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Estima-se que 40% das gestações no mundo sejam não planejadas. Em países de baixa renda, complicações no parto são a maior causa de morte entre mulheres de 15 a 19 anos. A disponibilidade de métodos contraceptivos reversíveis é necessária para o adequado planejamento reprodutivo. Entre os métodos reversíveis, os de longa ação (LARCs) são os mais efetivos. Métodos de curta ação (SARCs) são preferenciais para pacientes que desejam gestar a curto prazo e para as quais a gestação não será indesejada. O presente estudo é uma revisão narrativa da literatura, de artigos em inglês e português publicados entre 2009 e 2020, utilizando as bases de dados SciELO, Medline e Embase. O objetivo desta revisão é apresentar os LARCs e SARCs em uma tabela com dados comparativos que auxiliem na tomada de decisão do médico e da paciente e permita estabelecer estratégias para um planejamento familiar adequado.(AU)

It is estimated that 40% of pregnancies in the world are unplanned. In low-income countries, complications in childbirth are the major cause of death among women aged 15 to 19 years. The availability of reversible contraceptive methods is necessary for proper reproductive planning. Among the reversible methods, long-acting reversible contraception (LARCs) is the most effective. Short-acting reversible contraception (SARCs) methods are preferred for patients who wish to become pregnant in the short term and for whom pregnancy will not be undesirable. The present study is a narrative review of the literature, of articles in English and Portuguese published between 2009 and 2020, using the databases SciELO, Medline and Embase. The purpose of this review is to present the LARCs and SARCs in a table with comparative data that assist in the decision making of the doctor and the patient and allow to establish strategies for adequate family planning.(AU)

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Background: Toxicological events in animals may be accidental or intentional and could occur in the home environment.These events could involve different agents such as pesticides, rodenticides, medicines, foods, and plants. Indiscriminateuse of medication in pets by their owners is common. Self-medication of animals with drugs for human use can cause irreversible damage to their health. The emergency contraceptive pill (morning-after pill), comprising concentrated hormonalcompounds, is sold freely in Brazil. The objective of this article was to report a case of pyometra in a bitch possibly causedby simultaneous administration of human emergency contraceptive pill along with a veterinary contraceptive medication.Case: A 6-year-old bitch was referred to a Veterinary Medical Teaching Hospital for abdominal enlargement. Accordingto the guardian, during estrus (30 days before the consultation) the female dog was covered. After intercourse, the owneradministered a human emergency contraceptive pill (morning-after pill - Levonorgestrel) and a veterinary contraceptive(Estradiol Cypionate). Physical examination revealed severe dehydration (10%) and high temperature, besides the abdominalenlargement. The hemogram revealed leukocytosis with a left shift, characteristic of infection. After clinical examination,closed pyometra was suspected, and later confirmed by ultrasonography. Due to the poor clinical condition, fluid therapywas performed, and a systemic antibiotic was administered. After stabilization, the patient underwent ovariohysterectomy.In the postoperative period, the fluid therapy was continued, and antibiotic and anti-inflammatory drugs were administered.Two days after surgery, the patient was discharged for home recovery.Discussion: Most cases of drug poisoning in animals involve female dogs, similar to the patient in this report. There isno theory elucidating the same, but the rate of incidence in female dogs has been reported to be higher...(AU)

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Background: Toxicological events in animals may be accidental or intentional and could occur in the home environment.These events could involve different agents such as pesticides, rodenticides, medicines, foods, and plants. Indiscriminateuse of medication in pets by their owners is common. Self-medication of animals with drugs for human use can cause irreversible damage to their health. The emergency contraceptive pill (morning-after pill), comprising concentrated hormonalcompounds, is sold freely in Brazil. The objective of this article was to report a case of pyometra in a bitch possibly causedby simultaneous administration of human emergency contraceptive pill along with a veterinary contraceptive medication.Case: A 6-year-old bitch was referred to a Veterinary Medical Teaching Hospital for abdominal enlargement. Accordingto the guardian, during estrus (30 days before the consultation) the female dog was covered. After intercourse, the owneradministered a human emergency contraceptive pill (morning-after pill - Levonorgestrel) and a veterinary contraceptive(Estradiol Cypionate). Physical examination revealed severe dehydration (10%) and high temperature, besides the abdominalenlargement. The hemogram revealed leukocytosis with a left shift, characteristic of infection. After clinical examination,closed pyometra was suspected, and later confirmed by ultrasonography. Due to the poor clinical condition, fluid therapywas performed, and a systemic antibiotic was administered. After stabilization, the patient underwent ovariohysterectomy.In the postoperative period, the fluid therapy was continued, and antibiotic and anti-inflammatory drugs were administered.Two days after surgery, the patient was discharged for home recovery.Discussion: Most cases of drug poisoning in animals involve female dogs, similar to the patient in this report. There isno theory elucidating the same, but the rate of incidence in female dogs has been reported to be higher...

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CONTEXT AND OBJECTIVE: Fibroadenomas are the most common benign tumors of the female breast. The aim of this study was to evaluate the proliferative activity of breast fibroadenoma as shown by ultrasound measurements, following administration of oral contraceptives with and without associated estriol. DESIGN AND SETTING: This was a randomized, double-blind, placebo-controlled clinical trial carried out in the Mastology Sector, Department of Gynecology, Universidade Federal de São Paulo. METHODS: We studied 33 women with fibroadenomas. Ten were placed in group 1 and took an oral contraceptive consisting of levonorgestrel and ethinyl estradiol together with placebo material in the same capsule, for four consecutive cycles with a seven-day interval between them. The other 23 patients constituted group 2 and took the oral contraceptive as above together with estriol in the same capsule, in the same way as done by the group 1 patients. We took ultrasound measurements of their tumors (in three dimensions) before and after the intake of medication. At the end of the study, all the patients had their tumors removed by surgery. RESULTS: We observed decreased fibroadenoma width among the users of oral contraceptives with placebo, and this decrease was statistically significant. In the other group, we did not observe any changes (in width, length or height). CONCLUSION: The results confirm that estriol may block the protective effect of oral contraceptives on fibroadenomas, since we observed decreased fibroadenoma width among the group 1 patients but not the group 2 patients.

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CONTEXT AND OBJECTIVE: Fibroadenomas are the most common benign tumors of the female breast. The aim of this study was to evaluate the proliferative activity of breast fibroadenoma as shown by ultrasound measurements, following administration of oral contraceptives with and without associated estriol. DESIGN AND SETTING: This was a randomized, double-blind, placebo-controlled clinical trial carried out in the Mastology Sector, Department of Gynecology, Universidade Federal de São Paulo. METHODS: We studied 33 women with fibroadenomas. Ten were placed in group 1 and took an oral contraceptive consisting of levonorgestrel and ethinyl estradiol together with placebo material in the same capsule, for four consecutive cycles with a seven-day interval between them. The other 23 patients constituted group 2 and took the oral contraceptive as above together with estriol in the same capsule, in the same way as done by the group 1 patients. We took ultrasound measurements of their tumors (in three dimensions) before and after the intake of medication. At the end of the study, all the patients had their tumors removed by surgery. RESULTS: We observed decreased fibroadenoma width among the users of oral contraceptives with placebo, and this decrease was statistically significant. In the other group, we did not observe any changes (in width, length or height). CONCLUSION: The results confirm that estriol may block the protective effect of oral contraceptives on fibroadenomas, since we observed decreased fibroadenoma width among the group 1 patients but not the group 2 patients.

CONTEXTO E OBJETIVO: Fibroadenomas são os tumores benignos mais comuns na mama feminina. Avaliamos a atividade proliferativa do fibroadenoma mamário por medidas ultra-sonográficas após a administração de anticoncepcional hormonal combinado oral, associado ou não ao estriol. TIPO DE ESTUDO E LOCAL: Ensaio clínico randomizado, duplo-cego, placebo-controlado, realizado na Universidade Federal de São Paulo. MÉTODOS: Foram estudadas 33 pacientes portadoras de fibroadenoma, do setor de Mastologia da Disciplina de Ginecologia da Universidade Federal de São Paulo, sendo que 10 mulheres constituíram o grupo 1 e utilizaram anticoncepcional oral composto de levonorgestrel e etinilestradiol, associados a um comprimido de placebo, na mesma cápsula, por quatro ciclos consecutivos, com intervalo de sete dias entre os mesmos. As restantes 23 pacientes alocaram-se no grupo 2 e ingeriram, além do anticoncepcional oral descrito acima, um comprimido de estriol, que foi manufaturado conjuntamente ao anticoncepcional, em uma mesma cápsula, sendo utilizado da mesma forma que nas pacientes do grupo 1. Realizamos medidas ultra-sonográficas dos tumores (três dimensões) antes e após a ingestão da medicação. Ao término do estudo, as pacientes sofreram exérese de suas tumorações. RESULTADOS: Obtivemos diminuição da largura nos fibroadenomas de pacientes usuárias apenas de anticoncepcional oral e esse resultado foi estatisticamente significante. Não houve alteração de nenhuma dimensão (largura, altura ou comprimento) no outro grupo. CONCLUSÕES: Os resultados corroboraram que o estriol bloquearia o efeito protetor do anticoncepcional hormonal combinado oral sobre os fibroadenomas, já que observamos diminuição na largura dos fibroadenomas das pacientes do grupo 1 e não do grupo 2.

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Studies of phenotypic flexibility are central to the understanding of evolutionary and comparative physiology. Research conducted on many vertebrate species has shown that the digestive system is highly responsive and sensitive to environmental cues. However, amphibians, which are a standard and classic model organism for the study of many physiological processes, have been poorly considered in the study of ecological consequences on digestive flexibility. Here we review and analyze the current information on this topic for amphibians. We identify three major bodies of empirical evidence: a) seasonal changes in gut development, b) lack of dietary modulation of gut attributes in adult individuals, c) a relationship between feeding habits and the magnitude of digestive performance regulation. Once the natural history characteristics of the species under study are taken into account, all the evidence is in full agreement with the predictions of digestive theory. We propose that evolutionary and comparative physiology could benefit greatly from the study of phenotypic flexibility in amphibians.

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Studies of phenotypic flexibility are central to the understanding of evolutionary and comparative physiology. Research conducted on many vertebrate species has shown that the digestive system is highly responsive and sensitive to environmental cues. However, amphibians, which are a standard and classic model organism for the study of many physiological processes, have been poorly considered in the study of ecological consequences on digestive flexibility. Here we review and analyze the current information on this topic for amphibians. We identify three major bodies of empirical evidence: a) seasonal changes in gut development, b) lack of dietary modulation of gut attributes in adult individuals, c) a relationship between feeding habits and the magnitude of digestive performance regulation. Once the natural history characteristics of the species under study are taken into account, all the evidence is in full agreement with the predictions of digestive theory. We propose that evolutionary and comparative physiology could benefit greatly from the study of phenotypic flexibility in amphibians.

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Pese a los importantes beneficios que brinda la terapia de reemplazo hormonal (TRH), su uso actual es limitado debido al temor general sobre el riesgo de cáncer de mama que pudiera asociarse con su aplicación.Se trata de un estudio prospectivo cuyo objetivo principal es establecer el impacto sobre la glándula mamaria de diversas alternativas utilizadas comúnmente en la terapia de reemplazo hormonal.El presente trabajo pretende observar, que terapéutica hormonal (Estradiol, Estradiol más Noretisterona y Tibolona) presenta mayor tendencia a la proliferación celular en la glándula mamaria de ratas y en mujeres entre 25 y 55 años de edad con menopausia quirúrgica y con esto brindar información acerca de posibles perjuicios y/o beneficios sobre la glándula mamaria con este tipo de terapias y probables beneficios que se pueden obtener al administrar Tibolona, probablemente una nueva alternativa en la TRH. En las pacientes en las que se utilizó estrógenos solos o combinados, hubo un aumento de la densidad mamaria de forma significativa; esto se correlaciona con los reportes histopatológicos de las glándulas mamarias de ratas a las que se les administró estradiol y estradiol más noretisterona produciéndose hiperplasia celular. las mujeres en tratamiento con tibolona mostraran reducción de la densidad mamográfica en forma significativa, lo cual también tiene relación con los reportes histopatológicos de las ratas que tomaron tibolona en las que los conductos galactóforos se encontraron normales con focos de hipotrofia glandular.

Altrough the important benefits of hormone replacement therapy (HRT) its use is limited because of a general fear about the risk of mammary cancer associated with it. The following work attempts to indicate that hormone therapy (Estradiol, Estradiol + Noretisterone and Tibolone) has the tendency of cellular proliferation in mammary glands of rats and women between the ages of 25 and 55 with surgical menopause and bring information about the possibilities of poor results and/or benefits for the mammary gland. This tape of terapy suggest the probable benefits that we could obtain administrating tibolone (possibly a new alternative to HRT.

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A comparative multicenter clinical trial of two combined oral contraceptives (OCs) was conducted at clinics located in the Sudan, Sri Lanka, Chile, the Dominican Republic and Ecuador. The trial was designed to determine if there were differences in efficacy, safety and acceptability between a triphasic and a low-dose monophasic OC. This report includes analysis of 1088 women. At each center, subjects were randomly allocated to one of the two OCs. Follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. There were two accidental pregnancies attributed to user failure reported during the study period; one in the triphasic group and one in the monophasic group. Adverse experiences were mainly minor with headaches and dizziness being the most common complaints; frequency of reports was similar in both groups. Cycle control was good in both groups with women in the triphasic group reporting fewer complaints of intermenstrual bleeding. Both OCs were safe and effective.

PIP: Researchers compared the efficacy, safety, and acceptability of a triphasic oral contraceptive (OC), Triquilar, with those of a monophasic OC, Lo-Femenal, among 1088 women attending clinics in Chile, the Dominican Republic, Ecuador, Sri Lanka, and the Sudan. Both OCs contained levonorgestrel and ethinyl estradiol. 90% of women in each group exhibited good user compliance. Only 1 unplanned pregnancy occurred in each group, and both pregnancies were attributed to user failure. The gross cumulative efficacy rates at 11 months were 0.3/100 woman-years for the triphasic OC and 0.2/100 woman-years for the monophasic OC. The continuation rate at 11 months was lower for Lo-Femenal than it was for Triquilar (80.8% vs. 84.6%), but the difference was not significant. The leading side-effect-related reason for discontinuation in both groups was headache. Another key reason for OC discontinuation in both groups was personal reasons, such as planning a pregnancy. Most women in both groups did not have menstrual complaints (78.8% for the Triquilar group and 77.1% for the Lo-Femenal group). Intermenstrual bleeding rates were low (7.6% for the Triquilar group and 9% for the Lo-Femenal group). Significant intercenter differences for women reporting intermenstrual bleeding and side effects (e.g., headaches) existed (p .05). Women from both groups at the clinic in the Sudan always had lower reports of intermenstrual bleeding than those at the other clinics. In fact, no woman discontinued OC use because of intermenstrual bleeding in the Sudan. Women in Sri Lanka reported fewer side effects than those in other countries, suggesting they could better tolerate OCs than the other women. This multicenter study's findings indicates that both Triquilar and Lo-Femenal are effective and safe. In addition, they exhibit good cycle control.

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Purchasers of a low-cost oral contraceptive were intercepted and interviewed in a sample of Santo Domingo pharmacies that represented the highest sales of the product, yet also reflected the socioeconomic profile of the city's entire population. Users of the contraceptive were later interviewed in greater depth in their homes. The survey of users showed that the Dominican Republic's social marketing program, implemented by PROFAMILIA, was reaching an appropriate target market--that is, younger, lower-middle-class women of low parity. The program was, in addition, successful in attracting first-time adopters, and it was also expanding the overall commercial market for all contraceptives. The marketing campaign was successful in part because a mass audience was reached, through brief television spots. Program impact on contraceptive prevalence can be assessed from sales data.

PIP: Purchasers of a low-cost oral contraceptive were intercepted and interviewed (449 pharmacy interviews in a sample of pharmacies in Santo Domingo, Dominican Republic, that represented the highest sales of the product, yet also reflected the socioeconomic profile of the city's entire population. Contraceptive users were later interviewed in greater depth in 252 home interviews. The survey showed that the Dominican Republic's social marketing program, implemented by PROFAMILIA, was reaching appropriate target market, that is, younger, lower middle class women of low parity. The program was also successful in attracting 1-time contraceptive users, and it was expanding the overall commercial market for all contraceptives. The marketing campaign was successful in part because a mass audience was reached with brief television spots. It is concluded that program impact on contraceptive prevalence can be assessed from sales data.

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