Gisele Silva de Moraes

Clinical features of multiple sclerosis in the south of Brazil: a partial analysis

UNLABELLED There are no published studies on the characteristics of multiple sclerosis (MS) patients from the south of Brazil. OBJECTIVE To identify the clinical features of a series of MS patients and to compare to other Brazilian series. METHOD Retrospective study with 67 patients followed in The MS Reference Center - RS, Brazil during the year of 2008. We analyzed demographic and clinical data. RESULTS Most were women (74.6%), the general average age was 43.5 years old, and the general average EDSS score was 4.1. Of those patients, 81.8% had relapsing-remitting MS. Sexual dysfunction prevalence was 31.1% in men and 68.9% in women (p<0.01). We found a positive correlation (Spearman=0.444, p<0.05) between EDSS and depressive symptoms. CONCLUSION This study showed a very similar sample compared to other states of Brazil. Moreover, there was found a high prevalence of sexual dysfunction and a straight relation between EDSS and depressive symptoms.

Prospective, randomized comparison between raloxifene and clomiphene citrate for ovulation induction in polycystic ovary syndrome

OBJECTIVE To compare the ovulation rate between raloxifene and clomiphene citrate (CC) in patients with polycystic ovary syndrome (PCOS). DESIGN Double-blind, randomized, superiority clinical trial. SETTING Tertiary university hospital. PATIENT(S) Women with ovulatory dysfunction and PCOS based on the Rotterdam criteria. INTERVENTION(S) One of two oral treatments: 5 days of 100 mg/day of CC or R. MAIN OUTCOME MEASURE(S) Ovulation, based on follicle collapse on serial ultrasound and midsecretory serum progesterone concentration (≥3 ng/dL). RESULT(S) The women with PCOS (n = 82) were randomized to receive CC (n = 40) or raloxifene (n = 42). From these, 68 patients finished the trial according to the protocol (CC: n = 37; raloxifene: n = 31). There were no statistically significant differences between the groups in ovulation rates per an intention-to-treat analysis based on ultrasound alone (CC: 21 of 40 vs. raloxifene: 17 of 42) or on progesterone levels (CC: 16 of 40 vs. raloxifene: 11 of 42). No serious adverse events were observed in either group. CONCLUSION(S) No statistically significant difference in ovulation was observed between raloxifene and clomiphene citrate in patients with PCOS with ovulatory dysfunction.

Are antibiotics necessary after 48 hours of improvement in infected/septic abortions? A randomized controlled trial followed by a cohort study

OBJECTIVE We sought to investigate whether oral antibiotics are necessary, after 48 hours of clinical improvement, in uncomplicated septic abortion. STUDY DESIGN In a randomized double-blind clinical trial, 56 women with uncomplicated septic abortion were treated with intravenous antibiotics, followed by uterine evacuation. On hospital discharge (day 1), patients were randomized to receive either oral doxycycline plus metronidazole or placebo, until completing 10 days of treatment. Clinical cure was defined by the absence of fever (<37.7°C), reduced vaginal bleeding, and minimal or no pelvic pain. RESULTS Cure was observed in all 56 patients. The institutional review board stopped the treatment arm as it was adding risk with no further benefit to the patients. An observational cohort with additional 75 cases was followed up in the no treatment arm and no failure was identified (probability of an adverse event, 0%; 95% confidence interval, 0-0.03). CONCLUSION After 48 hours of clinical improvement, antibiotics may not be necessary.

Análise comparativa da acurácia in vitro de testes de detecção de hCG urinário

OBJETIVO: Identificar se os pontos de corte de sensibilidade anunciados por tres testes de gravidez na urina sao compativeis com os anunciados pelo fabricante e descrever os seus desempenhos diagnosticos. METODOS: A urina de um voluntario masculino foi usada para diluir β-hCG recombinante em concentracoes definidas de 0; 6,25; 12,5; 25; 50; e 100 mUI/mL. As amostras foram codificadas e cegamente analisadas para a positividade em tres diferentes lotes dos testes hCG Strip Test Plus®, BioEasy® e Visitect Pregnancy®. O tamanho da amostra foi calculado para um erro alfa de 5%, com um poder de 99%. RESULTADOS: As tres marcas apresentaram sensibilidade de 100% na deteccao do β-hCG nos tres lotes analisados, com 100% de valor preditivo negativo, usando somente controles negativos e amostras com concentracoes iguais ou superiores ao limite do teste (n = 180/marca). A acuracia dos testes foi 83% (BioEasy®), 84% (Visitect®) e 91% (Strip Test Plus®). O Strip Test Plus® apresentou o melhor desempenho para a razao de probabilidade positiva (52,5), enquanto que o produto Visitect® teve a melhor razao de probabilidade negativa (zero). CONCLUSAO: Os tres produtos analisados tem a sensibilidade dos pontos de corte anunciados. O produto Strip Test Plus® tem o melhor desempenho para identificar concentracoes urinarias de β-hCG > 12,5 mUI/mL, consequentemente, confirmando gravidez, enquanto que o Visitect® tem o melhor desempenho para descartar a presenca de β-hCG na urina (probabilidade pos-teste negativo: zero).

The influence of hydrosalpinx on endometrial elafin expression

The endometrium of women with hydrosalpinx has an increased number of neutrophils and lower expression of elafin, an elastase inhibitor and natural antimicrobial molecule. These findings suggest that women with hydrosalpinx have a reduced antimicrobial and antielastase activity.

Comparative analysis of the accuracy of urinary hCG tests in vitro

OBJECTIVE To identify whether cutoff for sensitivity advertised by three pregnancy tests in urine are compatible to those reported by the manufacturer and to describe their diagnostic performance. METHODS The urine of a male volunteer was used to dilute recombinant β-hCG at defined concentrations of 0, 6.25, 12.5, 25, 50, and 100 mIU/mL. The tubes containing each of the concentrations were coded and blindly assessed for positivity in three different lots of hCG tests: Strip Test Plus®, BioEasy®, and Visitect Pregnancy®. The sample size was calculated for an alpha error of 5%, with a power of 99%. RESULTS All three brands, in their three lots analyzed, had 100% of sensitivity for detecting β-hCG, with 100% negative predictive value, using only negative controls and samples with concentrations equal or higher than the test cutoff (n = 180/brand). The accuracy of the tests was 83% (BioEasy®), 84%(Visitect®) and 91% (Strip Test Plus®). Strip Test Plus® had the best positive likelihood ratio (52.5), while Visitect® had the best negative likelihood ratio (zero). CONCLUSION The three brands have adequate sensitivity for the advertised cutoffs. The Strip Test Plus® test had the best performance to identify urinary concentrations of β-hCG > 12.5 mIU/mL, and consequently, to confirm pregnancy, while Visitect® had the best performance to exclude β-hCG in urine (negative post-test probability: zero).