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The objective of this study was to investigate the effects of low-dose hCG supplementation on ICSI outcomes and controlled ovarian stimulation (COS) cost. Three hundred and thirty patients undergoing ICSI were split into groups according to the COS protocol: (i) control group (n = 178), including patients undergoing conventional COS treatment; and (ii) low-dose hCG group (n = 152), including patients undergoing COS with low-dose hCG supplementation. Lower mean total doses of FSH administered and higher mean oestradiol level and mature oocyte rates were observed in the low-dose hCG group. A significantly higher fertilization rate, high-quality embryo rate and blastocyst formation rate were observed in the low-dose hCG group as compared to the control group. The miscarriage rate was significantly higher in the control group compared to the low-dose hCG group. A significantly lower incidence of OHSS was observed in the low-dose hCG group. There was also a significantly lower gonadotropin cost in the low-dose hCG group as compared to the control group ($1235.0 ± 239.0×$1763.0 ± 405.3, p < 0.001). The concomitant use of low-dose hCG and FSH results in a lower abortion rate and increased number of mature oocytes retrieved, as well as improved oocyte quality, embryo quality and blastocyst formation and reduced FSH requirements.
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Gonadotropina Coriónica/administración & dosificación , Hormona Folículo Estimulante/administración & dosificación , Oocitos/efectos de los fármacos , Inducción de la Ovulación/métodos , Inyecciones de Esperma Intracitoplasmáticas/métodos , Adulto , Transferencia de Embrión , Femenino , Fase Folicular , Humanos , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
A Esclerose Lateral Amiotrófica (ELA) é uma doença neurodegenerativa do sistema nervoso central (SNC) que acomete tanto o neurônio motor superior (NMS) quanto o neurônio motor inferior (NMI), causando fraqueza e diminuição progressiva das habilidades funcionais. Entre os profissionais de saúde existe um déficit de informações sobre os objetivos e benefícios da fisioterapia nesta população. O objetivo deste estudo foi identificar os resultados da fisioterapia neurofuncional em pacientes com ELA. Realizou-se uma busca nas bases de dados Medline, Lilacs, SciELO, IBECS e PEDro, utilizando os seguintes descritores: esclerose lateral amiotrófica, espasticidade, força muscular, fadiga, fisioterapia, reabilitação, exercício e qualidade de vida. A busca resultou em dois artigos que tiveram seus resultados analisados, os dois avaliaram os resultados de um programa de exercícios domiciliares de intensidade moderada, associados ou não a outra conduta terapêutica. Os estudos encontrados apontaram menor deterioração na ALS Functional Rating Scale, e diminuição da espasticidade. Em conclusão, a fisioterapia neurofuncional mostrouse eficaz na manutenção da funcionalidade de pacientes com ELA por tempo mais prolongado.
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of the central nervous system that affects both the upper and lower motor neurons, causing weakness and a progressive decrease in functional skills. Among health professionals, there is a lack of information on the objectives and benefits of physical therapy in this population. The objective of this study was to identify the results of neurofunctional physical therapy in patients with ALS. A search of the Medline, Lilacs, SciELO, IBECS, and PEDro databases was performed by using the following keywords: "amyotrophic lateral sclerosis", "spasticity", "muscle strength", "fatigue", "physical therapy", "rehabilitation", "exercise", and "quality of life". The search led to analyze the results of two articles reviewing the data obtained from a moderate intensity home exercises program that was or was not associated with another therapeutic approach. The studies found showed less deterioration, according to the ALS Functional Rating Scale and decreased spasticity. In conclusion, neurofunctional physical therapy was shown to be effective in maintaining the functionality of patients with ALS for longer periods.
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Humanos , Especialidad de Fisioterapia , Esclerosis Amiotrófica Lateral/rehabilitación , Calidad de Vida , Actividades Cotidianas , Ejercicio FísicoRESUMEN
Objective The aim of this study was to study the effects of Tribulus terrestris on sexual function in menopausal women. Methods This was a prospective, randomized, double-blind, placebo-controlled clinical trial that included 60 postmenopausal women with sexual dysfunction. The women were divided into two groups, placebo group and Tribulus group, and evaluated by using the Sexual Quotient-female version (SQ-F) and Female Intervention Efficacy Index (FIEI) questionnaires. Results There was no significant difference between the groups in age, age at menopause, civil status, race, and religion. In the evaluation with the SQ-F questionnaire, there were significant differences between the placebo (7.6±3.2) and Tribulus (10.2±3.2) groups in the domains of desire and sexual interest (p d" 0.001), foreplay (3.3±1.5 versus 4.2±1.0) (p d" 0.01), arousal and harmonious interaction with the partner (5.7±2.1 versus 7.2±2.6) (p d" 0.01), and comfort in sexual intercourse (6.5±2.4 versus 8.0±1.9) (p d" 0.01). There was no significant difference between the placebo and Tribulus groups in the domains of orgasm and sexual satisfaction (p = 0.28). In the FIEI questionnaire, there was a significant improvement (p < 0.001) in the domains of vaginal lubrication during coitus and/or foreplay (20 versus 83.3%), sensation in the genitalia during sexual intercourse or other stimuli (16.7 versus 76.7%), sensation in the genital region (20 versus 70%), sexual intercourse and/or other sexual stimulations (13.3 versus 43.3%), and the ability to reach orgasm (20% versus 73.3%). There was no significant difference in adverse effects between the two groups. Conclusions After 90 days of treatment, at the doses used, we found Tribulus terrestris to be effective in treating sexual problems among menopausal women.
Objetivo Estudar os efeitos doTribulus terrestris na função sexual demulheres após a menopausa. Métodos Ensaio clínico, prospectivo, randomizado, duplo-cego, placebo controlado, com 60 mulheres após a menopausa com disfunção sexual, divididas em dois grupos: Grupo Placebo e Grupo Tribulus, avaliadas através dos questionários Quociente Sexualversão Feminina (QS-F) e Female Intervention Efficacy Index (FIEI). Resultados Não houve diferença significante entre os grupos quanto à idade, idade de menopausa, estado civil, raça e religião. Na avaliação do questionário QS-F houve diferença significante entre os grupos Placebo (7,6±3,2) e Tribulus (10,2±3,2) nos aspectos desejo e interesse sexual (p d" 0,001), preliminares (3,3±1,5 versus 4,2±1,0) (p d" 0,01), excitação da mulher e sintonia com o parceiro (5,7±2,1 versus 7,2±2,6) (p d" 0,01) e no aspecto conforto na relação sexual (6,5±2,4 versus 8,0±1,9) (p d" 0,01). O aspecto orgasmo e satisfação sexual não houve diferença significante entre o Grupo Placebo e Tribulus (p = 0,28). No questionário FIEI houve melhora significante (p < 0,001) na lubrificação vaginal durante o coito e/ou preliminares (20 versus 83,3%), na sensação nas genitálias durante a relação sexual ou outros estímulos (16,7 versus 76,7%), na sensação na área genital (20 versus 70%), nas relações sexuais e/ou outras estimulações sexuais (13,3 versus 43,3%) e na capacidade de ter orgasmo (20% versus 73,3%). Quanto aos efeitos colaterais não houve diferença significante entre os dois Grupos. Conclusões Após noventa dias, podemos concluir que o Tribulus terrestris nas doses utilizadas demonstrou ser efetivo no tratamento das queixas sexuais dasmulheres após a menopausa.
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Humanos , Femenino , Persona de Mediana Edad , Anciano , Menopausia , Fitoterapia , Extractos Vegetales/uso terapéutico , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Tribulus , Método Doble Ciego , Estudios Prospectivos , Conducta SexualRESUMEN
OBJECTIVE: The aim of this study was to study the effects of Tribulus terrestris on sexual function in menopausal women. METHODS: This was a prospective, randomized, double-blind, placebo-controlled clinical trial that included 60 postmenopausal women with sexual dysfunction. The women were divided into two groups, placebo group and Tribulus group, and evaluated by using the Sexual Quotient-female version (SQ-F) and Female Intervention Efficacy Index (FIEI) questionnaires. RESULTS: There was no significant difference between the groups in age, age at menopause, civil status, race, and religion. In the evaluation with the SQ-F questionnaire, there were significant differences between the placebo (7.6 ± 3.2) and Tribulus (10.2 ± 3.2) groups in the domains of desire and sexual interest (p ≤ 0.001), foreplay (3.3 ± 1.5 versus 4.2 ± 1.0) (p ≤ 0.01), arousal and harmonious interaction with the partner (5.7 ± 2.1 versus 7.2 ± 2.6) (p ≤ 0.01), and comfort in sexual intercourse (6.5 ± 2.4 versus 8.0 ± 1.9) (p ≤ 0.01). There was no significant difference between the placebo and Tribulus groups in the domains of orgasm and sexual satisfaction (p = 0.28). In the FIEI questionnaire, there was a significant improvement (p < 0.001) in the domains of vaginal lubrication during coitus and/or foreplay (20 versus 83.3%), sensation in the genitalia during sexual intercourse or other stimuli (16.7 versus 76.7%), sensation in the genital region (20 versus 70%), sexual intercourse and/or other sexual stimulations (13.3 versus 43.3%), and the ability to reach orgasm (20% versus 73.3%). There was no significant difference in adverse effects between the two groups. CONCLUSIONS: After 90 days of treatment, at the doses used, we found Tribulus terrestris to be effective in treating sexual problems among menopausal women.
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Menopausia , Fitoterapia , Extractos Vegetales/uso terapéutico , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Tribulus , Anciano , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Conducta SexualRESUMEN
In order to increase the success rate of in vitro fertilization cycles, several studies have focused on the identification of the embryo with higher implantation potential. Despite recent advances in the reproductive medicine, based on the OMICs technology, routinely applicable methodologies are still needed. Thus, in most fertilization centers embryo selection for transfer is still based on morphological parameters evaluated under light microscopy. Several morphological parameters may be evaluated, ranging from the pronuclear to blastocyst stage. In general, despite the day of transfer, some criteria are suggested to present a predictive value for embryo viability when analyzed independently or combined. However, the subjectivity of morphological evaluation, as well as the wide diversity of embryo classification systems used by different fertilization centers shows contrasting results, making the implementation of a consensus regarding different morphological criteria and their predictive value a difficult task. The optimization of embryo selection represents a large potential to increase treatment success rates, allowing the transfer of a reduced number of embryos and minimizing the risks of multiple pregnancy.
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Blastocisto/citología , Oocitos/citología , Transferencia de Embrión , Femenino , Humanos , Valor Predictivo de las PruebasRESUMEN
Com o objetivo de aumentar as taxas de sucesso das pacientes que são submetidas a técnicas de reprodução humana assistida (RHA), numerosos estudos apresentam como foco a identificação do embrião com maior potencial de implantação. Apesar dos avanços tecnológicos significativos da Medicina Reprodutiva baseados no advento da era da genômica, proteômica e metabolômica (OMICS), técnicas rotineiramente aplicáveis ainda não estão disponíveis. Dessa forma, laboratórios de fertilização in vitro(FIV) de todo o mundo selecionam para transferência embriões humanos cultivados in vitrobaseados em parâmetros morfológicos avaliados em microscopia de luz. Diversos parâmetros morfológicos podem ser avaliados desde o estágio pronuclear até o estágio de blastocisto para embriões humanos cultivados in vitro. De modo geral, independentemente do dia da transferência, tais critérios parecem apresentar valor preditivo de viabilidade embrionária quando avaliados individualmente ou coletivamente. No entanto, a subjetividade da avaliação morfológica, bem como a ampla diversidade de sistemas de classificação embrionária aplicados por diferentes clínicas, implica em resultados contraditórios, tornando extremamente difícil a implementação de um consenso do valor preditivo dos diferentes parâmetros morfológicos avaliados. A otimização da seleção embrionária representa um grande potencial de aumento das taxas de sucesso do tratamento, além de possibilitar a realização da transferência de um número reduzido de embriões, minimizando os riscos derivados de estações múltiplas.
In order to increase the success rate of in vitrofertilization cycles, several studies have focused on the identification of the embryo with higher implantation potential. Despite recent advances in the reproductive medicine, based on the OMICs technology, routinely applicable methodologies are still needed. Thus, in most fertilization centers embryo selection for transfer is still based on morphological parameters evaluated under light microscopy. Several morphological parameters may be evaluated, ranging from the pronuclear to blastocyst stage. In general, despite the day of transfer, some criteria are suggested to present a predictive value for embryo viability when analyzed independently or combined. However, the subjectivity of morphological evaluation, as well as the wide diversity of embryo classification systems used by different fertilization centers shows contrasting results, making the implementation of a consensus regarding different morphological criteria and their predictive value a difficult task. The optimization of embryo selection represents a large potential to increase treatment success rates, allowing the transfer of a reduced number of embryos and inimizing the risks of multiple pregnancy.
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Humanos , Femenino , Blastocisto/citología , Oocitos/citología , Transferencia de Embrión , Valor Predictivo de las PruebasRESUMEN
OBJECTIVE: To compare ethylenediamine tetraacetic acid (EDTA) tubes and plasma preparation tubes (PPT) for evaluating maternal plasma during the first trimester of pregnancy. METHODS: A cross-sectional study was conducted on 24 male fetuses in women between 6 and 14 weeks of pregnancy. Blood samples (10 mL) were collected and stored in EDTA and PPT tubes. Subsequently, the samples were centrifuged and sent for free fetal DNA extraction by means of the polymerase chain reaction (PCR) technique. The reactions were performed in a real time PCR machine for detecting the amplification products. The genome region chosen for performing the PCR reactions was a target specific for the Y chromosome, in which the DYS-14 marker was amplified only when the DNA was of male sex. The free fetal DNA concentration was given by the threshold cycle (TC). To compare the tubes, the paired Student t-test was used. RESULTS: The mean gestational age was 11.08 ± 2.30 weeks (range: 6-14). The mean TC for PPT was 30.08 ± 1.05 (range: 27.08-32.61) and for EDTA, 30.23 ± 0.96 (range: 28.01-32.09), but without statistical significance (p=0.357). CONCLUSION: We did not observe any statistically significant difference in free fetal DNA concentration between the EDTA and PPT tubes.
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Anticoagulantes/farmacología , Conservación de la Sangre/métodos , Recolección de Muestras de Sangre/métodos , ADN/sangre , Ácido Edético/farmacología , Feto/metabolismo , Primer Trimestre del Embarazo/sangre , Proteínas de Ciclo Celular/análisis , Proteínas de Ciclo Celular/genética , Estudios Transversales , ADN/análisis , Femenino , Edad Gestacional , Humanos , Masculino , Proyectos Piloto , Reacción en Cadena de la Polimerasa , Embarazo , Primer Trimestre del Embarazo/genéticaRESUMEN
OBJECTIVE: To evaluate if ICSI outcome are influenced by the number of cycles and oocyte injected per day. METHODS: Data of ICSI cycles performed in an unselected infertile population were included. The influences of the number of cycles and number of injected oocytes on the ICSI outcomes (fertilization rate, high quality embryos rates on day 3 of development, blastocyst formation rate, the proportion of cycles with embryo transfer, pregnancy rate and implantation rate) were investigated. RESULTS: Regression analyses results showed no significant influence of the number of cycles and oocytes injected per day on the ICSI outcomes. CONCLUSION: The outcomes of ICSI are not influenced by the number of cycles or the number of oocytes injected per day. We suggest that an appropriate number of embryologists per cases per year guarantee successful outcomes independently of the daily workload.
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The aim of this study was to investigate the association between MTHFR gene polymorphisms and IVF outcomes in Brazilian women undergoing assisted reproduction treatment. A prospective study was conducted in the Human Reproduction Department at the ABC University School of Medicine and the Ideia Fertility Institute between December 2010 and April 2012. The patient population was 82 women undergoing assisted reproduction cycles. The MTHFR polymorphisms C677T and A1298C were evaluated and compared with laboratory results and pregnancy rates. The C677T variant was associated with proportions of mature (P=0.006) and immature (P=0.003) oocytes whereas the A1298C variant was associated with number of oocytes retrieved (P=0.044). The polymorphisms, whether alone or in combination, were not associated with normal fertilization, good-quality embryo or clinical pregnancy rates. This study suggests that the number and maturity of oocytes retrieved may be related to the MTHFR polymorphisms C677T and A1298C. It is believed that folate has a crucial function in human reproduction and that folate deficiency can compromise the function of the metabolic pathways it is involved in, leading to an accumulation of homocysteine. The gene MTHFR encodes the 5-MTHFR enzyme, which is involved in folate metabolism, and C677T/A1298C polymorphisms of this gene are related to decreased enzyme activity and consequent changes in homocysteine concentration. Folate deficiency and hyperhomocysteinaemia can also compromise fertility and lead to pregnancy complications by affecting the development of oocytes, preparation of endometrial receptivity, implantation of the embryo and pregnancy. In folliculogenesis, hyperhomocysteinaemia can activate apoptosis, leading to follicular atresia and affecting the maturity of oocytes and the quality of embryos cultured in vitro. This study was performed to investigate the association between MTHFR polymorphisms and IVF outcomes in women undergoing assisted reproduction treatment.
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Fertilización In Vitro , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Polimorfismo Genético , Adulto , Brasil , Femenino , Genotipo , Humanos , Embarazo , Índice de Embarazo , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the changes in quality of life (QOL) over a 1-year follow-up period in patients submitted to laparoscopic colorectal resection for the treatment of deep endometriosis. METHODS: A prospective observational cohort study (Canadian Task Force Design Classification II) involving 40 women with intestinal deep endometriosis was conducted between June 2007 and September 2008 at the Department of Obstetrics and Gynecology, Santa Casa Medical School, Sao Paulo, Brazil. Prior to the surgical procedure, all patients received magnetic resonance studies of the pelvis and rectal echoendoscopy, which suggested intestinal involvement of the disease in all cases. The patients received laparoscopic colorectal resections and treatment for other endometriotic lesions. The subjects completed the QOL SF-36 at 3 time points (T0 pre-operatively; T1 6 months post-operatively; and T2 1 year post-operatively). RESULTS: The physical functioning, role physical, social functioning and role emotional subscales evidenced the most substantial median increases for T0, T1 and T2. The pain, general health, vitality and mental health domains showed slight changes and increases in medians but did not increase to the same extent as the previous group. Significant improvements were observed in all domains of the SF-36 throughout the study period (p < 0.05). Physical health-related QOL domains showed greater improvement than mental health domains. Analyses of age, parity and body mass index as potential factors influencing the impact of surgery on QOL revealed no differences. Therefore, these factors were not used as prognostic indicators for the surgical procedure or for patient follow-up. In addition, we noted that the patients with poorest results on the initial QOL questionnaire showed the greatest improvements at the end point. CONCLUSION: The study results showed that laparoscopic colorectal segment resection for endometriosis had a positive impact on QOL in this patient group. The positive effects persisted 1 year after surgery.
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Colectomía/psicología , Endometriosis/psicología , Endometriosis/cirugía , Laparoscopía/psicología , Calidad de Vida/psicología , Adulto , Brasil , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
Since endometriosis is a proliferative disease we evaluated the presence of anti-apoptotic factor (Bcl-2) and pro-apoptotic factor (Bax) in deep pelvic endometriosis. A Cross-sectional observational study was performed at Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil. Forty women aged 26 to 46 years with deep endometriosis were selected. They had not been clinically treated for at least 3 months prior to surgery and then underwent surgical laparoscopy to treat the disease. During the surgery, tissue was collected from the uterosacral ligaments and the rectosigmoid; an endometrial biopsy was also performed as a control. All interventions were performed by the same surgeon. The specimens were sent for pathological and immunohistochemical analyses; endometriosis was confirmed in all patients. After the immunohistochemical reaction a semi-quantitative evaluation of the staining intensity (relative optical density-ROD) was conducted, applying the digital densitometric analysis system. In the uterosacral ligaments 97.5% of the specimens were positive for Bcl2 whereas in the rectosigmoid 100% were positive. In the endometrium we observed that 87.5% were positive for Bcl2. BAX expression was null in the rectosigmoid and in the endometrium. In the uterosacral ligaments 2.5% of the specimens expressed BAX. The relative optical density of Bcl2 was higher in the rectosigmoid and in the uterosacral ligament when compared to the endometrium, 0.141±0.002; 0.129±0.001, respectively (p<0.01). We concluded that the anti-apoptotic factor Bcl-2 was expressed in all studied specimens, but in a higher staining intensity in the rectosigmoid and in the uterossacral ligaments in comparison to the endometrium. The pro-apoptotic factor Bax had virtually no expression in the studied tissues.
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Apoptosis/fisiología , Endometriosis/patología , Pelvis/patología , Proteínas Proto-Oncogénicas c-bcl-2/biosíntesis , Proteína X Asociada a bcl-2/biosíntesis , Adulto , Estudios Transversales , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Proteínas Proto-Oncogénicas c-bcl-2/análisis , Proteína X Asociada a bcl-2/análisisRESUMEN
A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOME) enables the evaluation of the nuclear morphology of motile spermatozoa in real time at high magnification and has allowed the introduction of a modified microinjection procedure, intracytoplasmic morphologically selected sperm injection (IMSI). Since its development, several studies have intensively investigated the efficacy of MSOME and IMSI. The objective of the present study is to review the current literature on the MSOME and IMSI techniques. A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOME), enables the evaluation of the nuclear morphology of motile spermatozoa in real time at high magnification and has allowed the introduction of a modified microinjection procedure, intracytoplasmic morphologically selected sperm injection (IMSI). Since its development, several studies have intensively investigated the efficacy of MSOME and IMSI. The objective of the present study is to review the current literature on the MSOME and IMSI techniques.
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Inyecciones de Esperma Intracitoplasmáticas/métodos , Motilidad Espermática , Reacción Acrosómica , Adulto , Factores de Edad , Criopreservación , Daño del ADN , Femenino , Humanos , Masculino , Embarazo , Índice de Embarazo , Espermatozoides/ultraestructura , Vacuolas/ultraestructuraRESUMEN
OBJECTIVE: To assess efficacy and tolerability of a isoflavone (Glycine max L. Merr.) vaginal gel to the treatment of vaginal atrophy in postmenopausal women. METHODS: The double-blind, randomized, placebo-controlled, clinical trial. Ninety women were treated for 12 weeks with isoflavone vaginal gel 4% (1g/day) and a placebo gel and conjugated equine estrogen cream (0.3mg/day). After 4 and 12 weeks, the vaginal atrophy symptoms were classified at none, mild, moderate and severe and the vaginal cytology were taken to determine the maturation value. The endometrial safety (by transvaginal ultrasonography) was evaluated through at screening and the end of the trial. RESULTS: Isoflavone vaginal gel appears to be effective for relief of vaginal dryness and dyspareunia symptoms and an increase in the intermediate and superficial cells was noted. These results were similar to the effects with use of conjugated equine estrogens and superior to placebo gel. No changes in endometrial thickness, sera FSH and estradiol levels were observed at study endpoint. CONCLUSION: Glycine max (L.) Merr. at 4% vaginal gel on a daily basis in postmenopausal women led to improvements in vaginal atrophy symptoms and a significant increase in cell maturation values. Isoflavones proved good treatment options for relief of vulvovaginal symptoms especially in women who do not wish to use hormonal therapy or have contra-indications for this treatment.
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Glycine max , Isoflavonas/uso terapéutico , Vagina/efectos de los fármacos , Atrofia , Método Doble Ciego , Dispareunia/tratamiento farmacológico , Endometrio/efectos de los fármacos , Estradiol/sangre , Terapia de Reemplazo de Estrógeno/métodos , Estrógenos Conjugados (USP)/uso terapéutico , Femenino , Hormona Folículo Estimulante/sangre , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Placebos , Posmenopausia/efectos de los fármacos , Resultado del Tratamiento , Ultrasonografía , Vagina/diagnóstico por imagen , Vagina/patología , Cremas, Espumas y Geles Vaginales/uso terapéutico , Enfermedades Vaginales/tratamiento farmacológicoRESUMEN
The objective of this study was to evaluate the correlation between cyclooxygenase-2 (COX-2) and markers of cell proliferation and apoptosis, including, Bcl-2, Bax, Ki-67 and the type I insulin-like growth factor (IGF) receptor (IGF1-R) in ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC), present in the same surgical specimen. A total of 110 cases were evaluated using tissue microarrays. Cases were classified in scores from 0 to 3 according to pre-defined methods. The results showed that the positivity rates were COX-2 in 87% of cases in DCIS and IDC; Bcl-2 in 55% of cases in DCIS and IDC; Bax in 23% of cases in IDC and 19% in DCIS, IGF-1 in 24% of cases in DCIS and IDC; and Ki-67 in 81% of cases in DCIS and IDC. We also observed a positive correlation between the expression of COX-2 and IGF1-R (p=0.045). Our results demonstrate a positive correlation between the expression of COX-2 and IGF1-R in DCIS and IDC, demonstrating that they are involved in breast cancer carcinogenesis. Further studies are required to prove the effectiveness of COX-2 and IGF1-R inhibitors for the prevention and treatment of breast cancer, as well as to explain their mechanism of action.
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OBJECTIVE: Development of an electronic protocol for cancer of the cervix. METHODS: We collected data through a literature review and formatted them to build a theoretical base for cancer of the cervix for inclusion in the protocol. The computerized database used the SINPE © (Integrated Electronic Protocols) developed at the Federal University of Parana by the Graduate Program in Surgery, Department of Health Sciences, with the help of the Laboratory of Computer and Multimedia. RESULTS: We created 2,687 items, grouped into seven main categories: history, physical examination, laboratory tests, diagnosis, final pathology, treatment and monitoring. We added items on socio-demographic indicators, contraceptive use, smoking, gynecological and obstetrical histories, staging, the most widely accepted classifications and nomenclatures, diagnostic methods, treatments and follow-up. CONCLUSION: It is possible to develop an electronic protocol with low cost, little space and minimal staff training. The use of computers avoids limitations and the subjective character of written records. With the data collected in an appropriate manner it is possible to determine, through statistical analysis, the importance of each factor in cancer development and progression and prognosis.
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Protocolos Clínicos , Registros Electrónicos de Salud , Neoplasias del Cuello Uterino , Femenino , Humanos , Programas InformáticosRESUMEN
Purpose. To compare the measurements of fetal nuchal fold (NF) thickness by two-dimensional (2D) and three-dimensional (3D) ultrasonography using the three-dimensional extended imaging (3DXI). Methods. A cross-sectional study was performed with 60 healthy pregnant women with a gestational age between 16 and 20 weeks and 6 days. The 2D-NF measurements were made as the distance from the outer skull bone to the outer skin surface in the transverse axial image in the suboccipital-bregmatic plane of the head. For the 3D we employed the 3DXI multislice view software, in which 3 × 2 tomographic planes was displayed on the screen and the distance between the tomographic slices was 0.5 mm. Maximum, minimum, mean, and standard deviation were calculated for 2D and 3D ultrasonography, as well the maximum and minimum, mean, and standard deviation for the difference between both methods. The Wilcoxon signed-rank test was used to compare the two different techniques. Results. 2D-NF showed a mean of thickness of 3.52 ± 0.95 mm (1.69-7.14). The mean of 3D-NF was 3.90 ± 1.02 mm (2.13-7.72). The mean difference between the methods was 0.38 mm, with a maximum difference of 3.12 mm. Conclusion. The NF thickness measurements obtained by 3D ultrasonography were significantly larger than those detected with 2D ultrasonography.
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OBJECTIVE: To evaluate the relation between total lung area (TLA) and thoracic circumference (TC) ratio by three-dimensional (3D) ultrasonography applying new anatomical landmarks as the fetal aorta and inferior angle of the scapula. METHODS: A longitudinal prospective study was conducted with 56 uncomplicated pregnancies between 24 and 32 weeks of gestation. Polynomial regressions were used to evaluate the correlation between TC and gestational age (GA) as well as TC and estimated fetal weight (EFW). A simple linear regression was used to evaluate the correlation between TLA and Total thoracic area (TTA) and GA. The intraclass correlation coefficient (ICC) was used to assess the intra and interobserver variability. RESULTS: 127 examinations were performed. TC values ranged from 150 to 174 mm (mean 166 mm) at 24 weeks and 215-248 mm (mean 231 mm) at 32 weeks. The TLA/TC ratio ranged from a mean of 0.64 at 24 weeks (range 0.56-0.70) to 0.90 at 32 weeks gestation (range 0.79-1.01). The intraobserver variability using the ICC was of 0.919 for TC; 0.916 for TTA; 0.860 for right lung area (RLA) and 0.910 for left lung area (LLA). Interobserver reproducibility was with an ICC of 0.970 for TC; 0.984 for RLA and 0.910 for LLA. CONCLUSIONS: Measurement of fetal TC and the relationship between TLA and TC by 3D-ultrasonography applying new anatomical landmarks shows good reproducibility and allows a new assessment of thoracic and lung growth.
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Desarrollo Fetal , Feto/anatomía & histología , Imagenología Tridimensional , Pulmón/embriología , Tórax/embriología , Ultrasonografía Prenatal , Adolescente , Adulto , Femenino , Edad Gestacional , Humanos , Modelos Lineales , Estudios Longitudinales , Pulmón/anatomía & histología , Pulmón/diagnóstico por imagen , Variaciones Dependientes del Observador , Embarazo , Estudios Prospectivos , Valores de Referencia , Tórax/anatomía & histología , Tórax/diagnóstico por imagen , Adulto JovenRESUMEN
New biological markers are emerging trying to identify earlier cardiovascular high risk subjects. Myeloperoxidases have been involved in the role of atherosclerosis process, by the beginning of the endothelial dysfunction up to the plaque rupture and clinical manifestation, and it has been demonstrated that this enzyme has also a prognostic value. We aimed to assess myeloperoxidases levels in patients with polycystic ovary syndrome (PCOS) with insulin resistance (IR), considering that these women represent a high risk group for cardiovascular disease. We developed a transversal study, comprising 26 patients with PCOS and IR and 30 controls (PCOS without IR). IR was considered with HOMA-IRâ≥3.0. IR absence was considered when HOMA-IRâ<3.0, triglyceridesâ<200, BMIâ<28.7, and BMI<27.8 in patients with familial history of type 2 diabetes. All patients went through anamnesis, physical examination, transvaginal ultrasound, and blood samples. IR PCOS patients had higher levels of myeloperoxidase (22.3â×â18.1, pâ=â0.047), and also higher BMI. Myeloperoxidase levels correlated directly with insulin. In conclusion, IR PCOS young patients have higher myeloperoxidase levels.
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Peroxidasa/sangre , Síndrome del Ovario Poliquístico/sangre , 17-alfa-Hidroxiprogesterona/sangre , Adulto , Androstenodiona/sangre , Biomarcadores/sangre , Índice de Masa Corporal , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Resistencia a la Insulina/fisiología , Síndrome del Ovario Poliquístico/diagnóstico , Síndrome del Ovario Poliquístico/enzimología , Adulto JovenRESUMEN
OBJETIVO: Desenvolvimento de um protocolo eletrônico para o câncer do colo do útero. MÉTODOS: Coletar dados através de revisão da literatura e formatá-los para a construção de uma base teórica sobre o câncer do colo uterino para inclusão no protocolo. A informatização do banco de dados utilizou o SINPE© (Sistema Integrado de Protocolos Eletrônicos), desenvolvido na Universidade Federal do Paraná pelo Programa de Pós-graduação em Clínica Cirúrgica do Setor de Ciências da Saúde com auxílio do Laboratório de Informática e Multimídia. RESULTADOS: Foram criados 2687 itens, agrupados em sete categorias principais: anamnese, exame físico, exames complementares, diagnóstico, anatomopatológico definitivo, tratamento e acompanhamento. Acrescentamos itens sobre indicadores sócio-demográficos, uso de anticoncepcionais, tabagismo, antecedentes ginecológicos e obstétricos, estadiamento, as classificações e nomenclaturas mais aceitas, métodos diagnósticos, tratamentos e seguimento. CONCLUSÃO: É possível o desenvolvimento de um protocolo eletrônico com baixo custo, pouco espaço físico e mínimo treinamento de pessoal. O uso de computadores evita limitações e o caráter subjetivo do prontuário escrito. Com os dados coletados de maneira adequada é possível determinar, através de análise estatística, a importância de cada fator no desenvolvimento do câncer e na evolução e prognóstico do paciente.
OBJECTIVE: Development of an electronic protocol for cancer of the cervix. METHODS: We collected data through a literature review and formatted them to build a theoretical base for cancer of the cervix for inclusion in the protocol. The computerized database used the SINPE © (Integrated Electronic Protocols) developed at the Federal University of Parana by the Graduate Program in Surgery, Department of Health Sciences, with the help of the Laboratory of Computer and Multimedia. RESULTS: We created 2,687 items, grouped into seven main categories: history, physical examination, laboratory tests, diagnosis, final pathology, treatment and monitoring. We added items on socio-demographic indicators, contraceptive use, smoking, gynecological and obstetrical histories, staging, the most widely accepted classifications and nomenclatures, diagnostic methods, treatments and follow-up. CONCLUSION: It is possible to develop an electronic protocol with low cost, little space and minimal staff training. The use of computers avoids limitations and the subjective character of written records. With the data collected in an appropriate manner it is possible to determine, through statistical analysis, the importance of each factor in cancer development and progression and prognosis.
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Femenino , Humanos , Protocolos Clínicos , Registros Electrónicos de Salud , Neoplasias del Cuello Uterino , Programas InformáticosRESUMEN
PURPOSE: to evaluate the performance of the combined first trimester screening for chromosomal abnormalities in a group of the Brazilian population. METHODS: a retrospective study including pregnant women with single fetuses referred to a fetal medicine center to perform the first trimester screening that combines maternal age, nuchal translucency measurement and two maternal serum biochemical markers: free B-hCG and PAPP-A. To evaluate the performance of the test, the detection rate, specificity, negative and positive predicted values and false-positive rates were calculated, considering as high risk the cut-off value above 1 in 300. RESULTS: we studied 456 patients submitted to the test. Advanced maternal age above 35 years was observed in 36.2% of cases. The incidence of chromosomal abnormalities in the study population was 2.2%. Twenty-one patients (4.6%) presented a high risk (above 1:300) by the combined test. Using this cut-off level, the detection rate of the test was 70% for all chromosomal abnormalities and 83.3% for trisomy 21, for a false-positive rate of 3.1%. CONCLUSIONS: the combined first trimester screening was effective to detect chromosomal abnormalities, mainly for trisomy 21, with low false-positive rates. The combined test contributed to decreasing the indication of an invasive test if we compare to maternal age alone as a risk factor.