Semana del 10 al 16 de enero de 2018 Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile   J Bone Miner Res. 2018 Jan 12. doi: 10.1002/jbmr.3384. [Epub ahead of print] Effects of Teriparatide Compared with Risedronate on the Risk of Fractures in Subgroups of Postmenopausal Women with Severe Osteoporosis: The VERO Trial. Geusens P, Marin F, Kendler DL, Russo LA, Zerbini CAF, Minisola S, Body JJ, Lespessailles E, et al. The 2-year, randomized, double-blind, active-controlled fracture endpoint VERO study included postmenopausal women with established osteoporosis, who had at least 2 moderate or 1 severe baseline vertebral fractures (VFx), and BMD T-score ≤-1.5. Patients were treated with either s.c. daily teriparatide 20 μg or oral weekly risedronate 35 mg. As previously reported, the risk of new VFx and clinical fractures (a composite of clinical VFx and non vertebral fragility fractures [NVFFx]) was statistically significantly reduced with teriparatide compared with risedronate. Here we present the prospectively planned subgroup analyses of fracture data across subgroups which were predefined by the following baseline characteristics: age, number and severity of prevalent VFx, prevalent non vertebral fractures (NVFx), glucocorticoid use, prior osteoporosis drugs, recent bisphosphonate use, clinical VFx in the year before study entry, and baseline BMD. Heterogeneity of the treatment effect on the primary endpoint (new VFx), and the 4 key secondary endpoints (including clinical fractures and NVFFx) were investigated by logistic and Cox proportional hazards regression models. 1,360 women were randomized and treated (680 per group). Mean age was 72.1 years, mean (SD) number of prevalent VFx was 2.7 (2.1), 55.4% had a BMD T score <-2.5, 36.5% had a recent clinical VFx, 28.3% had a prior major NVFx, 43.2% were osteoporosis drug naïve, 39.3% were recent bisphosphonate users, and 9.3% were taking glucocorticoids at a prednisone-equivalent dose of >5 mg/day. For most fracture endpoints, the risk reduction of teriparatide versus risedronate did not significantly differ in any of the subgroups analyzed (treatment-by-subgroup interaction p>0.1), with most subgroups mirroring results from the total study population. In conclusion, in postmenopausal women with severe osteoporosis, the anti-fracture efficacy of teriparatide compared with risedronate was consistent in a wide range of patient settings including treatment-naïve and previously treated patients.   Horm Metab Res. 2018 Jan;50(1):17-22. doi: 10.1055/s-0043-123265. Epub 2018 Jan 12. Association Between Body Weight Change Before and After Delivery and Development of Nonmetabolic Syndrome: A Prospective Study. Ya Z, Yue Z, Dan L, Neng-Bo L, Yi L, Ying M, Qin W. The aim of the work was to investigate the association between body weight change before and after delivery and development of nonmetabolic syndrome in Chinese females aged ≥40 years. We selected 789 participants without metabolic syndrome randomly from a baseline survey performed in Luzhou, China in 2011. We took the group with decreasing or no increasing body mass index difference during a pregnancy as «R-Body Mass Index 1» (n=286) and divided the group with increasing body mass index difference during a pregnancy into «R-Body Mass Index 2» (n=254) and «R-Body Mass Index 3» (n=249) based upon P50. All study participants were followed up every year, and a questionnaire, physical examination, and biochemical detection were administered after 3 years. Of 789 participants, 82 nonmetabolic syndrome women developed metabolic syndrome during 3-year follow-up. The morbidity of metabolic syndrome in the R-BMI1, R-BMI2, and R-BMI3 groups was 5.2%, 11.8%, and 14.9%, respectively. Compared to the R-BMI1 group, the relative risk for R-BMI2 was 1.92 (95% confidence interval: 1.03-3.58, p=0.040) and for R-BMI3 was 2.20 (95% confidence interval: 1.20-4.03, p=0.011). After adjusting for age, BMI, WHR, baseline blood glucose, HbA1c, TG, HDL-C, SBP, DBP, age of menarche and menopause, and delivery times, the relative risks were similar to the unadjusted relative risks. In conclusion, body weight change after delivery was associated with metabolic syndrome: the higher the weight gain, the higher the risk of metabolic syndrome.   Womens Midlife Health. 2017;3. pii: 2. doi: 10.1186/s40695-017-0021-y. Epub 2017 Jul 27. It is not just menopause: symptom clustering in the Study of Women’s Health Across the Nation. Harlow SD, Karvonen-Gutierrez C, Elliott MR, Bondarenko I, Avis NE, Bromberger JT, Brooks MM, et al. Patterns of symptom clustering in midlife women may suggest common underlying mechanisms or may identify women at risk of adverse health outcomes or, conversely, likely to experience healthy aging. This paper assesses symptom clustering in the Study of Women’s Health Across the Nation (SWAN) longitudinally by stage of reproductive aging and estimates the probability of women experiencing specific symptom clusters. We also evaluate factors that influence the likelihood of specific symptom clusters and assess whether symptom clustering is associated with women’s self-reported health status. Methods: This analysis includes 3289 participants in the multiethnic SWAN cohort who provided information on 58 symptoms reflecting a broad range of physical, psychological and menopausal symptoms at baseline and 7 follow-up visits over 16 years. We conducted latent transition analyses to assess symptom clustering and to model symptomatology across the menopausal transition (pre, early peri-, late peri- and post-menopausal). Joint multinomial logistic regression models were used to identify demographic characteristics associated with premenopausal latent class membership. A partial proportional odds regression model was used to assess the association between latent class membership and self-reported health status. Results: We identified six latent classes that ranged from highly symptomatic (LC1) across most measured symptoms, to moderately symptomatic across most measured symptoms (LC2), to moderately symptomatic for a subset of symptoms (vasomotor symptoms, pain, fatigue, sleep disturbances and physical health symptoms) (LC3 and LC5) with one class (LC3) including interference in life activities because of physical health symptoms, to numerous milder symptoms, dominated by fatigue and psychological symptoms (LC4), to relatively asymptomatic (LC6). In pre-menopause, 10% of women were classified in LC1, 16% in LC2, 14% in LC3 and LC4, 26% in LC5, and 20% in LC6. Intensity of vasomotor and urogenital symptoms as well as sexual desire) differed minimally by latent class. Classification into the two most symptomatic classes was strongly associated with financial strain, White race/ethnicity, obesity and smoking status. Over

Semana del 11 al 17 de octubre de 2017 Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile Bone Res. 2017 Oct 10;5:17021. doi: 10.1038/boneres.2017.21. eCollection 2017. Vitamin D and calcium are required at the time of denosumab administration during osteoporosis treatment. Nakamura Y, Suzuki T, Kamimura M, Murakami K, Ikegami S, Uchiyama S, Kato H. To evaluate the differences in outcomes of treatment with denosumab alone or denosumab combined with vitamin D and calcium supplementation in patients with primary osteoporosis. Patients were split into a denosumab monotherapy group (18 cases) or a denosumab plus vitamin D supplementation group (combination group; 23 cases). We measured serum bone alkaline phosphatase (BAP), tartrate-resistant acid phosphatase (TRACP)-5b and urinary N-terminal telopeptide of type-I collagen (NTX) at baseline, 1 week, as well as at 1 month and 2, 4, 8 and 12 months. We also measured bone mineral density (BMD) of L1-4 lumbar vertebrae (L)-BMD and bilateral hips (H)-BMD at baseline and at 4, 8 and 12 months. There was no significant difference in patient background. TRACP-5b and urinary NTX were significantly suppressed in both groups from 1 week to 12 months (except at 12 months for NTX). In the combination group, TRACP-5b was significantly decreased compared with the denosumab monotherapy group at 2 and 4 months (P<0.05). BAP was significantly suppressed in both groups at 2-12 months. L-BMD significantly increased at 8 and 12 months (8.9%) in the combination group and at 4, 8 and 12 months (6.0%) in the denosumab monotherapy group, compared with those before treatment. H-BMD was significantly increased in the combination group (3.6%) compared with the denosumab group (1.2%) at 12 months (P<0.05). Compared with denosumab monotherapy, combination therapy of denosumab with vitamin D and calcium stopped the decrease in calcium caused by denosumab, inhibited bone metabolism to a greater extent, and increased BMD (especially at the hips). Cytojournal. 2017 Sep 25;14:22. doi: 10.4103/cytojournal.cytojournal_16_17. eCollection 2017. Significance of finding benign endometrial cells in women 40-45 versus 46 years or older on Papanicolaou tests and histologic follow-up. Colletti SM, Tranesh GA, Nassar A. BACKGROUND: The 2014 Bethesda System recommends reporting the finding of benign-appearing, exfoliated endometrial cells on Papanicolaou (Pap) tests in women aged 45 years and older. We aimed to determine the significance of normal endometrial cells on liquid-based Pap tests in women aged 40 years and older and to correlate this finding with clinical factors and cytologic/histologic follow-up. MATERIALS AND METHODS: We retrospectively identified all women aged 40 years and older who had benign endometrial cells (BECs) on Pap tests at our institution during a 6-year period. Histologic follow-up and outcomes were evaluated. RESULTS: Among 18,850 Pap tests during the study period, 255 (1.4%) had findings of BECs and 159 (62.4%) of these women had follow-up Pap tests or subsequent tissue sampling by surgical procedures. Of the 159 cases, only 4 (2.5%) had significant endometrial pathologic processes, all endometrial endometrioid adenocarcinoma (three women had postmenopausal bleeding and 1 was perimenopausal with menorrhagia). No women between ages 40 and 45 years had significant pathologic findings and only one woman between 46 and 50 years (47 years) had an endometrial endometrioid carcinoma (1.5%). Women older than 47 years have higher odds (5.38) of having a significant endometrial lesion (P = 0.029) than those who are ≤47. CONCLUSION: Clinically significant endometrial lesions occurred predominantly in women older than 50 years (4.6%) and in only one woman between ages 46 and 50 years (1.5%). Therefore, endometrial sampling should be performed in women aged 47 years and older with BECs, especially when additional clinical indicators (e.g., postmenopausal bleeding) are recognized. Ceska Gynekol. 2017 Fall;82(5):383-389. What is the risk of pelvic organ prolapse recurrence after vaginal hysterectomy with colporrhaphy? Nováčková M, Pastor Z, Brtnický T, Chmel R. OBJECTIVE: To determine the risk of prolapse recurrence in patients after vaginal hysterectomy with colporrhaphy. DESIGN: Retrospective clinical study. SETTING:Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS: The trial involved 220 women who underwent vaginal hysterectomy with anterior and posterior kolporrhaphy at our department for uterine prolapse at least grade 2. It was the first vaginal surgery in all of the patients. Subjective feeling of pressure in the vagina and/or palpable mass in the vagina or in front of the vaginal entrance and/or objective finding decline of the vaginal walls or fundus at lest the second degree or repeated surgery for prolapse were considered as a prolapse recurrence. RESULTS: The mean age at the time of vaginal hysterectomy was 66.7 years (range 37-88). Only 11 patients were premenopausal (5%), the others were postmenopausal, a mean time of posmenopause was 16.9 years. The average parity rate of the study group was 2.1. The average duration of the surgery was 68 minutes. Postoperative urinary retention was observed in one patient (0.45%). 156 women were enrolled in the study. The average length of follow-up was 47 months (minimum 24 months). Recurrence of prolapse based on subjective assessment occured in 24 patients (15.4 %) with pressure and resistance in the vaginal introitus. According to objective criteria, the recurrence of prolapse was diagnosed in 33 (21.2%) patients, of which 16 had prolapse of the anterior vaginal wall, three of the posterior vaginal wall (two rectocoele, one rectoenterocoele), eight combination prolapse of anterior and posterior vaginal wall and vaginal vault prolapse was diagnosed in six women. Eight patients (5. 1%) underwent surgery because of prolapse recurrence. The mean interval from primary surgery to the time of reoperation was 24.4 months (range 6-62). CONCLUSION: Patients have to be preoperatively informed about the risk of the prolapse recurrence with the recommendation of appropriate preventive arrangements. Am J Epidemiol. 2017 Aug 10. doi: 10.1093/aje/kwx292. [Epub ahead of print] Cigarette Smoking and Risk of Early Natural Menopause. Whitcomb BW, Purdue-Smithe AC, Szegda KL, Boutot ME, Hankinson SE, Manson JE, Rosner B, et al. Menopause before age 45 affects roughly 5%-10% of women and is associated with higher risk of adverse health conditions. Smoking may increase early menopause

[button url=»https://www.sochiclim.com/wp-content/uploads/2017/10/PRUEBA-IV-BOARD.pdf» target=»_blank» color=»green» size=»medium» border=»false» icon=»»]Descargar Prueba[/button] Nota: Los resultados de esta encuesta agradecemos hacerlos llegar al siguiente correo: sochiclim@gmail.com (1). -El riesgo de fractura está aumentado en las mujeres que: A.- Se caen frecuentemente. B.-Tiene osteoporosis. C.-Tienen baja masa muscular. D.-Todas las anteriores. E.-Sólo la dos y la tres son correctas. (2). -El diagnóstico de sarcopenia requiere la presencia: A.- Baja masa muscular y disminución de la fuerza. B.-Poca fuerza muscular. C.-Falla coordinación motora. D.-Osteoporosis. E.-Envejecimiento y poca fuerza muscular. (3). -En la etiopatogenia de la osteosarcopenia es fundamental: A.- El excesivo sedentarismo. C.-La interacción de citoquinas anti-anabólicas entre el hueso y el músculo. D.-La desnutrición calórica. C.-El déficit de calcio. D.-La presencia de una factura previa. (4). -La prevención de la sarcopenia NO incluye: A.- Actividad física. B.- Ingesta de suplementos de calcio. C.- Aportes suplementarios de vitamina D. D.- Terapia hormonal de la menopausia. E.- Dieta rica en proteínas. (5). -En una densitometría una T menor de -1.5 en mujer postmenopáusica A.- No hace el diagnóstico de osteopenia. B.- Es un factor de riesgo de sarcopenia. C.- Debe indicarse terapia anti-osteoporótica. E.- Debe repetirse el examen. D.- Requiere solicitar determinaciones séricas de PTH, Calcio y Fósforo (6). -Uno de los problemas que se han relacionado con el uso de hormonas sexuales en cualquier etapa de la vida de la mujer es la alteración de la hemostasia y, concretamente, la tendencia hacia la trombosis. En relación todo ello, señale la afirmación que considera falsa: A. Es conocido de antiguo que el uso de hormonas sexuales, sobre todo los estrógenos, aumentan el riesgo de trombosis tanto en el territorio arterial como en el venoso, aunque este último es el sitio más prevalente. B. Ello determinará el síndrome isquémico coronario, el ictus cerebral y la enfermedad tromboembólica venosa, todas ellas consecuencias temidas durante este tipo de hormonoterapia. C. Una THM por vía oral aumenta moderadamente el riesgo tromboembólico, en particular en presencia de trombofilia hereditaria o adquirida y durante el primer año después del inicio del tratamiento. D. La THM transdérmica en dosis bajas no parece aumentar el riesgo tromboembólico. E. En realidad en este tema como en muchos otros no tenemos ni la menor idea y nada puede ser afirmado con rotundidad, o eso creo. (7). -Cuando se analizan con un cierto detalle las estadísticas poblacionales de Chile, puede observarse que es cierto solo uno de los asertos que a continuación se le ofrecen a su consideración: A. No estamos seguros de cuáles son las causas de mortalidad en Chile pues el estado no tiene datos estadísticos, ni se espera que los tenga en los próximos veinte años dado el carácter corrupto de alguno de nuestros políticos. B. Por encima de los 65 años, la población chilena es mayoritariamente sedentaria y presenta un riesgo cardiovascular alto o muy alto en más del 80% en esa franja de edad. C. En datos de 2015, en Chile un 16% de la población eran mujeres mayores de 60 años. D. Para 2020, la previsión gubernamental es que el 17% de la población general supere los 60 años. E. Para ese mismo año de 2010, los jóvenes menores de 15 años serán solo el 20.2% de la población por la decreciente tasa de natalidad. (8). – Cuando se analizan los datos de la literatura sobre la influencia de la THM sobre la hemostasia y la trombosis, en general, nos encontramos con todos los asertos verdaderos menos uno de los siguientes: A. Una de las principales dificultades a la hora de analizar el impacto de la terapia hormonal (TH) en el sistema hemostático es que los estudios publicados tienen un tamaño muestral pequeño y se analizan distintas modalidades de TH (varios tipos de preparados y combinaciones hormonales, dosis, vía de administración, etc.). B. Además, a las mujeres histerectomizadas sólo se les administra estrógenos (la vía de administración puede ser oral o transdérmica) y en la que tienen útero intacto debe asociarse un gestágeno (sintético o natural, con dosis y pautas diferentes y una vía de administración oral, transdérmica y, ahora intrauterina). C. Todo lo anterior no denota otra dificultad que las malsanas y aviesas intenciones de la industria farmacéutica que oculta la verdad de los principales estudios científicos a este nivel. D. Existen divergencias en la literatura en relación con los efectos de la TH sobre la hemostasia, aunque en general se acepta que producen una ligera hipercoagulabilidad y un aumento de la actividad fibrinolítica. E. Algunos autores no observan modificaciones significativas de los parámetros de la coagulación, mientras que otros estudios encuentran un aumento de los niveles de factores procoagulantes y reducción de los anticoagulantes. (9). -En relación con estos temas de THM y sus efectos sobre las trombosis venosas profundas, le rogamos destaque la afirmación que le parece menos seria y probablemente más falsa que un billete de tres dólares: A. Se sabe que la adición de progestágenos modifica poco el efecto de los estrógenos, aunque esto dependerá del tipo de progestágeno empleado. B. Es difícil valorar el impacto de las hormonas sexuales sobre el equilibrio hemostático debido a la complejidad de factores e interacciones que existen en la coagulación y los diferentes mecanismos que la acción hormonal ejerce sobre varios sistemas relacionados, como es el endotelio. C. Algunos factores se regulan por varios genes, como es el caso del factor VIII, y que la dieta y otros factores modificables pueden influir y variar los resultados. D. Los más importantes factores de la coagulación implicados en la génesis de las trombosis venosas profundas son los numerado por encima del XV, concretamente, los números XX y XIX. E. La dieta, el peso de las usuarias y otros factores modificables pueden influir y variar los resultados. (10). – Insistiendo en el tema de los tromboembolismos pulmonares (TEP) y las trombosis venosas profundas (TVP), es cierto todo menos uno de los siguientes asertos: A. La TVP y los TEP nada tienen que ver con el hecho de que la paciente tenga varices en las