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Objective: To evaluate the placental and decidual gene expression and maternal and umbilical serum concentrations of tumor necrosis factor alpha, interleukin 6 (IL-6), IL-8, IL-10, IL-1 receptor antagonist (IL-1RA), intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 (VCAM-1), along with the proinflammatory/anti-inflammatory cytokine ratios in women with preeclampsia (PE) vs. women with normal pregnancy (NP), and to analyze PE classified as early- (EO) and late-onset (LO).Methods: This cross-sectional study was performed with 50 women with PE (EO n = 30, LO n = 20) and 50 women with NP. Tissue gene expression levels were measured by real-time RT-PCR. Cytokines and adhesion molecules serum concentrations were measured by immunoassays.Results: In PE, placental expression of IL-10 and IL-1RA was lower, while placental IL-8/IL-1RA ratio and maternal concentrations of VCAM-1 were higher vs. NP. In EO, placental expression of IL-10 was lower, while placental IL-8/IL-10 and IL-8/IL-1RA ratios were higher than LO and NP. Maternal concentrations of IL-6 were higher in LO than EO and NP. Throughout PE, maternal VCAM-1 concentrations were higher vs. NP. No significant differences were observed in the decidual expression and umbilical concentrations of the markers between the groups.Conclusion: PE associates with a proinflammatory placental state; however, EO associates with a proinflammatory placental state, while LO associates with systemic maternal inflammation. Both subtypes associated with maternal endothelial dysfunction. [ABSTRACT FROM AUTHOR]

Currently, in medicine there is an environment replete with controversy and debate, partially due to the popular concept Evidence- Based Medicine, and to the development of technological advances and, apparently, better therapeutic resources. This has led to the establishment of an over-diagnosis epidemic and to an excess of therapeutic interventions, which do not necessarily lead to a longer life expectancy. Some medical controversies, which have called the attention of physicians and even of common people are those related with dislipoproteinemias, pre-diabetes and detection of cancer in asymptomatic persons. The debate and the controversy will surely continue and that is why it is very important to emphasize that clinical practice should be personalized, taking into account risks and implied benefi ts. [ABSTRACT FROM AUTHOR]

Cholesterol is a precursor of steroid hormones and an essential component of the cell membrane; however, altered regulation of the synthesis, absorption and excretion of cholesterol predispose to cardiovascular diseases of atherosclerotic origin. Despite the recognition of historical events for 200 years starting with Chevreul naming “cholesterine”; later on, Lobstein coining the term atherosclerosis and Marchand introducing it, Anichkov identifying cholesterol in atheromatous plaque, and Brown and Goldstein discovering LDL receptor (r-LDL), as well as the emergence of different drugs such as fibrates, statins and cetrapibs during this decade promising to increase HDL, and the most recent, ezetimibe and anti-PCSK9 to inhibit the degradation of r-LDL, morbidity has not been reduced in cardiovascular disease. To date, the controversy continues regarding the best and appropriate medical therapy for hypercholesterolemia; likewise, there is the recommendation of a healthy dietary content regarding the amount of sugar as well as the type of fats, either saturated or polyunsaturated. Together, control of circulating cholesterol, amelioration of hypertension, regulation of diabetes, and dietary recommendations might prevent atherosclerosis. [ABSTRACT FROM AUTHOR]

Cholesterol is a precursor of steroid hormones and an essential component of the cell membrane, however, altered regulation of the synthesis, absorption and excretion of cholesterol predispose to cardiovascular diseases of atherosclerotic origin. Despite, the recognition of historical events for 200 years, starting with Michel Chevreul naming «cholesterol», later on, Lobstein coining the term atherosclerosis and Marchand introducing it, Anichkov identifying cholesterol in atheromatous plaque, and Brown and Goldstein discovering LDL receptor, as well as the emerging of different drugs, such as fibrates, statins and cetrapibs this decade, promising to increase HDL and the most recent ezetimibe and anti-PCSK9 to inhibit the degradation of LDL receptor, however morbidity has not been reduced in cardiovascular disease. [ABSTRACT FROM AUTHOR]

Jules Hirsch was born in New York City and died at age 88 after a long illness. He was considered notorious leader in the study of human metabolism mainly in the area of lipids and obesity. His research at The Rockefeller University helps establish the mechanism of obesity and lipids metabolism. Hirsch joined Rockefeller's faculty in 1954 and remained there for the rest of his career. Hirsch's research helped to support the idea of dynamic interactions among diet, physical activity, general metabolism and obesity. At that time most scientific considered adipose tissue to be biologically inert such as a passive insulator in which the body reserved energy in the form of triglycerides. Hirsch had a natural characteristic of showing a nice smile and greeting for everyone he worked with at the university. Another important contribution was there relationship between diet and cardiovascular ailments as well as metabolism disturbance. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of low-dose conjugated equine estrogens (E) on circulating neurotransmitters and the efficacy for the treatment of psychological symptoms.Design: Controlled comparative clinical study.Setting: Endocrine Research Unit, Instituto Mexicano del Seguro Social, Mexico.Patient(s): Thirty postmenopausal women received conjugated equine E. Ten women acted as a comparison group.Intervention(s): Conjugated equine E, 0.312 mg/day, for 21 days per cycle during six cycles and added chlormadinone acetate, 2 mg/day, for the last 5 days of each cycle. Green scale for climateric women and Blatt-Kupperman Menopausal Index were used for measuring psychological well-being.Main Outcome Measure(s): Serum levels of dopamine (DA), noradrenaline, serotonin, and β-endorphin were quantified by specific assays at baseline and at the end of treatment.Result(s): Low baseline levels of DA, serotonin, and β-endorphin increased significantly (P<.001) from 181.9 ± 47.8 pg/mL to 202.9 ± 32.8 pg/mL (mean ± SD); from 206.4 ± 94.2 ng/mL to 279.2 ± 67.9 ng/mL; from 11.2 ± 1.8 pmol/L to 13.8 ± 2.4 pmol/L, respectively, after conjugated equine E. In parallel, augmented baseline noradrenaline levels diminished significantly (P<.05) from 30.2 ± 4.7 ng/mL to 24.0 ± 4.7 ng/mL. All neurotransmitter levels had a significant correlation with 17β-E2 concentrations at the end of the study. Alleviation of psychological symptoms was observed in all but eight treated women.Conclusion(s): Low-dose conjugated equine E associated with periodic administration of chlormadinone acetate elicited favorable changes in neurotransmitters and relieved psychological symptoms. [Copyright &y& Elsevier]

Preterm preeclampsia (PE) remains a leading cause of maternal death and perinatal morbidity. The pathophysiological process that underlies PE has been proposed to occur in two episodes, the first is a reduced placental perfusion and then the maternal clinical syndrome. Placental ischemia/hypoxia is believed to result in the release of a variety of placental factors such as cytokines including TNF-α and interleukin 6, activated circulating immune cells and autoantibodies that have profound effects on blood flow and arterial pressure regulation. PE is also associated with decreased formation of vasodilators such as nitric oxide and prostacyclin. It is accompanied by widespread maternal vascular dysfunction and a chronic inflammatory response. Additionally, anti-angiogenic peptides are released, inhibiting vascular remodeling essential for increased blood flow to the growing uteroplacental unit. Although these factors accompany the clinical syndrome of PE, it is suggested that they are secondary to the maternal decrease in placental blood flow. Experimental evidence has demonstrated the importance of these soluble factors to increase blood pressure and stimulate the production of such anti-angiogenic factors, thereby eliciting a vicious cycle existing within the maternal vasculature as well as within the placental unit. These alterations in vascular function not only lead to hypertension but to multi-organ dysfunction. The quantitative importance of the various endothelial and humoral factors that mediate vascular dysfunction and hypertension during PE remains to be elucidated. [ABSTRACT FROM AUTHOR]

The hormonal therapy should begin only in order to control the symptoms of the climacteric in women; its use is not recommended to prevent other types of affections associated to the posmenopause, because, despite some other recognizable benefits have been described, many of them have not been demonstrated. Before beginning the treatment of hormonal therapy, it is recommended to analyze the risk factors for heart attack or other cardiovascular diseases, and also estimate risk for osteoporosis and breast cancer. Diverse presentations and ways of administration of the hormonal therapy have been used, with which outcome have been obtained that vary in connection with predominant symptoms. Recently, the introduction of the concept based on the combined use of an estrogen associated to selective estrogen receptor modulator (SERM), the tissue selective estrogen complex (TSEC), allows a better clinical profile for the patient. With this combination it is obtained endometrial protection and positive action about the changes that the menopause produces. The decision to continue the hormonal therapy should be individualized, based on the severity of the symptoms and recurrence, considering the risk-benefit foreseen with the woman in the clinic. [ABSTRACT FROM AUTHOR]

In order to correct the high level of cholesterol in blood is necessary to improve the life style which includes proper nutrition and physical exercise, but frequently is added some medication. The initial medication that is used is a stantin which decreases total cholesterol and low density cholesterol associated with increment in high density cholesterol in order to prevent cardiovascular involvement. It is frequent the addition of other medicaments, such as niacin or ezetemiba to achieve a greater effect on cholesterol disorders. The effectively of anti-cholesterol elevation should be evaluated by the occurrence of cardiovascular events, instead of the improvement in biochemist markers. [ABSTRACT FROM AUTHOR]

Rosalyn Yalow lived all her life in the Bronx, New York, where she was born, educated, worked and met Solomon Berson, her scientific partner for a long time. Despite being a top student at Hunter College she was unable to be admitted to any graduate program in physics, mainly because she was Jewish and female. Later she joined the Veterans Administration Hospital in New York where she established the radioisotope laboratory. There she met Solomon Berson and formed the extraordinary scientific partnership and started publishing studies of radioactivity. Yalow received the Nobel Prize in Medicine and Phisiology or Medicine in 1977 and died on May 30, 2011. [ABSTRACT FROM AUTHOR]

Bone tissue was essentially considered as a mechanical structure; however is now well known that is the site of permanent bone remodelation. In addition, bone functions as an endocrine gland producing osteocalcin, which in turn interacts with other tissues, such as fat, pancreas and gastrointestinal tract. As a consequence, osteocalcin intervenes into glucose metabolism, peripheral insulin sensitivity and inflammatory process. In sum, bone may be accepted as an endocrine gland. [ABSTRACT FROM AUTHOR]

Endometriosis is the third cause of gynecological morbidity and the complications are associated to ectopically endometrial tissue implantation. The interest on this disease is the functional disability and its association with sterility. It has been established that endometrial growth is estrogen-dependent and that progesterone inhibits the cellular proliferation mediated by estrogens, therefore in endometriosis there is not an adequate response to hormonal signals that control the proliferative activity. It has been described that peritoneal fluid in women with endometriosis has high cytokines concentrations, growth factors and activated macrophages, which had shown adverse effects on fertility. Therefore, these are not the only causes of infertility since it has been described that endometriosis seems to have poor ovarian reserve and ovular quality. When there is infertility, the tendency is to treat the endometriosis due to the changes caused by ectopically tissue presented at immunological level and in the structure of genital organs, which disturbances the conception process. It has been observed that endometriosis has recurrences after a surgical procedure. For this reason we should be consider all therapeutic possibilities. [ABSTRACT FROM AUTHOR]

It is now generally accepted that the primary goal of osteoporosis management is to prevent fractures, which is accomplished by stopping bone loss and improving bone strength. Elderly postmenopausal women show a high prevalence of osteoporosis which in turn increases the risk of fracture. Men suffer of osteoporosis when either cortisone therapy is used or long periods of immobility. Antiresorptive drugs and bone anabolic are the two types for pharmacologic treatment; calcium and vitamin D should be considered adjuvant therapy for all individuals. Choice of treatment depends of age, the presence of fractures, and the degree of bone mineral density measured at the spine and hip. The main inconvenient for the adherence of treatment is the high cost of the medicaments as well as the poor information given to the patients. Probably one of the single most important factor for administering therapy for a condition that is largely asymptomatic is the patients compliance with the regimen that has been selected. [ABSTRACT FROM AUTHOR]

Aim: To determine the expression of two isoforms of the growth hormone (GH) receptor (GHR), which differ by the presence (GHR3+) or absence (GHR3–) of exon 3, and their correlation with circulating GH and insulin-like growth factor I (IGF-I) in normal subjects and in acromegalic patients. Methods: The expression of GHR isoforms was determined by reverse-transcriptase polymerase chain reaction in lymphocytes from 12 normal subjects and from 11 patients with acromegaly. The levels of GHR mRNA were normalized to those of β-actin, and ratios were calculated to assess the relative levels of expression. Results: All samples showed expression of both GHR isoforms, but the expression of GHR3+ and GHR3– was similar in acromegalic patients (6.0 ± 1.7 vs. 8.3 ± 2.0%, mean ± SE). In contrast, in healthy subjects, GHR3– was the predominant isoform (11.8 ± 3.0 vs. 5.1 ± 0.68%; p < 0.05), and the levels of expression of GHR3– correlated significantly with IGF-I. Conclusions: These data demonstrate coexpression of both GHR isoforms under normal and pathological conditions; however, GHR3– is the predominant form in normal subjects and shows a negative correlation with IGF-I levels.Copyright © 2003 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

On January 15, 2015, Carl Djerassi, an extraordinary personality, died at the age of 91 years. He was born in Vienna, Austria, on October 29, 1923. His parents were physicians and probably he wanted to be also a physician, but sooner than later he chose to be a chemist. In 1939 he arrived to live to New York with his mother. In 1945 he became American citizen. Part of his work is the first commercial antihistamine, pyribenzamine, and the first successful combined oral contraceptive pill. With this editorial we make a tribute to this steroid pioneer. [ABSTRACT FROM AUTHOR]

The physician's professional life, involves reading and analysis of scientific journals, regardless of the specialization field. The hospital and academic areas lead to the scientific-literary activity development. The aim of this editorial is to make some reflections about the way a physician reaches an intellectual development, through the creation of a culture of writing and reading scientific publications. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is the presence of functional endometrial tissue in the pelvic peritoneum and it affects several age groups. That is why the impact of endometriosis in quality of life is considerable. The objective of this study was to evaluate the effectiveness of dienogest in patients with pelvic pain associated to endometriosis (PPAE). Methods: The evaluation of the effectiveness was carried out through a systematic review using the Cochrane methodology. It was used Markov model, which considers two states of health (with and without PPAE), with the possibility of weekly transition. Women between 18 and 45 years with PPAE were included, in a temporary horizon of 26 weeks. A level of statistical significance of 95% was used forap< 0.05, with a multivariate probabilistic analysis of sensibility, as well as a univariate analysis of sensibility in several scenarios. Results: The probability that the female patient did not experience PPAE with the initial treatment was 87.91% with dienogest, 80.07% with danazol, 84.93% with medroxyprogesterone (injectable and oral) and 89.17% with gosereline. The probability that the female patient abandoned her initial treatment was 9% with dienogest, 12.07% with danazol, 9.6 and 6.75% with medroxyprogesterone injectable and oral, respectively, and 10.8 and 3.6% 3-monthly and monthly with gosereline. Conclusion: Compared to danazol, medroxiprogesterone and gosereline, dienogest is the most efficient alternative to treat PPAE. [ABSTRACT FROM AUTHOR]

It has been accepted that preclinicall detection of breast cancer by means of the routine practice of mammography could discover the disease at its initial stage; therefore, practicing a mammography annually became widespread as a preventive health measure to diagnose the disease and prevent death due to breast cancer. Over time, the benefit of detection tests has been questioned and demonstration of their benefit, as well as that of the undesirable effects they might cause, has been demanded. There is recent information with regard to an absence of difference in terms of breast cancer mortality as final index between women with or without routine mammography. Additionally, a 20 % frequency has been observed in false-positive diagnoses, with high numbers of women undergoing unnecessary diagnostic procedures due to suspicion of a non-clinically apparent presumed cancer. In Mexico, from 2004 on, the popularity of mammography to detect and effectively cure cancer has increased. Acceptance can be attributted to how easily detection campaigns can be promoted, since most women accept that mastography can offer the opportunity of receiving an early treatment that reduces dissemination and prevents early mortality. The age at which it is convenient to perform the first mammography, how frequently it should be repeated and even the age for its discontinuation is still under debate and no consensus has been reached. [ABSTRACT FROM AUTHOR]

Background/Aims: Hormone replacement therapy (HRT) is associated with an increased risk of thromboembolism dependent on the type of HRT; therefore, we compared therapy effects of intranasal with oral estrogens on coagulation and fibrinolysis markers in postmenopausal women. Methods: A randomized study in which 29 healthy hysterectomized women received intranasal 17β-estradiol or oral estrogens for 3 months. Results: There were no significant differences in the baseline characteristics between groups. Those women receiving intranasal estradiol showed a mild increment in plasminogen activator inhibitor-1 (PAI-I) (from 6.8 ± 3.5 to 9.6 ± 3.9 U/ml, p < 0.01); however, fibrinogen, factor VII-tissue factor complex (VIIa-rTF), antithrombin III (ATIII), protein C (PC) activity, protein S (PS) activity, plasminogen (PLG), and tissue-type plasminogen activator antigen (t-PA) were unchanged. In contrast, oral unopposed estrogens elevated t-PA (from 4.9 ± 2.9 to 9.6 ± 5.1 ng/ml, p < 0.01) in parallel with a decrement in PAI-I (from 5.2 ± 4.0 to 2.7 ± 1.7 U/ml, p < 0.05) and VIIa-rTF (from 201.2 ± 181.0 to 140.6 ± 108.7 mU/ml, p < 0.05). Fibrinogen, ATIII, PC, PS, and PLG were unchanged. Conclusions: Nasal 17β-estradiol had no effect on the coagulation markers, except a moderate increment in PAI-1. In contrast, oral estrogens elicited a decrement in both VIIa-rTF and PAI-1; however, those changes did not surpass normal limits. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of transdermal estradiol therapy (ET) on coagulation and fibrinolysis markers in postmenopausal women. Methods: Prospective open trial study in 59 healthy hysterectomized postmenopausal women. Thirty women received transdermal ET (50 μg per day) during 3 months and 29 women formed the untreated arm. Results: Baseline factor VII-tissue factor complex (VIIa-rTF), fibrinogen and plasminogen activator inhibitor-1 (PAI-1) levels decreased significantly (P<0.01) after therapy. In contrast, tissue-type plasminogen activator antigen (t-PA) levels increased significantly (P<0.01). After ET, there was no difference in protein C activity (PC), protein S activity (PS), plasminogen (PLG), and antithrombin III (ATIII) levels. None of participants reported thromboembolic events. Conclusion: ET elicited a decrement in blood biomarkers implicated in coagulation activation which in turn seemed to improve fibrinolytic activity. These results suggest that transdermal route does not impair thrombotic risk. [Copyright &y& Elsevier]

In this opinion article, it is discussed the importance of questioning the use of mammogram in the detection of breast cancer in asymptomatic women. [ABSTRACT FROM AUTHOR]

Background and Aims Pregnancy-related hypertensive disorders are complications in which risk factors are identified such as nulliparity, age, malnutrition, obesity and social issues. Those statements are explained by theories of abnormal placentation, immunological inadequacy, genetics and oxidative stress, but all theories converge in endothelial damage, which is able to mechanically deform and hemolyze erythrocytes as they pass through the capillaries. Given the effects of endothelial damage, the aim of the study was to determine erythrocyte alterations in peripheral blood smear of patients with hypertensive disorders of pregnancy that could be used as prognostic condition. Methods We performed a prospective, descriptive and observational study where all patients with hypertensive disorders admitted to the obstetrics and gynecology service of a specialty hospital were recruited. Patients who provided signed informed consent underwent peripheral blood smear. Results were tabulated in percentage graphics and analyzed with Cramer's V based on χ 2 . The peripheral blood smear consisted of an extended drop of peripheral blood from the patient with subsequent hematological staining done with Romanowsky stain. Results A total of 119 samples were analyzed; 74% showed abnormal morphology of erythrocytes and the most frequent abnormality was the presence of schistocytes in up to 39% of samples. Descriptive analysis showed a degree of association to independent variables with Cramer's V = 0.41 value ( p <0.05). Conclusions A high percentage of patients with hypertensive disorders of pregnancy show some morphologic alterations of erythrocytes in peripheral blood smear. [ABSTRACT FROM AUTHOR]

Background: diabetic neuropathy (DN) affects diverse aspects of patient's life and there is not an optimal treatment. It was done a comparative study of clinical improvement of DN with carbamazepine versus diclofenac was done. Methods: a prospective and longitudinal study, of two groups with signs and symptoms of DN was done. One group had 30 patients who used carbamazepine with an initial dose of 200 mg, every 24 hours for one week, with a gradual increase of up to 200 mg every 6 hours for 10 months. The other group had 29 patients who used diclofenac sodium 100 mg every 12 hours. Bimonthly evaluations were made to graduate the pain according to the patients' perception and laboratory studies that included glucose and lipids profile. The statistical test used was ANOVA. Results: the patients who used carbamazepine presented absence of pain after 10 months compared with the diclofenac group (p < 0.01). The presence of cramps, muscular strength, pulses, perception of temperature and pressure improved significantly (p < 0.05) with the use of carbamazepine. On the other hand, muscular strength, tact and perception of temperature were even deteriorated with the use of diclofenac. Conclusions: it is important to provide the appropriate treatment to diabetic patients with DN. [ABSTRACT FROM AUTHOR]

Human papilloma virus can infect any mucous of the body and to cause cancer of the uterine cervix. The last recommendation suggests making the Papanicolaou combined with a test for detection of human papillomavirus with a frequency interval of 3 years, since it grants greater information and fidelity of the result. The detection studies should begin at the age of 21 years and should stop the pursuit at 65 years age. Until recently specific treatments did not exist on this burden, but have arisen some drugs that have demonstrated good effectiveness to cure the infection for human papilloma virus, as the glycirrhicinic acid that has demonstrated less adverse effects, as well as the possibility of its systemic employment, that allows to arrive to the lesions with difficult to approach. The medical recommendations should be in constant revision, since the trial of the clinical can modify the interpretation, for what it is necessary to personalize each patient treatment. [ABSTRACT FROM AUTHOR]