RESUMO
BACKGROUND/AIMS: Evidence of an increased bone fracture risk in coeliac disease is on debate. Our aim was to review systematically the current published information on fractures in coeliac disease and to perform a meta-analysis. METHODS: Case-control and cohort designs were identified by searching MEDLINE (1966-April 2007) and LILACS (1982-April 2007). Participants were adult coeliac disease patients of any sex and the outcome measure was the presence of any fracture. Studies were screened for inclusion by two authors who independently extracted the data. Methodological quality was assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology Statement) recommendations. Data were analysed using the RevMan Analyses statistical package in Review Manager (version 4.2.8) and reported as pooled odds ratio using a random effect model. Heterogeneity was investigated (standard chi(2) test) and sensitivity analysis was performed based on the reported quality and design type. RESULTS: While 60 of 405 studies met the initial screening criteria, only 8 met inclusion criteria after detailed review. These studies evaluated a total of 20,955 coeliac disease patients having 1819 (8.7%) fractures and 96,777 controls with 5955 (6.1%) fractures (pooled odds ratio=1.43; 95% confidence interval 1.15-1.78) with considerable heterogeneity among studies (p<0.00001). CONCLUSIONS: Our meta-analysis confirms a significant association between bone fractures and coeliac disease. However, qualitative and quantitative differences among studies were evident. Further research is necessary to investigate the relevance of this heterogeneity.
Assuntos
Doença Celíaca/complicações , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Observação/métodos , Estudos de Coortes , Humanos , Osteoporose/complicações , Osteoporose/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
PIP: Although less distinct than those of the endometrium, the Fallopian tubes show definite changes due to ovarian hormones. The effect of the hormones on the tubes determines certain modifications in their secretions and activities. The estrogens increase the secretions, but progesterone decreases the effect of the estrogens. In the study, a single dose of 200 mgm of norethisterone enanthate was given im on the 6th day of the cycle to 10 patients of fertile age. The effects were studied using conventional histological methods. During the first 6 weeks there was a definite decrease in growth and differentiation of the epithelial cells and gradual recovery toward the end of the 12 weeks of observation. The salpingian mucus in the first 6 weeks indicated a state of rest, similar to that of menopause. This aspect gradually modified itself with the increase in the volume of cells and the appearance of cellular secretions. In the last 2 weeks, cellular hypertrophy, and the appearance of intercalary cells indicated the anatomical and functional recovery of the epithelium. As a possible explanation it was suggested that during the first 6 weeks the action of the estrogens was inhibited, but by the 7th week their proliferative effects became dominant. It is implied that the changes were due to the contraceptive action of norethindrone enanthate.^ieng