the importance of progestin in unfavorable results of this therapy. In addition, we review the used of estrogen and progestin in reduced dosages, enphasizing the molecular and clinical evidences that suggest safety with good clinical results. In conclusion, HRT with low oral dose of estrogen may achieve the main espected metabolic objectives in postmenopausal women. Cyclic progestin should be added with the only purpose of endometrial protectio

Quality of life in climacteric Chilean women treated with low-dose estrogen

Objectives: To evaluate the impact of low-dose oral estrogen therapy on the health-related quality of life (HRQoL) in 45-64-year-old women from the East Metropolitan Health Service (SSMO) in Santiago, Chile. Material and methods: We conducted an observational cross-sectional study. A random population sample of women between 45 and 64 years of age was obtained through an invitation to contact one of 15 primary health care centers of the SSMO of Santiago, Chile. Out of the 927 women who were originally contacted, 844 women were able to complete the Menopausal Rating Scale (MRS) questionnaire. Information about demographic parameters, health issues, and modality of hormonal therapy (HT) were registered. Three groups were compared: group 1 (n = 647; non-users of HT), group 2 (n = 82; users of low-dose oral estrogen HT), and group 3 (n = 115; users of non low-dose estrogens HT). Results: There were no differences among groups in terms of demographic and health issue parameters. The result

TESTOSTERONA SÉRICA EN TRASTORNOS HIPERTENSIVOS DEL EMBARAZO

Objetivo: Se ha comunicado asociación de hiperandrogenemia y preeclampsia; además de confirmarlo se pretende dilucidar si también hay esa asociación con embarazadas con hipertensión arterial crónica esencial (HACE). Métodos: 45 mujeres con gestación de tercer trimestre separadas en 3 grupos: 1) 15 normotensas, 2) 16 preeclámpticas, 3) 14 HACE. Se registró edad, paridad, índice de masa corporal (IMC), presión arterial sistólica y diastólica (mm de Hg), proteinuria en 24 horas, semanas de gestación, y niveles séricos de testosterona total (Tt), RIA de testosterona libre (Tl), proteína ligante sexual (SHBG), índice de andrógenos libres (IAL). Resultados: Los 3 grupos estudiados, normotensas, preeclámpticas y HACE, presentaron los siguientes valores séricos, respectivamente: Tt (nmol/L) 2,3±1,4; 5,2±3,0; 1,9±1,5 (p=0,001). IAL (pmol/L) 0,5±0,3; 1,1±0,9; 0,4±0,2 (p=0,001). No hubo diferencias significativas en Tl (pmol/L) 7,2±4,7; 7,39±4,5; 4,5±2,6; ni en SHBG (nmol/L) 468±112; 503±134; 512±96. Conclusiones: Las embarazadas con HACE presentaron niveles séricos de Tt y de IAL similares a las embarazadas normotensas. En cambio, las mujeres con preeclampsia presentaron niveles de Tt sérica e IAL claramente aumentados en comparación con las embarazadas normotensas. Se concluye que existiría una asociación de hiperandrogenemia con preeclampsia; asociación que no fue encontrada en embarazadas con HAC

Reflexiones sobre la conducta obstétrica en la embarazada con feto anencefálico

Pregnancy of an anencephalic fetus generates deep thoughts about its diagnosis, treatment and management of maternal risk, having in mind the irreversibility of the fetal situation. At the present moment, there are no guidelines for labor care in these cases, probably because in most developed countries in which abortion is legal, these pregnancies are interrupted earlier. In Chile, where abortion is illegal we must deal with these situations at the end of the pregnancy period. Of 35,682 labors attended at our hospital, 14 were anencephalic fetuses. In 50% of these a cesarean section was done and in one, a hysterectomy was required due to uterine inerti

Epigenetic signatures at the RUNX2-P1 and Sp7 gene promoters control osteogenic lineage commitment of umbilical cord-derived mesenchymal stem cells

Wharton's Jelly mesenchymal stem cells (WJ-MSCs) are an attractive potential source of multipotent stem cells for bone tissue replacement therapies. However, the molecular mechanisms involved in their osteogenic conversion are poorly understood. Particularly, epigenetic control operating at the promoter regions of the two master regulators of the osteogenic program, RUNX2/P57 and SP7 has not yet been described in WJ-MSCs. Via quantitative PCR profiling and chromatin immunoprecipitation (ChIP) studies, here we analyze the ability of WJ-MSCs to engage osteoblast lineage. In undifferentiated WJ-MSCs, RUNX2/P57 P1, and SP7 promoters are found deprived of significant levels of the histone post-translational marks that are normally associated with transcriptionally active genes (H3ac, H3K27ac, and H3K4me3). Moreover, the RUNX2 P1 promoter lacks two relevant histone repressive marks (H3K9me3 and H3K27me3). Importantly, RUNX2 P1 promoter is found highly enriched in the H3K4me1 mark, which has been shown recently to mediate gene repression of key regulatory genes. Upon induction of WJ-MSCs osteogenic differentiation, we found that RUNX2/P57, but not SP7 gene expression is strongly activated, in a process that is accompanied by enrichment of activating histone marks (H3K4me3, H3ac, and H3K27ac) at the P1 promoter region. Histone mark analysis showed that SP7 gene promoter is robustly enriched in epigenetic repressive marks that may explain its poor transcriptional response to osteoblast differentiating media. Together, these results point to critical regulatory steps during epigenetic control of WJ-MSCs osteogenic lineage commitment that are relevant for future applications in regenerative medicine. (C) 2016 Wiley Periodicals, Inc.FONDAP, 15090007 / CONICYT-DRI, 2013-0030 / FONDECYT, 1130706, 1140301, 3140368 FONDEF, D09I1047 / CONICYT, Chil

Women's Health Initiative estrogen plus progestin clinical trial: A study that does not allow establishing relevant clinical risks

© 2015 by The North American Menopause Society. Objective: This study aims to determine time differences (differences in restricted mean survival times [RMSTs]) in the onset of invasive breast cancer, coronary heart disease, stroke, pulmonary embolism, colorectal cancer, and hip fracture between the placebo group and the conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg group of the Women's Health Initiative (WHI) trial based on survival curves of the original report and to provide adequate interpretation of the clinical effects of a given intervention. Methods: Distribution of survival function was obtained from cumulative hazard plots of the WHI report; Monte Carlo simulation was performed to obtain censored observations for each outcome, in which assumptions of the Cox model were evaluated once corresponding hazard ratios had been estimated. Using estimation methods such as numerical integration, pseudovalues, and flexible parametric modeling, we determin