Prevalência do papilomavírus humano em mulheres portadoras do vírus da imunodeficiência humana atendidas no serviço de atendimento especializado de Imperatriz-MA

O presente trabalho tem objetivo de avaliar a prevalência do HPV e os fatores de risco associados à coinfecção HIV HPV. Foram analisadas 78 amostras cervicais de mulheres HIV-positivas atendidas no SAE do Programa Municipal de DST/AIDS de Imperatriz do Maranhão. Realizaram-se os exames de citopatologia e amplificação por PCR. Como instrumento para coleta de dados foi utilizado um questionário. A positividade do DNA de HPV foi de 74,36%. Em nosso estudo a citologia diagnosticou alterações em 16 (20,51%) dos casos. Foi detectado DNA HPV em 71% das pacientes com citologia classificada como inflamatória, e 93,7% das citologias alteradas. Dentre as alterações destacamos ASCUS com 100%; ASCUH 100%; LIE de baixo grau 100%; LIE de alto grau 66,6%. Analisando os fatores de risco sócio-demográficos desta população em relação a prevalência da infecção pelo HPV, notou-se que mulheres que relataram nunca ter feito uso de álcool apresentaram maior prevalência 87,5% e mulheres que fazem uso de cigarro atualmente, 84,6% estavam infectadas pelo HPV. Não houve diferenças entre as variáveis “situação marital”, “escolaridade”, “número de parceiros”, “uso de preservativo” e “uso de anticoncepcional”, ocorrendo perfil semelhante. Esse estudo foi o pioneiro na cidade de Imperatriz e comprovou uma alta prevalência da co-infecção. O combate ao câncer de útero deve ser adotado como uma prioridade dos serviços de saúde pública por se tratar de doença com potencial para a prevenção, cujo rastreamento é eficaz.

Long-term clinical and ultrasonographic evaluation of thrombophilic patients with deep venous thrombosis

OBJECTIVE:The purpose of this study was to evaluate the long term clinical and ultrasonographic outcomes of thrombophilic patients with deep venous thrombosis (DVT).METHOD:Cohort study, retrospective case-control with cross-sectional analysis. Thirty-nine thrombophilic patients and 25 non-thrombophilic patients were assessed 76.3 ± 45.8 months after diagnosis. Demographic and family data were collected, as well as data from clinical and therapeutic progress, and physical and ultrasound examinations of the limbs were performed. Groups were matched for age and gender and the variables studied were compared across groups.RESULTS:Deep venous thrombosis was more frequent in women. The most common thrombophilias were antiphospholipid syndrome and factor V Leiden mutation. There was no difference between groups in terms of the number of pregnancies or miscarriages and the majority of women did not become pregnant after DVT. Non-spontaneous DVT prevailed. Proximal DVT and DVT of the left lower limb were more frequent, and the main risk factor was use of oral contraceptives. All patients were treated with anticoagulation. There was a higher frequency of pulmonary embolism in non-thrombophilic patients. Most patients considered themselves to have a normal life after DVT and reported wearing elastic stockings over at least 2 years. Seventy-one percent of patients had CEAP > 3, with no difference between groups. Deep venous reflux was more frequent in thrombophilic patients.CONCLUSION:There were no significant differences between groups with respect to most of the variables studied, except for a higher frequency of pulmonary embolism in non-thrombophilic patients and greater frequency of deep venous reflux in thrombophilic patients.

Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study

BACKGROUND: Acne vulgaris has an important genetic predisposition, as well as keratosis pilaris. Clinical observations suggest that patients with keratosis pilaris have less frequent or less severe acne breakouts; however, we found no studies on this regard OBJECTIVE: To determine if the presence of keratosis pilaris is associated with lower prevalence and severity of acne. METHODS: A cross-sectional study was conducted with dermatology outpatients aged between 14 and 35 years. We evaluated history and clinical grade of acne, demographic variables, history of atopy, smoking, and use of hormonal contraceptives. Two groups were defined by the presence or absence of moderate to severe keratosis pilaris on the arms and were compared by bivariate analysis and by conditional multiple logistic regression. RESULTS: We included 158 patients (66% women), with a median age of 23 +/- 11 years. Twenty-six percent of them had keratosis pilaris, which was associated with a history of atopy (odds ratio [OR]=2.80 [1.36 to 5.75]; p<0.01). Acne was present in 66% of subjects, and was related to family history of acne (OR=5.75 [2.47 to 13.37]; p<0.01). In bivariate and multivariate analysis, the group with keratosis pilaris had a less frequent history of acne (OR=0.32 [0.14 to 0.70]; p<0.01). CONCLUSION: The presence of moderate to severe keratosis pilaris on the arms was associated with lower prevalence of acne vulgaris and lower severity of facial lesions in adolescents and young adults.

Comportamento sexual entre universitários da área da saúde: um estudo transversal

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Low-dose combined oral contraceptive use is associated with lower bone mineral content variation in adolescents over a 1-year period

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Coagulation Factor XII Gene Mutation in Brazilian Families with Hereditary Angioedema with Normal C1 Inhibitor

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Melasma: a clinical and epidemiological review

Melasma is a chronic acquired hypermelanosis of the skin, characterized by irregular brown macules symmetrically distributed on sun-exposed areas of the body, particularly on the face. It is a common cause of demand for dermatological care that affects mainly women (especially during the menacme), and more pigmented phenotypes (Fitzpatrick skin types III-V). Due to its frequent facial involvement, the disease has an impact on the quality of life of patients. Its pathogeny is not yet completely understood, although there are some known triggering factors such as sun exposure, pregnancy, sexual hormones, inflammatory processes of the skin, use of cosmetics, steroids, and photosensitizing drugs. There is also a clear genetic predisposition, since over 40% of patients reported having relatives affected with the disease. In this manuscript, the authors discuss the main clinical and epidemiological aspects of melasma.

Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review

To re-evaluate the safety of hormonal contraceptives (HC) after uterine evacuation of complete hydatidiform mole (CHM). Historical database review. Charing Cross Hospital Gestational Trophoblastic Disease Centre, London, United Kingdom. Two thousand four hundred and twenty-three women with CHM of whom 154 commenced HC while their human chorionic gonadotropin (hCG) was still elevated, followed between 2003 and 2012. We compared time to hCG remission between HC users and nonusers. The relationship between HC use and gestational trophoblastic neoplasia (GTN) development was assessed. The relationship between HC use and a high International Federation of Gynecology and Obstetrics (FIGO) risk score was determined. Time to hCG remission, risk of developing postmolar GTN and proportion of women with high FIGO risk score. No relationship was observed between HC use with mean time to hCG remission (HC users versus non-users: 12 weeks in both, P = 0.19), GTN development (HC users versus non-users: 20.1 and 16.7%, P = 0.26) or high-risk FIGO score (HC users versus nonusers: 0% and 8%, P = 0.15). Moreover, no association between HC and GTN development was found, even when an age-adjusted model was used (OR = 1.37, 95% CI 0.91-2.08, P = 0.13). The use of current HC is not associated with development of postmolar GTN or delayed time to hCG remission. Therefore, HC can be safely used to prevent a new conception following CHM regardless of hCG level. Non-concurrent cohort study to re-evaluate the safety of low dose HCs after uterine evacuation of CHM.

Avaliação dos dados obtidos em um programa de esterilização cirúrgica de gatos em Araçatuba, SP no período de 1996 a 2010

Cats are gradually occupying a more important position as pets and this preference is a result of how easy cat maintenance in an urban environment is, even though they are very prolific and need surgical sterilization. This paper aims at evaluating obtained data within 15 years of research in a university service program that offers free cats sterilization surgery. We carried out a statistical analysis of data shown in the records of animals treated by the program. Surgical sterilization was performed on 647 animals (409 females – 63% and 238 males – 37%). Unilateral cryptorchidism was observed in 9 (3.8%) male cats. Forty (10%) female cats were pregnant at the time of the surgery and the treatment with contraceptives was observed in 67 (16.4%) female cats. One death occurred during anesthesia recovery and 2 cats were euthanized because of wound infection, totalizing an amount of 0.5% of severe complications. From 1996 to 2004, 212 female cats were spayed (122 adults and 90 prepubertal) and during that time two different approaches for ovariohysterectomy were compared: flank laparotomy and ventral midline celiotomy. The flank laparotomy approach was used in only 46 female cats (21.7%) due to some disadvantages observed – the need of an incision on each flank in prepubertal or nulliparous animals and the difficulty or impossibility of total uterus removal. In the same period, 105 male cats underwent orchiectomy via an open technique in which the spermatic cord was linked with nylon thread. From 2005 to 2010, 197 females (106 adults and 91 prepubertal) were spayed. The minilaparotomy technique was used to perform ovariohysterectomy on 139 female cats (70.6%). In this procedure, ovaries and uterus were exteriorized in a blind fashion with a hook through a small midline incision. The traditional midline ovariohysterectomy, which incision length permits direct visualization of the ovaries and uterus, had to be performed in 58 (29.4%) female cats due to advanced pregnancy, full urinary bladder during surgery or obesity. Over the past 6 years, 133 male cats (48 adults and 85 prepubertal) were castrated by means of an open technique in which the spermatic cord was tied to itself. The demand for surgeries during the project demonstrated that people are becoming aware concerning the importance of sterilization when facing cat overpopulation and abandonment.

Percepção de adolescentes em relação a doenças sexualmente transmissíveis e métodos contraceptivos

Introduction: sexually transmitted diseases (DST) can represent an important impact on teenager’s health due its consequences. Objective: to identify the perception and knowledge of teenagers about DST, its transmission forms and contraception. Methods: it was made a cross-sectional study type investigation, with 136 teenager students from a Technical Education Public Institution in a middle-sized city. It was used a tested instrument, self answered, with opened and closed questions about theme and sociodemographic data. The same data were stored and analyzed by Program Epi Info version 3.5.1. Results: 97,1% affirmed to know male condoms, 89,0% oral contraceptives, 87,5% female condoms, 74,3% postcoital contraceptives, 47,8% natural family planning methods, 41,9% hormonal injection, 33,1% intrauterine devices, 31,6% coitus interruptus and 1,5% other contraceptive methods. According with them, the information was gave principally on high school (46,1%), by friends or partners (20,3%), doctor (10,9%), television (10,2%). In relation to DST, 98,5% affirmed that diseases can be transmitted during coitus. The aids (91,2%) and herpes (72,8%) were the most cited diseases. Just 31,6% of teenagers affirmed that run the risk to acquire some DST, and 88,4% of them, due no use of condoms, 30,2% due their partner make relation with other people, 18% due have many sexual partners and 9,3% due other causes. Conclusion: even teenagers knowing many contraceptive methods and sexually transmitted diseases, the teenagers have not prevented theirselves yet. It’s necessary that the high school reinforce the use of contraceptive methods, because the school is an important source of educative information on health area.

Histomorfometria do útero de gatas submetidas à ovariosalpingohisterectomia

Histomorphometric data were obtained from cats uterine horns: either nulliparous (n = 6), primiparous (n = 6), multiparous (n = 6) and treated with contraceptive (n = 6). The material was collected after surgery, fixed in paraformaldehyde and embedded in paraplast® resin to be sliced in a microtome. The obtained sections were stained with hematoxylin - eosin and measured under a light microscope: uterine wall total thickness (μm), endometrium total height, endometrial glands diameter and glandular epithelia height, total myometrium, internal and external myometrium and vascular layer thickness. It was concluded that: 1 - contraceptive use and number of pregnancies altered the uterine structure, 2 - one pregnancy does not appear to affect the uterine lining structures as occurs in multiparous cats, 3 – there was no variation on the evaluated structures between nulliparous and primiparous cats except for inner myometrium, 4 - the total myometrium hight and the endometrium hight showed similar variations except for the contraceptive treated cats group, 5 - the outer myometrium showed marked changes in the treated cats, 6 – the less marked morphological variations were for the endometrial glands diameter and glandular epithelium hight, 7 - the presence of dilated endometrial glands was found only in treated cats.

Avaliação da atividade da unidade epidermo-melânica e do dano dérmico no melasma

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudo com familiares de pacientes com câncer de mama: abordando conhecimento sobre fatores de risco

Breast cancer (BC) is the most common malignancy in women worldwide, with one million new cases confirmed each year. This study aimed at identifying the knowledge of patients? relatives concerning the risk factors (RF) for BC. It is a descriptive quantitative study carried out in the Chemotherapy Technical Division of a University Hospital in São Paulo state, Brazil, from September to October 2006. Only female (30) relatives were included due to the fact that BC is more frequent in females. The major RF cited were family history for BC 33.3% (10), smoking 16.6% (5), alcoholic-drink consumption 10% (3), animal-fat-rich diet 3.3% (1). Other factors such as not breastfeeding, environmental factors, use of oral contraceptives and hormone-replacement therapy were mentioned by 10% (3) of the relatives. It was concluded that the relatives of patients undergoing chemotherapeutic treatment showed to have little knowledge concerning RF for BC. Hence, it is important to rethink the inclusion of the health education process in the family scenario. This issue reaches far beyond thesimple transmission of information. Healthcare professionals and nurses in particular, must focus on these individuals? social context, values, beliefs and needs.

The effects of 2 mg chlormadinone acetate/30 mcg ethinylestradiol, alone or combined with spironolactone, on cardiovascular risk markers in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder associated with metabolic dysfunction and changes in cardiovascular risk markers, and using oral contraceptives (OCs) may exert a further negative effect on these alterations in patients with PCOS. Thus, the primary objective of this study was to assess the effects on arterial function and structure of an OC containing chlormadinone acetate (2 mg) and ethinylestradiol (30 mcg), alone or combined with spironolactone (OC+SPL), in patients with PCOS. Study Design: This was a randomized, controlled clinical trial. Fifty women with PCOS between 18 and 35 years of age were randomized by a computer program to use OC or OC+SPL. Brachial artery flow-mediated vasodilation, carotid intima-media thickness and the carotid artery stiffness index were evaluated at baseline and after 6 and 12 months. Serum markers for cardiovascular disease were also analyzed. The intragroup data were analyzed using analysis of variance with Tukey's post hoc test. A multivariate linear regression model was used to analyze the intergroup data. Results: At 12 months, the increase in mean total cholesterol levels was greater in the OC+SPL group than in the OC group (27% vs. 13%, respectively; p=.02). The increase in mean sex hormone-binding globulin levels was greater in the OC group than in the OC+SPL group (424% vs. 364%, respectively; p=.01). No statistically significant differences between the groups were found for any of the other variables. Conclusion: The addition of spironolactone to an OC containing chlormadinone acetate and ethinylestradiol conferred no cardiovascular risk-marker advantages in young women with PCOS. (C) 2012 Elsevier Inc. All rights reserved.

Oral Contraceptive Containing Chlormadinone Acetate and Ethinylestradiol Reduces Plasma Concentrations of Matrix Metalloproteinase-2 in Women with Polycystic Ovary Syndrome

Biochemical markers of cardiovascular disease, including matrix metalloproteinases (MMPs), are altered in women with polycystic ovary syndrome (PCOS), with many of these alterations thought to be due to excess androgen concentrations. Despite oral contraceptives (OCs) being the first-line pharmacological treatment in women with PCOS and the importance of MMPs in many physiological conditions and pathological states, including cardiovascular diseases, no study has yet evaluated whether OCs alter plasma concentrations of MMPs. We therefore assessed whether treatment with an OC containing the anti-androgenic progestogen alters MMP profiles in women with PCOS. We analysed 20 women with PCOS who wanted hormonal contraception (OC-PCOS group), 20 ovulatory women who required hormonal contraception (OC-control group) and 20 ovulatory women who wanted non-hormonal contraception (non-OC-control group). OC consisted of cyclic use of 2 mg chlormadinone acetate/30 mu g ethinylestradiol for 6 months. Plasma concentrations of MMP-2, MMP-9, TIMP-1 and TIMP-2 were measured by gelatin zymography or enzyme-linked immunoassays. OC treatment for 6 months significantly reduced plasma MMP-2 concentrations in the OC-control and OC-PCOS groups and TIMP-2 and TIMP-1 concentrations levels in the OC-control group (all p < 0.05), but had no effects on MMP-9 concentrations or on MMP-2/TIMP-2 and MMP-9/TIMP-1 ratios in any group (all p > 0.05). These findings indicated that long-term treatment with an OC containing chlormadinone acetate plus ethinylestradiol reduced plasma MMP-2 concentrations in both healthy and PCOS women. As the latter have imbalances in circulating matrix MMPs, treatment of these women with an OC may be beneficial.