RESUMO
OBJECTIVE: This article addresses the connection between loneliness and physical contact. Evolutionary and psychological research has shown that touch is an important part of bond-building and emotion communication; loneliness is intimately related to these elements as well. In this paper, we ask whether physical contact reduces feelings of loneliness -which might derive from evolutionary ancient bonding mechanisms-despite a cultural context that is relatively non-tactile. METHOD: An experimental study (40 participants, 13 males) tested for observable effects of touch on loneliness scores in a low-contact culture to analyse whether they respond positively to that stimulus despite cultural training against it. RESULTS: Participants exposed to physical contact reported significantly lower neglect scores from their close relationships in a short loneliness scale, thus suggesting that there is an underlying mechanism that persists despite enculturation. The effects were particularly strong among single people, which could mean that lower loneliness among married people might be partly explained by the regular availability of physical contact. Participants in the experimental condition also showed a faster reduction in heart rate, interpreted as a sign of physiological wellbeing. CONCLUSIONS: These findings help to specify mechanisms within the evolutionary theoretical framework of loneliness that link internal feelings to environmental cues. This article aims at contributing to a more complex discussion on the interactions between emotions, cultural practices and psychological well-being.
RESUMO
BACKGROUND: Levonorgestrel (LNG) consistently prevents follicular rupture only when it is given before the onset of the ovulatory stimulus. As locally synthesized prostaglandin (PG) plays a crucial role in follicular rupture and cyclooxygenase-2 (cox-2) catalyses the final step of PG synthesis, we reasoned that adding a cox-2 inhibitor to LNG would prevent follicular rupture even after the ovulatory process had been triggered by the gonadotrophin surge. METHODS: Forty-one women were divided into two groups. One was treated when the size of the leading follicle was 15-17 mm (n=10) and the other when it was >or=18 mm (n=31). Each woman contributed with one cycle treated with LNG 1.5 mg single dose plus placebo and another treated with LNG + meloxicam (Melox) 15 mg, in a randomized order. Serial blood sampling for the assay of LH and follicular monitoring by transvaginal ultrasound were performed before and after treatment. RESULTS: Follicular rupture failed to occur within the 5-day period that followed treatment in 50 and 70% of cycles treated with LNG + Placebo and LNG + Melox, respectively, in the 15-17 mm group (P=0.15) and in 16 and 39% of cycles treated with LNG + Placebo and LNG + Melox, respectively, in the >or=18 mm group (P < 0.052). The overall proportion of cycles with no follicular rupture or ovulatory dysfunction increased significantly by the addition of Melox to LNG (66 versus 88%, P < 0.012; n=41-matched pairs). CONCLUSIONS: The trend towards increased incidence of no follicular rupture when Melox was combined with LNG suggests that the addition of a cox-2 inhibitor has the potential to improve the contraceptive efficacy of LNG by a pre-fertilization effect.
Assuntos
Anovulação/induzido quimicamente , Anticoncepcionais Sintéticos Pós-Coito/farmacologia , Inibidores de Ciclo-Oxigenase 2/farmacologia , Levanogestrel/farmacologia , Tiazinas/farmacologia , Tiazóis/farmacologia , Adolescente , Adulto , Chile , Anticoncepcionais Sintéticos Pós-Coito/administração & dosagem , República Dominicana , Feminino , Humanos , Meloxicam , Folículo Ovariano/efeitos dos fármacos , Folículo Ovariano/fisiologiaRESUMO
The relationship between ovarian hormones and bleeding patterns during continuous progestin contraception was studied in 29 women who used Nestorone (NES) releasing implants. Oestradiol and progesterone were measured in blood samples taken twice a week for 6 consecutive weeks, during months 6, 12, 18 and 24 of implant use. Retrospectively, the association between hormonal concentrations and bleeding patterns was evaluated. Twenty-four short (
Assuntos
Anticoncepcionais Femininos/administração & dosagem , Glândulas Endócrinas/efeitos dos fármacos , Menstruação/efeitos dos fármacos , Norprogesteronas/administração & dosagem , Adolescente , Adulto , Amenorreia/sangue , Anticoncepcionais Femininos/farmacologia , Implantes de Medicamento , Glândulas Endócrinas/fisiologia , Estradiol/sangue , Feminino , Humanos , Ciclo Menstrual/sangue , Menstruação/sangue , Norprogesteronas/farmacologia , Concentração Osmolar , Progesterona/sangue , Estudos Retrospectivos , Fatores de TempoRESUMO
Levonorgestrel has an inhibitory effect on sex hormone binding globulin (SHBG). This decrease in SHBG leads to an increase in the free levonorgestrel index (FLI), which has a stronger biological effect. The interaction between serum levels of levonorgestrel and SHBG in long-term users of Norplant implants has been described. This study was designed to understand the same interaction immediately after the insertion of the implants, in a group of 16 women, sampled at 0 and 6 h and at 1, 3, and 7 days after Norplant implant insertion. Peak serum levonorgestrel levels were achieved at 24 h after insertion, remaining stable on day 3 and decreasing by > 10% by day 7. SHBG did not change during the first 24 h, but decreased by 19% and 60% on days 3 and 7, respectively. FLI more than doubled from day 1 to day 7 after insertion. The large decrease in SHBG and doubling of FLI is not followed by a similar reduction in levonorgestrel, which is hard to explain without an increase in the release rate of the steroid from the capsule.
PIP: It has been documented that levonorgestrel (LNG) administration by any route induces a significant reduction in circulating levels of sex hormone binding globulin (SHBG), which, in turn, leads to an increase in the free LNG index (FLI). A previous study found a pronounced reduction in SHBG levels as early as 7 days after insertion of the LNG-releasing Norplant contraceptive implants. The present study investigated the same interaction 1-7 days after Norplant insertion in 16 women recruited from a family planning clinic in Santo Domingo, Dominican Republic. Mean SHBG level at insertion was 75.9 nmol/l and was essentially unchanged 24 hours later. On postinsertion day 3, however, a 19% reduction over baseline was recorded. This decrease in SHBG was even more marked between days 3 and 7. By day 7, the mean SHBG serum level was only 40% of that found at the time of implant insertion. 6 hours after implant insertion, LNG levels were already above 700 pg/ml and peaked at over 1000 pg/ml at 24 hours, remained stable at this level until day 3, and then showed a moderate and nonsignificant decline of about 10%. The FLI was 5.1 at 24 hours postinsertion, remained at this level until day 3, and reached 11.9 by day 7. The lack of a significant reduction in LNG between postinsertion days 1 and 7 was unexpected given the 60% drop in SHBG and the doubling in the FLI. Two possible explanations for this finding are an increase in the amount of LNG entering the circulation or a large cross-reaction of the LNG assay with LNG metabolites in serum.
Assuntos
Anticoncepcionais Femininos , Levanogestrel/efeitos adversos , Levanogestrel/sangue , Globulina de Ligação a Hormônio Sexual/metabolismo , Implantes de Medicamento , Feminino , Humanos , Cinética , Levanogestrel/administração & dosagem , Estudos ProspectivosRESUMO
Studies were conducted from 1986 through 1993 to further define the geographic distribution and relative importance of different species of Leishmania as a cause of leishmaniasis in Peru. Patients with a clinical diagnosis of cutaneous and/or mucosal or diffuse cutaneous leishmaniasis were enrolled at the Naval Medical Research Institute Detachment (NAMRID) Laboratory in Lima, the Tropical Disease Clinic at San Marcos University Daniel A. Carrión, the Central Military Hospital, and a Ministry of Health hospital in Cusco, Peru. Clinical features, lesion aspirates, and biopsy tissue were obtained from each patient. All specimens were collected and assayed separately, including multiple specimens from some of the same patients for Leishmania parasites by inoculating aliquots of either aspirates or biopsy tissue suspensions onto Senekji's blood agar medium. Stocks of Leishmania isolates were used to prepare promastigotes to produce extracts for identifying the Leishmania species by the cellulose acetate electrophoresis enzyme technique. A total of 351 isolates of Leishmania were obtained from 350 patients who were infected primarily in the low and high jungle of at least 15 different Departments of Peru. Of the 351 isolates, 79% were identified as L. (V.) braziliensis, 7% as L. (V.) guyanensis, 10% as L. (V.) peruviana, 2% as L. (V.) lainsoni, and 1.7% as L. (L.) amazonensis. The clinical form of disease varied depending on the species of Leishmania, with L. (V.) braziliensis being associated most frequently with cutaneous, mucosal ulcers and mixed cutaneous and mucosal disease, and L. (V) peruviana, L. (V.) guyanensis, L. (V.) lainsoni with cutaneous lesions. Leishmania (L.) amazonensis was isolated from six patients, three with cutaneous lesions, one with mucosal lesions, and two with diffuse cutaneous lesions. Among all of the leishmaniasis cases, males were affected more frequently, and cases occurred among patients less than 10 to more than 51 years of age. These data further defined the geographic distribution and the relative frequency of Leishmania species associated with different clinical forms of leishmaniasis in Peru.
Assuntos
Leishmania/classificação , Leishmaniose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Animais , Criança , Pré-Escolar , Eletroforese em Acetato de Celulose , Feminino , Geografia , Humanos , Lactente , Isoenzimas/análise , Leishmania/enzimologia , Leishmaniose/parasitologia , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Distribuição por SexoRESUMO
With the objective of evaluating the ovulatory function among long-term Norplant implants users with regular menstrual cycles, we undertook this prospective study including 11 Norplant implants users and 11 control women who were not using hormonal methods of fertility control. Exposed and unexposed women had had at least three regular menstrual cycles preceding enrollment. All women were followed during one menstrual cycle by serial vaginal ultrasound and estradiol (E2), progesterone (P), LH, and FSH measurements. Three Norplant implants users ovulated, three had luteinization of an unruptured follicle (LUF), three had persistent follicle growth up to a mean of 33 mm without rupture, and two had no follicular development beyond 16 mm. Ten of the controls had normal ovulation and one had LUF. Mean peak LH and FSH among Norplant implants users who ovulated were three- to four-fold lower than among controls. Although users of Norplant implants with regular cycles frequently have luteal activity, the results of this study suggest that elevation of P during the second half of the cycle does not necessarily indicate ovulation has occurred and may frequently be associated with the presence of luteinized unruptured follicle. When ovulation occurs, there are usually abnormal hormone levels (low LH/FSH peak, low progesterone) which may also contribute to the contraceptive effect of Norplant implants.
Assuntos
Anticoncepcionais Femininos/farmacologia , Levanogestrel/farmacologia , Ciclo Menstrual/sangue , Folículo Ovariano/fisiologia , Congêneres da Progesterona/farmacologia , Implantes de Medicamento , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Hormônio Luteinizante/efeitos dos fármacos , Ciclo Menstrual/efeitos dos fármacos , Ciclo Menstrual/fisiologia , Folículo Ovariano/diagnóstico por imagem , Folículo Ovariano/efeitos dos fármacos , Progesterona/sangue , Estudos Prospectivos , UltrassonografiaRESUMO
Se presenta la expericia del Servicio de Cirugía Plastica y de Patología Mamaria del Hospital Oncológico "Padre Machado", en pacientes con reconstrucción por cáncer de mama, desde enero 1982 hasta diciembre 1992. El método de reconstrucción en nuestro Hospital viene dado por la selección y discusión en común acuerdo entre ambos Servicios, para este trabajo se revisaron 130 casos entre los años citados, 79 pacientes pudieron ser incluidos en el análisis. La edad promedio fué de 44 años; con una paridad de 4 hijos: 31,6 por ciento (25 pacientes) eran fumadores: 33 pacientes (41,8 por ciento) tenían cirugía abdominal superior; 30 pacientes tenían receptores estrogénicos positivos. El tipo de tumor más frecuente fué 3el Adenocarcinoma Ductal Infiltrante (80 por ciento) en 60 pacientes. El estudio más frecuente fue el II 45,8 por ciento (33 pacientes) y el III 26,3 por ciento (19 pacientes); la Reconstrucción Diferida fue realizada en 41 pacientes (51,9 por ciento) e Inmediata en 38 pacientes (48,1 por ciento), el tipo de reconstrucción más frecuente fué el Colgajo de Recto Anterior en 49 pacientes (59,5 por ciento); la recidiva local fué de 5,9 por ciento (4 pacientes). Se observó metástasis en 11 casos (13,9 por ciento) de los cuales eran pacientes estadio IIIB. En la recopilación de esta experiencia se ve claramente el papel que ocupa el procedimiento reconstructivo en el tratamiento del cáncer de mama. Hoy por hoy se ha demostrado que la evolución de la enfermedad no se modifica aún en estadios avanzados, por el contrario da un apoyo psíquico y facilita la adaptación de estos pacientes a su medio. La tendencia actual es realizar Reconstrucción Inmediata en todos los casos, quedando Diferencia por criterio del equipo médico tratante ó deseo de la paciente
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Feminino , Neoplasias da Mama/cirurgia , MastectomiaRESUMO
Surveys were conducted from 1986 through 1992 to define the etiology and geographic distribution of human leishmaniasis in Peru. Lesion aspirates and skin biopsies were obtained from clinically diagnosed cases of leishmaniasis and tested for promastigotes by standard culture techniques. The isozyme profile of the isolates was determined by the cellulose acetate electrophoresis technique. Data indicated that the isozyme profiles for Leishmania isolates from six patients were similar to that of reference strains of L. lainsoni. These results are the first reported evidence of L. lainsoni and the first association of this parasite with human cases of cutaneous leishmaniasis in Peru.
Assuntos
Leishmania/isolamento & purificação , Leishmaniose Cutânea/parasitologia , Adolescente , Adulto , Animais , Biópsia , Eletroforese em Acetato de Celulose , Humanos , Isoenzimas/análise , Leishmania/classificação , Leishmania/enzimologia , Leishmaniose Cutânea/epidemiologia , Masculino , Peru/epidemiologia , Pele/parasitologiaRESUMO
A Peruvian female prostitute population was evaluated over a 3-year period to determine the incidence and risk factors of retroviral and viral hepatitis transmission. At three survey periods, a questionnaire was administered and serum samples were obtained. A total of 966 subjects were studied, with 34% followed for 38 months, 22% followed for 18 months, and 44% evaluated just once. On initial evaluation, 3 (0.3%) had HIV-1 antibody, 170 (17.6%) had HTLV-I antibody, 578 (59.8%) had anti-HBc, and 7 (0.7%) had antibody to hepatitis C virus. The mean annual incidence of HTLV-I and hepatitis B infection was 1.6% and 4.7%, respectively. Univariate and logistic regression analysis of prevalence data indicated an association between sexual activity and HTLV-I and hepatitis B infection, but no independent risk factors were identified in cohort analysis. Parenteral risk factors were not associated with transmission, except for a small percentage of subjects who may have acquired hepatitis B infection from blood transfusions. These findings suggest that there is a high incidence of HTLV-I and hepatitis B infection from heterosexual contact in this female prostitute population.
Assuntos
Infecções por HTLV-I/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Hepatite Viral Humana/epidemiologia , Trabalho Sexual , Adulto , Feminino , Anticorpos Anti-HIV/sangue , HIV-1/imunologia , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/transmissão , Hepacivirus/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatite B/transmissão , Anticorpos Anti-Hepatite B/sangue , Hepatite C/transmissão , Anticorpos Anti-Hepatite C , Hepatite Viral Humana/transmissão , Humanos , Incidência , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Análise de Regressão , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Reação TransfusionalRESUMO
En Julio y diciembre de 1974, se capturaron de insectos de la familia Psichodidae, en las proximidades de un campamento de exploración de petróleo en la zona selvática, frente a la desembocadura del Río Manu, Madre de Dios, Perú, donde se presentaron casos de Leishmaniasis tegumentaria. Las especies identificadas corresponden a: Brumptomyia galindoi, B. hamata, Brumptomya sp.; Pressatia choti. Psychodopygus (T.) abunaenisis, Psychodopygus (T.) auraensis, Psychodopygus (T.) aragoi, Psychodopygus (T.)nordestinus, Psychodopygus (T.) paraensis, Psychodopygus (T.) rostrans, Psychodopygus (T.) sp. Se observaron algunos elementos del ciclo biológico en la naturaleza en una cueva de tierra parcialmente cubierta por hojarasca como son huevos, larvas, adultos en cópula. La disección de algunos insectos hembras para buscar promastigotes fue negativa. Se logró infectar Phlebotominos aplicados, en lesiones leishmaniásicas humanas, como Xenodiagnóstico con formas flageladas, sin llegar a identificar la especie de Leishmania, por contaminación de los cultivos.
On July and December of 1974, thousand of flies from de Psichodidae family were captured in the proximities of a petroleum exploration camp. This camp was located in the jungle in front of the ManuÆs River mouth, Madre de Dios, Peru, where cases of cutaneous leishmanisis were presented. The specimens identified were: Brumptomyia galindoi, B. hamata, Brumptomya sp.; Pressatia choti. Psychodopygus (T.) abunaenisis, Psychodopygus (T.) auraensis, Psychodopygus (T.) aragoi, Psychodopygus (T.)nordestinus, Psychodopygus (T.) paraensis, Psychodopygus (T.) rostrans, Psychodopygus (T.) sp. In a cave which was partially covered by excessive foliage were observed some elements from the biologic cicle, like eggs, larva and adults in copulation. The dissection made in some females insects to find promastigotes was negative. Phebotomines were infected with flagellate forms by putting the insects on human leishmaniasic lesions, as xenodiganosis. Leishmania specie could not be identified because the contaminations of the cultures.
Assuntos
Humanos , Entomologia , Leishmaniose , PeruRESUMO
Levonorgestrel serum levels and sex hormone binding globulin (SHBG) were measured in 82 women during different years of use of Norplant implants. The ratio between levonorgestrel and SHBG was calculated as an indicator of the free biologically active fraction of levonorgestrel (free levonorgestrel index, FLI). These parameters were then correlated with the presence of luteal activity, as determined by progesterone levels above 9.6 nmol/L, in a sampling run of 10 samples taken twice a week for five consecutive weeks. Levonorgestrel serum levels remained constant around 1.0 nmol/L during the five-year period. SHBG levels were below normal for the first 18 months of use, returning to normal levels during the last three years of use. The FLI in the first two years was significantly higher than that observed in the later years. The frequency of cycles with luteal activity was 12% during the first 2 years, increasing to 44% in the latter years, when FLI levels were lower. Our results suggest that the changes in SHBG and consequently in the free biologically active fraction of levonorgestrel may largely account for the differences in degree of ovarian suppression observed between the first two years of use of Norplant implants and the latter three, even in the absence of a significant variation in total levonorgestrel concentrations.
Assuntos
Levanogestrel/sangue , Levanogestrel/farmacologia , Fase Luteal/efeitos dos fármacos , Globulina de Ligação a Hormônio Sexual/análise , Implantes de Medicamento , Feminino , Humanos , Estudos Longitudinais , Ovário/efeitos dos fármacos , Progesterona/sangue , RadioimunoensaioRESUMO
The epidemiology of HTLV-I infection in female prostitutes was studied in a survey of 395 prostitutes from Callao, Peru (the port city of Lima), 72 prostitutes from Iquitos, Peru (another port city on the Amazon River), and 510 prenatal clinic patients from Lima. Prostitutes reported a mean of 8.8 years (range, 1-39 years) of active prostitution and a mean of 205 sexual contacts during the month prior to the study. The percentage of prostitutes with HTLV-I antibody (21.8%) was significantly higher than patients attending a prenatal clinic (3.1%; P less than .0001). The prevalence of HTLV-I antibody increased steadily with age in prostitutes, but no age trend was noted in prenatal patients. By multiple logistic regression analysis, an independent association was found between HTLV-I seropositivity and a history of prostitution in Callao, age, and positive syphilis serology when all 977 study subjects were evaluated. When prostitutes alone were analyzed, the number of years of exposure as a practicing prostitute was associated with HTLV-I seropositivity after controlling for age. These data indicate a greatly increased risk of HTLV-I infection in prostitutes in Callao, Peru, and suggest an association between sexual activity and HTLV-I transmission.
Assuntos
Infecções por HTLV-I/transmissão , Trabalho Sexual , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Fatores Etários , Feminino , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , Humanos , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Fatores de Risco , Estudos SoroepidemiológicosRESUMO
The prevalence in Peru of antibody to hepatitis C virus (anti-HCV) was determined in a survey of populations living in the northern jungle region and in groups at high risk of parenterally and sexually transmitted diseases. All sera were initially screened for anti-HCV using commercial first and second generation ELISAs; repeatedly reactive sera were further verified with a second generation immunoblot assay. Serum samples were also tested by ELISA for HBsAg, anti-HBs, and anti-HBc. None of 2,111 sera obtained in the survey of jungle residents was positive for anti-HCV by immunoblot assay. Twelve of 16 HIV-1 antibody positive hemophiliacs, one of 103 HIV-1 antibody positive homosexuals, and three of 602 HIV-1 negative registered female prostitutes were positive for anti-HCV. A high prevalence of total markers of hepatitis B infection was found in all subjects, especially in older subjects and groups at high risk of parenterally and sexually transmitted diseases. The findings of this study indicate that seropositivity for hepatitis C virus antibody is uncommon in Peru except in high risk groups and suggest that the epidemiology of hepatitis C differs substantially from hepatitis B.
Assuntos
Hepacivirus/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatite C/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados , Feminino , Hepatite B/epidemiologia , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Hepatite C/imunologia , Anticorpos Anti-Hepatite C , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVE: To study the endocrinologic profile of regularly menstruating users of levonorgestrel subdermal implants. DESIGN: Observational, prospective, case-controlled comparative study. SETTING: The Family Planning Clinic of PROFAMILIA, in Santo Domingo, Dominican Republic. PATIENTS, PARTICIPANTS: Thirty one regularly cycling Norplant users and 12 nonhormonal contraceptors who volunteered to participate. INTERVENTIONS: Norplant contraceptive implants were inserted in 31 subjects between 13 and 77 months before this study. MAIN OUTCOME MEASURES: Follicle-stimulating hormone, luteinizing hormone, estradiol (E2), and progesterone (P) were serially assayed for one menstrual cycle. RESULTS: Almost half of the cycles among Norplant users were anovulatory; all the rest (55%) had some form of dysfunction: diminished gonadotropin surge, luteal phase insufficiency (low P levels and shortened luteal phase), and E2 profiles different from normal controls. CONCLUSIONS: Anovulation is clearly one of the main mechanisms of action of Norplant, but even in presumptive ovulatory cycles, the dysfunctions described possibly contribute to the high contraceptive effectiveness of Norplant.
PIP: The study sought to examine the endocrinologic profile of regularly menstruating users of levonorgestrel subdermal implants. This observational, prospective, case-controlled, comparative study occurred at the Family Planning Clinic of PROFAMILIA in Santo Domingo, Dominican Republic. 31 subjects agreed to receive Norplant contraceptive implants between 13-77 months prior to this study and there were 12 nonhormonal contraceptors who also volunteered to participate. Follicle stimulating hormone, luteinizing hormone, estradiol (E2), and progesterone (P) were serially assayed for 1 menstrual cycle, and almost 1/2 of the cycles of norplant acceptors were anovulatory: the remainder (55%) had some form of dysfunction such as diminished gonadotropin surge, luteal phase insufficiency (low P levels and shortened luteal phase), and E2 profiles different from controls. Anovulation is clearly 1 of the main mechanisms of Norplant action, but even in presumptive ovulatory cycles, the dysfunctions described could have contributed to the high contraceptive effectiveness of Norplant.
Assuntos
Anticoncepcionais Orais Combinados/farmacologia , Norgestrel/farmacologia , Ovulação/efeitos dos fármacos , Adulto , Anovulação/induzido quimicamente , Estudos de Casos e Controles , Anticoncepcionais Orais Combinados/administração & dosagem , Implantes de Medicamento , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Levanogestrel , Hormônio Luteinizante/sangue , Norgestrel/administração & dosagem , Progesterona/sangue , Estudos ProspectivosRESUMO
The main side effect associated with the use of Norplant contraceptive implants is a disruption of the menstrual bleeding pattern. To explore the relationship between bleeding and hormonal changes, we analyzed the estradiol (E2) and progesterone (P) patterns that preceded bleeding episodes or that corresponded to periods of amenorrhea in 103 cycles observed among 82 women using Norplant subdermal implants. Five different bleeding patterns were defined: 'normal' (24-45 day cycles), oligomenorrhea (46-90 day cycles), amenorrhea (over 90 day cycles), irregular/frequent bleeding (less than 25 day cycles), and prolonged bleeding (continuous bleeding/spotting for more than 10 days). All 'normal' cycles were associated with a rise followed by a fall in E2 levels preceding bleeding. In half of the 'normal' cycles (28/54), a rise and fall of P was also observed. The same pattern was found in oligomenorrheic cycles, but only two of 12 cycles had a rise and fall of both E2 and P. None of the subjects with amenorrhea had luteal activity. Six of the nine amenorrheic cycles displayed persistently low E2 levels (below 75 pg/ml). The remaining three had a moderate elevation in E2 levels during the sampling period. Sixty percent of the subjects who showed irregular/frequent bleeding (15/25) had low E2 levels (less than 75 pg/ml), without luteal activity, and bleeding occurred without clear evidence of a further drop in E2 levels. In the remaining 40%, bleeding was preceded by a rise and drop of E2 without luteal activity, with the exception of one women, who exhibited a rise and fall of both E2 and P. Samples were obtained in only three subjects during continuous bleeding. One had low E2 levels, and the remaining two bled continuously, in spite of having E2 levels in the normal range. We conclude that ovarian hormones continue to influence endometrial shedding during the use of Norplant contraceptive implants.
Assuntos
Anticoncepcionais Femininos/farmacologia , Implantes de Medicamento , Estradiol/sangue , Ciclo Menstrual/efeitos dos fármacos , Norgestrel/farmacologia , Progesterona/sangue , Amenorreia/induzido quimicamente , Amenorreia/metabolismo , Feminino , Humanos , Levanogestrel , Menstruação/efeitos dos fármacos , Oligomenorreia/induzido quimicamente , Oligomenorreia/metabolismoRESUMO
The epidemiology of hepatitis B in female prostitutes was studied in a cross-sectional survey of 467 prostitutes and 510 control prenatal clinic patients from Lima and Iquitos, Peru. Prostitutes reported a mean of 8.8 +/- 6.7 years of active prostitution and a mean of 205 +/- 137 sexual contacts in the month prior to the study. Hepatitis B surface antigen (HBsAg) was found in comparable percentages of prostitutes (1.7%) and controls (0.8%; P = .305). In contrast, seropositivity for both antigen and antibody markers (HBsAg, anti-HBs, or anti-hepatitis B core) was found in a significantly higher percentage of prostitutes than controls (67.0% vs. 10.0%; P less than .0001). By multivariate analysis, both prostitution (odds ratio [OR] 14.6) and the number of years of exposure as a prostitute (OR 3.2 for 10 years of exposure at age 35 years) were significantly associated with seropositivity for hepatitis B markers when adjusted for age. In this study, the prevalence of HBsAg was not substantially increased in highly active female prostitutes compared with the general population, even though hepatitis B transmission was greatly increased. These data suggest that in adult women with a high level of hepatitis B infection, hepatitis B antigenemia may not persist as frequently as previously indicated in studies of other populations.
Assuntos
Antígenos de Superfície da Hepatite B/sangue , Hepatite B/epidemiologia , Trabalho Sexual/estatística & dados numéricos , Adulto , Fatores Etários , Doença Crônica , Estudos Transversais , Feminino , Anticorpos Anti-Hepatite B/sangue , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Análise Multivariada , Peru/epidemiologia , Prevalência , Inquéritos e QuestionáriosRESUMO
Ovarian endocrine function was assessed in 88 women using NORPLANT subdermal implants during different periods of use and in a control group of 15 women using non-hormonal contraception. Blood samples for estradiol (E2) and progesterone (P) assays were obtained twice a week for five consecutive weeks. Three distinct E2 patterns were observed: one was characterized by fluctuating levels within a normal range (20 to 400 pg/ml), a second pattern corresponded to continuous low E2 levels (below 75 pg/ml in the 10 samples) and the third was characterized by high broad estradiol peaks reaching over 400 pg/ml. The proportion of sampling runs characterized by normal fluctuating levels increased from 38% in the first two years of use to 80% during the fifth year of use. Low E2 profile was only observed during the first two years of use (27%) and in only 1 case at the beginning of the third year of use (5%). The percentage of cycles with high broad estradiol peaks remained between 20-40% without a clear tendency to change in either direction with duration of use. Thirty-three percent of the observed sampling runs had luteal activity (P above 3 ng/ml). The proportion of runs with luteal activity increased from 14% during the first two years of use to 40% during the third and fourth, and 60% during the fifth year of use. All control subjects had luteal activity. The mean highest progesterone level was lower in the NORPLANT runs (8.7 +/- 3.9 ng/ml) as compared to the controls (11.3 +/- 3.8 ng/ml). NORPLANT sampling runs with luteal activity had normal fluctuating E2 levels with only one exception. However, not all cycles with normal E2 levels showed luteal activity. On the other hand, all runs with low E2 levels or high broad E2 peaks were without luteal activity. In summary, women using continuous low-dose levonorgestrel contraception through NORPLANT subdermal implants, have a variable degree of ovarian activity as compared with the more complete depression of ovarian function observed among pill or injectables' users. Ovarian activity becomes closer to normal during the third through fifth year of use.
PIP: Ovarian endocrine function was assessed in 88 women using NORPLANT subdermal implants during different periods of use and in a control group of 15 women using non-hormonal contraception. Blood samples for estradiol (E) and progesterone (P) assays were obtained twice a week for 5 consecutive weeks. 3 distinct E patterns were observed; one was characterized by fluctuating levels within a normal range (20 to 400 pg/ml), a 2nd pattern corresponded to continuous low E levels (below 75 pg/ml in the 10 samples) and the 3rd was characterized by high broad estradiol peaks reaching over 400 pg/ml. The proportion of sampling runs characterized by normal fluctuating levels increased from 38% in the first 2 years of use to 80% during the 5th year of use. Low E profile was only observed during the first 2 years of use (27%) and in only 1 case at the beginning of the 3rd year of use (5%). The % of cycles with high broad estradiol peaks remained between 20-40% without a clear tendency to change in either direction with duration of use. 33% of the observed sampling runs had luteal activity (p 3 ng/ml). The proportion of runs with luteal activity increased from 14% during the first 2 years of use to 40% during the 3rd and 4th, and 60% during the 5th year of use. All control subjects had luteal activity. The mean highest progesterone level was lower in the NORPLANT runs (8.7 + or - 3.9 ng/ml) as compared to the controls (11.3 + or - 3.8 ng/ml). NORPLANT sampling runs with luteal activity had normal fluctuating E levels with only 1 exception. However, not all cycles with normal E levels showed luteal activity. On the other hand, all runs with low E levels or high broad E peaks were without luteal activity. In summary, women using continuous low-dose levonorgestrel contraception through NORPLANT subdermal implants, have a variable degree of ovarian activity as compared with the more complete depression of ovarian function observed among pill or injectables' users. Ovarian activity becomes closer to normal during the 3rd through 5th year of use. (Author's).
Assuntos
Anticoncepcionais Femininos/farmacologia , Norgestrel/farmacologia , Ovário/efeitos dos fármacos , Implantes de Medicamento , Estradiol/sangue , Feminino , Humanos , Levanogestrel , Estudos Longitudinais , Fase Luteal/efeitos dos fármacos , Ovário/fisiologia , Progesterona/sangueRESUMO
Surgical sterilization has become one of the most widely used methods of fertility regulation in the world. A common concern is the not yet clarified possible disturbance of the ovarian function resulting from the surgical procedure. A prospective study was carried out to contribute toward answering this question. Twenty subjects were enrolled in a longitudinal study of ovarian endocrine function before, and 2 and 6 months after, tubal ligation. The Pomeroy technique, which may compromise ovarian circulation, and the Uchida technique, which is free of this risk, were used randomly. Eight women who underwent to the Pomeroy technique and 9 who underwent the Uchida technique completed the protocol. Luteinizing hormone, follicle-stimulating hormone, estradiol, and progesterone were measured daily from days 10 through 18 of the cycle and every other day until the onset of the next menses. No change in any of the hormones studied was observed, with the exception of a significant increase in progesterone 2 months after tubal ligation by the Uchida technique.
Assuntos
Ovário/fisiologia , Hipófise/fisiologia , Esterilização Tubária/métodos , Feminino , Hormônio Foliculoestimulante/sangue , Hormônios Esteroides Gonadais/sangue , Humanos , Hormônio Luteinizante/sangue , Estudos ProspectivosRESUMO
We serologically tested 140 female prostitutes (mean age, 30 years) from the port city of Callao, Peru, for evidence of infection with human immunodeficiency virus (HIV), Chlamydia trachomatis, Treponema pallidum, herpes simplex viruses (HSV) I and II, and hepatitis B virus. The women had worked as prostitutes for an average of 5 years; one-fourth serviced foreign visitors exclusively, mainly sailors. Only 4 women used condoms, and only 1 woman gave a history of parenteral narcotic abuse, although 53% were regularly exposed to unsterile needles outside the medical setting for injections of vitamins, antibiotics, or steroids; another 29% are thought to probably use unsterile needles. None of the 140 prostitutes screened was seropositive for HIV, despite a very high prevalence of antibody to T. pallidum (24%), C. trachomatis (97%), HSV I and II (100%), and hepatitis B (51%); 5% were HbsAg positive. These data indicate that HIV has not yet been introduced into female prostitutes in the Peruvian port city. We believe that widespread use of unsterile needles in developing countries, such as Peru, represents a serious health threat and will amplify the spread of HIV, once introduced.