Reprodu??o & Climatério最新文献

The present research is a continuation of another one previously developed about unsafe abortion, associated socio-demographic characteristics and morbidity, and goes further in its analysis of the social determinants of health that influence this occurrence, generating inequities in health. This study compared data of three groups of 51 women (total of 153) submitted to induced abortion, as per situation and site of the procedure: one with “unsafe abortion” (Slum), one with “legal and safe” induced abortion (Public hospital) and a third group with “illegal and safe” induced abortion (Private clinics with appropriate standard of care). Univariate and multiple analyses of multiple multinomial logistic regression analyses were performed for the three categories with Private as reference. In the final model, the variables that proved to have a statistically significant association with induced abortion (CI = 95%; p < 0.05) were: income, level of schooling, ethnicity/color and place of birth for Slum and, for the Hospital location, the variable ethnicity lost significance. Morbidity, resulting from the outcome, showed a highly significant discrepancy between the first sample (Slum), with 94.12% of women who reported post-abortion complications, and the other two samples (Hospital and Private) in which no case of complication was identified or reported. A critical analysis was also made on the influence of the social determinants of health implied in abortion in all samples, and on the degree of inequity generated in each one (intra-group) and among them. We aimed to better understand social determinants of health concepts in practice. Proposals of action/intervention related to the “entry points” and findings were also suggested.

Introduction

Polycystic Ovary Syndrome (SOP) is a common endocrine disorder that affects 5‐10% of women of reproductive age. The association between metabolic syndrome and changes related to glucose and insulin is frequent in patients with SOP, increasing the cardiovascular risk of these patients. The LAP is an emerging cardiovascular risk based on the combination of waist circumference (WC) and triglycerides (TGL) and fasting simply reflects the lipid accumulation in adults.

Objectives

This study examined the possible correlation between metabolic syndrome or LAP and reproductive and metabolic parameters in patients with SOP.

Materials and Methods

The study included two hundred ninety‐nine patients with SOP, defined by the Rotterdam criteria followed at HC‐UFMG who had assessed their levels of triglycerides, total testosterone, fastingand two hours after 75 grams of overload dextrosol (GPD), TSH, LAP, Ferriman index, ovarian volume and abdominal circumference, and the presence or absence of metabolic syndrome.

Results

The mean LAP was 60.9 and the median 51.3. Patients with and without metabolic syndrome when compared to each others howed no differences in ovarian volume, total testosterone, Ferriman, fastingand post‐dextrosol. Women with metabolic syndrome had higher TSH levels than women without metabolic syndrome. The women in the top quartile of the LAP had TSH, Ferriman and GPD higher than women in the lower quartiles of LAP.

Conclusions

The higher values of LAP suggested good correlation of this index with insulin resistance. TSH levels were higher in patients with metabolic syndrome and LAP in the top quartile in SOP patients represent a new element in the literature and needs to be better studied.

Aim of the work

To compare the effect of adding short course follicular phase dexamethazone to clomiphene citrate versus increasing clomiphene citrate dose in cases of resistance.

Materials and methods

The study was conducted on 85 with polycystic ovary syndrome who were resistant to 150 mg clomiphene citrate daily for 5 days for 3 months and were attending El Shatby Maternity University Hospital in the period between September 2011 and May 2013. These patients were randomly allocated by closed envelope method into one of the two groups: Group I: 44 patients received 200 mg daily of clomiphene citrate from day 3 and for 5 days together with 2 mg dexamethazone daily from day 3 and for 10 days. Group II: 41 patients received 200 mg daily of clomiphene from day 3 and for 5 days.

Results

We found that a significant higher rate of ovulation was reported in the dexamethazone group compared to clomphine citrate only group, endometrial thickness was more favorable in dexamethazone group than the other group, mid luteal serum progesterone was a higher level in dexamesathone group compared to the other group and serum pregnancy rate was higher in dexamethazone group than the other group.

Conclusion

Although the mechanism underlying the beneficial effects of dexamesathone is not exactly understood, it is apparent from our data that dexamesathone therapy during the follicular phase can enhance follicular development and ovulation. Dexamethazone (corticosteroids) therapy combined with clomphine citrate can improve folliculogenesis, ovulation, and pregnancy rate in clomphine citrate resistant polycystic ovary syndrome.

Objective

To identify the profile of violence and drug use on sexual minorities and their implications for health.

Method

Cross‐sectional study, quantitative conducted with 316 individuals lesbian, gay, bisexual, and transgender during realization of Gays stops in the cities of Juazeiro and Crato, Ceará, Brazil. Used as form data collection instrument structured with questions related to violence, alcohol/drugs and health implications. For data analysis we used chi‐square test to associations between nominal variables. The significance value was p ≤ 0.05. The study was approved by the Ethics Committee.

Results

The psychological/verbal was the most prevalent in the sample (78.8%) and alcohol was the drug of choice for consumption (70.9%). Alcohol, when associated with violence, implied health consequences, resulting in suffering, through the manifestation of withdrawal symptoms (p = 0.04) and problems to resist consumption (p = 0.01).

Conclusions

Sexual minorities are victims of violence and consume drugs. The use of these substances resulted in injuries to Group Health.

Introduction

Illicit drugs promote social and health harm. Many female illicit drug users live on the streets, exchanging sex to buy drugs leaving aside proper contraception methods. This situation facilitates the occurrence of sexually transmitted diseases (STD) and unplanned pregnancies among these women in such vulnerable conditions, causing an increase in abortion and premature birth as well as direct effects on the newborn, which often are abandoned or forced to live with relatives. The efforts to reduce such damages must involve the realization of activities that stimulate greater social inclusion, and prevent unplanned pregnancies through the etonogestrel implant.

Objective

Use the subdermal etonogestrel implant to prevent unplanned pregnancy among female illicit drug users as a mean of social inclusion and social damage control.

Method

The project applied 106 etonogestrel implants in women living in Cracolândia, central region of São Paulo, where information regarding general and specific history of 101 female drug users was collected. Also, from these 101 users, exams were performed in 54 women in order to diagnose STD and uterine cervix cancer.

Result

Among the 106 women who had implant insertion, 41.6% use crack as main drug, in which 48.5% associate the drug with alcohol and 85.2% with tobacco. Regarding contraception methods, 36.7% do not use any kind of contraceptive method. As for pregnancy conditions, an increase in gestational morbidity was stated, where 16.1% had abortion and 20.6% had premature deliveries.

Conclusion

The etonogestrel subdermal implant is a precise indication to prevent unplanned pregnancy among female drug users, because it reduces the risk of gestational and neonatal morbidity, promoting also a reduction in social damage.

Objective

The aim of this study was to evaluate the effect of stopping the agonist with the first follow up visit when the initial response was poor in cases undergoing intracytoplasmic sperm injection, comparing this to the conventional continuation of the agonist.

Methodology

A prospective single blinded study was conducted on 50 infertile cases who were planned to have intracytoplasmic sperm injection by long protocol in infertility unit of El-Shatby Maternity University Hospital in the period between May 2011 and January 2013 and these patients had poor response on day 6 of stimulation (serum estradiol (E2) less than 100 pg/ml and 5 or less follicles developed). They were randomly allocated by closed envelope method into two groups, (I) 30 patients to whom we stopped the agonist and continued stimulation and (II) 20 patients to whom we continued the agonist together with stimulation.

Results

Group II had statistically higher days of stimulation than group I (p = 0.009). The number of metaphase II oocytes did not show statistical significant difference between the two groups (p = 0.418). The mean of number embryos replaced were statistically higher in group II than group I (p = 0.025). Pregnancy rate showed no statistical significant differences between the two studied groups (p = 0.466).

Conclusions

There was no difference between stopping the agonist or continuing it when the initial response was poor on first follow up visit in cases undergoing intracytoplasmic sperm injection.

Recommendations

Alternative measures should be looked for, to improve results of intracytoplasmic sperm injection when initial response is poor.

Oncofertility is an interdisciplinary field of interest, which intends to merge the knowledge in oncology and reproductive endocrinology, to develop strategies for preservation of reproductive function in cancer survivors. As with any discipline under construction, it is currently undergoing a period of maturation and transformation, in weighing the recognition of diverse and ephemeral situations, and raising ethical and bioethical questions in the search for safe and efficient solutions. This article aims to provide foundations for bioethical reflection on the subject and thus contribute to its development and solidification.

Dermoid cysts of the uterus are extremely rare. A case of an asymptomatic dermoid cyst in the previous caesarean section scar is reported in a 39-year-old woman who presented for pre-conception evaluation. A nodular lesion of the uterus was identified through transvaginal ultrasound examination and magnetic resonance imaging and its characteristics are described. The first treatment option was hysteroscopic resection but complete removal could not be achieved. Surgical excision is likely to be the definitive treatment and a hysterectomy will be proposed to the patient after she completes her family. Our literature review indicates that this is the first case of a dermoid cyst located in the previous caesarean section scar.

Objectives

Diabetes mellitus is among the main causes of death in postmenopausal women. Bilateral oophorectomy, commonly offered together with hysterectomy, promotes, in addition to the abrupt interruption of estrogen production, the reduction of the androgens that would continue to be produced by the ovary in natural menopause. Such hormonal changes can have their own repercussions, making the oophorectomized patient more susceptible to numerous chronic diseases, among them diabetes. The objective of this study is to review the available literature about the risk of diabetes attributable to oophorectomy.

Methods

A literature review was performed, searching in the Pubmed data bank about the risk of diabetes mellitus related to oophorectomy, natural menopause and orchiectomy.

Result

Diabetes is strongly associated with oophorectomy in most studies. Related to natural menopause, the majority showed an increase in conditional or independent risk. Androgens appear to offer a protective role in insulin resistance.

Conclusion

In spite of the need for more studies to reach definitive conclusions related to the association between oophorectomy and risk of diabetes, current evidence points to an increased risk of diabetes in oophorectomized women.