Los trastornos hipertensivos del embarazo son un importante contribuyente a la morbimortalidad y la discapacidad para las mujeres embarazadas y sus bebés. El diagnóstico de preeclampsia mediante la presión arterial y la proteinuria es de uso limitado debido a que son características individuales que se manifiestan hasta que el padecimiento esté presente. Los factores angiogénicos son marcadores secundarios de la disfunción placentaria asociada en la preeclampsia, sus concentraciones plasmáticas se han descrito bajas o altas dependiendo del marcador en la enfermedad. El objetivo de este artículo es describir los principales biomarcadores útiles en el diagnóstico precoz de la preeclampsia. Concluyendo que los 2 biomarcadores con mayor desempeño predictivo pudieran considerarse al factor de crecimiento placentario y a la forma soluble de la tirosina cinasa 1 ya que existen diversos estudios que evalúan su utilidad.

El síndrome de ovario poliquístico es un trastorno endocrino-metabólico que se explica como un hiperandrogenismo femenino funcional. Asociado a ello se desencadenan diversas alteraciones sistémicas, siendo la acumulación de tejido adiposo visceral una de las más importantes. Se ha demostrado que los andrógenos y el aumento de los ácidos grasos libres, como se ve en la obesidad de tipo central, inhiben la acción hepática de insulina que resulta en el hiperinsulinismo compensatorio secundario a la resistencia a la insulina, por lo tanto, las pacientes con síndrome de ovario poliquístico presentan diversas características clínicas, hormonales y metabólicas, dependiendo de su grasa corporal y del patrón de distribución, por lo que la clasificación en subgrupos nos puede ayudar a identificar los trastornos sistémicos que puede presentar cada paciente. Uno de estos parámetros es el fenotipo otorgado por la composición corporal, el cual puede determinarse a través de impedancia por fluido eléctrico, que permite conocer las proporciones de los distintos componentes del cuerpo humano. Por esta razón, debe considerarse actualmente, como parte del seguimiento de las pacientes con síndrome de ovario poliquístico, el estudio de la composición corporal para establecer la respuesta a los tratamientos empleados en la corrección de este trastorno sistémico.

Roberto Caldeyro-Barcia nació en Montevideo en 1921, estudió Medicina graduándose como médico cirujano en 1947. Fue aceptado como investigador asociado en el Instituto de Fisiología bajo la supervisión del profesor Hermógenes Álvarez, quien estaba trabajando sobre el efecto de la actividad uterina en el pulso cardiaco fetal durante el parto. La presión amniótica se registró con el uso de un pequeño catéter introducido dentro de la cavidad amniótica, por lo que Caldeyro-Barcia propuso introducir un microcatéter directamente en el músculo uterino para obtener información más específica de la contracción uterina y su efecto sobre la actividad cardiaca fetal. Se observó que la frecuencia cardiaca disminuía en los casos de hipoxia fetal. Dichos descensos fueron llamados DIP I y II. Así, se confirmó que la hipoxia durante el parto tiene una deletérea acción en la oxigenación fetal, lo cual fue registrado y graduado como unidades montevideo. Dos años después, Edward H. Hon, quien trabajaba en la Universidad de Yale, confirmó estos hallazgos, lo que fue el inicio de la monitorización fetal durante el trabajo de parto en todo el mundo. Caldeyro-Barcia fue galardonado por muchas asociaciones académicas internacionales; asimismo fue designado director del Centro Sudamericano de Perinatología y presidente de la Federación Internacional de Ginecología y Obstetricia. Se consideró un amigo de México, país que visitó muchas veces, por lo que tuvo una relación académica muy cercana con Luis Castelazo-Ayala.

En el presente articulo de opinion se discute acerca de la necesidad de cuestionar la practica rutinaria del empleo de la mamografia para detectar cancer de mama en mujeres asintomaticas

Objective To measure serum osteocalcin (OC), under-carboxylated osteocalcin (ucOC), osteopontin (OPN), and leptin in pregnant women with gestational diabetes mellitus (GDM) and in healthy pregnant women during pregnancy and after birth and relate these markers to glucose metabolism. Methods This was a prospective study including 60 women with GDM and 60 subjects with normal gestation who were evaluated at gestational week 30 and 6 weeks postpartum. Serum OC, ucOC, OPN, leptin, insulin and insulin resistance were evaluated during the study. Results Bone biomarkers and leptin were similar between GDM and normal pregnancy. After delivery, OC, ucOC and OPN increased in both groups, while leptin decreased only in healthy controls. Bone markers did not correlate with insulin and insulin resistance in the two groups, but leptin was positively correlated with insulin and insulin resistance and negatively correlated with bone biomarkers only in healthy women. Furthermore, the women who developed diabetes postpartum had lower levels of OC than women with normal glucose tolerance. Conclusion GDM is not associated with OC, ucOC, OPN, and leptin and does not correlate with insulin resistance. At postpartum, women who develop diabetes have lower osteocalcin concentrations. Leptin correlates with insulin resistance and bone biomarkers in non-diabetic women.

Carl Djerassi nació en Viena en 1923 y emigró a New York en 1939 donde escribió una carta a Eleanor Roosevelt solicitando un apoyo para continuar sus estudios, graduándose en química en 1942 y obteniendo su doctorado en química en la Universidad de Wisconsin en 1945. Sintetizó el esteroide básico del “anticonceptivo oral”, genéricamente conocido como noretisterona. Desde el siglo pasado se sabía que la administración parenteral de estrógenos y progesterona inhibía la ovulación, pero resultaba de un costo muy elevado. Jorge Rosenkranz invitó a Djerassi a incorporarse a Syntex para buscar la síntesis de progesterona, quienes junto con Luis E. Miramontes emplearon el esteroide esencial obtenido del barbasco descubierto por Rusell E. Marker. De esta manera se consiguió industrializar el anticonceptivo hormonal oral conocido trivialmente como la “píldora”.

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.

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.

In this paper, the automatic recognition of broken and blurred, multifont typewritten digits in forms will be addressed. The classification, which is based on the utilization of a global feature, is divided in two phases: first, a minimum distance method (1-NN) is applied to provide a global classification of the patterns in a form; second, the patterns in the form previously classified are used to validate, or reject and reclassify them, on the basis of the mean distance to the predefined classes. In this way, a classification accuracy rate of 99.42

This work presents a solution to the problem of the segmentation of digits in forms characterized by its low quality, as well as the existence of breaks and touching digits. We propose a new function of segmentation that adds to two traditional techniques (vertical projections and Tsujimoto metric) information of background of the digit. Unlike other techniques reported in the literature, ours obtains a near-optimum number of break points in fields containing broken, blurred and touching characters, leading to high accuracy in the global OCR system. The accuracy obtained in the segmentation of the forms fields is of 99,74

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 (50μg 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.

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.

The effect of thyroid hormone excess on glucose tolerance as well as insulin secretion and its peripheral action has been a matter of debate for many years. Thyrotoxicosis caused by Graves' disease is associated in some patients with impaired glucose tolerance and insulin resistance. The objective of the present study was to investigate if the insulin sensitivity, assessed by the euglycemic insulin clamp technique, increase after correction of hyperthyroidism due to Graves' disease. After four months of medical treatment, patients became euthyroid and insulin sensitivity increased significantly from 3.47 to 6.39 mg/kg/min; therefore it was concluded that insulin resistance could be improved after successful treatment of hyperthyroidism. The precise mechanism underlying the effect of thyroid hormone excess on insulin sensitivity remains to be elucidated.

Objective: The aim of this study was to analyze the effect of transdermal estradiol replacement therapy (HRT) on immune function in menopausal women. Study Design: A prospective comparative study was carried out in 30 women, aged 48–55 years, who were divided into two groups; 20 of them received transdermal estradiol 50 µg/day during 3 months and 10 who refused to receive HRT served as controls. Serum interleukins were quantified by specific immunoenzymatic assays; in addition, hormones of somatotropin axis and prolactin (PRL) were quantified by IRMA and RIA. Results: Baseline elevated interleukin (IL)-6 levels decreased significantly (p < 0.001) after transdermal HRT as compared with the nontreated group. Contrarily, IL-2 and IL-10 levels as well as mitogenic induced T-cell proliferation were unchanged under HRT. Insulin-like growth factor-I, growth hormone and PRL levels were unaltered by transdermal HRT. Conclusion: Decrement of IL-6 in parallel with absent effect on some indices of immune activity suggests a beneficial action of transdermal HRT. These findings contrast with those demonstrating an increment of immune response in women taking oral HRT. Thus, the route of administra tion determines the effect of HRT on immune function.

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, scrotonin, and beta-endorphin were quantified by specific assays at baseline and at the end of treatment.Result(s): Low baseline levels of DA. serotonin, and beta-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 17beta-E-2 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. (Fertil Sterill((R)) 2002 77:952-5. (C)2002 by American Society for Reproductive Medicine).

The effect of Tibolone, and estrogen-like therapeutic agent used for menopause, on insulin and glucose was investigated in 18 healthy postmenopausal women. At baseline and after 3 months of Tibolone, 2.5 mg daily, blood levels of glucose and insulin were evaluated in each participant. Fasting levels of glucose were not modified by Tibolone, whereas plasmatic insulin levels were reduced significantly (p < 0.01). High-density lipoprotein cholesterol and total cholesterol were not affected by Tibolone. From these data it may be suggested that Tibolone does not negatively influence glucose fasting levels, but reduces the already elevated insulin levels which may be due to an improvement in peripheral tissue sensitivity to insulin.

Aim: Fetal intrauterine growth retardation (IUGR) is one of the most common obstetric problems, with a frequency of 12% in Mexico. In the past, investigations have focused on extrinsic causes of IUGR. More recent studies have examined the intrinsic factors that cause fetal intrauterine growth. Maintenance of fetal growth has been attributed to insulin‐like growth factor (IGF), epidermal growth factor (EGF) and transforming growth factor beta (TGF‐β). The objective of this study was to assess the levels of these growth factors during pregnancy and to determine whether or not low concentrations are associated with IUGR.Methods: Nine women whose pregnancies were complicated by IUGR and a group of nine women whose pregnancies exhibited normal fetal intrauterine growth were studied. IUGR was determined by sonography and confirmed by weight at birth. Venous blood samples were taken from both groups of pregnant women at the end of each trimester. Enzyme‐linked immunosorbent assays, immunoradiometric assays and radioimmunoassays were used to process samples, and the results were analysed by anova.Results: IGF‐I levels increased in both groups during pregnancy, but the increase was lower (p < 0.001) in the IUGR group throughout pregnancy and at delivery. EGF did not show any significant changes during pregnancy. Blood TGF‐β levels varied only during the first trimester of pregnancy. The differences were not statistically significant. However, TGF‐β concentrations were higher in the pregnancies with IUGR. Women in the IUGR group were smaller than in the control group (p < 0.05), and, using the covariance test (p < 0.05), this was found to be correlated with IGF‐I levels but not with EGF or TGF‐β levels.Conclusions: Changes in fetal weight might be explained by the different concentrations of IGF. The structural homology between IGF‐1 and insulin could mean that the presence of higher levels of IGF would result in a increased energetic metabolism that could contribute to fetal growth. EGF levels were not related to IUGR, and TGF‐β levels increased only during the first 3 months in the IUGR group. This observation correlates with the in vitro action of TGF‐β as a negative factor of growth, but as a positive support for sustaining early pregnancy. Our data illustrates that low height represents an increased risk factor for IUGR. These data also correlate with the studies involving extrinsic factors.

Objective: To determine whether cord sera leptin and components of the somatotropin axis – growth hormone (GH), total (t) and free (f) insulin-like growth factor (IGF), IGF-binding protein-3 (IGFBP-3), and insulin – correlate with birth weight. Design: Cross-sectional study of 22 newborns, 12 with normal birth weight (NBW) and 10 with low birth weight (LBW), in a population of healthy mothers with an apparent normal pregnancy. Methods: Paired mother–neonate blood samples were obtained at vaginal delivery in order to measure leptin and the somatotropin axis components. Results: In all cases maternal blood concentrations of leptin, t and fIGF-I, its carrier protein IGFBP-3, and insulin were higher than in the cord sera of the newborns, regardless of their birth weight. On the contrary, maternal GH levels were lower than in their neonates. LBW neonates had decreased levels of leptin, tIGF-I, and IGFBP-3 as compared with those levels in NBW offspring; however, GH concentrations were higher in LBW neonates. Birth weight showed a significant correlation with cord sera leptin, tIGF-I, IGFBP-3, and GH; nevertheless birth weight was neither interrelated with fIGF-I nor with insulin levels. Conclusion: These data demonstrate that birth weight is significantly correlated with both leptin and some components of the somatotropin axis; on the other hand, no correlation was observed between leptin concentrations and each one of the components of the somatotropin axis. It is suggested that fetal leptin and the somatotropin axis cooperate in intrauterine growth and birth weight.