Pulmonary Lymphangioleiomyomatosis on a Post-Menopausal Woman with Chronic Lymphocytic Leukaemia

A 62 years old, post-menopausal female was admitted to the Internal Medicine Ward due to dyspnoea, cough and sputum of at least 2 months. Shortness of breath, cough and hypoxaemia persisted and the patient was submitted to a pulmonary angiogram ct which revealed numerous thin-walled air cysts affecting upper and medial zones of both lungs, typical images of pulmonary lymphangioleiomyomatosis. After discharge to Internal Medicine Consultation Service with Metilprednisolone, the patient was no longer hypoxaemic and remained asymptomatic, even after withdrawal of oral corticosteroid to inhalatory formulation. Further surveillance in short time was scheduled in order to implement rapid imunossupressive treatment when necessary.

Sternal Insufficiency Fractures of Post-menopausal Women:Retrospective Analysis of 17 Cases

Objective To retrospectively investigate the clinical characteristics of sternal insufficiency fractures(SIFs) of post-menopausal women.Methods Findings on the clinical presentation,associated diseases,and imaging of SIFs in 17 postmenopausal women admitted to our hospital between February 1999 and January 2009 were reported.Results Twelve patients complained of severe pain in their anterior chest.Other symptoms included cough(5 cases),dyspnoea(3 cases),breathlessness(3 cases),and wheeze(2 cases).Four patients had no discomfort.The sternums of 11 cases were tender to palpation.Seventeen patients had osteoporosis.Other associated diseases were chronic obstructive pulmonary disease(7 cases),rheumatoid arthritis(3 cases),systemic lupus erythematosus(1 case),asthma(1 case),and thoracic vertebral fracture(13 cases).Nine patients had received glucocorticoid treatment.The fractures were located in the body of the sternum in 15 patients,in the manubrium in 1 patient,and in the manubriosternal junction in 1 patient.Displaced fracture was present in 13 cases.Lateral radiography of the sternum showed a fracture line in 14 patients.In the remaining 3 cases,other imaging examinations such as bone scan,computed tomography or magnetic resonance imaging demonstrated the presence of a fracture.Conclusions Osteoporosis,glucocorticoid therapy,chronic obstructive pulmonary disease,and rheumatoid arthritis might be risk factors for SIFs.SIFs should be considered in the differential diagnosis of chest pain.

The influence of resistance training on adipokines in post-menopausal women:A brief review

The onset of menopause elicits changes in body composition that negatively influence adipokine levels.Consequently,various health risk factors(e.g.,cardiovascular disease,osteoporosis,physical inactivity,obesity,arterial hypertension,hypercholesterolemia,sarcopenia)are influenced by adipokines due to changes in body composition after menopause.Thus,improvements in body composition are considered the primary influencer of adipokines.Though several therapeutic interventions(e.g.,medication,diet,meditation,exercise)are employed to target changes in body composition,resistance training appears to be more effective in positively improving body composition through changes in lean-muscle mass/fat-mass ratio.However,due to the lack of research,very little is known about adipokines'anti/inflammatory response in postmenopausal women after completing resistance training.Most resistance training studies in postmenopausal women have focused on leptin,adiponectin,and resistin,with limited research assessing other adipokines that are important in metabolic regulation and inflammatory processes.Additionally,the consistency of resistance training protocols as an intervention is not standardized or fully recognized.Therefore,the focus of this review is to establish a more comprehensive understanding of the benefits of resistance training on influencing adipokine levels based on changes to total body composition in postmenopausal women.

Nutraceutical Supplementation Based on Colostrum as Osteoporosis Treatment: A Pilot Study

Introduction: Naturally based treatments for osteoporosis are currently limited. The purpose of this investigation was to ascertain whether bovine colostrum supplementation can improve bone health in humans. Methods: In total 63 individuals volunteered in a 4-month supplementation project. They were stratified into three groups: 1) healthy post-menopausal women (n = 24); 2) individuals with osteopenia (n = 25); 3) people with osteoporosis (n = 14). Participants of each group were randomly assigned into two experimental sub-groups: a) the bovine colostrum (BC) supplementation (200 mL/day;5 days/week); b) the placebo sub-group. Before and after the 4-month supplementation, blood samples were obtained and bone mineral density (BMD) was measured. Dual-Energy X-ray Absorptiometry (DXA) was performed on three different anatomical sites: lumbar spine (LS), left femur neck (FN), and left forearm (Arm). Bone health markers (bone alkaline phosphatase (BAP), osteocalcin, C-terminal telopeptide (CTX-I), deoxypyridinoline (DPD)) as well as immunological markers (interleukin 6 (IL6) and immunoglobulin E (IgE)), were assessed in blood serum with enzyme immunoassays, at baseline and 4-months after BC supplementation. Results: No significant changes were found in bone densitometry factors (p > 0.05), for all studied blood parameters and their calculated effect sizes. Conclusions: It is concluded that, as studied herein, BC does not seem to affect human bone health. This pilot study though warrant the need for further research into the efficacy of BC in patients with osteoporosis.

Hypovitaminosis D and Associated Risk Factors in Postmenopausal Women

Given the relevance of vitamin D in calcium metabolism homeostatic control, as well as its role as differentiation and cell proliferation modulator, it is important to study its circulating level in patients considered at risk, in order to develop prevention strategies. We studied 77 postmenopausal women with no history of osteoactive drug therapy, corticosteroid intake or diseases that could alter bone metabolism, attending the Menopause Center at the Hospital Provincial del Centenario, Rosario, Argentina. A medical history was taken, and a food consumption frequency questionnaire was applied in order to estimate daily calcium intake. To assess daily physical exercise, work and sports activities were investigated. Serum parathyroid hormone (PTH) and 25(OH)D were measured, and a hip DXA scan was performed in every patient. An inappropriate level of 25(OH)D was observed in 86.3% of patients. The 25(OH)D average value was found within the insufficiency range (<30 ng/ml) whereas PTH average concentration fell within the normal range, and bone mineral density average value was found within the osteopenic category. A statistically significant negative logarithmic association was observed between serum PTH level and vitamin D status (p = 0.01). Mean 25(OH)D concentration among patients who had reported fractures was significantly lower than the corresponding to women who had not suffered this type of event. Patients with vitamin D deficiency had significantly wider mean Cobb angle;higher sum of wedge angles of T4 - T12 vertebral bodies mean values, and higher uncompromised vertebrae wedge angle values than non-deficient women. This study shows high hypovitaminosis D occurrence among these postmenopausal women.

Quality of Life before and after the Use of Vaginal Estriol in Postmenopausal Women with Lower Urinary Tract Symptoms

Background: Nowadays, a substantial number of women spend more than one-third of their lives in the postmenopausal period. It is characterized by a marked decrease in the production of estrogen, which leads to urogenital atrophy. The symptoms stemming from vulvovaginal atrophy and the lower urinary tract are currently referred to as the Genitourinary Syndrome of Menopause (GSM), which can have a negative impact on the quality of life (QoL). Estrogen replacement is the ideal treatment for GSM, and vaginal administration is the most recommended. Objective: To assess the impact of the use of topical vaginal estriol on the quality of life (QoL) of postmenopausal women with lower urinary tract symptoms (LUTS). Methods: This is an interventional, prospective study, performed in 49 women at the Antonio Pedro Hospital, at the Universidade Federal Fluminense, in Niterói, Brazil, from August 2014 to April 2015. It included postmenopausal women with lower urinary tract symptoms who were not using any estrogen hormone therapy, and it excluded those with contraindications for the use of estriol. A specific questionnaire on QoL and urinary tract symptoms, the King’s Health Questionnaire (KHQ), which identifies LUTS and assesses to what extent those symptoms interfere with QoL, has been used as a research tool. Results: The average age was 62.24 years. Urinary urgency and urge incontinence were reported by 91.8% of women. The average scores of the domains of the KHQ decreased in the domains General Health Perception (before: 46.42 ± 21.65;after: 40.81 ± 22.64), Incontinence Impact (before: 74.82 ± 27.66;after: 41.49 ± 30.83), Role Limitations (before: 43.20 ± 32.80;after: 21.09 ± 24.71), Physical Limitations (before: 38.09 ± 32.09;after: 14.62 ± 24.20), Social Limitations (before: 30.38 ± 28.75;after: 12.62 ± 19.85), Emotions (before: 43.31 ± 32.96;after: 20.18 ± 26.41), Sleep/Energy (before: 41.48 ± 37.74;after: 15.98 ± 23.31) and Severity Measures (before: 48.02 ± 24.68;after: 22.31 ± 20.25). All the differences were statistically significant (p-value ≤ 0.05). Conclusion: In the group of postmenopausal women with lower urinary tract symptoms included in the study, the use of topical vaginal estriol led to a decrease in the frequency of each symptom and the average scores in all domains of the KHQ, suggesting a positive effect on women’s QoL.

Menopausal Status and Metabolic Syndrome in Women in Climacteric Period Treated at a Clinic in Southern Brazil

Background: This study aims to understand the relationship between menopausal status and the presence of Metabolic Syndrome in women from 40 to 65 years, as well as to describe the distribution of each component of Metabolic Syn- drome according to sample characteristics. Methods: A cross-sectional study was conducted with 551 women treated at a clinic in southern Brazil. MetS and its components were defined according to NCEP-ATP III and menopausal status as pre, peri, and post-menopause. Prevalences of menopausal status and of MetS and its components were calculated. Estimates of prevalence ratios crude and adjusted with confidence intervals of 95% were calculated by Poisson Regression with robust variance. Demographic, socioeconomic, behavioral, and reproductive characteristics were considered as potential confounding factors in multivariable models based on a conceptual framework of MetS determination. Results: The prevalence of Metabolic Syndrome in the sample was 56.1% (CI95%: 51.9 to 60.2), being more common among older women (56 to 65 years), with low education, menarche 11 years old, with three or more pregnancies and in the post-menopausal period. In multivariate analysis, there was an increase of prevalence ratios when comparing perimenopause and post-menopause with pre-menopause;however, the confidence intervals include the unit. Regarding the analysis of isolated components in the sample, the most prevalent altered components were: hypertension (84.8%;CI95%: 81.7 to 87.8), waist circumference (66.4%;CI95%: 62.5 to 70.4) and HDL cholesterol (51.7%;CI95%: 47.5 to 55.9). There was a linear increase on mean blood glucose through menopausal status. Conclusions: Our study indicates variation on the distribution of MetS and each component according to menopausal status and other women characteristics. Future studies on MetS should also have foresight to use this type of approach to improve understanding and targeting of actions and programs focusing on women in this period of life.

Correlation of estrogen receptor alpha gene polymorphisms and bone mineral density in Chinese women with chronic periodontitis

Background Periodontitis and osteoporosis are one of the frequently encountered diseases in post-menopausal women. Estrogen receptors （ERs） regulated bone metabolism. To investigate the possible effect of ER-elpha （a） gene polymorphisms on bone mineral density （BMD） in pre- and post-menopausal Chinese women with chronic periodontitis （CP）, we provided sufficient quantitative information concerning the correlation between ER gene polymorphisms and BMD in periodontitis. Methods Sixty-five post-menopausal and eighty pre-menopausal CP women, and sixty post-menopausal healthy individuals were recruited in this study. Genomic DNA was extracted from oral mucosa swab sample of each subject by the Chelex-100 method. Determination of the ER-a polymorphisms was performed by polymerese chain reaction-restriction fragment length polymorphism （PCR-RFLP） technique with Xbal and Pvull enzyme. The index for periodontal examination includes clinical attachment loss （CAL） and probing pocket depth （PPD）. BMD was measured by dual-energy X-ray absorptiometry （DEXA）. Results There were no significant differences between the ER-α genotypes of Pvull and Xbal and BMD in post-menopausal and pre-menopausal CP patients, respectively （P 〉0.05）. However, there was association between pre- and post-menopausal CP patients at BMD of lumbar spine L2-L4 （P=0.027） and Ward＇s BMD （P=0.004）. Furthermore, the post-menopausal CP women who carried Pvull TT genotype presented significantly lower Ward＇s BMD than the pre-menopausal CP women （P=-0.007）, meanwhile, the post-menopausal CP women who carried Xbal AA genotype presented significantly lower spine L2-L4 BMD than the pre-menopausal CP women （P=0.003）. Conclusions ER-α gene polymorphisms may be a susceptible indicator for BMD variation of lumbar spine L2-L4 and Ward in Chinese pre- and post-menopausal women patients with CP.