RESUMO
OBJECTIVE: To evaluate the efficacy of sertraline versus placebo in the management of somatic and psychological complaints of the climacteric syndrome. METHODS: We conducted a randomized, double-blind, placebo-controlled trial. A total of 44 women with moderate to severe complaints, defined as 16 or more points according to the Menopause Rating Scale (MRS) considering only the psychological and somatic domains, were incorporated into the trial and randomized to receive either sertraline (50 mg/day) or placebo. Both groups were evaluated at baseline and after 45 and 90 days of treatment. A reduction of 50% or more in the score was considered as a successful response. RESULTS: Thirty-three patients finished the trial (16 in the sertraline group and 17 in the placebo group), showing an odds ratio of 7.94 (95% confidence interval 1.3-57.3), p = 0.0038 for the sertraline group, in spite of the prominent effect of placebo. CONCLUSIONS: Sertraline was more effective than placebo in the management of the somatic and psychological complaints of the climacteric syndrome.
Assuntos
Antidepressivos/uso terapêutico , Menopausa/fisiologia , Menopausa/psicologia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Método Duplo-Cego , Feminino , Fogachos/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Razão de Chances , PlacebosRESUMO
BACKGROUND: Double beam bone densitometry allows to select climacteric women who will benefit from hormone replacement. However, it is not always affordable in clinical practice. AIM: To study possible alternative markers of bone mineral density. PATIENTS AND METHODS: A retrospective survey of climacteric women in whom bone mineral density was measured when hormone replacement therapy was started. Eighty one women were studied and in 27, uterine size index was obtained from pelvic ultrasound examinations. Women with and without uterine size index measurements were analyzed separately. Relationships of bone mineral density with age, lapse from menopause, body mass index and uterine size index were sought. RESULTS: There was a significant regression between the lapse in years from menopause and lumbar bone mineral density in the group without uterine size index measurements (r2 = 0.228, ANOVA p = 0.014). There was also a significant regression of lumbar bone mineral density with the uterine size index (r2 = 0.236, ANOVA p = 0.01) in those women in whom this measurement was available. No other variables were associated with bone mineral density. CONCLUSION: In this group of patients, the lapse after menopause and uterine size index are predictors of lumbar bone mineral density (Rev Méd Chile 2000; 128: 1127-31).
Assuntos
Densidade Óssea , Climatério/fisiologia , Útero/anatomia & histologia , Adulto , Idoso , Análise de Variância , Índice de Massa Corporal , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/fisiopatologia , Densitometria , Feminino , Humanos , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Estudo comparativo, aberto, randomizado, foi conduzido em 10 centros da América Latina (oito no Brasil, um na Argentina e um no Chile), para avaliar a eficácia e segurança de dois sistemas transdérmicos para liberação de estradiol. Um total de 182 pacientes foi aleatoriamente distribuído para receber o sistema matricial (Climaderm-Wyeth-Ayerst) ou sistema clássico do tipo reservatório (Estraderm TTS 50 - Ciba-Geigy). Os sistemas foram aplicados na região inferior do abdome em áreas alternadas, durante seis ciclos consecutivos de 28 dias. Os sistemas liberavam aproximadamente, 50gr de estradiol por dia. Em ambos os grupos houve, em relação ao pré-tratamento, decréscimo significativo do número diário de fogachos nos ciclos de um a seis, porém houve, em relação ao sistema matricial, melhora significativa nos ciclos 4 (p = 0,033) e 6 (p = 0,046). Houve também diferença significativa entre os grupos com relação à fraqueza nos ciclos 2 (p = 0,019) e 3 (p + 0,015), fadiga no ciclo 2 (p = 0,033), interrupções do sono no ciclo 6 (p + 0,048), nervosismo no ciclo 3 (p = 0,045) e escore total nos ciclos 2 (p = 0,030) e 3 (p = 0,041), a favor do sistema matricial e 18 ( 21,2 por cento) do grupo medicado com o sistema reservatório abandonaram o tratamento
Assuntos
Humanos , Feminino , Administração Cutânea , Climatério/efeitos dos fármacos , Estradiol/administração & dosagem , Estradiol/uso terapêutico , Menopausa/efeitos dos fármacosRESUMO
The prevalence of steroid 21-hydroxylase (21-OHase) deficiency of late onset was investigated in a Chilean population of hirsute women. In 33 hirsute patients, not family related, plasma 17-alpha hydroxyprogesterone (170H-P) was measured under basal conditions and after ACTH stimulation. Three cases of complete deficiency of late onset or post menarche type were found, a prevalence of 91% similar to that reported by others. Affected patients were indistinguishable from other hirsute women, except in 170H-P concentrations after ACTH. Plasma testosterone and dihydroepiandrosterone sulphate were significantly higher in hirsute women, either deficient of without enzyme deficiency, compared with a control group of 19 normal women. The 170H-P post ACTH levels of hirsute women who did not comply with criteria for enzyme deficiency were similar to control's. However, in these patients there was a significant correlation between hirsutism and 170H-P post ACTH, suggesting the presence of patients with mild enzyme deficiency, perhaps heterozygous for the defective gene. In conclusion, measurement of basal and post ACTH 170H-P during diagnostic work up in hirsute patients allows the detection of a significant number of cases with enzyme deficiency.
Assuntos
Hiperplasia Suprarrenal Congênita , Hirsutismo/etiologia , 17-alfa-Hidroxiprogesterona , Adulto , Análise de Variância , Chile , Feminino , Hirsutismo/sangue , Humanos , Hidroxiprogesteronas/sangue , Testosterona/deficiênciaRESUMO
The efficacy of a new schedule for the use of Clomiphene citrate (50 mg daily, during the first ten days of the cycle) is reported, in relation to ovulation induction and fertility. We treated 41 patients with the syndrome of polycystic ovary, who were anovulant and desired fertility. Ovulation was successfully induced in 35 of them (85.4%). Pregnancy was achieved in 28 patients (68.3%). In 87.5% of those becoming pregnant, gestations was achieved with less than 6 months of treatment. Our results are equally good or better than those reported in the literature with conventional treatment. Pregnancies obtained were normal. No congenital malformations were observed. There were only two abortions, spontaneous. No patient presented ovarian hyperstimulation syndrome. This new schedule is recommended because it is effective and it may give less complications. Also, it is not necessary to increase progressively the dose of clomiphene citrate.