Arturo Villena

Effect of Lepidium meyenii (MACA) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men

Summary.  This study was a 12‐week double blind placebo‐controlled, randomized, parallel trial in which active treatment with different doses of Maca Gelatinizada was compared with placebo. The study aimed to demonstrate if effect of Maca on subjective report of sexual desire was because of effect on mood or serum testosterone levels. Men aged 21–56 years received Maca in one of two doses: 1500 mg or 3000 mg or placebo.

Age at Menopause in Central Andean Peruvian Women

The objective of the present study was to determine median age at natural menopause using the status quo method and the sociodemographic and reproductive variables that determine the age at natural menopause in Peruvian women from Lima and Cerro de Pasco. The study was performed in one urban area from Cerro de Pasco (4,340 m above sea level) and in one urban area from Lima (150 m above sea level). The total sample was 469 women aged 28–56 years, 216 from Cerro de Pasco and 253 from Lima. Median age at menopause was 47.1 years at sea level, and 46.14 years at high altitude (p = 0.0005). Results of the proportional hazard regression analysis showed that life at high altitude and lack of use of oral contraceptives were factors associated with early age at menopause, whereas later age at menarche and higher chronological age were associated with delayed age at menopause. In conclusion, altitude is a factor that independently accelerated age at natural menopause.

Age at menarche in Peruvian girls at sea level and at high altitude: Effect of ethnic background and socioeconomic status

The objective of the present study was to determine median age at menarche using the status quo method and the independent effects of ethnic background and socioeconomic status on the age at menarche in Peruvian girls from two distinct levels at altitude: Lima (150 m) and Cerro de Pasco (4,340 m). The sample included 503 girls from Lima and 625 girls from Cerro de Pasco, ages 10–18 years. Ethnic background was determined by four parental surnames. Subjects were classified as Quechua when one or more surnames were from Quechua origin and Spanish when four surnames were from Spanish origin. Socioeconomic status was determined using a socioeconomic index score and subjects were classified as belonging to the middle‐low, low, or very low class. Median age at menarche was calculated by survival analysis using the Life Table Method with a 95% Confidence Interval (CI). Among Quechua and Spanish girls, age at menarche occurred later at high altitude than at sea level. Median ages at menarche for the overall groups were 13.08 (12.91–13.25, 95% CI) years in Lima and 14.33 (14.17–14.48, 95% CI) years in Cerro de Pasco (P < 0.0001). Socioeconomic status had no significant effect on menarcheal age (P > 0.05). Controlling socioeconomic status in the design, median age at menarche was still higher at high altitude than at sea level (P < 0.05). After logistic regression analysis, an effect on age at menarche of chronological age and place of residence was observed, but not by ethnic background, socioeconomic status and not by interactions of age and place of residence, age and socioeconomic status, place of residence and socioeconomic status, place of residence and ethnic background, or socioeconomic status and ethnic background. Thus later age at menarche observed in girls at high altitude is not due the differences in ethnicity or socioeconomic status.

Age of natural menopause among women in Lima City, Peru

The median age at natural menopause in developed countries is approximately 50-51 years [l]. Studies on age at menopause in women from developing countries showed that natural age at menopause is 4 years earlier than that observed in developed nations [2]. Natural menopause occurring prior to 46 years of age is associated with substantial excess mortality. There is no data published in the scientific literature related to age at menopause in sea level populations of South America and the factors associated to its presentation. The present study has been designed to determine the median age at menopause in women resident in Lima, the capital of the Republic of Peru, an urban place located at sea level, on the coast of the Pacific Ocean in South America. The factors influencing the age at menopause have also been assessed. The study was performed using a cross-sec-

Influence of low corrected seminal fructose levels on sperm chromatin stability in semen from men attending an infertility service

OBJECTIVE To determine any correlation between sperm chromatin stability under sodium dodecyl sulfate (SDS), and SDS-ethylendiamine tetraacetic acid (SDS and EDTA) conditions with levels of corrected seminal fructose, obtained multiplying logarithm of sperm count by seminal fructose concentration, in men attending an infertility service. DESIGN Cross sectional study to compare semen parameters of two groups (control and experimental), one with normal levels of corrected fructose (control) and the second with low levels of corrected fructose (experimental). Subjects were also grouped according to number, motility and morphology of sperm, and according to results of hypo-osmotic test. SETTING Andrology laboratory at the Instituto de Investigaciones de la Altura, Lima, Perú. PATIENT(S) Two hundred and twenty five male partners in infertile couples attending the Andrology Laboratory. INTERVENTION(S) None MAIN OUTCOME MEASURE(S) semen analysis, hypo-osmotic swelling test, sperm chromatin stability after SDS, and SDS and EDTA, and seminal fructose. RESULT(S) Seminal volume, sperm motility, and seminal fructose were significantly lower in samples from subjects with low levels of corrected fructose. Subjects with low levels of corrected fructose had also high sperm chromatin stability under SDS, and SDS and EDTA treatment. After SDS treatment, sperm chromatin stability was similar in normal samples and in those with oligozoospermia, asthenozoospermia, teratozoospermia, or abnormal hypo-osmotic swelling test. After SDS and EDTA treatment, a high sperm stability was observed in samples with asthenozoospermia. This hyper-stability is observed in asthenozoospermic samples with low corrected fructose levels, but not in asthenozoospermic samples with normal corrected fructose levels. The logistic regression analysis applied to asthenozoospermic data showed that chronological age, seminal volume, acid phosphatase per ejaculate and percent of stable sperm after SDS and EDTA treatment were significantly associated to levels of corrected fructose. CONCLUSION(S) Low levels of corrected fructose were associated to low seminal volume, low sperm motility, and high sperm chromatin stability under SDS and EDTA treatment.

Low pulse oxygen saturation in post‐menopausal women at high altitude is related to a high serum testosterone/estradiol ratio

Objective: The present study was designed to determine if low pulse oxygen saturation (Spo2) in post‐menopausal women at high altitude was related to high serum testosterone/estradiol (T/E2) ratio. Method: Studies were carried out in 191 women living in Cerro de Pasco, Peru (4340 m above sea level) and in 56 women living in Lima (150 m asl). Body weight, height, Spo2, hematocrit, serum follicle stimulating hormone (FSH), T and E2 levels were measured in all women. Body mass index (BMI), menopausal status and serum T/E2 ratio were calculated from data. Result: At high altitude, the values of Spo2, serum T, and serum E2 were significantly lower in post‐menopausal than in pre‐menopausal women. Hematocrit, serum FSH levels, and serum T/E2 ratios were significantly higher in post‐menopausal women. Serum T and E2 levels, T/E2 ratio, Spo2, and hematocrit levels were not further changed with time after menopause. Women with Spo2<85% had lower serum E2, a higher serum T/E2 ratio, and higher hematocrit values than women with Spo2>90%. At high altitude, multiple regression analysis showed that low Spo2 was related to menopausal status (−2.6±0.83; β±S.E.; P<0.002) and not to chronological age (−0.06±0.04; P: NS). Further analysis showed that low Spo2 was related to high basal serum FSH levels and a high serum T/E2 ratio in the presence of an interaction between FSH and T/E2. Conclusion: Low values of Spo2 in women at high altitude were related to a high T/E2 ratio.

Prevalencia de anemia en gestantes, Hospital Regional de Pucallpa, Perú

Las encuestas demograficas de salud y poblacion del Peru indican que las tasas globales de fecundidad, la proporcion de adolescentes embarazadas y la mortalidad maternoinfantil son mas altas en la selva que en otras zonas del pais. Las parasitosis intestinales endemicas agravan el riesgo de anemia ya generalmente presente en las embarazadas por deficiencias de hierro, acido folico y otros nutrientes. En muchos paises latinoamericanos, esa es la complicacion mas frecuente del embarazo y esta asociada con partos pretermino, bajo peso al nacer y mortalidad perinatal. Los estudios realizados sobre este tema en la selva peruana son escasos y no se dispone de estimaciones confiables de la prevalencia de anemia durante la gestacion. Los autores se propusieron determinar la prevalencia de anemia en mujeres gestantes que acudian al Hospital Regional de Pucallpa, en la selva del Peru, entre enero de 1993 y junio de 1995. El estudio de corte transversal se baso en los registros de control prenatal y de parto de 1 015 embarazadas y permitio estudiar la asociacion entre la prevalencia de anemia y variables como edad cronologica, escolaridad, numero de gestaciones previas y peso de la madre al inicio del embarazo. Tambien se compararon los valores de la hemoglobina materna con el peso de los recien nacidos. La prevalencia de anemia en la poblacion de gestantes fue de 70,1%, valor que no se modifico por efecto de la edad materna, la escolaridad ni el intervalo intergenesico. La prevalencia de anemia se asocio directamente con el numero de gestaciones e inversamente con la ganancia de peso durante el embarazo. La tasa de mortalidad perinatal fue de 37,7 por 1 000 nacidos. Ni esta tasa ni el peso de los recien nacidos resultaron asociados con el grado de anemia de la madre. El analisis de regresion multivariado muestra que el peso de la madre al inicio de la gestacion (P = 0,0001), el peso ganado durante la gestacion (P = 0,0001) y el numero de gestaciones (P = 0,008) predicen el peso del recien nacido. Los resultados indican que la alta prevalencia de anemia en las gestantes de Pucallpa no se asocia con un bajo peso al nacer ni con una alta mortalidad perinatal. En estudios futuros deben investigarse las causas principales de la anemia que padecen las embarazadas de Pucallpa y sus efectos en el desarrollo psicomotor de sus hijos.

USE OF CLOMIPHENE CITRATE IN THE TREATMENT OF MEN WITH HIGH SPERM CHROMATIN STABILITY

OBJECTIVE To determine whether improvements of the seminal vesicle function after a 5-day course with clomiphene citrate (CC) may reduce the prevalence of men with high sperm chromatin stability under conditions of sodium dodecyl sulfate (SDS)-ethylenediaminetetraacetic acid (EDTA). DESIGN A prospective study. SETTING Andrology laboratory at the Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru. PATIENT(S) Forty-one male partners of infertile couples attending the andrology laboratory. INTERVENTION(S) Clomiphene citrate was administered orally twice a day. Men were treated with CC at 100 mg daily for 5 days. Blood and semen samples were collected before treatment and 24 hours after the last administration. MAIN OUTCOME MEASURE(S) Serum testosterone, seminal fructose, sperm motility, sperm chromatin stability after SDS and EDTA, and prevalence of high sperm chromatin stability. RESULT(S) The percentage of stable sperm after SDS-EDTA correlated inversely with the basal corrected concentration of seminal fructose (-1.77 +/- 0.89, beta +/- SE). High sperm chromatin stability was observed in 53.8% of the study population and in 66.7% of patients with hypofunction of the seminal vesicles. In those men whose seminal vesicle function improved after treatment with CC, the prevalence of high sperm chromatin stability was reduced from 67% to 25% (chi2 = 5.34). Logistic regression analysis showed that the higher the basal corrected seminal fructose levels and the higher the basal serum testosterone levels, the lower the probability of nonresponse of the sperm chromatin stability to treatment with CC (0.54 +/- 0.15, odds ratio +/- SE for corrected fructose; and 0.50 +/- 0.15, odds ratio +/- SE for serum testosterone). CONCLUSION(S) Hypofunction of the seminal vesicles was associated with high sperm chromatin stability, and this high sperm chromatin stability under SDS-EDTA conditions may be reduced by treatment with CC.

Prevalence of the metabolic syndrome in the mestizo population of peru.

BACKGROUND The metabolic syndrome (MS) has been shown to predict mortality due to cardiovascular disease. Currently, no population-based data on the prevalence of the MS is available in Peru. This study was aimed to assess the prevalence of the MS in urban Peruvian Mestizos, in the coastal districts of Lima, the capital of Peru. METHODS A cross-sectional, epidemiological survey was undertaken, including 612 unrelated subjects aged 30-92 years (68.3% females). Prevalence of the MS was defined by the National Cholesterol Education Program Expert Panel on Detection Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) criteria. Insulin resistance was estimated by the homeostasis model assessment (HOMA). RESULTS Age and sex standardized prevalence of the MS was 14.9% (13.2% in males, 16.5% in females). The MS was significantly more prevalent in females aged 45-59 years old (20.2% vs. 6.7%, p = 0.019). In individuals with the MS, the prevalence of insulin resistance (IR) was 45% in males/42% in females. Abdominal obesity (80% in males/92.8% in females), and low HDL cholesterol (55% males/75.4% females), but neither hypertriglyceridemia (85% in males/81.2% females) nor high fasting glucose (55% in males/36.2 % females) were more common in females. Prevalence of arterial hypertension was similar in both sexes. CONCLUSIONS In this Mestizo Peruvian population, prevalence of the MS is relatively low as compared to other ethnic groups; the higher prevalence in females is likely due to a higher prevalence of abdominal obesity. Overall, abdominal obesity and hypertriglyceridemia were the predominant combination of metabolic disorders in individuals fulfilling criteria for the diagnosis of the MS.

Diabetic KetoaciDosis in Peruvian Patients With tyPe 2 Diabetes Mellitus

OBJECTIVE To describe the clinical and laboratory characteristics of diabetic ketoacidosis (DKA) in adult Peruvian patients with type 2 diabetes mellitus. METHODS In this cross-sectional analysis, we reviewed clinical charts of type 2 diabetic patients with DKA admitted to Cayetano Heredia Hospital between 2001 and 2005 for data on demographics, previous treatment, previous hospital admissions for DKA, family history of diabetes, precipitating factors, hospital course, mortality, and insulin use 3 and 6 months after the index DKA episode. Patients older than 18 years who had confirmed DKA were included. Patients with type 1 diabetes mellitus were excluded. RESULTS We report on 53 patients with DKA for whom complete clinical and laboratory data were available. Of the 53 patients, 39 (74%) were men; mean age (+/- SD) was 45 +/- 12 years; and 22 (42%) had no previous diagnosis of type 2 diabetes. The following mean (+/- SD) laboratory values were obtained at DKA diagnosis: glucose, 457 +/- 170 mg/dL; pH, 7.15 +/- 0.14; bicarbonate, 7.73 +/- 6 mEq/L; and anion gap, 24.45 +/- 7.44 mEq/L. Of the 53 DKA episodes, 35 (66%) were severe (arterial pH <7.0 and/or serum bicarbonate <10 mEq/L). The following precipitating factors were discerned: discontinuation of treatment in 21 (40%), infections in 16 (30%), intercurrent illness in 3 (6%), and no identifiable cause in 13 (25%). Mortality rate was 0%. Three and 6 months after the index DKA episode, insulin was used by 65% and 56% of patients, respectively. CONCLUSION In countries with a low incidence of type 1 diabetes, DKA is frequently reported in patients with type 2 diabetes. In this study, 42% of patients had new-onset disease. Most DKA episodes were severe and were related to infection or noncompliance with treatment.