Aconselhamento contraceptivo para o paciente transgênero designado mulher ao nascimento / Contraceptive counseling for the transgender patient designated female at birth

Apesar de 0,7% da popul ação brasileira se identificar como transgênero, não existe treinamento para que o profissional de saúde realize um acolhimento de maneira integral a esse paciente, incluindo a discussão do planejamento reprodutivo. O uso de testosterona promove amenorreia nos primeiros meses de uso, entretanto esse efeito não garante eficácia contraceptiva e, consequentemente, aumenta os riscos de uma gravidez não planejada. Trata-se de uma revisão integrativa com o objetivo de avaliar e organizar uma abordagem do aconselhamento contraceptivo na população transgênero que foi designada mulher ao nascimento. Realizou-se busca estratégica em PubMed e Embase, bem como em guidelines internacionais, sobre cuidados à população transgênera. De 88 artigos, 11 foram utilizados para desenvolver o modelo de aconselhamento contraceptivo. O modelo segue as seguintes etapas: (1) Abordagem das informações relacionadas à necessidade de contracepção; (2) Avaliação das contraindicações ao uso dos métodos contraceptivos (hormonais e não hormonais); (3) Efeitos colaterais e possíveis desconfortos associados ao uso do contraceptivo. O modelo de aconselhamento contraceptivo é composto de 20 questões que abordam as indicações e contraindicações ao uso desses métodos e um fluxograma que auxilia na escolha entre os métodos permitidos ao paciente de acordo com a sua necessidade.(AU)

Migration of liquid silicone, an emerging contraindication of neuraxial anesthesia / Migración de silicona líquida, una contraindicación emergente de la anestesia neuroaxial

Abstract The illegal use of liquid silicone products or biopolymers in gluteal augmentation procedures is giving rise to multiple complications, with a significant negative health impact, both in the short and long-term. The migration of polymers to the sacral and lumbar region represents a major limitation to conducting neuraxial anesthesia procedures. This silicon migration is unpredictable through the superficial tissue as is widely described in the literature. Caudal, spinal and epidural anesthesia may cross the silicone in the fascia and contaminate the neural axis with substances that are highly capable of causing inflammation, edema and tissue necrosis. In order to improve the safety of neuraxial anesthetic procedures and avoid the potential risk of dissemination and contamination of the neural axis, this complication must be ruled out, or be considered an emerging contraindication for these anesthetic procedures.

Resumen La aplicación ilegal de productos como silicona líquida o biopolímeros en procedimientos de aumento de glúteos está generando múltiples complicaciones con gran impacto negativo para la salud tanto a corto como a largo plazo. La migración de polímeros a la región sacra y lumbar representa una importante limitación para la realización de procedimientos de anestesia neuroaxial. Esta migración de silicona es impredecible a través del tejido superficial, la cual está ampliamente descrita en la literatura. Los procedimientos anestésicos caudal, espinal y epidural podrían atravesar los silicomas en la fascia del tejido y contaminar el neuroeje con sustancias con alta capacidad de generar inflamación, edema y necrosis de tejidos. Con el fin de aumentar la seguridad de los procedimientos anestésicos neuroaxiales y evitar el riesgo potencial de dispersión y contaminación del neuroeje, es necesario descartar esta complicación o considerar una contraindicación emergente en estos procedimientos anestésicos.

Vacuna Johnson & Johnson contra COVID-19: distribución mundial de la vacuna, mecanismo de acción, indicaciones, contraindicaciones y efectos secundarios. Una revisión bibliográfica / Johnson & Johnson vaccine against COVID-19: worldwide vaccine distribution, mechanism of action, indications, contraindications and side effects. A literature review

El SARS-CoV-2, causante de que estemos viviendo una pandemia mundial, tuvo sus orígenes en China, desde donde ha traspasado fronteras rápidamente, llegando a todos los rincones del mundo. Muchos han sido los equipos de investigación que se enfrentan el reto de conseguir una vacuna que logre combatir este mortal virus. Es por este motivo que en esta investigación se pretendió analizar la bibliografía referida a la vacuna Johnson & Johnson (J&J) contra COVID-19: distribución mundial de la vacuna, mecanismo de acción, indicaciones, contraindicaciones y efectos secundarios. Varios estudios demuestran que su eficacia varía de acuerdo con la edad y género de cada individuo; sin embargo, esta vacuna alcanzó un grado de certeza moderada. Los efectos adversos en su mayoría son leves y se resolvieron al cabo de dos días, siendo excepción algunos casos, ya que se registró un efecto adverso poco común denominado trombocitopenia prevalente en mujeres de 18 a 40 años, por este motivo, la FDA (Administración de Alimentos y Medicamentos de EE.UU.) recomienda la precaución en el uso de la vacuna con respecto a este efecto adverso que en algunos casos podría ser mortal (AU)

The SARS-CoV-2, which caused us to be experiencing a global pandemic, had its origins in China, from where it has crossed borders rapidly, reaching all corners of the world. Many research teams have faced the challenge of getting a vaccine to fight this deadly virus. For this reason, this research aimed to analyze the literature on the Johnson & Johnson COVID-19 vaccine: global distribution of the vaccine, mechanism of action, indications, contraindications and side effects. Several studies show that its effectiveness varies according to the age and gender of each individual, but this vaccine reached a moderate degree of certainty. The adverse effects are mostly mild and resolved within two days, with some exceptions being a rare adverse effect called prevalent thrombocytopenia in women aged 18 to 40 years. For this reason, the FDA recommends caution in the use of the vaccine with respect to this potentially fatal adverse effect in some cases (AU)

Cognition of traditional Chinese medicine properties and thinking of clinical rational use of drug / 中国中药杂志

This paper discusses the rational use of traditional Chinese medicine based on chemical composition, body state and biological effect. The essence and connotations of traditional Chinese medicine are explained by modern scientific theory and technical means, and the mechanism of traditional Chinese medicine in the treatment of diseases is defined in modern medicine language, which is conducive to promoting rational and safe clinical use of drugs. Based on the chemical composition of traditional Chinese medicine,the selected genuine medicinal materials were collected and processed in a standardized way, and then used in the combination with other traditional Chinese medicines, with the aim to improve the efficacy of traditional Chinese medicine in clinical indications, increase the advantages, eliminate the disadvantages, and adapt to flexible and safe clinical drug demands. Based on the body state elements, clinical diagnosis and treatment shall be patient-centered, and doctors shall distinguish the differences of pathogenesis, symptoms and diseases, and consider the drug contraindications of special groups. According to the " dose-effect-toxicity" relationship, doctors shall select the appropriate dosage form, control the drug dosage, balance the benefits and risks of drugs, and carry out appropriate medical treatment. Based on the biological effect elements and the regulatory mechanism of traditional Chinese medicine on the target and pathway of disease, traditional Chinese medicine shall strengthen the precise positioning, provide accurate treatment; evaluate the safety of traditional Chinese medicine combination, explore the adverse reaction mechanism, strengthen the clinical safety monitoring of traditional Chinese medicine, and guide the clinical rational use of drugs, in the expectation of ensuring the safe use of traditional Chinese medicine and maximize the clinical efficacy of traditional Chinese medicine.

Manejo del síndrome coronario agudo durante pandemia por COVID ­ 19 / Management of acute coronary syndrome during COVID ­ 19 pandemic

INTRODUCTION: Acute Myocardial Infarction is a medical emergency, being his early and adequate treatment highly effective mainly in relation to reperfusion therapy. Unfortunately, COVID ­ 19 pandemic, has brought changes in its management due to availability of conditioned hemodynamic rooms, infection risk of the professionals, patient conditions and availability of critical unit beds. A review of the topic was made aimed to give a guide for the management of these patients with the available tools. MATERIALS AND METHOD: A review of the topic was made using the Medline/ Pubmed platform, in English and Spanish. Further, published articles in journals as The journal of the American college of cardiology and Circulation were included. CONCLUSIONS: The reperfusion strategies must be used according to the clinical context of the patient. In the acute myocardial infarction with ST elevation, fibrinolytic treatment may be chosen in low risk and without hemodynamic instability. In patients with hemodynamic instability, not eligible for fibrinolytic treatment or in whom this therapy fails, percutaneous angioplasty is indicated considering the protection of personnel. In the case of acute myocardial infarction without ST elevation, the treatment by urgent percutaneous angioplasty is considered in cases of hemodynamic instability or malignant arrhythmias.

Drug interactions for elderly with respiratory disorders and times of covid-19: a systematic scoping review / Interacciones farmacológicas para ancianos con enfermedades respiratorias y tiempos de covid-19: una revisión sistemática del alcance

Background: The elderly people have high morbimortality associated with respiratory disorders, in addition to the presence of other safety risk factors, such as the use of potentially inappropriate medication and the occurrence of drug interactions. Objective: Considering the current pandemic scenario, it was intended to identify explicit criteria-based tools that reported drug interactions between potentially inappropriate medication and respiratory system disorders and possibly worse prognosis of COVID-19 infection. Methods: A systematic scoping review was conducted until February 2020. Study characteristics of explicit criteria-based tools, and potentially inappropriate medication, drug interactions, and therapeutic management, were extracted. Results: Nineteen explicit criteria-based tools were included. Nineteen drug interactions and 17 potentially inappropriate medications with concerns for three respiratory disorders (asthma, chronic pulmonary obstructive disease, and respiratory failure) were identified. The most frequent pharmacological classes reported were benzodiazepines and beta-blockers. For clinical management, the tools recommend using cardioselective beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type I receptor blockers and benzodiazepines with a short or intermediate half-life. Conclusion: Considering the increased risk of COVID-19 infection in the elderly, drug interactions and the use of potentially inappropriate medication associated with the occurrence of adverse drug events in the respiratory system may also worsening COVID-19 infection in patients with uncontrolled respiratory disorders. Thus, it is essential to assess drug therapy in use, to identify safety risks and monitor the elderly in general and those with a worse prognosis concerning COVID-19, promoting patient safety.

Antecedentes: Los ancianos tienen alta morbimortalidad asociada a trastornos respiratorios, además de la presencia de otros factores de riesgo de seguridad, como el uso de medicación potencialmente inapropiada y la ocurrencia de interacciones medicamentosas. Objetivo: Teniendo en cuenta el escenario pandémico actual, se pretendía identificar herramientas explícitas basadas en criterios que informaran interacciones farmacológicas entre medicamentos potencialmente inapropiados y trastornos del sistema respiratorio y posiblemente un peor pronóstico de la infección por COVID-19. Métodos:Se realizó una revisión sistemática del alcance hasta febrero de 2020. Se extrajeron las características del estudio de las herramientas explícitas basadas en criterios y la medicación potencialmente inapropiada, las interacciones entre medicamentos y el manejo terapéutico. Resultados: Se incluyeron diecinueve herramientas explícitas basadas en criterios. Se identificaron diecinueve interacciones farmacológicas y 17 medicamentos potencialmente inapropiados con preocupaciones por tres trastornos respiratorios (asma, enfermedad pulmonar obstructiva crónica e insuficiencia respiratoria). Las clases farmacológicas más frecuentes comunicadas fueron las benzodiacepinas y los betabloqueantes. Para el manejo clínico, las herramientas recomiendan el uso de betabloqueantes cardioselectivos, bloqueadores de los canales de calcio, inhibidores de la enzima convertidora de angiotensina y bloqueadores del receptor de angiotensina II tipo I y benzodiacepinas con una vida media corta o intermedia. Conclusión: Teniendo en cuenta el mayor riesgo de infección por COVID-19 en los ancianos, las interacciones farmacológicas y el uso de medicamentos potencialmente inapropiados asociados con la aparición de eventos farmacológicos adversos en el sistema respiratorio también pueden empeorar la infección por COVID-19 en pacientes con trastornos respiratorios no controlados. Por tanto, es fundamental evaluar la farmacoterapia en uso, identificar los riesgos de seguridad y monitorizar a los ancianos en general y a aquellos con peor pronóstico en relación con el COVID-19, promoviendo la seguridad del paciente.

Classificação de risco dos medicamentos usados na internação para o parto na amamentação: coorte de nascimentos de Pelotas/2015 / Breastfeeding and risk classification of medications used during hospitalization for delivery: 2015 Pelotas Birth Cohort

RESUMO: Objetivo: Classificar os medicamentos usados durante o parto quanto aos riscos na amamentação, utilizando diferentes fontes e verificando suas discordâncias. Métodos: Estudo transversal inserido na coorte de nascimentos de Pelotas de 2015. Coletaram-se informações sobre o uso de medicamentos, classificando-os quanto ao risco de acordo com: manual do Ministério da Saúde (MS), Organização Mundial da Saúde (OMS), classificação de Newton e Hale e Academia Americana de Pediatria (AAP). Resultados: Participaram 1.409 mães, utilizando 14.673 medicamentos, sendo 143 fármacos diferentes, dos quais 28 tiveram classificação de risco na amamentação discordante. Entre aqueles com classificação discordante estão morfina (64%), classificada pela AAP e OMS como compatível e pelo MS e por Newton e Hale como criterioso; hioscina (23%), criterioso pelo MS e compatível (A) pela AAP; e metoclopramida (18%), compatível pelo MS, de efeitos desconhecidos (D) pela AAP e evitado de acordo com a OMS. Do total de medicamentos, 49,7% foi classificado como compatível com a amamentação. Quase a totalidade das mulheres utilizou ocitocina (97,4%), seguida de lidocaína (75%), cetoprofeno (69%), cefalotina (66%) e diclofenaco (65%), classificados como compatíveis. Conclusão: Houve amplo uso de medicamentos pelas mães durante a internação para o parto, a maioria deles classificada no mesmo grau de risco, e quase a metade classificada como compatível com a amamentação, porém houve discordância entre as fontes para 19,6% dos medicamentos analisados, o que pode colocar em risco a saúde do lactente ou deixar dúvida quanto ao uso do medicamento ou à prática da amamentação.

ABSTRACT: Objective: To classify the drugs used during childbirth in relation to risks in breastfeeding, by using different sources of information and determining their disagreements. Methods: Cross-sectional study, within the 2015 Pelotas Birth Cohort. Information about the use of drugs was collected, classified and compared regarding risk according to: 1) Brazil Ministry of Health Manual (MS), 2) World Organization (WHO), 3) Newton and Hale's classification and 4) American Academy of Pediatrics (AAP). Results: A total of 1,409 mothers participated, and they had used 14,673 medicines, with 143 different drugs, of which 28 showed discordant classification with regard to breastfeeding risk. These 28 drugs included the following: morphine (64%), classified by AAP and WHO as compatible and as judicious use use by MS and Newton and Hale; hyoscine (23%), classified as judicious use by MS and compatible (A) by AAP; and metoclopramide (18%), classified as compatible by MS, of effects unknown (D) by AAP, and should be avoided according to WHO. Of the total drugs, 49.7% were classified as compatible during breastfeeding. Almost all women used oxytocin (97.4%), followed by lidocaine (75%), ketoprofen (69%), cephalothin (66%) and diclofenac (65%), which were classified as compatible. Conclusion: There was extensive use of drugs by mothers in labor during admission, most of the drugs being classified at the same risk and almost half classified as compatible with breastfeeding. However, there was disagreement between the sources for 19.6% of the drugs analyzed, which could endanger the infant's health or leave doubts about the use of the drug or breastfeeding.

Primum non nocere - Are chloroquine and hydroxychloroquine safe prophylactic/treatment options for SARS-CoV-2 (covid-19)?

ABSTRACT Chloroquine (CQ) and its analog hydroxychloroquine (HCQ) were recently included in several clinical trials as potential prophylactic and therapeutic options for SARS-COV-2 infection/covid-19. However, drug effectiveness in preventing, treating, or slowing the progression of the disease is still unknown. Despite some initial promising in vitro results, rigorous pre-clinical animal studies and randomized clinical trials have not been performed yet. On the other hand, while the potential effectiveness of CQ/HCQ is, at best, hypothetical, their side effects are factual and most worrisome, particularly when considering vulnerable groups of patients being treated with these drugs. in this comment, we briefly explain the possible mechanisms of action of CQ/HCQ for treating other diseases, possible actions against covid-19, and their potent side effects, in order to reinforce the necessity of evaluating the benefit-risk balance when widely prescribing these drugs for SARS-COV-2 infection/covid-19. We conclude by strongly recommending against their indiscriminate use.

Vacunación BCG e inmunodeficiencias primarias: ¿es momento de un cambio? / BCG vaccine administration schedule and primary immunodeficiencies: Is it time for a change?

Resumen: Los pacientes con Inmunodeficiencias primarias (IDP) tienen un riesgo elevado de complicaciones severas por la vacuna BCG, incluso mortalidad. Es necesario evaluar periódicamente el riesgo versus beneficio de la vacunación universal BCG en el periodo neonatal. Chile es un país con baja incidencia de tuberculosis (TB) pero cuya epidemiología ha cambiado recientemente con un aumento de los casos. Cambios en esquemas de vacunación BCG en países con incidencias mayores o similares de TB y con coberturas de vacunación menores han sido posibles sin aumento de los casos graves de TB que son los que previene la BCG. El cambio ha evitado complicaciones graves en pacientes con IDP. Creemos que un análisis crítico de la fecha de vacunación BCG debe realizarse hoy en Chile. Más aún dada la posibilidad técnica de realizar screening neonatal de IDP.

Abstract: Patients with Primary Immunodeficiencies (PID) are at a higher risk of developing severe morbidities and mortality due to the administration of BCG vaccine. Risk-to-benefit of universal BCG vaccina tion of newborns must be assessed periodically. Chile has a low incidence of tuberculosis (TB) but the local epidemiology has recently changed with an increase of TB cases. Changes in the BCG vaccine schedule have been made in countries with similar or higher TB incidences and lower BCG vaccine coverage, with no increase in the severe TB cases, which are prevented by BCG. These changes have prevented serious complications in PID patients. We propose a critical analysis of the BCG adminis tration date in Chile due to the technical possibility of performing neonatal PID screening.

Método Pilates: benefí­cios e aplicabilidade para melhorar a qualidade de vida / Pilates method: benefits and applicability to improve the quality of life

O método Pilates de condicionamento corporal foi criado por Joseph H. Pilates, que transmitiu os benefícios de um equilíbrio perfeito entre corpo e mente, e chamou de Contrologia, coordenação completa do corpo, da mente e do espírito. Utilizando princípios específicos para promover a integração entre eles, que são a concentração, centro de força (power house), fluidez, precisão, respiração e controle dos movimentos. Como o número de praticantes do método Pilates tem aumentado muito nas últimas décadas demonstra a necessidade de evidências científicas sobre os benefícios desse método. Sendo assim, este artigo teve como objetivo geral verificar através de um levantamento bibliográfico no qual foram realizadas buscas sistematizadas em três bases de dados eletrônicas (Lilacs, Scielo e Google Acadêmico). Os termos de busca utilizados nas bases foram Pilates, método Pilates, indicações do método Pilates e contraindicações do método Pilates. Dentre os resultados, verificou-se que o método Pilates é utilizado como recurso para condicionamento físico e mental em diversas áreas da saúde, e os estudos analisados evidenciaram a eficácia do método Pilates como ferramenta na prevenção, promoção, reabilitação e melhora da qualidade de vida das pessoas que o praticam. (AU)

The Pilates method of body conditioning was created by Joseph H. Pilates, who conveyed the benefits of a perfect balance between body and mind, and called Contrology, complete coordination of body, mind and spirit. Using specific principles to promote integration between them, they are concentration, power house, fluidity, precision, breathing and movement control. Since the number of Pilates practitioners has increased greatly in the last decades, scientific evidence on the benefits of the Pilates method is needed. Therefore, this article had as general objective to verify through a bibliographic survey carried out in three electronic databases (Lilacs, Scielo and Academic Google). The search terms used in the bases were Pilates, Pilates method, Pilates method indications and contraindications of the Pilates method. Among the results it was verified that the Pilates method is used as a resource for physical and mental conditioning in several areas of health and the studies analyzed demonstrated the effectiveness of the Pilates method as a tool in prevention, promotion, rehabilitation and improvement of people's quality of life who practice it. (AU)

Neuroproteção fetal: uma utilização contemporânea do sulfato de magnésio / Fetal neuroprotection: a contemporary use of magnesium sulfate

Os principais usos contemporâneos do sulfato de magnésio na prática obstétrica incluem a prevenção e o tratamento de convulsões em portadoras de pré-eclâmpsia e eclâmpsia, o prolongamento da gravidez para administração antenatal de corticosteroides e a neuroproteção fetal na iminência de interrupção prematura da gestação, uma indicação mais recente. A paralisia cerebral é a causa mais comum de deficiência motora na infância e apresenta como fator de risco mais importante o nascimento pré-termo, cuja incidência tem aumentado significativamente. Como consequência, a ocorrência da paralisia cerebral também tem aumentado, a despeito da melhoria da sobrevida dos fetos pré-termos. No atual contexto de procura por estratégias que se mostrem efetivas na redução da paralisia cerebral nos recém-nascidos prematuros e que deveriam ser implementadas com o objetivo de diminuir os seus efeitos danosos nos indivíduos e suas famílias, nos serviços de saúde e na sociedade como um todo, o sulfato de magnésio tem se mostrado como o mais promissor agente neuroprotetor fetal. Desde a década de 1990, estudos resultantes das suas indicações para a prevenção das convulsões eclâmpticas ou para tocólise têm evidenciado redução nas taxas de paralisia cerebral e leucomalácia periventricular em prematuros. Diretrizes nacionais e internacionais mais recentes, baseando-se em resultados de ensaios randomizados controlados e metanálises de boa qualidade, têm avançado na recomendação sobre os regimes terapêuticos e na construção de algoritmos para utilização do sulfato de magnésio na neuroproteção fetal.(AU)

The main contemporary uses of magnesium sulfate in obstetric practice include the prevention and treatment of seizures in patients with preeclampsia and eclampsia, prolongation of pregnancy for antenatal administration of corticosteroids and fetal neuroprotection at the imminence of premature termination of pregnancy, a more recent indication. Cerebral palsy is the most common cause of motor deficits in childhood and has a significant increase in preterm birth as a major risk factor. As a result, the occurrence of cerebral palsy has also increased, despite the improvement in the survival of preterm fetuses. In the current context of search for strategies that are effective in reducing cerebral palsy in preterm newborns and that should be implemented with the aim of reducing their harmful effects on individuals and their families, health services and society as a whole, magnesium sulfate has been shown to be the most promising fetal neuroprotective agent. Since the 1990s, studies arising from its indications for prevention of eclamptic seizures or tocolysis have shown a reduction in the rates of cerebral palsy and periventricular leukomalacia in preterm infants. More recent national and international guidelines, based on results from randomized controlled trials and good quality meta-analyzes, have advanced the recommendation on therapeutic regimens and the construction of algorithms for the use of magnesium sulphate in fetal neuroprotection.(AU)

Expert consensus on treatment of intravesical therapy in non-muscle invasive bladder cancer / 中华肿瘤杂志

Bladder cancer is one of the common malignant tumors in China. Three-quarter bladder cancer is non-muscle invasive bladder cancer with a high recurrence rate. Intravesical therapy can reduce the risk of recurrence and progression in bladder cancer. According to the recent updates of evidence-based medical evidence at home and abroad, as well as the deepening of domestic experts' research on the diagnosis and treatment of bladder cancer, the consensus has summarized the current intravesical therapy for non-muscle invasive bladder cancer in China, including the indications, contraindications and methods for intravesical therapy, as well as commonly used drugs in bladder cancer.

Anticoncepcionais reversíveis de longa duração: Implante Liberador de Etonogestrel (Implanon®) / Long-acting reversible contraceptives: etonogestrel-releasing implant (Implanon®)

Apesar do crescente número de usuárias de métodos contraceptivos, 41% das gestações mundiais não foram planejadas. Os métodos de longa duração são uma alternativa eficaz de reduzir o número de gestações não planejadas diminuindo, assim, taxas de mortalidade materna e infantil. O implante é um método reversível de longa duração, com alta eficácia e taxa de continuidade. Este estudo tem como proposta fazer uma revisão sobre o implante liberador de etonogestrel, seus efeitos adversos e benefícios contraceptivos e não contraceptivos.(AU)

Despite the growing number of users of contraceptive methods, 41% of worldwide pregnancies were unplanned. Long acting reversible contraceptives (LARCS) are an effective alternative to reduce the number of unplanned pregnancies thereby reducing maternal and child mortality. The implant is a LARC, with high efficacy and continuation rate. This study has the objective to review the use of the etonogestrel-releasing implant, its adverse effects and contraceptive and non-contraceptive benefits.(AU)

Contracepção de longo prazo: dispositivo intrauterino (Mirena®) / Long-acting reversible contraceptive: levonorgestrel-releasing intrauterine system (Mirena®)

Atualmente, os estudos apontam para a alta eficácia dos contraceptivos de longa duração (LARCs - Long-Acting Reversible Contraceptives). O artigo se propôs a apresentar um breve histórico sobre o desenvolvimento de um dos mais importantes LARCs da atualidade, o dispositivo intrauterino liberador de 20 µg de levonorgestrel por dia (SIU-LNG), conhecido como Mirena®, bem como os resultados dos principais estudos publicados nas últimas décadas no que se refere à aceitabilidade, tolerância, segurança, satisfação e aspectos relacionados ao uso desse método contraceptivo.(AU)

Currently, studies have shown the high effectiveness of long-acting contraceptives (LARCs). This paper is aimed to present a brief history of the development of one of the most important LARCs today, the levonorgestrel intrauterine system releasing levonorgestrel 20 µg per day (LNGIUS), known as Mirena® as well as the results of major studies published in recent decades with regard to the acceptability and tolerance and safety aspects related to the use of this contraceptive method.(AU)

Contracepção injetável trimestral / Progestin-only injectable contraception

Os contraceptivos injetáveis trimestrais representam métodos de longo prazo muito utilizados, sendo acessíveis a grande contingente de pacientes. São altamente eficazes e com fácil posologia, colaborando com eficiente planejamento familiar. Suas taxas de gravidez oscilam entre 0,0 e 0,7/100 mulheres por ano. É método contraceptivo interessante para pacientes que não desejam ingestão de comprimidos, que apresentam contraindicações ao uso de estrogênios, que optam por amenorreia e para as adolescentes. No Brasil, é comercializado com a formulação de 150 mg de Acetato de Medroxiprogesterona de depósito (AMPD). Injeções intramusculares são capazes de inibir a ovulação e, também, alterarem o muco cervical e o endométrio. Seus efeitos adversos são reduzidos, destacando-se ganho de peso, dor abdominal, cefaleia, mudança de humor e diminuição do desejo sexual. Estudos atuais não demonstram maior risco de fraturas, apesar de haver discreta diminuição na densidade óssea. Apresenta benefícios relevantes como diminuição no risco de câncer endometrial, de câncer ovariano, de doença inflamatória pélvica e pode apresentar efeito benéfico nos sintomas da endometriose. Os autores realizaram revisão sobre o contraceptivo injetável trimestral priorizando seu modo de uso, efeitos benéficos, efeitos adversos e critérios de elegibilidade para sua prescrição.(AU)

The progestin-only injectable contraceptives are long-term methods widely used. They are accessible to large numbers of patients and are highly effective and easy to use. This collaborate with effective family planning. The pregnancy rates range between 0.0 and 0.7/100 women per years. They are a good alternative for contraception to patients who do not wish intake of pills, have contraindications to the use of estrogens, choose to amenorrhea and are adolescents. In Brazil it is marketed with the formulation of 150 mg of medroxyprogesterone acetate depot (DMPA). Intramuscular injections are able to inhibit ovulation and also modifies the cervical mucus and endometrium. Its adverse effects are few, especially weight gain, abdominal pain, headache, mood swings and decreased sexual desire. Current studies show no increased risk of fractures, although there is a slight decrease in bone density. It offers significant benefits such as reduced risk of endometrial cancer, ovarian cancer, pelvic inflammatory disease and may have beneficial effect on the symptoms of endometriosis. The authors conducted a review of the progestin-only injectable contraceptive focusing on its manner of use, benefits, side effects and eligibility criteria for prescription.(AU)