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This study aimed to evaluate the self-reported satisfaction of Spanish postmenopausal women currently treated for vulvovaginal atrophy (VVA) symptoms. The CRETA (CRoss sectional European sTudy on Adherence) is a multicenter cross-sectional study conducted in 29 public and private hospitals in Spain, which enrolled postmenopausal women receiving treatment with ospemifene, local hormone therapy (HT) or vaginal moisturizers for VVA. After the prior informed consent of the patients, sociodemographic and treatment perception data were collected using a structured questionnaire. Among 752 women who completed the survey, the satisfaction score was significantly higher for the group treated with ospemifene (mean 8.3 ± 1.4) compared with the local HT group (7.2 ± 1.7) and the vaginal moisturizer group (6.5 ± 2.1) according to a 10-point Likert scale (p < 0.0001). Compared to vaginal moisturizers and local HT, participants treated with ospemifene reported the highest adherence (96.7% vs. 70.2% and 78.6%, respectively) and the lowest number of missed doses in the last month (0.6 ± 1.3 standard deviation [SD] vs. 3.5 ± 4.3 SD and 2.0 ± 2.8 SD, respectively) (p < 0.0001). Ospemifene was significantly perceived as easy to use (83.9% vs. 44.9% and 58.6%, respectively; p < 0.0001), efficacious in reducing the time to relieve symptoms (17.1% vs. 7.0% and 6.7%, p = 0.0005 and p = 0.0006, respectively) and convenient for sexual life (53.1% vs. 25.6% and 42.3%, p < 0.0001 and p = 0.0234, respectively). Among postmenopausal women with VVA, treatment with ospemifene has the most positive perceptions and the highest overall satisfaction level and could be an optimal therapeutic approach, maximizing patient adherence. [ABSTRACT FROM AUTHOR]

Background: DT56a (Femarelle®) is a natural medication that contains a variety of phytoestrogens derived from tofu. Treatment with DT56a affects bones, vascular tissues and the nervous system in a manner similar to that of estrogen but DT56a acts as an estrogen antagonist in breast and uterine tissues.Aim: The objective of this study was to analyze the efficacy of DT56a in the reduction of menopause symptoms in Spanish women who participated in the Post Marketing Menopausal Symptoms International Survey (POMMSIS).Patients and Methods: A total of 631 Spanish menopausal or perimenopausal women with vasomotor symptoms who took DT56a for 4 weeks participated in this study. This study was an observational, questionnaire-based investigation that consisted of a baseline questionnaire, a hot flushes daily diary and a feedback questionnaire.Results: A statistically significant (p < 0.01) reduction in the number and intensity of hot flushes was experienced after 2 and 4 weeks of DT56a treatment. After 4 weeks of treatment with DT56a, 80.7% of the patients reported that their hot flushes were 'better' or 'much better'. The severity of hot flushes was also reduced by 38% in all study participants and by 36% in women who had experienced more than seven hot flushes per day initially, before treatment.Conclusion: Treatment with DT56a resulted in a significant reduction in the number and intensity of hot flushes in postmenopausal women, especially in those with frequent symptoms, and these effects were observed within the first month of treatment. [ABSTRACT FROM AUTHOR]

In this review, we analyze the efficacy and safety of DT56a in the treatment of postmenopausal symptoms. Similar to all selective estrogen receptor modulators (SERMs), DT56a demonstrates dual agonistic and antagonistic effects due to the synergy between its components. DT56a is referred to as a plant-origin SERM (phyto-SERM) and, for this reason, its therapeutic capacity in postmenopausal women differs from other phytoestrogens used independently. Although interesting data on relief of vasomotor symptoms have been reported for DT56a, further clinical studies with a greater number of cases and a longer period of study are required to correctly identify its indications for use as an alternative to hormone therapy, especially in preventing osteoporosis. [ABSTRACT FROM AUTHOR]

Abstract: Perimenopause is an imprecise period in woman over 40 years of age, which comprises the time between the moment that the first changes in the menstrual cycle appear and the year following the definitive cessation of the menses. Besides irregular bleeding, many women also complain of hot flashes and other characteristic symptoms of postmenopause. Moreover, most of them are concerned about the future impact that these events may have on their health, such as needing health exams or continuing to use contraceptive methods. A panel of experts from the Spanish Menopause Society has met to establish diagnostic and therapeutic guidelines for this period based on the best available evidence. [Copyright &y& Elsevier]

Abstract: Women make up 55% of the total world population. This percentage is set to steadily increase over the next three decades. Europe also has the highest proportion of older women in the world. In fact, there are now approximately 3 women for every 2 men over 65. All of this data confirms the importance of prevention. An ideal approach for the female post-menopausal population would be treatment of any condition that can improve physical, mental and social well-being. Nevertheless, it is understood that the efficacy and cost/benefits of every screening programme need to be analysed. One of the largest and most neglected groups that could benefit from prevention consists of women without hot flushes (asymptomatic women), but with risk factors. The strategic measures are information, research and development of programmes. The more practical approach would be to identify patients and therefore yield better results in terms of health status and improvement. Statistics show that the three main causes of mortality and disability in developed countries for post-menopausal women are cardiovascular disease (CVD), cancer and osteoporosis-associated fractures. There are agreed recommendations to include some preventive measures for these three disorders in clinical practice for health professionals, at least at the minimal level. Research into the role that other diseases play will allow strategies to be developed in order to enhance prevention. Disorders such as urinary incontinence, dyspareunia, visual and hearing impairment and cognitive dysfunction are seen in significant percentages in post-menopausal women and may affect their quality of life. Health care professionals should bear in mind that many women may be reluctant to raise questions about some disorders spontaneously. Physicians should therefore search for patients with risk factors for these diseases. Prevention and treatment to avoid medical accidents will improve the quantity and quality of life. [Copyright &y& Elsevier]

Background Kidney transplantation (KT) is the replacement therapy of choice in patients with end-stage renal disease (ESRD). Here we show a cohort of kidney transplant recipients from the period of May 1994 to May 2016 in 2 2nd-level private hospitals from the city of Toluca in the state of Mexico. Methods We checked the clinical files of all the patients that received KT in the period of study. Results We report 25 KT: 23 performed in Sanatorio Toluca and 2 in Sanatorio Florencia; 16 (64%) male and 9 (26%) female; mean age 36.03 ± 15.9 years (range, 10–66); 19 (76%) hemodialysis and 9 (24%) continuous ambulatory peritoneal dialysis before KT; ESRD etiology unknown in 16 (64%), diabetes in 5 (20%), IgA nephropathy in 2 (8%), and other in 2 (8%); living donors in 13 (52%) and deceased donors in 12 (48%); blood group 0+ in 18 (72%), A+ in 5 (20%), and B+ in 2 (8%); 21 (84%) with 0 and 4 (16%) with 1 HLA mismatch; and delayed graft function in 8 (32%), of which 7 were from deceased donors and 1 from a living donor. All 25 (100%) had a functional kidney at 1 year of follow-up. Immunosuppression regime consisted of multitarget maintenance therapy in all 25 (100%): cyclosporine in 18 (72%) and tacrolimus in 7 (28%). We used only methylprednisolone (MTP) as induction therapy. There were only 2 cases (8%) of acute rejection during the 1st 6 months of follow-up, and both responded to treatment with MTP. Conclusions KT is the treatment of choice for patients with ESRD. The obtained results using only an MTP induction regime are satisfactory, with graft and patient survivals of 100% in the 1st year of follow-up. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "European guidance for the diagnosis and management of osteoporosis in postmenopausal women," by J. A. Kanis, E. V. McCloskey, H. Johansson, C. Cooper, R. Rizzoli, and J. Y. Reginster.

Objectives: To gain a deeper comprehension of current vulvovaginal atrophy (VVA) knowledge among Spanish postmenopausal women.Methods: An online survey (REVIVE) was conducted in four European countries with an overall sample of 768 participants included in Spain. Perceptions, experiences and needs of Spanish postmenopausal women in terms of sexual and vaginal health were reported.Results: Vaginal dryness was the most common VVA symptom in Spain (81%). The severity of symptoms reported by postmenopausal women tended to be similar or worse than at onset, especially in the most troublesome symptom, dyspareunia (80%). VVA symptoms significantly impact on Spanish participants' ability to achieve sexual enjoyment (75%), relationship with partner (67%) and sexual spontaneity (66%). Although 71% of participants with partners (83%) were sexually active, their sex drive was reduced by one-third as a consequence of VVA. Despite the fact that women expected doctors to start asking them about menopausal symptoms, this rarely occurred. Treatments were administered mainly vaginally without prescription (62% were using over-the-counter products at the time). Postmenopausal women who had discussed their symptoms with physicians were twice as likely to be treated (66% vs. 33%) than those who had not. Low compliance with treatment was justified by Spanish participants with not bothersome enough symptoms (22%), relief (21%), inability to reverse vaginal changes (15%) and treatment price (13%). Almost half of the participants with a current local estrogen prescription showed satisfaction. The acknowledged main limitation for all treatments was the inability to restore the natural conditions of the vagina. The price of over-the-counter products was also reported as an important concern in Spanish postmenopausal women.Conclusion: VVA remains underdiagnosed and undertreated in Spain, despite its high frequency and significant impact on quality of life. Since patient satisfaction with available treatments remains compromised, an effective discussion of symptoms and therapies with doctors would improve its management. [ABSTRACT FROM AUTHOR]

Background To date, more than 150 candidate genes related to osteoporosis have been described, but osteoporosis has increasingly been considered a polygenic disease modulated by environmental factors. It is thought that osteoporosis predisposition, pathology, and treatment response depend on the interaction between different genes or between genes and environmental factors. Objective The aim of this study was to evaluate the relationship between the presence of single nucleotide polymorphisms (SNPs) in the estrogen metabolic pathway and the development of osteoporosis and to determine whether this relationship is monogenic or whether interactions between genes exist. Materials and methods A multicentric study with 1980 postmenopausal Spanish women in five Spanish communities was conducted. The women completed a specific questionnaire that inquired about risk factors for osteoporosis. Data on participants' bone mineral density were obtained with dual-energy X-ray densitometers, and genetic data were obtained from frozen peripheral blood. Results The digenic protection combinations indicated involvement of the wild-type genotype (WT) of the 3′UTR marker for the CYP19A1 gene, the IVS4 marker of the same gene, and the BMP15 and FSHR genes. Among patients who carried two or more of the genotypes considered 'risky', the triple combination among markers of the ESR2 and NRIP1 genes with any of the two mutations of the analyzed markers of the BMP15 gene gave a mean T-score value of −2.32±0.91 ( p =0.02). Conclusion Variants of the new candidate genes ( NRIP and BMP15) can predispose patients to osteoporosis. [ABSTRACT FROM AUTHOR]

Purpose We present a case report with an ocular vascular event and multiple organ thrombosis and dysfunction in the presence of antiphospholipid antibodies. Methods We report a case of a 79 years old female related visual loss in left eye. She had a venous occlusion and vitreous haemorrhage. In two weeks presented a maculopapular, bullous skin lesions on the legs, rapidly followed by widespread cutaneous necrosis and skin ulceration on all the limbs showing the tendons tissues of the heels. Later, she had an extension of thrombotic events to other vessels in the body. With medical treatment, there was initially a small functional improvement and then a general degradation in 10 weeks, followed by the death of the patient secondary to sever pulmonary emboli in the intensive care unit. Results It was found histopathologic evidence of multiple small‐vessel occlusions, and laboratory confirmation of the presence of antiphospholipid and anticardiolipin antibodies, in high title. It was refractory to anticoagulation, steroids and immunomodulation treatment Conclusion Catastrophic antiphospholipid syndrome is an autoimmune disorder characterized by a rapidly progressive life‐threating disease. Catastrophic occurs when three or more organ systems are affected by thromboses in a very short time less than a week. Roughly 50% of these patients have systemic lupus erythematosus. The overall mortality of this desvasting syndrome is about one‐half. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to compared the effect of cataract extraction by phacoemulsification and posterior chamber lens implantation on measured intraocular pressure (IOP) using the Goldmann applanation tonometer, the Pascal dynamic contour tonometer (DCT), the Goldmann applanation tonometer (GT) and pneumotonometer (PT) Methods 97 eyes were measured in the operated eye one day before and one day, one week and one month after cataract surgery with the three tonometers, the IOP, ocular pulse amplitude (OPA),and central corneal thickness (CCT) Results Corneal edema induced by phacoemulsification cataract surgery resulted in statistically significant increases in CCT (87,8 μm SD 56,8 ;p< 0,001), Pascal DCT IOP (4,8 mmHg, SD 8,0; p< 0,001),Goldmann IOP (1,4 mmHg, SD 5,1;p<0,015) and OPA (0,9 mmHg, SD 3,5; p< 0,025) but not in pneumotonometry IOP (1,1mmHg, SD 5,3; p=0,065). Changes in IOP measured by GT and PT were less than those measured by the Pascal DCT. The variation between the Pascal DCT (Rho 0,247; p=0,038), and Pneumotonometer (Rho 0,358; p=0,002) was strongly correlated to the change in CCT Conclusion Corneal edema after phacoemulsification cataract surgery increased IOP readings in the three tonometer compared, this increment is bigger in Pascal DCT readings. Changes in CCT are statistically significant associated with increased Pascal DCT IOP readings. Change in corneal biomechanics may in part be responsible for increased in the measured of IOP with Pascal DCT and GT [ABSTRACT FROM AUTHOR]