CLINICAL, BIOCHEMICAL - MOLECULAR AND ETIOLOGICAL ASPECTS OF THE METABOLIC SYNDROME AFTER THE MENOPAUSE

The metabolic syndrome (METS) is a cluster of lipid and non-lipid factors that increase cardiovascular risk [1]. The National Cholesterol Educational Program and its Third Adult Treatment Panel (NCEP ATP-III) have established diagnostic criteria for the METS, which are met when three or more of the following are present: abdominal obesity, decreased highdensity lipoprotein cholesterol (HDL-C) levels and increased serum triglycerides (TG), fasting glucose and/or blood pressure levels [2]. A. Prevalence Prevalence of the METS is higher in women, especially those of Latin America ancestry [3], with an increased frequency observed in relation to age and the menopausal status. Indeed, during the menopausal transition there is an emergence of features related to the METS: obesity, dyslipidemia, diabetes, hyperinsulinism, hypertension and co-morbid conditions [4], possibly but not totally related to increasing estrogenic deficiency [5]. Rates may also vary according to the studied population from 22% [6] to 34% as determined in seven crosssectional studies of non-diabetic Europeans [7]. This syndrome increases cardiovascular morbidity and mortality and the risk of developing diabetes [8]. B. The effect of the menopause over female weight The prevalence of abdominal obesity is nearly double that of general obesity, with rates in North American women calculated for 2008 in 65.5% (aged 40-59 years) and 73.8% (60 years or more)[9]. It has been suggested that body mass index (BMI) but not menopausal status determines central adiposity in postmenopausal women. However, there is substantial evidence that the perimenopause is associated with a more rapid increase in fat mass and redistribution of fat to the abdomen, resulting in a transition from a gynoid to an android pattern of fat distribution and an increase in total body fat [10]. Moreover, postmenopausal women have greater amounts of intra-abdominal fat as compared to premenopausal ones, as determined with several radiological modalities [11]. Waist circumference represents both 5 subcutaneous and visceral adipose tissue depot size and correlates closely with the risk for cardiovascular disease. In women, it is also closely associated with dyslipidemia [12]. Abdominal fat is considered an endocrine organ as it has the capacity to secrete adipokines and other active substances closely related to metabolic diseases: insulin resistance, type 2 diabetes and the METS [13]. Both, the menopausal transition and aging, are associated with changes in adipose tissue metabolism, which contribute to the accumulation of body fat after menopause [14]. Deleterious changes in inflammatory markers and adipokines correlate strongly with increased visceral adiposity after the menopause [15]. Waist circumference significantly changes in relation to the time since final menstrual period. Moreover, significant increases in central abdominal fat have been reported from longitudinal studies in Caucasian and Asian women [16]. It has been observed that when non-obese premenopausal women are followed-up for several years, significant increases in total, percentage and truncal and visceral fat mass occur [16]. Women who later became peri or postmenopausal displayed a significant increase in visceral fat compared with baseline [16]. C. The impact of increased weight over menopausal symptoms Severity and prevalence of menopausal symptoms relate several factors. These include not only the hormonal changes imposed by the transition, but also psychosocial factors. As weight increased during the menopausal transition, so do menopausal symptoms. Obesity is an independent risk factor for more severe menopausal symptoms [17,18]. Reduction of weight, BMI and abdominal circumference have been associated with a significant reduction in vasomotor symptoms women who are overweight and obese [19]. The combination of dietary modification and exercise also has positive effects on health related quality of life (HRQOL) and psychological health, which may be greater than that from exercise or diet alone [20]. Improvements in weight, aerobic fitness and psychosocial factors may mediate some of the effects of these interventions on HRQOL [20]. Weight loss in 6 overweight and obese women improves psychological wellbeing, HRQOL, self-esteem and health practices [21]. In addition, dietary weight loss and exercise exert a positive effect over insulin resistance in postmenopausal women, which together with a decrease in menopausal symptoms may potentially decrease cardiovascular risk. D. The METS a state of pro-inflammation and endothelial dysfunction The METS is associated with increased inflammation, endothelial dysfunction, oxidative stress and abnormalities in both the macro- and microvasculature [22]. Adipocytes and adipose-tissue macrophages are involved in the production of IL-6, which is one of the main mediators of chronic inflammation [23]. Elevated IL-6 is an established risk factor for cardiovascular events in women after the menopause; thus, it is interesting to find that the presence of METS, rather than the menopause itself, relates to increased IL-6 levels. IL-6 serum levels are associated with visceral adipose tissue and can influence insulin levels [24]. On the other hand, it has been reported that IL-6 polymorphisms may play a role in the pathogenesis of the METS through the modulation of IL-6 levels [25]. F. Endothelial dysfunction during pregnancy as a model for future METS risk Preeclampsia is a leading cause of maternal mortality and morbidity worldwide [26]. Epidemiological data indicate that women complicated with preeclampsia are more likely to develop future cardiovascular disease (CVD). Population-based studies relate preeclampsia to an increased risk of later chronic hypertension (RR, 2.00 to 8.00) and cardiovascular morbidity/mortality (RR, 1.3 to 3.07), compared with normotensive pregnancy [27]. Women who develop preeclampsia before 36 weeks of gestation or have multiple hypertensive pregnancies are at highest risk (RR, 3.4 to 8.12). The underlying mechanism for the remote effects of preeclampsia is complex and probably multifactorial. Many risk factors are shared by CVD and preeclampsia, including endothelial dysfunction, obesity, hypertension, hyperglycemia, insulin resistance, and dyslipidemia. Therefore, it has been proposed that the METS may be a possible underlying mechanism common to CVD 7 and preeclampsia. Follow-up and counseling of women with a history of preeclampsia may offer a window of opportunity for prevention of future disease [27]

Vitamin D supplementation after the menopause

The purpose of this review was to assess recent evidence regarding the effects of low vitamin D levels on some highly prevalent clinical conditions of postmenopausal women. We reviewed and selected recent literature regarding menopause-related conditions associated with vitamin D deficiency and interventions to manage them. Low circulating 25-hydroxyvitamin D (25(OH)D) levels related to menopause are linked to diet, lifestyle, changes in body composition, insulin sensitivity, and reduced physical activity. Vitamin D supplementation increases serum 25(OH)D levels while normalizing parathyroid hormone and bone markers, and in women with serum 25(OH)D levels below 10 ng/ml supplementation may improve bone mineral density. Low vitamin D status has been associated with the metabolic syndrome, high triglyceride levels, and low high-density lipoprotein cholesterol levels. When compared with placebo, vitamin D supplementation may lower the risk of the metabolic syndrome, hypertriglyceridemia, and hyperglycemia. There is an inverse relationship between fat mass and serum 25(OH)D levels and, therefore, the dosage of supplementation should be adjusted according to the body mass index. Although vitamin D supplementation may improve glucose metabolism in prediabetic subjects, data regarding muscle strength are conflictive. There is evidence that vitamin D over-treatment, to reach extremely high circulating 25(OH)D levels, does not result in better clinical outcomes. The identification and treatment of vitamin D deficiency in postmenopausal women may improve their general health and health outcomes. Vitamin D supplementation should preferably be based on the use of either cholecalciferol or calcifediol

Frecuencia y severidad de síntomas menopáusicos en una población de mujeres afro descendientes colombianas

ResumenIntroducción: Es diferente la prevalencia y la severidad de los síntomas relacionados con la menopausia cuando se evalúan diferentes grupos étnicos o poblacionales. Se ha señalado que las mujeres de raza negra pueden tener mayor riesgo de oleadas de calor que las mujeres caucásicas. Objetivos: Evaluar la frecuencia y severidad de síntomas menopáusicos entre mujeres afro descendientes colombianas. Método: Estudio transversal, parte del proyecto CAVIMEC (Calidad de vida en la menopausia y etnias colombianas), realizado en mujeres afro descendientes colombianas entre 40 y 59 años. Fueron evaluadas con Menopause Ranting Scale (MRS) para establecer la frecuencia e intensidad de síntomas menopáusicos. Resultados: 201 mujeres afro descendientes colombianas fueron incluidas. La edad promedio fue de 47.2±5.2 años,estando el 43% en premenopausia, 18% en perimenopausia y 38% en postmenopausia; el tiempo promedio desde la última regla fue de 3.2±2.7 años y con edad promedio de la menopausia fue 45.9±4.8 años; el 50% delas pacientes con menopausia natural. La mitad de las participantes manifestó tener síntomas de menopausia, siendo moderados en el 28% y severos o muy severos en el 9%. El 77% presenta síntomas musculares o articulares, 54% oleadas de calor, 64% irritabilidad y 16% problemas vesicales. La puntuación de MRS fue: dimensión somático-vegetativa 5.0±3.3, psicológica 4.8±3.3 y global 10.6±6.3. Conclusión: En mujeres afro descendientes colombianas se observa elevada puntuación en la escala MRS, dada por una elevada presencia de síntomas somático-vegetativos y psicológicos La puntuación observada supera significativamente la de otras poblaciones tomadas como referente.[Monterrosa A, Blumel JE, Chedraui P. Frecuencia y severidad de síntomas menopáusicos en una población de mujeres afro descendientes colombianas. MedUNAB 2008; 11:113-119].Palabras  clave:  Menopausia,  Síntomas  menopáusicos, Menopause rating scale, Raza negra, Colombia

Depressive Symptoms and Resilience among Pregnant Adolescents: A Case-Control Study

Background. Data regarding depression and resilience among adolescents is still lacking. Objective. To assess depressive symptoms and resilience among pregnant adolescents. Method. Depressive symptoms and resilience were assessed using two validated inventories, the 10-item Center for Epidemiologic Studies Short Depression Scale (CESD-10) and the 14-item Wagnild and Young Resilience Scale (RS), respectively. A case-control approach was used to compare differences between adolescents and adults. Results. A total of 302 pregnant women were enrolled in the study, 151 assigned to each group. Overall, 56.6% of gravids presented total CESD-10 scores 10 or more indicating depressed mood. Despite this, total CESD-10 scores and depressed mood rate did not differ among studied groups. Adolescents did however display lower resilience reflected by lower total RS scores and a higher rate of scores below the calculated median (P < .05). Logistic regression analysis could not establish any risk factor for depressed mood among studied subjects; however, having an adolescent partner (OR, 2.0 CI 95% 1.06–4.0, P = .03) and a preterm delivery (OR, 3.0 CI 95% 1.43–6.55, P = .004) related to a higher risk for lower resilience. Conclusion. In light of the findings of the present study, programs oriented at giving adolescents support before, during, and after pregnancy should be encouraged

Effect of Red Clover Isoflavones over Skin, Appendages, and Mucosal Status in Postmenopausal Women

Objective. Evaluate in postmenopausal women the effect of red clover extract (RCE) isoflavones over subjective status of skin, appendages, and several mucosal sites. Method. Postmenopausal women (n = 109) were randomly assigned to receive either two daily capsules of the active compound (80 mg RCE, Group A) or placebo of equal appearance (Group B) for a 90-day period. After a washout period of 7 days, medication was crossed over and taken for 90 days more. Subjective improvement of skin, appendages, and several mucosal site status was assessed for each studied group at 90 and 187 days using a visual analogue scale (VAS). In addition, libido, tiredness, and urinary, sleep, and mood complaints were also evaluated. Results. Women after RCE intervention (both groups) reported better subjective improvement of scalp hair and skin status, libido, mood, sleep, and tiredness. Improvement of urinary complaints, nail, body hair, and mucosa (oral, nasal, and ocular) status did not differ between treatment phases (intra- and intergroup). Overall satisfaction with treatment was reported higher after RCE intervention (both groups) as compared to placebo. Conclusion. RCE supplementation exerted a subject improvement of scalp hair and skin status as well as libido, mood, sleep, and tiredness in postmenopausal women

Frequency and severity of menopausal symptoms in a population of Colombian Afro-descendant women

Introducción: Es diferente la prevalencia y la severidad de los síntomas relacionados con la menopausia cuando se evalúan diferentes grupos étnicos o poblacionales. Se ha señalado que las mujeres de raza negra pueden tener mayor riesgo de oleadas de calor que las mujeres caucásicas. Objetivos: Evaluar la frecuencia y severidad de síntomas menopáusicos entre mujeres afro descendientes colombianas. Método: Estudio transversal, parte del proyecto CAVIMEC (Calidad de vida en la menopausia y etnias colombianas), realizado en mujeres afro descendientes colombianas entre 40 y 59 años. Fueron evaluadas con Menopause Ranting Scale (MRS) para establecer la frecuencia e intensidad de síntomas menopáusicos. Resultados: 201 mujeres afro descendientes colombianas fueron incluidas. La edad promedio fue de 47.2&plusmn;5.2 años, estando el 43% en premenopausia, 18% en perimenopausia y 38% en postmenopausia; el tiempo promedio desde la última regla fue de 3.2&plusmn;2.7 años y con edad promedio de la menopausia fue 45.9&plusmn;4.8 años; el 50% delas pacientes con menopausia natural. La mitad de las participantes manifestó tener síntomas de menopausia, siendo moderados en el 28% y severos o muy severos en el 9%. El 77% presenta síntomas musculares o articulares, 54% oleadas de calor, 64% irritabilidad y 16% problemas vesicales. La puntuación de MRS fue: dimensión somático-vegetativa 5.0&plusmn;3.3, psicológica 4.8&plusmn;3.3 y global 10.6&plusmn;6.3. Conclusión: En mujeres afro descendientes colombianas se observa elevada puntuación en la escala MRS, dada por una elevada presencia de síntomas somático-vegetativos y psicológicos La puntuación observada supera significativamente la de otras poblaciones tomadas como referente.[Monterrosa A, Blumel JE, Chedraui P. Frecuencia y severidad de síntomas menopáusicos en una población de mujeres afro descendientes colombianas. MedUNAB 2008; 11:113-119].Introduction: The prevalence and severity of symptoms related to menopause is different when different ethnic or population groups are evaluated. It has been suggested that black women may be at greater risk of hot flashes than Caucasian women. Objectives: To evaluate the frequency and severity of menopausal symptoms among Colombian women of African descent. Method: Cross-sectional study, part of the CAVIMEC project (Quality of life in menopause and Colombian ethnicities), carried out in Colombian women of African descent between 40 and 59 years old. They were evaluated with the Menopause Ranting Scale (MRS) to establish the frequency and intensity of menopausal symptoms. Results: 201 Afro-descendant Colombian women were included. The average age was 47.2+5.2 years, with 43% in premenopause, 18% in perimenopause and 38% in postmenopause; the average time since the last period was 3.2+2.7 years and the average age of menopause was 45.9+4.8 years; 50% of patients with natural menopause. Half of the participants reported having menopause symptoms, being moderate in 28% and severe or very severe in 9%. 77% present muscle or joint symptoms, 54% have hot flashes, 64% irritability and 16% have bladder problems. The MRS score was: somatic-vegetative dimension 5.0+3.3, psychological 4.8+3.3 and global 10.6+6.3. Conclusion: In Colombian Afro-descendant women, a high score is observed on the MRS scale, given by a high presence of somatic-vegetative and psychological symptoms. The observed score significantly exceeds that of other populations taken as a reference.[Monterrosa A, Blumel JE, Chedraui P Frequency and severity of menopausal symptoms in a population of Colombian Afro-descendant women. MedUNAB 2008; 11:113-119]

Aspectos hematimétricos y del metabolismo del hierro vinculados a la anemia en mujeres gestantes con amenaza de parto pretérmino

Objetivo: Evaluar los aspectos hematimétricos y del metabolismo del hierro asociados a la anemia en pacientes con amenaza de parto pretérmino. Metodología: Estudio prospectivo, longitudinal, analítico realizado en la Unidad de Cuidados Intermedios del hospital Gineco-Obstétrico Enrique C. Sotomayor, en pacientes con amenaza de parto pretérmino. Estas fueron apareadas por edad materna, paridad y edad gestacional con controles obtenidas de la consulta externa. Todas las pacientes fueron seguidas hasta el final de la gestación, evaluándose la resultante materna y neonatal. Resultados: En un período de 6 meses, sesenta pacientes (n=60) entraron al estudio, 30 casos o grupo estudio (amenaza de parto pretérmino) y 30 controles. El nivel promedio de hematócrito, hemoglobina, ferritina, transferrina, volumen corpuscular medio (VCM) y hemoglobina corpuscular media (HCM) fue menor en los casos (32.9 3.5 % vs 35.5 ± 3%; 10.4 1.4g/dl vs 11.5 ± 1g/dl; 11.1 ± 5.4ng/ml vs 14 ± 7.8ng/ml; 338.6 ± 49.3mcg/dl vs 375.8 ± 48.4mcg/dl; 79.9 ± 7.7 micra3 vs 84 ± 5.1 micras3 y 25 ± 3.1mmcg vs 26.6 ± 2mmcg, respectivamente p< 0.05). El porcentaje de pacientes con un valor de ferritina < 20ng/mL y una concentración de hemoglobina corpuscular media (CHCM) < 32% fue mayor en los casos (93.3% vs 63.3% y 80% vs 23.3% respectivamente, p <0.05). Aunque no hubo diferencias en cuanto a la resultante materna, el peso neonatal, edad gestacional y el intervalo transcurrido desde el ingreso materno al estudio hasta el parto, fue menor en el grupo estudio (2,638 ± 429g vs 3,247 ± 418g; 35.7 ± 2 sem. vs 38.4 ± 1.5 sem.; 3.8 ± 2 sem. vs 6 ± 1.8 sem., respectivamente, p <0.05)

Coronavirus disease 2019 (COVID-19) and human pregnancy: a scoping review

The coronavirus disease 2019 (COVID-19) is caused by the infection with a coronavirus (SARS-CoV-2). Pregnants present mild or moderate symptoms, with 5% presenting as a severe pneumonia. Prevalence and evolution of COVID-19 in pregnancy is similar to that of the general population, including the risk of maternal death. Radiography, computed tomography or ultrasound imaging are pivotal for the diagnosis and given the clinical suspicion of COVID-19 pneumonia. Lab findings include lymphocytopenia, thrombocytopenia, leukopenia, and the elevation of D-dimer and ferritin. To date, there is no specific treatment or vaccination for COVID-19; yet clinical management in pregnants is also similar to that of the general population, with prophylactic antibiotic treatment for bacterial pneumonia and oxygen support. Thromboprophylaxis should be indicated in severe cases, given that pregnancy is a hypercoagulable state that may be exacerbated by COVID-19. Hospital management should focus on treating the mother and protecting the newborn and the health personnel. Regarding COVID-19 and perinatal outcomes, premature deliveries are mainly associated to iatrogenic pregnancy termination through cesarean section aimed conserving maternal well-being. To date, vertical transmission to the fetus has not been demonstrated, neither intrauterine, nor through the birth canal. The virus has not been detected in vaginal fluids, or in breast milk. Breastfeeding may be allowed depending on maternal and neonatal health status. There are still many unknown issues, although there is a continuous update of scientific information related to pregnancy and COVID-19

Linfoma No Hodgkin y embarazo: revisión

La ocurrencia de linfoma No-Hodgkin (LNH) durante el embarazo es muy raro, sin embargo la incidencia general de los LNH va en aumento debido a la relación existente entre esta entidad y el virus de la inmunodeficiencia adquirida humana (VIH). La mayoría de los LNH que complican el embarazo son agresivos y diseminados, lo que amerita una quimioterapia agresiva pero debido a los poco casos estudiados y por el temor a la teratogenicidad, su uso al principio fue limitada. Sin embargo actualmente esta entidad es tratada exitosamente en los 3 trimestres del embarazo con excelentes resultados materno-fetales.El objetivo de este trabajo es hacer una revisión histórica del linfoma no Hodgkin, su relación con el embarazo y esquemas de tratamiento durante el

Prevalencia de la anemia en el embarazo y sus efectos sobre las medidas antropométricas perinatales y el apgar en el hospital gineco-obstétrico Enrique C. Sotomayor en el año 2013

Introducción: la anemia es una condición muy frecuente en el embarazo a nivel mundial, la prevalencia es especialmente elevada en países en vías de desarrollo, esto podría causar problemas maternos, fetales y neonatales. Objetivo: determinar la prevalencia de anemia gestacional en el hospital Gineco-Obstétrico Enrique C. Sotomayor y conocer las características perinatales asociadas. Materiales y métodos: estudio transversal realizado en 26500 gestantes que acudieron al hospital Gineco-Obstétrico Enrique C. Sotomayor a atender su parto en el año 2013. Se obtuvo el valor de hemoglobina materna y se calculó la prevalencia de anemia (Hb <11gm/dl). De la población de mujeres anémicas, se estudiaron las características neonatales. Se relacionó el nivel de hemoglobina con las variables del recién nacido. Resultados: la prevalencia de anemia gestacional fue del 9%. De las pacientes anémicas el 100% presentaron anemia leve. El 49% de los recién nacidos fueron prematuros, un tercio presentó bajo peso, talla baja y perímetro cefálico disminuido para edad gestacional. El menor nivel de hemoglobina se correlacionó únicamente con un perímetro cefálico disminuido (valor p: 0,01) sin mostrar diferencia estadísticamente significativa con las otras variables. Conclusiones: la prevalencia de anemia gestacional en Guayaquil es alta, al igual que la carga que ésta implica. En aproximadamente un tercio de los recién nacidos se encontraría medidas antropométricas disminuidas lo que podría afectar en su desarrollo psicomotor y cognitivo en el futuro. Por consiguiente se debe valorar implementar medidas preventivas a nivel comunitario para mejorar esta situació