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On the other hand Tibolone treatment leads to a decrease in concentrations of plasma lipid peroxide purchase doxycycline 200 mg on line, increase plasma concentrations of vitamin E and alpha-tocopherol and significant decrease in lipid peroxide concentrations [75 discount generic doxycycline canada, 76] buy doxycycline 100 mg online. These results indicate that hormone replacement therapy may affect platelet membrane fatty acid content and oxidant-antioxidant balance in postmenopausal women . Moreover tibolone reduces the concentration of malondialdehyde compared to those who had no treatment [84, 85]. Effect of nutrition and exercise on oxidative stress biomarkers Adequate nutrition and physical exercise are two factors of health promotion and its effect on oxidative stress has been investigated in postmenopausal women, which has given con troversial data. With respect to foods, they contain large amount of antioxidant molecules from there arouse the interest to check if their use can reduce the oxidative stress observed in postmenopause. For example it was reported that the intake of fresh, greenhouse-grown vegetables for 3-wk did not induced changes in the urine concentrations of 8-isoprostane F2, hexanoyl lysine, and serum high sensitivity C-reactive protein despite that plasma carotenoids were elevated in overweight postmenopausal women . Previous studies do not allow a conclusion on the effect of foods rich in antioxidant com pounds, because were used different markers and administration time, and still more the age range of the postmenopausal differs considerably. With respect to the lycopene, the following mechanism of the role of lycopene in chronic diseases has been mentioned by Agarwal and Rao  and Waliszewski and Blasco . This highlights the importance of promote healthy lifestyles (balanced diet and moderate in tensity exercise) in vulnerable populations, such as menopausal women, in order to prevent aging induced oxidative stress-related diseases. Lycopene and its mechanism in preventing of chronic diseases (Adapted from 101 and 102). Contrary to the above has also been reported, that the exercise does not modify the antioxi dant status (although this is lower in metabolic healthy obese postmenopausal women than non-metabolic healthy obese postmenopausal women) and worse increases serum levels of thiobarbituric acid-reactive substances . Conclusion The studies presented here were performed with different number of patients, methodolo gies and biomarkers, but most of them indicate that estrogen depletion induces oxidative stress and hormone replacement therapy seems to reduce it. With respect to the modifica tion of biomarkers of oxidative stress damage by food and exercise needs more research be cause so far no conclusive data have been obtained. Author details Claudia Camelia Calzada Mendoza and Carlos Alberto Jimnez Zamarripa1* 2 *Address all correspondence to: cccalzadam@yahoo. Street Salvador Daz Mirn S/N, Colony Casco de Santo Toms, Dele gation Miguel Hidalgo, C. Samuel Ramrez Moreno-psychiatric careservices- Secretaria de Salud, highway Mxico-Puebla Km 5. Review of hor monal changes during the menopausal transition: focus on findings from the Mel bourne Womens Midlife Health Project. Hot flushes, menstrual status and hormone levels in a population-based sample of midlife wom en. Significance of incidentally thick endometrial echo on transva ginal ultrasound in postmenopausal women. Intravaginaldehydroepiandrosterone (Pras terone), a physiological and highly efficient treatment of vaginal atrophy. Urinary incontinence in the elderly: part 3 of a series of articles on inconti nence. Relation ships between menstrual and menopausal attitudes and associated demographic and health characteristics: the Hilo Womens Health Study Women Health,, 50(5), 397-413. Management of menopause- associated vasomotor symptoms: Current treatment options, challenges and future directions. Bone mineral densi ty and risk of fractures in aging, obese post-menopausal women with type 2 diabetes. Relation of leptin, adiponectin and insulin resistance to bone mineral density in type 2 diabetic postmenopausal women. Periodontitis and bone mineral density among pre and post menopausal women: A comparative study. The role of body mass index, insulin, and adiponectin in the relation between fat distribution and bone mineral density. Effects of the transition from premenopause to postmenopause on lipids and lipoproteins: quantification and related parameters. Estrogen-induced improvement in coronary flow responses during atrial pacing in relation to endothelin-1 levels in postmeno pausal women without coronary disease. Insulin resistance and management of the meno pause: a clinical hypothesis in practice. Association of sex hormones and sex hormone-binding globu lin with depressive symptoms in postmenopausal women: the Multiethnic Study of Atherosclerosis. Oxidative Profile of the Menopausal Woman: Estrogens Rol in the Prevention and Treatment of Diseases. Structural basis for an drogen specificity and oestrogen synthesis in human aromatase. Hyperhomocysteinemia, oxidative stress, endothelial dysfunction in postmenopausal women. Research into Specific Modulators of Vascular Sex Hormone Receptors in the Management of Post menopausal Cardiovascular Disease. Role of estrogens in pathogenesis of age-related disease in women of menopausal age. Neuroprotective effects of oestrogen against oxidative toxicity through activation of G-protein-cou pled receptor 30 receptor. Serum -glutamyltransfer ase as Oxidative Stress Marker in Pre-and Postmenopausal Iraqi Women. Correlation of increased oxidative stress to body weight in disease-free post menopausal women. Oxidative stress, body fat composition, and endocrine status in pre- and post menopausal women. Total antioxidant capacity and superoxide dismutase activity levels in serum and gingival crevicular fluid in post-menopausal women with chronic periodontitis. Behaviour of some indica tors of oxidative stress in postmenopausal and fertile women. Decreased oxidant profile and increased antioxidant capacity in naturally postmenopausal women. Estradiol levels and oxidative bal ance in a population of pre-, peri-, and post-menopausal women. Total antioxidant status correlates with cognitive impairment in patients with recurrent depressive disorder. Effect of Chronic Administration of Estradiol, Progesterone, and Tibolone on the Expression and Phosphorylation of Glycogen Synthase Kinase-3b and the Microtubule-Associat ed Protein Tau in the Hippocampus and Cerebellum of Female Rat. Lifetime History of Depression, Type 2 Diabetes, and Endothelial Reactivity to Acute Stress in Postmenopausal Women. Homocysteine oxidative stress and relation to bone mineral density in post-menopausal osteoporosis. Association of oxidative stress, iron, and centralized fat mass in healthy post menopausal women. Study of changes in antioxidant enzymes status in diabetic post menopausal group of women suffering from cardiovascular complications. Oxidative stress contributes to chronic leg vasoconstriction in estrogen-deficient postmenopausal women.
Patients hospitalized in the Internal Medicine ward were used as a comparison group order doxycycline 100mg on line, as well as outpatient groups of both the internal medicine and the endocrine Departments generic 200mg doxycycline. In support of the relevance of psychiatric syndromes in these patients and specifically in hyperthyroid Thyroid and Parathyroid Diseases and Psychiatric Disturbance 241 patients buy doxycycline 200 mg with mastercard, the prevalence of disorder at the time of admission (first three days) was significantly higher than in all the comparison groups (Table 2). Prevalence of any Disorder Comments Admission Discharge Severity of psychiatric All patients (n=100) 91% 54% disorders is Controls significantly higher in I. M out-patients (n=100) (++); and decreases 38% Endocrine out-patients significantly at 70% (n=100) discharge (+++) Correlations biochemical variables Hyperthyroidism 100% 86% (any)/ Irrtability, Psychastenia. Psychiatric disorders in endocrine in-patients and in hyperthyroidism in- patients. The sections dedicated to specific endocrine diseases suggest when the search may be mandatory, such as in cases of hyperthyroidism, where anxiety, but also depressive syndromes may be severe or in cases of cognitive deficits in hypothyroid disease. Table 1 also summarizes the authors judgement about the clinical relevance (+ to +++) of the psychiatric syndromes in these specific endocrine conditions, according to their frequency, severity and/or special characteristics. Non-biological hypotheses have been formulated to explain depressive or anxiety syndromes when there is considerable stress and psychosocial difficulties associated with conditions such as hyperthyroidism. However, the authors suggest that the organic, endocrine origin of the psychiatric syndromes in these patients is most important. The following data support this contention: studies documenting a higher prevalence of psychiatric disturbance than in comparable general population samples (Mayou et al. In relation to diagnosis the dictum of experienced, anonymous liaison psychiatrists seem to be quite appropriate here: In the general hospital, every psychiatric symptom is organicunless you can document otherwise. In taking the history of rather atypical psychiatric presentations, the clinical psychiatrist should include questions related to the thyroid or parathyroid disorder, particularly when there are signs and /or symptoms suggesting the endocrine abnormality (table 3). If the suggestions are well founded, he or she should also perform at least focal physical examinations to document the presence or absence of endocrine signs. In these cases, but not routinely, he or she should also indicate tests of endocrine function. Endocrinopathy Symptoms Signs Exophthalmos Diaphoresis Tachycardia Hyperthyroidism Heat intolerance Arrytmia (in elderly) Oligomenorrhea Tremor Goiter Cold intolerance Hypothyroidism Slow relaxing reflexes Menorrhagia Myxedema Nausea Muscular weakness Hyperparathyroidism Hypertension (proximal) Abdominal pain Choreiform movements Muscle spams Hypoparathyroidism Chvosteks sign Paresthesias Trousseaus sign Table 3. Specifically, the organic psychiatric syndrome in cases of thyroid or parathyroid disease is supported when: a) the psychiatric symptoms, the course of illness and/or the age of presentation are atypical for a primary psychiatric disorder; b) there is no family or personal history of the psychiatric condition; c) no precipitating stress is known; d) there is a temporal relationship between the onset of the psychiatric and the endocrine symptoms. The challenge for the consulting psychiatrist is to make explicit the diagnosis of the endocrine origin of the psychiatric syndrome early in the procedure, before his or her diagnosis is confirmed after observing that the syndrome disappears following the removal or improvement of the underlying endocrine disorder. Most psychiatric syndromes in endocrine patients resolve with standard treatment of the endocrine disease, and this applies to thyroid and parathyroid disorders. However, when symptoms are particularly severe or life-threatening; or when they last longer than reasonably expected (table 4), good clinical sense suggests the importance of psychiatric Thyroid and Parathyroid Diseases and Psychiatric Disturbance 243 treatment. Relevant clinical factors, and exceptions to these general norms will now be discussed for the specific endocrine diseases. Treat if psychiatric syndromes Endocrinophaty Psychiatric syndromes persist after adequate endocrine treatment* >4 weeks Hyperthyroidism Anxiety (Depression) or extreme severity Hypothyroidism Depression/ Anxiety >4 weeks Hyperparathyroidism >4 weeks Hypoparathyroidism Depression? Treatment of psychiatric syndromes with psychotropic medications in endocrine patients. Thyroid disease and the clustering of somatic and psychiatric morbidity In relation to epidemiology, we have recently studied the role of thyroid disease in the clustering of somatic and psychiatric morbidity in the elderly population. Pioneer studies by authors such as Eastwood and Trevelyan found that psychiatric and somatic illnesses tend to cluster in a limited group of individuals in the general population. The first author speculated about vulnerability to illness, and research in this area was considered the main task for epidemiology in the field of psychosomatic medicine. Since then, a considerable number of studies have approached this subject, and some authors argued that the association between somatic and psychiatric morbidity is well established. However, previous research was conducted primarily in clinical samples, and not in representative, general population samples (Scott et al. Furthermore, Eastwoods statement (Eastwood, 1989) suggesting that the association of general psychiatric and somatic morbidity has not been convincingly shown in the elderly population is still valid. Given the relationships between comorbidity and frailty described in the elderly, as well as the negative consequences (Slaets, 2006), studies in the older population were considered to be a research priority. The main objective in this specific study was to try to confirm in the elderly population the tendency of general psychiatric morbidity to cluster with general 244 Thyroid and Parathyroid Diseases New Insights into Some Old and Some New Issues somatic morbidity. In view of the considerable prevalence of thyroid disease in the elderly and the documented association between thyroid disturbances and psychopathology, we also set as an objective to study the role of thyroid disease in the clustering. The site of the study was Zaragoza, a capital concentrating 622,371 inhabitants (fifth city in Spain) or 51% the population of the historical kingdom of Aragn. It was the baseline, cross-sectional study, intended to document the prevalence and distribution of somatic and psychiatric morbidity and of comorbidity. A stratified, random sample of 4,803 individuals aged 55 and over was selected for the baseline study. Prevalence of thyroid disease in community-dwelling individuals aged 55 years (distribution by age group). As expected, the prevalence of somatic disease tended to increase with age in most categories (Table 4). However, it decreased after the age of 84 in several categories, including thyroid disease. General comorbidity was associated with age, female sex and limited education, but did not increase systematically with age. The frequency of psychiatric illness was higher among the somatic cases than among non-cases, and the frequency of somatic morbidity among the psychiatric cases was higher than among non- cases. Prevalence of thyroid disease in patients with or without psychiatric morbidity in community-dwelling individuals aged 55 years. This was the first study documenting in the (predominantly) elderly population that there is a positive and statistically significant association of general somatic and general psychiatric morbidity. Furthermore, in support of the initial hypothesis our results suggest that thyroid disease may have more weight in this association. Hyperthyroidism Hyperthyroidism is usually accompanied by physiological symptoms such as sweating, heat intolerance and muscle weakness. However, also common symptoms such as nervousness, fatigue or weight lost may be confounded for primary psychiatric symptoms. Graves disease, an autosomal disorder, is the most frequent cause of hyperthyroidism or thyrotoxicosis. While proponents of psychosomatic theories suggested in the last century that an important etiological factor for hyperthyroidism was the presence of psychological conflicts, there is very slight evidence to support the theory. Clinicians in Europe, certainly do not support this conjecture, as shown in the E. No cases of this endocrine condition were referred for psychiatric consult among 15,000 medical inpatients seen in psychosomatic psychiatry services because of psychopathological reasons (Lobo et al, 1992). However, there is some evidence to support the idea that stress can precipitate the hyperthyroidism (Santos et al, 2002) or complicate the clinical course (Fukao et al, 2003 ).