Clinical assessment of ethinylestradiol and cyproterone acetate in menstrual irregularities of hyper-androgenic origin

We report on the results of a double-blind, randomized, controlled clinical trial comparing two preparations of ethinylestradiol and cyproterone acetate in the treatment of women of reproductive age presenting menstrual irregularities of hyper-androgenic origin. After obtaining informed consent, subjects were randomized to a 4-month treatment period consisting of one daily dose of 0.035mg ethinylestradiol + 2mg cyproterone acetate. The treatment regimen cycle consisted of one pill, once daily for 21 days, followed by a 7-day pill-free period. We compared the efficacy of two presentations of the drug combination after each treatment cycle (Visits 2, 3, 4, and 5) in establishment and maintenance of menstrual regulation, intensity of menstrual flow, and dysmenorrhea, as well as a comparison of the two presentations in terms of Global Satisfaction and Drug Satisfaction assessments performed by the patients and the investigating physician. At each study visit, drug compliance and use of concomitant medications, as well as incidence, severity and duration of adverse events were recorded. A total of 86 subjects were randomized to treatment, with 43 subjects in each treatment group. At Visit 2 and each subsequent visit, all patients in both treatment groups reported an episode of withdrawal bleeding during the 7-day hormone-free period. We observed a statistically significant (p<0.0001) decrease in the incidence of dysmenorrhea at each study visit in relation to the pretreatment assessment. There was a significant reduction (p<0.0001) in the number of subjects reporting intermenstrual bleeding at each study visit in both treatment groups. Global Satisfaction scores by the patient and physician increased significantly at each successive study visit in both treatment groups. There were no clinically significant changes in vital signs, weight, and body mass index throughout the study period in either group. The number of subjects reporting adverse events at each visit did not vary between treatment groups. The combined oral contraceptive pill containing ethinylestradiol and cyproterone acetate was found to be both effective and safe in the menstrual irregularities of hyper-androgenic origin (amenorrhea, dysmenorrhea, and intermenstrual bleeding) assessed in this study. © Copyright Moreira Jr. Editora. Todos os direitos reservados.

Clinical study of a multivitamin and polymineral complex associated with Panax ginseng extract (Natus Gerin®)

This study aimed to stablish the efficacy of a multivitamin and polyminerals supplemented with Panax ginseng extract (Natus Gerin ®) on patients subjected to common physical or mental stress. Patients were randomly divided in two groups and underwent a thorough clinical examination. Group A received Natus Gerin ® capsules and B placebo capsules. Two capsules were taken daily during meals during four weeks. Mood and physical activity were evaluated through a questionnaire assessing quality of life. From the 176 patients enrolled, 17 were excluded due to voluntary withdrawal, 81 completed the study in group A and 78 in group B. The treatment with Natus Gerin ® increased the quality of life when compared to placebo. After 15 and 30 days, group A showed a significant increase in average scoring score from 1.78 to 3.78, and finally 5.32 points. The study has shown that the daily use of Natus Gerin ® can be effective in improving quality of life in patients suffering from physical and mental stress.

Estudo comparativo entre a administração de toxina botulínica “A” e a orquiectomia no tratamento da hiperplasia prostática benigna do cão

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

Avaliação clínica de doadores de sangue portadores do vírus linfotrópico de células T humanas (HTLV - I/II)

Os vírus linfotrópicos de células T humanas do tipo I e II (HTLV-I/II) são retrovírus que podem ser transmitidos por transfusão de sangue. Estes vírus estão associados com paraparesia espástica tropical (PET), leucemia/linfoma de células T do adulto (L/LTA) e outras doenças sistêmicas imunomediadas. O presente estudo teve como objetivo investigar sinais clínicos de patologias associadas a esses vírus para utilizar na triagem clinica de candidatos à doação de sangue. Usou procedimentos padronizados para avaliação clinica de 30 doadores de sangue soropositivos para HTLV-I/II confirmados pela técnica de reação em cadeia da polimerase (PCR) matriculados no ambulatório do Núcleo de Medicina Tropical da UFPA. Paralelamente, através de interrogatório clínico complementar, estudou grupo controle com 40 candidatos à doação de sangue escolhidos aleatoriamente, que tiveram resultados sorológicos negativos. Dos 30 pacientes examinados, verificou-se que 23 eram portadores de HTLV-I e 07 HTLV-II. Na avaliação clínica, 15 pacientes (50%) não referiram queixas, sendo que 12 pacientes com queixas exclusivamente neurológicas. Observou 05 pacientes com formigamentos; 05 com diminuição da força muscular; 04 com constipação intestinal; 02 com parestesia; 02 com nódulos subcutâneos; 01 com incontinência urinária; 01 com visão borrada; 01 com diminuição do libido. No grupo controle, 05 candidatos (12,5%) referiram queixas. Os resultados indicam que diminuição da força muscular e formigamento devem ser questionados na triagem clínica prévia à doação de sangue para reduzir risco de infecção transfusional.

Características reprodutivas de garanhões mantidos sob luz natural ou contínua, em ambiente tropical

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

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study

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

Lack of reproductive toxicity in adult male rats exposed to interferon-alpha

Interferon-alpha (IFN- α ), a type I IFN, is a protein with antiviral, antiproliferative, and immunoregulatory activities, widely used in the treatment of several types of cancers as well as hepatitis B and C. Decrease of libido and erectile dysfunction are commonly reported by male patients during treatment of chronic hepatitis C with IFN- α . However, IFN therapy-associated underlying factors attributed to sexual dysfunction are still not well defined. Currently, there are few studies investigating the effects of IFN on male reproductive system functions. Given that, the aim of the present investigation was to examine effects of subchronic exposure to IFN- α (5 × 10(4) U/kg and 10 × 10(4) U/kg, 30 d) on serum hormones, sperm parameters, fertility, and testicular and epididymal hystopathology and morphometry in adult male Wistar rats. None of the evaluated parameters was markedly altered by IFN- α . Thus, our results suggest that exposure to IFN- α , in this experimental design, did not adversely affect sperm quality and fertile capacity of male rats.

Retorno à atividade reprodutiva de touro angus após fimose traumática com obliteração parcial da luz prepucial: relato de caso

The main disturbs affecting the genital segment of bulls are balanitis, phimosis and preputial injuries, abscesses or prolapses, resulting in decreased libido or mating ability. One case of traumatic phimosis with partial obliteration of preputial lumen is reported in Aberdeen Angus bull. During anamnesis, it was reported that the animal was unable to expose the penis and presented increased penile and preputial volume of unknown etiology after being submitted to a libido test. During clinical examination, a firm preputial mass of 15 cm in diameter was observed in the middle third of the prepuce and stenosis of preputial lumen was detected approximately 17 cm from the preputial orifice. Reconstructive surgery was the chosen therapy, with amputation of the affected foreskin portion. A skin segment of about 12 cm and affected mucosal portion were removed. Postoperative therapy consisted of dressing with chlorhexidine digluconate based ointment, povidone iodine and topical insect repellent (cypermethrin and carbamyl), systemic antibiotic therapy with benzathine penicillin (30,000 IU / kg, repeated after 48 hours) and anti-inflammatory therapy with flunixin meglumine (2 , 0 mg / kg SID) for three days. After twenty days, semen was collected by massage of the accessory glands. The ejaculate volume was 3 mL, with 200x106 spermatozoa / mL, white color, "suis generis" odor, 88% of motile sperm, 64% of progressively motile sperm and 82% of rapid sperm. Thus, the chosen surgical treatment was effective to correct the pathology and reintroduce the animal into reproductive activity

Heritability Estimate and Genetic Correlations of Reproductive Features in Nellore Bulls, Offspring of Super Precocious, Precocious and Normal Cows Under Extensive Farming Conditions

The present work aimed to estimate heritability and genetic correlations of reproductive features of Nellore bulls, offspring of mothers classified as superprecocious (M1), precocious (M2) and normal (M3). Twenty one thousand hundred and eighty-six animals with average age of 21.29 months were used, evaluated through the breeding soundness evaluation from 1999 to 2008. The breeding soundness features included physical semen evaluation (progressive sperm motility and sperm vigour), semen morphology (major, minor and total sperm defects), scrotal circumference (SC), testicular volume (TV) and SC at 18 months of age (SC18). The components of variance, heritability and genetic correlations for and between the features were estimated simultaneously by restricted maximum likelihood, with the use of the vce software system vs 6. The heritability estimates were high for SC18, SC and TV (0.43, 0.63 and 0.54; 0.45, 0.45 and 0.44; 0.42, 0.45 and 0.41, respectively for the categories of mothers M1, M2 and M3) and low for physical and morphological semen aspects. The genetic correlations between SC18 and SC were high, as well as between these variables with TV. High and positive genetic correlations were recorded among SC18, SC and TV with the physical aspects of the semen, although no favourable association was verified with the morphological aspects, for the three categories of mothers. It can be concluded that the mothers sexual precocity did not affect the heritability of their offspring reproduction features.

Sleep disorders in climacteric women

Introduction: This paper examines the various factors that contribute to the occurrence of sleep alterations during peri and post climacteric and thus produce significant imperil to women's quality of life. Among the probable causes of insomnia or sleep disorders associated to climacteric stand out the occurrence of vasomotor symptoms, depressive state and respiratory distress during sleep, such as sleep apnea, along with chronic pain, although psychosocial factors related to the climacteric bear major influence on such clinical status. Method: The bibliographic analysis was carried out using several electronic data base namely: Cochrane, Medline, Embase, Bni Plus, Biological Abstracts, Psycinfo, Web Of Science, Sigle, Dissertation Abstracts and ZETOC published in English, Spanish and Poruguese. The key terms used were: sleep, REM sleep, slow wave sleep polysomnography; electroencephalogram; sleep disturbances; disturbances of sleep onset and maintenance; excessive somnolence disturbances; climacteric; menopause; depression; neurobiology; biologic models; circadian rhythm; mental health and epidemiology. Case studies and letters to the editor were excluded. The summaries of the identified studies found in the data base were analyzed and assessed, and the data analyzed separately according to the subjective or objective criteria for data collection. Results: The climacteric transition constitutes a period of major risk for the development of depressive, vasomotor and insomnia symptoms although not caused solely by hypoestrogenism. The diagnostic methods used in the study of sleep disorders range from subjective assessment by means of response to specific questionnaires to the objective analysis of actigraphic or polissonographic daytime and nocturnal reports. Polissonographic studies of the whole night, performed at the laboratory, are the golden method of choice for diagnostic of sleep disorders. Studies point to the high prevalence of sleep disorders in the climacteric, especially insomnia, apnea and periodic movement of legs and also to the fact that this phase of life presents decrease in the quality of sleep. Women in peri and post climacteric show higher sleep latency and difficulty in its maintenance and refer being less satisfied with its quality even when compared to those who are not climacteric. Exception made to the vasomotor symptomatology, the other climacteric complaints such as mood disturbances, libido alterations, cognitive deficit, articular pain and sleep disorders are markedly associated to psychosocial factors, lifestyle and especially to women's perception of what the climacteric means to their lives. Conclusion: The analysis of the available studies revealed a proneness to deterioration of quality of life of climacteric women markedly in the sleep disturbances, depressed mood and anxiety domains and should not to be basically attributed to the climacteric. It is necessary that the professionals consider the need of assessment of such pathologies as complex phenomena and the literature lacks studies contemplating such dimensions.

Evaluation des effets de l’extrait aqueux des fleurs de Nymphaea lotus Linn. (Nymphéacées) sur la fonction de reproduction des rats normoglycémique et diabétique de type 1

In traditional medicine of Cameroon, Nymphaea lotus Linn. (Nympheaceae) is used for treatment of male sexual disorders. The aim of this study was to evaluate the effects of the N. lotus flowers aqueous extracts on general mating behavior, fertility and some androgenic parameters of normoglycemic and diabetic adult male rats. Mating behavior assessment was carried out with primiparous and with oestrus female rats. Male rats were divided into 5 groups and subjected once in a day to the following treatment: distilled water (10 mL/kg), Sildenafil citrate (5mg/kg), Testosterone enanthate (5mg/kg) and plant extract (75 mg/kg and 150 mg/kg). Treatment lasted for 8 and 55 days before sacrifice. Organ weight, epididymal sperm counts, motility, viability, histomorphometric analysis, muscular strength, seminal fructose, cholesterol level, epididymal and serum proteins testicular were determined. Results showed a dose- dependant influence of the treatment in sperm count and motility which significantly increases compared to the distilled water-administered control. An increase in some sexual performance parameters (mount and intromission frequencies) was observed in both diabetic and normal rats compared to respective controls. The latencies of mount and intromission were significantly reduced. Computed frequencies of penile licking, index of libido and sexual motivation were higher in normal and diabetic extract-treated animals; which suggest an enhancement of motivational parameters. The treatment also caused significant increases in the weight of the testis, prostate, epididymis, in serum cholesterol and epididymal protein level in normal rats compared to the distilled water-administered control. These results indicate an androgenic pro-sexual potential of N. lotus in male rats and justify the empirical use of N. lotus in the management of erectile dysfunction and fertility disorders in males. Key-words: Nymphaea lotus, prosexual, androgenic, fertility, diabetic, male rat. //Selon les tradipraticiens de l’Ouest-Cameroun, Nymphaea lotus Linn. (N. lotus), de la famille des Nymphéacées, est utilisé pour le traitement des dysfonctionnements sexuels chez les hommes. Dans cette étude, l’effet de l’extrait aqueux des fleurs de N. lotus sur la fonction de reproduction des rats mâles adultes normaux et diabétiques a été évalué. Dans le but d’évaluer les effets de l’extrait aqueux des fleurs de N. lotus sur les paramètres généraux de copulation, d’androgénicité et de fertilité, les rats normoglycémiques et diabétiques ont été divisé en 3 groupes contrôle [Groupe I- recevant de l’eau distillée, Groupe II et III recevant respectivement du citrate de sildénafil (5 mg/kg) et l’énanthate de testostérone (5 mg/kg)] et deux groupes expérimentaux traités à l’extrait aux doses 75 mg/kg (Groupe IV) et 150 mg/kg (Groupe V). L’eau distillée, l’extrait et la substance de référence était administré per os une fois par jour. Pour analyser le comportement sexuel et la fertilité, des femelles primipares et en oestrus étaient utilisées. Le traitement a duré 8 et 55 jours avant le sacrifice. Le poids relatif des organes, le nombre de spermatozoïde, la motilité, les analyses morphométriques, la force musculaire, le taux de cholestérol, le taux de protéines sériques et épididymaires étaient déterminé. Le temps de latence de monte et d’intromission a diminué significativement alors que la fréquence d’éjaculation a augmenté. L’index de libido, la fréquence de monte, d’intromission, d’éjaculation, d’orientation des mâles vis-à-vis d’eux même et l’index de motivation sexuelle a augmenté chez les animaux traités l’extrait comparés à ceux ayant reçu de l’eau distillée aussi bien chez les normaux que chez le diabétiques qui n’enregistrent d’ailleurs aucune éjaculation. Le traitement a augmenté significativement (P < 0,01) le poids des testicules, de la prostate et de l’épididyme. Il est observé une augmentation dose-dépendante du nombre et de la motilité des spermatozoïdes (P < 0,05), ainsi qu’une augmentation significative (P < 0,001) temps-dépendant du taux de cholestérol sérique et de protéines épididymaires. Ces résultats indiquent un potentiel androgénique pro-érectile de N. lotus chez les rats mâles et justifient l’utilisation empirique des fleurs de N. lotus dans le traitement des dysfonctions érectiles et des problèmes de fertilité chez les hommes. Mots-clés: Nymphaea lotus, pro-érectile, androgénique, fertilité, diabétiques, rat male

Sexual dysfunction in multiple sclerosis

Multiple sclerosis is a chronic disease that commonly affects young adults who may be sexually active. Sexual dysfunction is a significant, but often underestimated, symptom of multiple sclerosis, affecting 50-90% of men and 40-80% of women. The types of sexual dysfunction can be categorized in terms of the normal sexual response cycle: sexual interest/desire dysfunction (reduced libido), sexual arousal dysfunction (including erectile dysfunction) and ejaculatory and orgasmic dysfunction. Sexual dysfunction may not only be due to lesions affecting the neural pathways involved in physiological function (primary dysfunction), but also result from general physical disabilities (secondary dysfunction) or psychological and emotional issues (tertiary dysfunction). Comprehensive management should address all these possible contributing problems. Specific pharmacotherapy is only currently available for erectile dysfunction. This review summarizes the available information about sexual dysfunction in men and women with multiple sclerosis.

Akupunktur – Möglichkeiten zur Behandlung des klimakterischen Syndroms

Hitzewallungen, Palpitationen, emotionale Labilität, verminderte Libido – bei vielen Frauen gerät in den Wechseljahren ihr gewohntes Leben aus dem Gleichgewicht. In Anbetracht der bekannten Nebenwirkungen sollte die Indikation zu einer Hormontherapie streng gestellt werden, oft ist diese sogar kontraindiziert. Das Interesse an weiteren Therapieoptionen wächst daher stetig. In den Überlieferungen und Schriften der traditionellen chinesischen Medizin (TCM), welche teilweise mehrere 1000 Jahre alt sind, wurden klimakterische Beschwerden bereits beschrieben. Das wohl älteste Lehrbuch der chinesischen Medizin ist das Huang di Neijing – der Klassiker des Gelben Kaisers, eine Kompilation verschiedener Autoren aus dem Zeitraum zwischen 400 und 200 v. Chr.: Dort fi nden sich erste genaue Anweisungen, Behandlungsformen und diagnostische Herangehensweisen. Insgesamt umfasst das traditionelle Medizinsystem der TCM 5 Behand lungs säulen: Neben der Akupunktur werden Beschwerden mit chinesischen Arzneimitteln, TuiNa (eine chinesische Physiotherapie), Ernährungstherapie und körperlicher Ertüchtigung (z. B. QiGong) behandelt.

The Potential Effects of Social Interactions on Reproductive Efficiency of Stallions

The reproductive efficiency of stabled domestic stallions is often lower than what could be expected from observations in feral herds. In the wild, stallions typically live with mares in harem bands, with other stallions in bachelor bands, or occasionally in mixed-sex transitional bands. We, therefore, argue that permanent contact with mares may increase reproductive efficiency of stallions suffering from low libido and/or fertility. We also provide a summary of our present knowledge of natural conditions, management, and husbandry of domestic stallions, and of intra- and intersexual behavioral interactions in horses.

[Klinik und Diagnose von Hypogonadismus und Andropause]

Diagnosis and therapy of male hypogonadism is still a challenge because of the unspecific clinical signs and symptoms. The clinical presentation of a androgen deficiency is age-related. In the adult men, one can often observe fatigue, decrease in physical capacity, loss of libido and erectile dysfunction. At the physical examination, genitalia have always to be assessed in search of a testes/penis atrophy. Two fasting measurements of total testosterone concentrations by a reliable assay are needed to confirm the diagnosis. By assessing gonadotropines the origin of hypogonadism can be determined (central/secondary or peripheral/primary). Exogenous administration of androgens should be considered in young, sportive, healthy and muscular males. Patients with metabolic syndrome should only be screened for hypogonadism in the presence of suggestive symptoms. Prostate disease, hematocrit higher than 50 %, uncontrolled heart failure and severe obstructive sleep apnea are contraindications of a testosterone replacement therapy. Patients with metabolic-syndrome-associated low testosterone levels should firstly benefit from a lifestyle intervention that can normalize clinical and biochemical hypogonadism. So far, there is no clear evidence for a possible benefit of testosterone therapy in patients with the metabolic syndrome. Similarly, in patients with PADAM (partial androgen deficiency of the aging male) testosterone therapy is not established or recommended.