Sebastião Freitas de Medeiros

Toxoplasmose: soroprevalência em puérperas atendidas pelo Sistema Único de Saúde

OBJECTIVE: to establish the rate of toxoplasmosis soroprevalence in postpartum women, attended in two hospitals of the Public Health System (SUS) in Cuiaba, and its correlation with age, previous abortion and womens knowledge of the disease. METHODS: a cross-sectional study including 205 women with ages from 14 to 43 (mean 22.4) years old, attended in these hospitals for two months, in the first or second days postpartum. Each woman answered a short questionnaire and had peripheral blood sample collected. Blood samples were stored at 20°C until assay. The seroprevalence was determined by quantitative detection of specific IgG antibody against Toxoplasma gondii, using a microparticle enzyme immunoassay. All samples were assayed at the same time. RESULTS: The average number of pregnancies in the women included in this study was 2.2, and the majority of them was pregnant for the first time. The seroprevalence found was 70.7% (165 of 205 women). No statistical correlation was found between seroprevalence and age (p = 0.967) or previous abortion (p = 0.82). Most of the women in this study (78%) did not know about toxoplasmosis and no statistical correlation was found between this condition and seroprevalence (p = 0.49). CONCLUSION: the high seroprevalence found in the present study is in accordance with surveys previously reported in our country and other developing countries. Among the women included in this study, an expressive number (29.3%) is still under risk of contamination. The lack of statistical correlation between seroprevalence and womens age, lack of knowledge about the disease and report of previous abortion is in accordance with some previous studies and in disagreement with others.

Climacteric complaints among very low-income women from a tropical region of Brazil

CONTEXTO E OBJETIVO: Sintomas climaterios podem mudar em diferentes culturas e paises. Aspectos socio-economicos e clima podem estar envolvidos. Este estudo tem como proposta identificar os sintomas em mulheres climatericas brasileiras de baixa renda de uma regiao quente e umida do Brasil. TIPO DE ESTUDO E LOCAL: Estudo de coorte transversal, realizado no Hospital Universitario Julio Muller em Cuiaba. METODOS: Este estudo incluiu todas as 354 mulheres climatericas do Distrito Oeste de Cuiaba. Incluiu-se na analise as variaveis classe social, sintomas e doencas coexistentes. Possiveis associacoes foram examinadas pelo teste c2 e regressao logistica. RESULTADOS: 65% das pacientes eram muito pobres e de baixa escolaridade. O numero medio de sintomas referidos por mulher foi de 8.0 ± 5.7. Fogachos, nervosismo, esquecimento e fadiga foram encontrados em quase 60% das mulheres. Choro imotivado, melancolia, depressao e insonia tambem foram frequentes. Disfuncoes sexuais foram relatadas por cerca de 25% das mulheres. Fogachos foram associados com esquecimento, nervosismo e choro imotivado. As doencas coexistentes mais frequentes foram hipertensao arterial (33,9%), obesidade (26,5%), artrite/artrose (15,0%) e diabetes mellitus (9,6%). CONCLUSAO: Mulheres climatericas brasileiras de baixa renda e baixa escolaridade sao plurisintomaticas. Os sintomas vasomotores e psicosexuais foram os mais prevalentes. Fogachos foram associados a nervosismo, esquecimento e choro imotivado.Climacteric symptoms may vary between different countries and cultures. Socioeconomic factors and climate may be implicated. The aim of this study was to identify climacteric symptomatology among very low-income Brazilian women living in a hot and humid region. This cross-sectional population-based study was conducted in Cuiaba at Julio Muller University Hospital a tertiary institution. The study enrolled 354 climacteric women. The variables analyzed were social class symptomatology and abnormal concurrent conditions. The study was approved by the hospitals research ethics committee. Sixty-five percent of the participants (232/354) were very poor and had had little schooling. The number of symptoms per woman was 8.0 ± 5.7. Hot flushes nervousness forgetfulness and fatigue were each found in nearly 60.0%. Tearfulness depression melancholy and insomnia were also frequent. Sexual problems were reported by 25%. The most relevant concurrent abnormal conditions reported were hypertension (33.9%) obesity (26.5%) arthritis/arthrosis (15.0%) and diabetes mellitus (9.6%). Hot flushes were associated with tearfulness nervousness and forgetfulness. Brazilian climacteric women of low income and low schooling present multiple symptoms. Vasomotor and psychosexual symptoms were the most prevalent disorders. Hot flushes were associated with nervousness forgetfulness and tearfulness. (authors)

Adrenal androgen participation in the polycystic ovary syndrome

PURPOSE to reassess the adrenal function of patients with PCOS after the introduction of the Rotterdams criteria. METHODS descriptive and cross-sectional study including 53 patients 26 ± 5.1 years old. Glucose, glycosylated hemoglobin, lipids, estradiol, progesterone, 17-OHP4, DHEAS, FSH, LH, TSH, PRL, androstenedione, free thyroxine, insulin, total testosterone, SHBG, and free androgen index were measured. Insulin resistance was considered to be present with a homeostatic model assessment index >2.8. The adrenal response to cortrosyn was assessed by the hormonal rise observed at 60 minutes, and by the area under the response curve. RESULTS biochemical hyperandrogenism was found in 43 of 53 eligible patients (81.1%). Thirty-three women had adrenal hyperandrogenism (62.2%). The weight of these 33 women, aging 25.1 ± 5.0 years, was 74.9 ± 14.9 kg, BMI was 28.8 ± 6.0 and the waist/hip ratio was 0.8 ± 0.1. DHEAS was >6.7 nmol/L in 13 (39.4%) and androstenendione was >8.7 nmol/L in 31 (93.9%). The increments in 17-OHP4, cortisol, A, and progesterone were 163%, 153%, 32%, and 79%, respectively. The homeostatic insulin resistance model was >2.8 in 14 (42.4%). Insulin and estradiol were not correlated with cortisol or androgens. CONCLUSIONS the use of multiple endocrine parameters showed a high prevalence of biochemical hyperandrogenism in patients with PCOS. Two thirds of the patients had adrenal hyperandrogenism, and estradiol and insulin did not influence adrenal secretion.

Comparison of steroidogenic pathways among normoandrogenic and hyperandrogenic polycystic ovary syndrome patients and normal cycling women

To compare the corticosteroidogenic enzyme activities between normal cycling non‐polycystic ovary syndrome (PCOS), and normoandrogenic PCOS (NA‐PCOS) and hyperandrogenic PCOS (HA‐PCOS) patients.

New insights into steroidogenesis in normo- and hyperandrogenic polycystic ovary syndrome patients

OBJECTIVE This study sought to examine corticosteroidogenic enzyme activities in normo- and hyperandrogenic polycystic ovary syndrome (PCOS) patients. SUBJECTS AND METHODS This cohort study included 81 patients with biochemical hyperandrogenism and 41 patients with normal androgen levels. Enzyme activities were assessed according to the serum steroid product/precursor ratios at baseline and after adrenal stimulation. RESULTS At baseline, in the delta 4 (Δ4) pathway, hyperandrogenic patients showed greater 17-hydroxylase and 17,20 lyase activities in converting progesterone (P4) into 17-hydroxyprogesterone (17-OHP4) and 17-hydroxypregnenolone (17-OHPE) into androstenedione (A) (p = 0.0005 and p = 0.047, respectively) compared to normoandrogenic patients. In the delta 5 (Δ5) pathway, the 17-hydroxylase and 17,20 lyase enzymes showed similar activities in both groups. Hyperandrogenic patients presented lower 21-hydroxylase, lower 11β-hydroxylase (p = 0.0001), and statistically significant increases in 3β-hydroxysteroid dehydrogenase II (3β-HSDII) activities (p < 0.0001). Following tetracosactrin stimulation, only the 17,20 lyase activity remained up-regulated in the Δ4 pathway (p < 0.0001). CONCLUSION Hyperandrogenic patients had higher 17,20 lyase activity, both at baseline and after adrenal stimulation. Greater conversion of dehydroepiandrosterone (DHEA) into A with normal conversion of 17-OHPE to 17-OHP4 in hyperandrogenic PCOS patients indicated different levels of 3β-HSDII activity in adrenal cells, and hyperandrogenic patients had lower 11β-hydroxylase and 21-hydroxylase activities.

Características clínicas e citogenéticas da síndrome de Turner na região Centro-Oeste do Brasil

PURPOSE to examine the association between cytogenetic characteristics and clinical and epidemiological changes in patients with Turner syndrome (TS). METHODS Forty-two patients were included. Data were collected using a standardized questionnaire in interviews conducted with the responsible person and, when possible, with the patient. A detailed physical examination was performed. The association between karyotype, stigmata and clinical disorders were examined using the χ2 test. RESULTS Sixty-four percent of TS patients were 45,X; 26,2% 45,X/46,X;7% 45,X/46Xi(Xq), and 2,3% 45,X/46,X,Del(Xq). Regardless of the karyotype, all patients had short stature. Low hair implantation was more frequent in patients with 45,X (p=0.03). Cardiovascular abnormalities (45%), otitis (43%), thyroid dysfunction (33%) and hypertension (26.6%) were the most frequent clinical disorders, but without correlation with the karyotype. Anthropometric measurements revealed a positive linear correlation of waist and hip circumference with age (r=0.9, p=0.01). Thirty-one patients (74%) were using or had previously used growth hormone (43%), sex steroids (30%), thyroxine (11.9%) or oxandrolone (9.5%). Comparison between gestational age at birth and learning difficulties showed a prevalence ratio of 1.71 (p>0.05). CONCLUSION Low hair implantation is the most prevalent stigma in patients with a 45,X karyotype and the most common clinical changes were cardiovascular problems, otitis, thyroid dysfunction and hypertension; however, they did not show any correlation with the karyotype.

Molecular identification of chromosome Y sequences in Brazilian patients with Turner syndrome

The investigation of Y-specific sequences in patients with Turner Syndrome (TS) with karyotype 45,X or mosaic, has a fundamental role in the clinical management of these patients. The relationship between the presence of Y chromosome fragments and a higher risk of gonadoblastoma in TS has already been established. The aim of the study was to investigate the presence of Y-chromosome fragments in a population of 42 female Brazilian patients with TS from Mato Grosso state. Cytogenetic analysis has shown the karyotypes 45,X in 27 of them (64.3%) and mosaic in 15 (35.7%). The presence of the Y-primers SRY, DYZ3, ZFY, DYZ1, DYS1 and PABY was investigated in all patients. These markers were amplified by polymerase chain reaction (PCR) technique, using DNA genomic from peripheral blood lymphocytes. None of these patients had shown any Y-chromosome fragments when they were analysed only by the classic cytogenetic technique. The PCR analysis with the Y-specific sequences ZFY and DYZ3 were identified in two different patients (4.8%), both with karyotype 45,X. It was concluded that PCR is efficient in the investigation of hidden Y-fragments in TS patients. Therefore, this method should be included in the routine assistance of these patients.

Topical estradiol does not interfere with the expression of the metalloproteinase-1 enzyme in photo exposed skin cells

BACKGROUND In postmenopausal women there is a rapid destruction of dermal collagen, resulting in accelerated skin ageing, which is manifested by cutaneous atrophy, increased number and depth of wrinkles and sagging. This accelerated catabolism of the collagen is due to estrogen deficiency and increased synthesis of the metalloproteinase-1 enzyme, which degrades the dermal collagen. OBJECTIVES To assess whether the use of topical estradiol 0.05% cream on photo exposed skin can inhibit the expression of the metalloproteinase-1 enzyme on the dermis and subsequently the rapid loss of collagen in women after menopause. METHODS We included 40 postmenopausal women without hormone replacement therapy. Information about lifestyle, lipid profile, blood glucose level, thyroid hormones, mammography, Pap smear and transvaginal ultrasound were obtained to rule out associated diseases. Skin biopsy of the right preauricular region was performed before and after treatment with topical estradiol 0.05% for 30 days. The biopsy specimens were subjected to immunohistochemistry to identify the expression of the metalloproteinase-1 enzyme. RESULTS There was no statistically significant difference on the expression of the metalloproteinase-1 enzyme in keratinocytes, fibroblasts and endothelial cells before and after treatment with topical estradiol for 30 days. CONCLUSION Treatment with estradiol 0.05% cream, in photo exposed skin for 30 days, does not inhibit the production of metalloproteinase-1.

Current insights into gonadotropic pituitary function in the polycystic ovary syndrome

Abstract Objective To assess the gonadotrope cell function in patients with polycystic ovary syndrome (PCOS). Methods This study included 42 patients with polycystic ovary syndrome, aged 26.6 ± 5.9 years, and 13 eumenorrheic controls, aged 30.1 ± 4.6 years. Gonadotropins, sex steroids, sex hormone binding globulin (SHBG), cortisol, thyroid stimulating hormone (TSH), prolactin, free thyroxin, and insulin were measured. Gonadotrope cell function was assessed at baseline and at 30 and 60 min after gonadotropin releasing hormone (GnRH) injection. Results Luteinizante hormone (LH), prolactin (PRL), total testosterone (T), androstenedione (A), and 17- hidroxyprogesterone (17-OHP4) levels were higher ( P P P P >0.05). Positive correlation between insulin and the AUC of LH was identified in controls. Conclusion The current study confirms the hypersecretion of LH in PCOS patients after the newest diagnostic systematization. The gonadotrope response to GnRH stimulation in PCOS patients was associated with the baseline levels of LH, P4, insulin.

Efeitos da terapia hormonal na menopausa sobre o sistema imune

There is evidence that estrogen, progesterone and testosterone have modulatory effects over both cellular and humoral immune responses. These effects occur via immune-neuroendocrine interactions, involving the pituitary, gonadal steroids, thymic hormones, and the presence of specific receptors and messengers. These immune responses may be altered during pregnancy, gonadectomy, menopause and hormone therapy. Estrogen depresses the cellular immunity, suppresses the natural killer cell activity and increases the production of antibodies. Progesterone/progestogen suppresses the cellular immune system. Androgens, after metabolization in estrogens, might stimulate the humoral immune response. Hormone therapy is still broadly used in post-menopause women with the purpose of decreasing climacteric symptoms, as well as preventing genital atrophy and bone loss. Its use to attenuate the risk of cardiovascular and neurodegenerative diseases remains in debate. A few studies have been carried out to examine the effect of post-menopause hormone therapy on the immune system. There is evidence that the hypoestrogenic state, following menopause, could result in less resistance to infections. The present review examines the interaction between sexual steroids and the immune system and, based on epidemiological and clinical studies, evaluates the effects of hormone therapy on the immune responses. It was concluded that the hormone therapy normalizes the cellular immune response in post-menopausal women.