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1.
Gac Med Mex ; 160(2): 161-169, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39116865

RESUMO

BACKGROUND: Infertility increases stress and affects life quality. Mindfulness reduces stress and improves life quality, but its role in infertility remains unclear. OBJECTIVE: To evaluate the effect of mindfulness on stress and quality of life of women with infertility. MATERIAL AND METHODS: An exploratory clinical study was conducted in women under infertility treatment, together with an 8-week mindfulness intervention (MND) or only infertility treatment (CTRL). Anxiety and quality of life were assessed at baseline and at the end of intervention with IDARE and FertiQoL questionnaires respectively, as well as salivary alpha-amylase and cortisol concentrations. Non-parametric statistics was used for analysis using an alpha value of 0.10. RESULTS: 14 MND and 15 CTRL completed follow-up. At baseline, CTRL patients exhibited better quality of life than MND; anxiety scores correlated negatively with quality of life. At the end of intervention, cortisol concentrations (p = 0.097), and the increments of amylase (p = 0.039), were higher in CTRL than in MND. Increases in quality of life were associated with basal anxiety score (p = 0.002), improvements in tolerability (p < 0.001), and mindfulness intervention (p = 0.014). CONCLUSION: Our results suggest that mindfulness reduces stress and improves quality of life in women under infertility treatment.


ANTECEDENTES: La infertilidad incrementa el estrés y afecta la calidad de vida. OBJETIVO: Evaluar el efecto de mindfulness (atención plena) sobre la ansiedad, estrés y calidad de vida de mujeres infértiles. MATERIAL Y MÉTODOS: Estudio exploratorio en pacientes tratadas por infertilidad más una intervención de ocho semanas con mindfulness (grupo MND) o solo tratamiento de la infertilidad (grupo de control). Al inicio y después de ocho semanas se evaluaron la ansiedad (Inventario de Ansiedad Rasgo-Estado), la calidad de vida (FertiQoL), y las concentraciones salivales de α-amilasa y cortisol. Se utilizó estadística no paramétrica, con α = 0.10. RESULTADOS: 14 mujeres del grupo MND y 15 del grupo de control completaron el seguimiento. Al inicio, las pacientes del grupo de control mostraron mejor calidad de vida; las puntuaciones de ansiedad correlacionaron negativamente con la calidad de vida. Al final, el incremento de cortisol (p = 0.097) y amilasa (p = 0.039) fueron mayores en el grupo de control. Los incrementos en la calidad de vida se asociaron a ansiedad basal (p = 0.002), incremento en la subescala tolerabilidad (p < 0.001) y mindfulness (p = 0.014). CONCLUSIÓN: Los resultados sugieren que mindfulness disminuye el estrés y mejora la calidad de vida de pacientes bajo tratamiento de la infertilidad.


Assuntos
Ansiedade , Hidrocortisona , Infertilidade Feminina , Atenção Plena , Qualidade de Vida , Estresse Psicológico , Humanos , Feminino , Atenção Plena/métodos , Adulto , Infertilidade Feminina/terapia , Infertilidade Feminina/psicologia , Estresse Psicológico/terapia , Ansiedade/terapia , Ansiedade/etiologia , Inquéritos e Questionários , Seguimentos
2.
J Pers Med ; 13(9)2023 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-37763087

RESUMO

Polycystic ovary syndrome (PCOS) is often accompanied with metabolic disturbances attributed to androgen excess and obesity, but the contribution of each has not been defined, and the occurrence of metabolic disturbances is usually not investigated. Ninety-nine women with PCOS and forty-one without PCOS were evaluated. The clinical biomarkers of alterations related to glucose (glucose, insulin, and clamp-derived glucose disposal - M), liver (aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase), and endothelium (arginine, asymmetric dymethylarginine, carotid intima-media thickness, and flow-mediated dilation) metabolism were measured; participants were categorized into four groups according to their obesity (OB) and hyperandrogenemia (HA) status as follows: Healthy (no-HA, lean), HA (HA, lean), OB (no-HA, OB), and HAOB (HA, OB). Metabolic disturbances were very frequent in women with PCOS (≈70%). BMI correlated with all biomarkers, whereas free testosterone (FT) correlated with only glucose- and liver-related indicators. Although insulin sensitivity and liver enzymes were associated with FT, women with obesity showed lower M (coef = 8.56 - 0.080(FT) - 3.71(Ob); p < 0.001) and higher aspartate aminotransferase (coef = 26.27 + 0.532 (FT) + 8.08 (Ob); p = 0.015) than lean women with the same level of FT. Women with obesity showed a higher risk of metabolic disorders than lean women, independent of hyperandrogenemia. Clinicians are compelled to look for metabolic alterations in women with PCOS. Obesity should be treated in all cases, but hyperandrogenemia should also be monitored in those with glucose-or liver-related disturbances.

3.
Ginecol. obstet. Méx ; Ginecol. obstet. Méx;90(8): 701-705, ene. 2022. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1404962

RESUMO

Resumen ANTECEDENTES: El procedimiento quirúrgico del embarazo intersticial puede complicarse con hemorragia difícil de controlar; por esto en los últimos años se recurre a las técnicas que permiten el control hemostático, con lo que disminuyen la morbilidad y mortalidad relacionadas con el procedimiento. OBJETIVO: Describir el proceso para establecer el diagnóstico y decidir el tratamiento quirúrgico conservador en una paciente con embarazo intersticial con antecedente de salpingectomía homolateral y deseo de preservación uterina. CASO CLINICO: Paciente de 27 años, con antecedentes de un parto, tres abortos y un embarazo ectópico previo, con salpingectomía izquierda. Acudió a consulta debido a un retraso menstrual de siete semanas y dolor pélvico agudo. Ante la sospecha de embarazo ectópico se integró el protocolo diagnóstico. La cuantificación de la fracción-β de hormona gonadotropina coriónica fue de 8962 mlU/mL, el ultrasonido transvaginal reportó una imagen compatible con saco gestacional hacia la región del cuerno izquierdo y probable hemoperitoneo. En la laparotomía exploradora se encontraron: hemoperitoneo y embarazo intersticial izquierdo. Con el propósito de preservar la fertilidad se hizo una doble ligadura de la arteria uterina izquierda, a nivel de istmo uterino y del ligamento útero-ovárico y resección del saco gestacional intersticial, con cornuostomía. CONCLUSION: El embarazo intersticial es una urgencia obstétrica con alto riesgo de ruptura y hemorragia, por fortuna poco frecuente. La ligadura de las arterias uterinas, previa a la ablación quirúrgica del saco gestacional, es una alternativa individualizada en pacientes con esta complicación.


Abstract BACKGROUND: The surgical procedure of interstitial pregnancy can be complicated by bleeding that is difficult to control; for this reason, in recent years, techniques that allow hemostatic control to have been used, thus reducing morbidity and mortality related to the procedure. OBJECTIVE: To describe the process to establish the diagnosis and decide the conservative surgical treatment in a patient with interstitial pregnancy with a history of homolateral salpingectomy and desire for uterine preservation. CLINICAL CASE: 27-year-old patient, with a history of one childbirth, three miscarriages and a previous ectopic pregnancy, with left salpingectomy. She came for consultation due to a seven-week menstrual delay and acute pelvic pain. In view of the suspicion of ectopic pregnancy, the diagnostic protocol was integrated. The quantification of the β-fraction of chorionic gonadotropin hormone was 8962 mlU/mL, the transvaginal ultrasound reported an image compatible with gestational sac towards the left horn region and probable hemoperitoneum. At exploratory laparotomy, hemoperitoneum and left interstitial pregnancy were found. To preserve fertility, a double ligation of the left uterine artery at the level of the uterine isthmus and the utero-ovarian ligament and resection of the interstitial gestational sac with cornuostomy was performed. CONCLUSION: Interstitial pregnancy is an obstetric emergency with a high risk of rupture and hemorrhage, fortunately rare. Ligation of the uterine arteries, prior to surgical ablation of the gestational sac, is an individualized alternative in patients with this complication.

4.
Ginecol. obstet. Méx ; Ginecol. obstet. Méx;88(1): 48-53, ene. 2020. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1346140

RESUMO

Resumen ANTECEDENTES: Los leiomiomas uterinos son los tumores benignos ginecológicos más frecuentes en las mujeres en edad reproductiva; por tanto, son extremadamente raros en las adolescentes (menos de 1%) y solo se encuentran reportes de caso en la bibliografía. CASO CLÍNICO: Paciente de 16 años, con tumor suprapúbico de rápido crecimiento, acompañado de dolor abdominal generalizado, enviada a la unidad médica con diagnóstico de miomatosis uterina para descartar su malignidad. El ultrasonido pélvico reportó múltiples lesiones hipoecoicas diseminadas en el miometrio, similares a metástasis. La tomografía abdomino-pélvica informó hepatomegalia, a expensas del lóbulo izquierdo y leiomiomas intramurales de medianos y grandes elementos; los marcadores tumorales se encontraron en límites normales. En la laparotomía se encontró una tumoración interligamentaria izquierda de 25 cm; el estudio histopatológico reportó: leiomioma uterino de patrón histológico convencional. CONCLUSIONES: El cuadro clínico de los leiomiomas en adolescentes representa un reto clínico por la edad, signos, síntomas y necesidad de preservación de la función reproductiva, aspectos decisivos a la hora de decidir el tratamiento.


Abstract BACKGROUND: The uterine leiomyomas are the most common gynecological benign tumors in fertile females; however, they are very rare in adolescents (less than 1%) and there are only a few reports in the literature. CLINICAL CASE: A 16-year-old patient with a fast-growing suprapubic tumor, accompanied by generalized abdominal pain, sent to the hospital with diagnosis of pelvic tumor probable uterine miomatosis, to rule out malignant tumor. Pelvic ultrasound was performed with a report of multiple disseminated hypoechoic lesions in myometrium giving appearance of metastasis, without being the characteristic images of myomas, pelvic abdominal tomography reported hepatomegaly of the left lobe, intramural leiomyomas of medium and large elements, tumor markers within normal limits. The laparotomy was performed, left intraligamentary myoma of giant elements was located; and the histopathological study reported uterine leiomyoma of conventional histological pattern. CONCLUSIONS: The clinical of leiomyomas in adolescent patients represents a challenge for the gynecologist. The age, symptomatology, and preservation of reproductive function are important aspects to decide the therapeutic regimen.

5.
Gac Med Mex ; 153(Supl. 2): S34-S41, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-29099111

RESUMO

Objective: To evaluate the frequency of some subtle metabolic alterations in a group of adolescents with obesity and polycystic ovary syndrome (PCOS). Materials and Methods: A cross-sectional, comparative study was conducted in a group of adolescents with obesity, and characterized as with or without PCOS according with the Rotterdam Consensus. Medical history, anthropometry, gynecologic pelvic ultrasound (to evaluate ovarian volumes, number of antral follicles and endometrial width), as well as serum glucose, insulin, lipoproteins, interleukin-6, tumor necrosis factor alpha, total testosterone, dehydroepiandrosterone, sexual hormones binding globulin, leptin, adiponectin and insulin-like growth factor 1, the free-androgen index, free and available testosterone, and homeostatic model assessment index were calculated. For statistics, mean and standard deviation, or median and ranges were used for description as appropriate. Likewise, Student t-test or Mann-Whitney test were used for comparisons. Results: From a sample of 180 adolescents, 47 attached to selection criteria. Mean age was 13.5 year and Z-score 2.5. Eighty percent of adolescents presented central distribution of body fat and 95% hyperinsulinemia. The more frequent dyslipidemias were hypertriglyceridemia in 57% and hypercholesterolemia in 12.8%; 25.5% of adolescents presented two out of three criteria for polycystic ovary syndrome (PCOS). Body mass index and insulin were correlated with free testosterone, but the multivariate analysis demonstrated that the magnitude of the association was significantly higher in SOP patients. Conclusions: The metabolic alterations detected in obese adolescents with SOP suggest that the clinical manifestations that accompany the syndrome characterize the PCOS as a metabolic disease, which carry important health risks at short, medium and long term. Therefore, they merit intervening actions to prevent, diagnose and provide timing treatment in order to limit the damage in the course of the natural history of PCOS.


Assuntos
Dislipidemias/etiologia , Obesidade Infantil/complicações , Síndrome do Ovário Policístico/complicações , Adolescente , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Hipercolesterolemia/etiologia , Hiperinsulinismo/etiologia , Hipertrigliceridemia/etiologia , Insulina/sangue , Obesidade Infantil/sangue , Síndrome do Ovário Policístico/sangue , Testosterona/sangue
6.
Arch Med Res ; 47(7): 550-556, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-28262197

RESUMO

BACKGROUND AND AIMS: When pregnancy occurs in obese women, two opposite mechanisms for iron homeostasis concur: increased need for available iron to support erythropoiesis and decreased iron mobilization from diets and stores due to obesity-related inflammation linked to overexpressed hepcidin. Few studies have examined the role of hepcidin on maternal iron homeostasis in the context of obese pregnancy. The aim of the study was to evaluate the combined effect of maternal obesity and pregnancy on hepcidin and maternal iron status while accounting for inflammation and iron supplementation. METHODS: We conducted a secondary analysis of a cohort of pregnant women recruited from a referral obstetric hospital in Mexico City. Circulating biomarkers of iron status (hepcidin, ferritin [SF], transferrin receptor [sTfR], erythropoietin [EPO]), and inflammation (C-reactive protein [CRP], tumor necrosis factor-[TNF]α, and interleukin-[IL]6) were determined monthly throughout pregnancy. Repeated measures ANOVA and logistic regression models were used for statistics. RESULTS: Twenty-three obese (Ob) and 25 lean (Lc) women were studied. SF and hepcidin declined, and EPO and sTfR increased throughout pregnancy in both groups. sTfR increased more in Ob than in Lc (p = 0.024). The smallest hepcidin decline occurred in iron-supplemented Ob women compared to non-supplemented Lc women (p = 0.022). The risk for iron deficiency at the end of pregnancy was higher for Ob than for Lc (OR = 4.45, 95% CI = 2.07-9.58) after adjusting for iron supplementation and hepcidin concentration. CONCLUSION: Pre-gestational obesity increases the risk of maternal iron deficiency despite iron supplementation. Overexpressed hepcidin appears to be a potential mechanism.


Assuntos
Ferro/sangue , Obesidade/sangue , Complicações na Gravidez/sangue , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Suplementos Nutricionais , Eritropoetina/sangue , Feminino , Ferritinas/sangue , Hepcidinas/metabolismo , Homeostase , Humanos , Deficiências de Ferro , Ferro da Dieta , México , Gravidez , Receptores da Transferrina/sangue
7.
Ginecol Obstet Mex ; 83(7): 393-9, 2015 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-26422909

RESUMO

BACKGROUND: Almost 10% of women in reproductive age had a chronic disease, and contraception is frequently ignored by these patients. The lack of use of contraceptives methods has a higher repercussion in these patients; if pregnant, the risk is increased in morbidity and feto-maternal mortality. OBJECTIVES: to know the contraceptive coverage in women with chronic degenerative diseases, the kind of contraceptive methods and the unsatisfied demand. MATERIAL AND METHODS: A descriptive study was made with the application of a survey from the one elaborated by the IMSS. It explores contraception socio-demographic data, causes of non-protection and also explores Medical Doctor (MD) participation. Sample size was calculated in 385 women in reproductive age with a chronic disease. RESULTS: 428 women about 30-49 years old were interviewed, 53% of them were married, they had various diseases, the contraceptive coverage was 84%. The definitive methods were the most used with 47%, followed by the condom with 20%, intrauterine device with 13% and others in minor proportion. 38.5% of patients with sexual life have risk of pregnancy for lack of use of method or for using one of low effectiveness and continuity. Of 45 (16%) patients with sexual life that did not use methods, 29% because they wish pregnancy, 18% by collateral effects and the rest for other causes. From this same patients 21 wished getting pregnant and 24 did not, this is an unsatisfied demand of 53%. The MD's informed about risks in case of pregnancy of 83.4% of the patients. CONCLUSIONS: The contraceptive coverage is low and the unsatisfied demand is higher than in the general population. It requires the effective participation of health personal in this group of high reproductive risk.


Assuntos
Anticoncepção/métodos , Comportamento Sexual , Adolescente , Adulto , Doença Crônica , Coleta de Dados , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
8.
Ginecol Obstet Mex ; 83(6): 329-39, 2015 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-26285484

RESUMO

BACKGROUND: Preeclampsia is a pregnancy-related pathological condition triggered by an abnormal placentation which produces endothelial dysfunction (ED). ED, in turn, is associated with an increase in homocysteine (hcy) and asymmetric dimethylarginine (ADMA); these molecules are also increased when some of the B-vitamins are deficient. It is unclear whether increases in hcy and ADMA during preeclampsia are the result of ED, or the consequence of a B-vitamin deficiency. OBJECTIVE: To evaluate hcy, ADMA, folic acid (FA), vitamin B6 and B2 concentrations in patients with preeclampsia. METHODS: In a cross-sectional design 19 patients with severe preeclamp- sia (preeclampsia) and 57 with normal pregnancy (no-preeclampsia), paired by gestational age and body mass index, were studied. Plasma hcy, ADMA, FA and vitamins B6 and B12 were determined. Non-parametric statistics was used for between-groups comparisons and regression analyses to evaluate interactions among molecules. RESULTS: 72% of women were vitamin B deficient, 40% were deficient of B12 and 4% of FA. Preeclamptic patients presented hcy and ADMA concentrations higher than no-preeclamptic ones. Inferential analyses demonstrated that: hcy and ADMA are increased during preeclampsia independently from vitamins blood concentration; that the risk for pre- eclampsia is associated with high hcy but not with vitamins deficiency; and that the ratio L-arginine:ADMA decreases the preeclampsia risk. CONCLUSION: In patients with preeclampsia, increases of hcy and ADMA are associated with ED, but not with deficiency of the vitamins involved in their metabolism.


Assuntos
Arginina/análogos & derivados , Homocisteína/sangue , Pré-Eclâmpsia/fisiopatologia , Complexo Vitamínico B/sangue , Adolescente , Adulto , Antioxidantes/metabolismo , Arginina/sangue , Biomarcadores/metabolismo , Estudos Transversais , Feminino , Humanos , Gravidez , Estudos Prospectivos , Análise de Regressão , Deficiência de Vitaminas do Complexo B/epidemiologia , Adulto Jovem
9.
Reprod Health ; 12: 45, 2015 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-25981399

RESUMO

BACKGROUND: To compare the expression of receptivity markers in epithelial and stromal cells in the endometrium of ovulatory women and infertile with hypothalamic pituitary dysfunction (HPD), untreated or treated with clomiphene citrate (CC), or with recombinant follicle stimulating hormone (rFSH). METHODS: Twelve control ovulatory and 32 anovulatory women, 22 of whom received ovulation induction with CC (n = 12) or rFSH (n = 10). Endometrial biopsies were obtained during the mid-secretory phase. Hormonal secretion was measured by chemiluminescence immunoassay, endometrial dating and cellular expression and distribution of receptivity proteins were evaluated by quantitative immunohistochemistry. RESULTS: CC or rFSH treatments, modified the expression of epithelial receptivity markers, such as Glycodelin A, beta-catenin, CD166/ALCAM and IGF-1R, but not in stromal markers. Also, a change in their cell distribution was observed. CONCLUSIONS: Treatment of infertile women with HPD modified the expression and distribution of receptivity markers in the mid-secretory phase of the endometrium in epithelial but not stromal cells, which can help to explain changes in the receptivity of the endometrium during treatments and suggest an important role of these cells in the receptivity window.


Assuntos
Biomarcadores/metabolismo , Implantação do Embrião/efeitos dos fármacos , Endométrio/patologia , Células Epiteliais/patologia , Fármacos para a Fertilidade Feminina/uso terapêutico , Infertilidade Feminina/patologia , Indução da Ovulação/métodos , Adulto , Estudos de Casos e Controles , Clomifeno/uso terapêutico , Endométrio/efeitos dos fármacos , Endométrio/metabolismo , Células Epiteliais/metabolismo , Feminino , Hormônio Foliculoestimulante/uso terapêutico , Seguimentos , Humanos , Hipotálamo/efeitos dos fármacos , Hipotálamo/metabolismo , Hipotálamo/patologia , Técnicas Imunoenzimáticas , Infertilidade Feminina/tratamento farmacológico , Infertilidade Feminina/metabolismo , Hipófise/efeitos dos fármacos , Hipófise/metabolismo , Hipófise/patologia , Proteínas Recombinantes/metabolismo
10.
Rev Med Inst Mex Seguro Soc ; 53(2): 214-25, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25760751

RESUMO

Post-menopause is the period of life where a deep decline occurs in circulating estrogen levels, inducing the appearance of psycho and somatic symptoms. The classification to understand the chronology of reproductive aging in women (known as STRAW) determines the clinical and endocrine changes contemplating menstrual cycles, symptoms, measurements of FSH, LH, inhibin B, anti-Mullerian hormone , and follicular account. The diagnosis of menopause is established by the absence of menstruation for 12 months or more. The most frequent clinical manifestations of the climacteric syndrome transition to menopause are menstrual disorders, vasomotor symptoms (flushes and/or sweats) and genitourinary manifestations. The assessment of women in the peri- or postmenopause aims to develop: cervicovaginal cytology , lipid profile , serum glucose, basal Mammography at least a year before, pelvic ultrasound, urinalysis, serum TSH, Densitometry in patients older than 60 years if there is no recourse can be applied and FRAX. Drug therapy for the treatment of disorders of the transition to menopause or menopause is divided into: hormone therapy (HT) based estrogens and progestin hormone not being the most recommended the serotonin reuptake inhibitors and norepinephrine, clonidine, gabapentin or veralipride.


La posmenopausia es el periodo de la vida en el que ocurre un profundo descenso en las concentraciones circulantes de estrógenos, lo cual induce la aparición de los síntomas psico y somáticos. La clasificación para entender la cronología del envejecimiento reproductivo en la mujer (reconocida como STRAW) determina los cambios clínicos y endocrinos a partir de examinar los ciclos menstruales, los síntomas, las mediciones de FSH, LH, inhibina B, hormona antimulleriana y la cuenta folicular. El diagnóstico de menopausia se establece por la ausencia de menstruación por 12 meses o más. Las manifestaciones clínicas más frecuentes del síndrome climatérico o transición a la menopausia son los trastornos menstruales, los síntomas vasomotores (bochornos o sudoraciones) y las manifestaciones genitourinarias. La evaluación de la mujer en la peri o la postmenopausia contempla la realización de citología cervicovaginal, perfil de lípidos, glucosa sérica, mastografía basal (por lo menos un año antes), ultrasonido pélvico, examen general de orina, TSH sérica, densitometría (ver la Guía de práctica clínica de osteoporosis) en pacientes mayores de 60 años (y si no se cuenta con el recurso se puede aplicar el FRAX). El tratamiento farmacológico para las alteraciones de la menopausia (o de la transición a esta) se divide en: tratamiento hormonal (TH) con base en estrógenos o progestágenos, y tratamiento no hormonal; los más recomendados son los inhibidores de recaptura de serotonina y norepinefrina, clonidina, gabapentina o veraliprida.


Assuntos
Doenças Urogenitais Femininas , Fogachos , Menopausa/fisiologia , Distúrbios Menstruais , Osteoporose Pós-Menopausa , Feminino , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/etiologia , Doenças Urogenitais Femininas/terapia , Fogachos/diagnóstico , Fogachos/etiologia , Fogachos/terapia , Humanos , Distúrbios Menstruais/diagnóstico , Distúrbios Menstruais/etiologia , Distúrbios Menstruais/terapia , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/terapia , Pós-Menopausa/fisiologia , Síndrome
11.
Ginecol Obstet Mex ; 82(2): 123-42, 2014 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-24779268

RESUMO

BACKGROUND: Hyperprolactinemia is a common finding within clinical practice in both endocrinology and general practice fields, amongst other specialties. The general practitioner and other specialists must know the indications and serum prolactin determination parameters in order to, once detected, derive the patient for a correct assessment and begin treatment. OBJECTIVE: Formulate a clinical practice guideline evidence-based for the diagnosis and treatment of hyperprolactinemia. METHOD: It took the participation of eight gynecologists, two pathologists and a pharmacologist in the elaboration of this guideline due their experience and clinical judgement. These recommendations were based upon diagnostic criteria and levels of evidence from treatment guidelines previously established, controlled clinical trials and standardized guides for adolescent and adult population with hyperprolactinemia. RESULTS: During the conformation of this guideline each specialist reviewed and updated a specific topic and established the evidence existent over different topics according their field of best clinical expertise, being enriched by the opinion of other experts. At the end, all the evidence and decisions taken were unified in the document presented here. CONCLUSIONS: It is presented the recommendations established by the panel of experts for diagnosis and treatment of patients with high levels of prolactin; also the level of evidence for the diagnosis of hyperprolactinemia, handling drug-induced hyperprolactinemia and prolactinomas in pregnant and non-pregnant patients.


Assuntos
Hiperprolactinemia/terapia , Guias de Prática Clínica como Assunto , Prolactinoma/terapia , Adolescente , Adulto , Medicina Baseada em Evidências , Feminino , Humanos , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/fisiopatologia , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/terapia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Prolactina/metabolismo , Prolactinoma/diagnóstico , Prolactinoma/patologia
12.
Ginecol Obstet Mex ; 82(2): 143-53, 2014 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-24779269

RESUMO

It has been reported that infertility affects approximately 20% of couples in reproductive age around the world. Although many factors involved, ovulatory dysfunction and particularly the hypothalamus pituitary dysfunction are quite common. The first line treatment for these pathologies consists on the administration of inducing ovulation agents such as recombinant gonadotropins and clomiphene citrate which it was obtained high rates of ovulation but not of pregnancy. So determine the effect of these treatments on the endometrium at morphological and molecular level is very important to understand the female reproductive physiology and optimize clinical strategies to obtain better pregnancy rates after treatments. In this paper we detailed the studies that have reported changes at the molecular and morphological level in human endometrium.


Assuntos
Clomifeno/farmacologia , Fármacos para a Fertilidade Feminina/farmacologia , Hormônio Foliculoestimulante/farmacologia , Infertilidade Feminina/tratamento farmacológico , Endométrio/efeitos dos fármacos , Endométrio/metabolismo , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez , Proteínas Recombinantes/farmacologia
13.
Ginecol Obstet Mex ; 82(12): 785-90, 2014 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-25826962

RESUMO

OBJECTIVE: To assess IR in PCOS patients, using the HE-clamp as the IR gold standard. MATERIAL AND METHODS: A transversal design was done. All patients who accepted to participate provided written informed consent. PCOS was diagnosed according to the 2003 Rotterdam criteria. IR was assessed using the H-clamp, and other IR surrogates such as; fasting plasma insulin (FPI), homeostasis model assessment (HOMA) index and insulin/ glucose rate (I/G rate). Statistical analysis was performed using measures of location and spread was used according to data distribution. RESULTS: 21 patients were included. The mean age of the total group studied was 29.5 +/- 4.8 years, and the body mass index (BMI) was 27.2 +/- 3.08 kg/m2. The 85.7% of the patients met the three Rotterdam criteria for the diagnosis of PCOS. According to the HE clamp 95.2% were IR (M/I value < 6 mg/Kg/min), in contrast the prevalence of IR using sur- rogates was 47.6%, 33.3%, and 66.6% for FPI, G/I rate, and HOMA index respectively. CONCLUSIONS: Our findings show that IR is highly prevalent in patients with PCOS, and that this prevalence is even higher when insulin sensitivity is assessed using the glucose clamp technique. This evidence suggests that IR could be considered diagnostic criteria for PCOS.


Assuntos
Resistência à Insulina , Síndrome do Ovário Policístico/metabolismo , Adulto , Estudos Transversais , Feminino , Técnica Clamp de Glucose , Humanos , Síndrome do Ovário Policístico/sangue , Adulto Jovem
14.
Gene ; 511(2): 404-10, 2012 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-23036713

RESUMO

Lipoprotein lipase (LPL) plays a pivotal role in lipid metabolism, contributes to metabolic disorders related to insulin action and body weight regulation, and is influenced by inflammation. The Pro12Ala polymorphism of the peroxisome proliferator-activated receptor (PPAR)γ2 gene seems to influence LPL functioning, but its role in obesity and insulin resistance status, which usually coexist in the clinical setting, has not been explored. Our aim was to analyze the association of obesity and insulin resistance with adipose LPL activity and expression, and the influence of the PPARγ2 Pro12Ala polymorphism. A cross-sectional study was conducted in 58 reproductive-age women who underwent elective abdominal surgery. Free-fatty acids, glucose, insulin, and selected adipokines were measured in fasting blood samples. DNA was isolated and the polymorphism genotyped. Biopsies of abdominal subcutaneous adipose tissue obtained during surgery were used to determine enzymatic LPL activity and expression; and expression of selected cytokines. Overweight/obese women presented lower LPL activity (P=0.022) and higher circulating TNF-α (P=0.020) than controls. Insulin resistant women also showed borderline lower LPL activity than non-resistant (P=0.052), but adiposity and inflammatory molecules were comparable. Nevertheless, LPL activity was higher in Pro12Ala carriers than in non-carriers after adjusting for obesity, insulin resistance and inflammation. Likewise, adipose LPL expression was increased in carriers while expression of cytokines was decreased. Our data suggest that insulin resistance is associated with low adipose LPL activity independently of obesity, but the PPARγ2 Pro12Ala polymorphism seems to protect the LPL functioning of obese insulin resistant women, likely through regulating inflammation in adipose tissue.


Assuntos
Tecido Adiposo/enzimologia , Alanina/genética , Resistência à Insulina , Lipase Lipoproteica/metabolismo , Obesidade/metabolismo , PPAR gama/genética , Prolina/genética , Adulto , Sequência de Bases , Primers do DNA , Feminino , Humanos , Lipase Lipoproteica/química , Lipase Lipoproteica/genética , Pessoa de Meia-Idade , Obesidade/enzimologia , Obesidade/genética , PPAR gama/química , Reação em Cadeia da Polimerase
15.
Ginecol Obstet Mex ; 80(7): 454-60, 2012 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-22916638

RESUMO

BACKGROUND: The role of insulin resistance (IR) of infertile patients with chronic anovulation in their therapeutic failure to clomiphene citrate (CC) is not quite clear. OBJECTIVE: Determine the sensitivity to insulin in patients with chronic anovulation and failure to the treatment with clomiphene citrate. MATERIAL AND METHODS: A cross-sectional clinical study in infertile patients with clomiphene citrate resistance and in patients with adequate response to clomiphene citrate was carried out. In all patients insulin resistance was determined by the rate of glucose/insulin, HOMA (Homestatic Model Assessment) and the insulin sensitivity test. For the inferential statistical analysis, a Student's t test for independent samples was used. RESULTS: The average total basal insulin was 19.6 +/- 8.1 microU/mL. We observed higher concentrations in the clomiphene citrate resistance group (22.1 +/- 8.9 vs. 15.8 +/- 5.1 mU/mL p = 0.07). The glucose/insulin rate was statistically minor in patients with resistance to clomiphene citrate (4.2 +/- 1.9 versus 6.9 +/- 2.1 p = 0.02), but HOMA was not significantly different in both groups (4.3 +/- 1.4 vs. 3.9 +/- 1.3 p = 0.6). The total rate of glucose disappearance (KIIT) was 4.1 +/- 1.2. However, the statistical analysis did not show significant statistical differences between the two groups. CONCLUSIONS: Our preliminary results suggest that insulin resistance can be a mechanism involved in the pharmacologic response to ovulation induction in infertile patients, but coexisting pathophysiological mechanisms such as hyperandrogenism might also account for the lack of response to clomiphene citrate.


Assuntos
Anovulação/tratamento farmacológico , Anovulação/metabolismo , Clomifeno/uso terapêutico , Fármacos para a Fertilidade Feminina/uso terapêutico , Infertilidade Feminina/tratamento farmacológico , Resistência à Insulina , Indução da Ovulação , Adulto , Anovulação/complicações , Estudos Transversais , Feminino , Humanos , Infertilidade Feminina/etiologia , Falha de Tratamento
16.
Cir Cir ; 79(5): 432-8, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-22385763

RESUMO

BACKGROUND: Plasma homocysteine (Hcy) determination at 6-8 h after an oral methionine load (OML) allows for identification of some, but not all, individuals at risk to develop cardiovascular disease. It is probable that in some cases the Hcy increases occur later, or it elevates between normal ranges but in a sustained manner. However, the entire Hcy response curve has not been described. We undertook this study to determine Hcy concentrations from baseline to 24- and 48-h after an OML in non-B-vitamin deficient adult subjects with other risk factors for high levels of Hcy such as smoking and overweight. METHODS: In a cross-over, clinical design, Hcy concentrations were determined at 2-h intervals throughout 12 h and at 24 h and 48 h after an OML (0.1 g/kg). Hcy and vitamin B6 (VB6) concentrations were measured by high-performance liquid chromatography (HPLC). Folic acid (FA) and vitamin B12 (VB12) were measured by radioimmunoassay (RIA). Statistical analysis included delta values and areas under the curve. Student t-test and repeated measurement analyses were conducted to control for confounders. RESULTS: Twenty-nine subjects with adequate Hcy, FA, VB6 and VB12 status were included. The maximum Hcy concentration occurred 8 h after the load and returned to baseline concentrations after 24 h. All subjects presented Hcy after the load within normal ranges, but smoking and overweight synergistically influenced the response to the challenge, producing a sustained elevation after the dose. CONCLUSIONS: Hcy concentrations after an OML remained above baseline for at least 24 h. Smoking and overweight affected the response to the methionine challenge.


Assuntos
Doenças Cardiovasculares/sangue , Homocisteína/sangue , Metionina , Vitamina B 12/sangue , Vitamina B 6/sangue , Adulto , Doenças Cardiovasculares/epidemiologia , Estudos Cross-Over , Suscetibilidade a Doenças , Diagnóstico Precoce , Feminino , Ácido Fólico/sangue , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Prognóstico , Fatores de Risco , Fumar/epidemiologia , Fatores de Tempo , Adulto Jovem
17.
Ginecol Obstet Mex ; 76(11): 659-66, 2008 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-19065817

RESUMO

BACKGROUND: Women's reproductive potential is closely related to nutritional status. Some of the molecules that participate in ovarian regulation are produced in the adipose tissue, and therefore their production is associated with adiposity. OBJECTIVE: To determine serum leptin, adiponectin, C-reactive protein, interleukin-6, and tumor necrosis factor alpha in infertile women with or without insulin resistance; and to associate these molecules with adiposity. METHODS: Thirty-one infertile women were included. Nutritional status was evaluated through clinical and biochemical parameters. Patients were stratified according with their body mass index and the presence of insulin resistance. For statistics, parametric analyses were conducted. RESULTS: The prevalence of overweight was 67.5%; high adiposity was present in 92.3% and central distribution of fat in 96.2% of studied women. Hypercholesterolemia was found in 32.3% of patients, hypertriglyceridemia in 25.8%, and 61.3% presented hyperinsulinemia. Overweight women presented lower adiponectin, and higher TNF-alpha and C-reactive protein concentrations, than those with normal body mass index (p < 0.05). Overweight women had also a higher probability for insulin resistance (p = 0.04). These women with insulin resistance presented lower adiponectin and higher C-reactive protein concentrations than non insulin resistance women. Body mass index correlated with leptin (r= 0.41), TNF-alpha (r= 0.41), and C-reactive protein (r= 0.33) concentrations. CONCLUSION: The prevalence of overweight, high adiposity, dislipidemias, and IR was high in our population studied. We conclude that adiposity is closely associated with some of the molecules that participate in the reproductive process and that also regulate inflammatory responses.


Assuntos
Adiponectina/sangue , Proteína C-Reativa/análise , Infertilidade Feminina/sangue , Infertilidade Feminina/metabolismo , Resistência à Insulina , Interleucina-6/sangue , Leptina/sangue , Fator de Necrose Tumoral alfa/sangue , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Adulto Jovem
18.
Obesity (Silver Spring) ; 16(10): 2296-301, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18719664

RESUMO

Common polymorphisms in the fat mass and obesity-associated gene (FTO) have shown strong association with obesity in several populations. In the present study, we explored the association of FTO gene polymorphisms with obesity and other biochemical parameters in the Mexican population. We also assessed FTO gene expression levels in adipose tissue of obese and nonobese individuals. The study comprised 788 unrelated Mexican-Mestizo individuals and 31 subcutaneous fat tissue biopsies from lean and obese women. FTO single-nucleotide polymorphisms (SNPs) rs9939609, rs1421085, and rs17817449 were associated with obesity, particularly with class III obesity, under both additive and dominant models (P = 0.0000004 and 0.000008, respectively). These associations remained significant after adjusting for admixture (P = 0.000003 and 0.00009, respectively). Moreover, risk alleles showed a nominal association with lower insulin levels and homeostasis model assessment of B-cell function (HOMA-B), and with higher homeostasis model assessment of insulin sensitivity (HOMA-S) only in nonobese individuals (P (dom) = 0.031, 0.023, and 0.049, respectively). FTO mRNA levels were significantly higher in subcutaneous fat tissue of class III obese individuals than in lean individuals (P = 0.043). Risk alleles were significantly associated with higher FTO expression in the class III obesity group (P = 0.047). In conclusion, FTO is a major risk factor for obesity (particularly class III) in the Mexican-Mestizo population, and is upregulated in subcutaneous fat tissue of obese individuals.


Assuntos
Obesidade/etnologia , Obesidade/genética , Polimorfismo de Nucleotídeo Único , Proteínas/genética , Adulto , Dioxigenase FTO Dependente de alfa-Cetoglutarato , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/genética , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , RNA Mensageiro/análise , Medição de Risco , Fatores de Risco , Gordura Subcutânea/química , Regulação para Cima
19.
Fertil Steril ; 86(1): 176-85, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16730720

RESUMO

OBJECTIVE: To determine DNA fragmentation and several molecules associated with apoptosis or proliferation in ovaries of patients with diminished ovarian reserve. DESIGN: Cross-sectional analysis. SETTING: Tertiary institutional hospital. PATIENT(S): Patients with benign uterine pathology who had undergone a hysterectomy and oophorectomy were categorized by the citrate clomiphene challenge test in diminished ovarian reserve or control group. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Apoptosis was determined using TUNEL (terminal deoxynucleotidyl transferase biotin-dUTP nick end-labeling) assay and p53, p27, Bax, caspase-3, caspase-8, caspase-9, Fas-L, Bcl-2, GATA-4, Ki-67, proliferating-cell nuclear antigen (PCNA), estrogen receptor, P receptor, and androgen receptor expression by immunohistochemistry. RESULT(S): Fifteen patients were studied. DNA fragmentation and expression of Bax, caspase-3, caspase-8, caspase-9, Fas-L, Bcl-2, GATA-4, Ki-67, and PCNA were observed in the whole ovary in both groups. In the control group, the expression of caspase-3 and caspase-8 in the ovarian stroma was significantly higher. CONCLUSION(S): DNA fragmentation and the expression of several molecules that participate in ovarian proliferation or apoptosis are present in cycling ovaries, but these markers were not significantly different in patients with diminished ovarian reserve. Thus, the mechanism leading to diminished ovarian reserve does not involve an easily detectable dysregulation in apoptosis or proliferation of ovarian follicles.


Assuntos
Proteínas Reguladoras de Apoptose/metabolismo , Substâncias de Crescimento/metabolismo , Infertilidade Feminina/metabolismo , Infertilidade Feminina/patologia , Ovário/metabolismo , Ovário/patologia , Adulto , Apoptose , Biomarcadores/metabolismo , Proliferação de Células , Células Cultivadas , Estudos Transversais , Feminino , Humanos , Técnicas In Vitro
20.
Ginecol Obstet Mex ; 73(3): 117-23, 2005 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-21961348

RESUMO

OBJECTIVE: To describe nutritional status, B6, B12, and antioxidant vitamins, as well as homocysteine concentrations in postmenopausal women. PATIENTS AND METHODS: A cross-sectional study was conducted in Mexico City. One hundred twenty-five women were selected if they were healthy and were in their first five years after menopause onset. Women were spontaneously divided in two groups: women who did not receive any hormonal treatment for at least six months before the study (n = 66), and those who received hormonal treatment at the moment of the study (n = 59). Anthropometry was measured and a fasting blood sample from a peripheral vein was obtained to determine homocysteine, vitamins A, C, E, B6, B12, and folic acid. Results were compared with Student t-test, and a logistic regression model was used to calculate the risk of hyperhomocystinemia after adjusting by some potential confounders. RESULTS: Women who did not receive hormone replacement therapy presented higher body mass index and waist-hip ratio than those who received such treatment. In contrast, this group presented higher prevalence of folic acid deficiency and hyperhomocystinemia, despite they consumed higher amounts of folic acid in the diet. This high risk of hyperhomocystinemia was independent of vitamin serum concentrations and the level of physical activity (OR = 15.1, IC95 = 1.60,141.9). CONCLUSIONS: These results suggest that hormone replacement therapy may protect against overweight and central fat distribution that occur after menopause, but increases the risk of hyperhomocystinemia.


Assuntos
Antioxidantes/análise , Ácido Fólico/sangue , Homocisteína/metabolismo , Pós-Menopausa/sangue , Vitamina B 12/sangue , Vitamina B 6/sangue , Gordura Abdominal , Índice de Massa Corporal , Estudos Transversais , Estrogênios/uso terapêutico , Feminino , Ácido Fólico/farmacocinética , Deficiência de Ácido Fólico/epidemiologia , Terapia de Reposição Hormonal , Humanos , Hiper-Homocisteinemia/epidemiologia , Hiper-Homocisteinemia/etiologia , Pessoa de Meia-Idade , Atividade Motora , Sobrepeso/epidemiologia , Sobrepeso/prevenção & controle , Progesterona/uso terapêutico , Risco , População Urbana , Relação Cintura-Quadril
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