O impacto do uso de métodos contraceptivos orais na função sexual de mulheres em idade reprodutiva / The impact of the use of oral contraceptive methods on the sexual function of women of reproductive age

Objetivo: Investigar o impacto dos contraceptivos orais hormonais na função sexual de mulheres. Métodos: Estudo transversal realizado por meio do questionário traduzido e validado "Índice da Função Sexual Feminina", capaz de estimar o risco de disfunção sexual feminina. Dados sociodemográficos, ginecológicos, medicamentosos e outros foram avaliados e correlacionados estatisticamente a esse escore, estimando possíveis causas da disfunção sexual, com destaque para o uso de anticoncepcional oral. O estudo foi baseado em uma amostragem por conveniência, incluindo mulheres > 18 anos em idade reprodutiva, de 04/01/2021 a 04/01/2022, obedecendo aos critérios de inclusão e exclusão. Resultados: Participaram deste estudo 105 mulheres com média e desvio-padrão de idade de 23,4 ± 3,8 anos, predominantemente heterossexuais (84,0%) e bissexuais (13,2%). A maioria delas (93,4%) utiliza métodos contraceptivos, sendo esses anticoncepcional oral (45,3%), DIU hormonal (19,8%) e camisinha (17,0%). A composição hormonal mais utilizada foi levonorgestrel (26,4%) e etinilestradiol (25,5%). Oitenta por cento das mulheres são sexualmente ativas, 69,3% delas têm parceria fixa, 42,5% tinham relações quase sempre e 33,0% referiam que as relações sexuais eram sempre satisfatórias. Houve boa adequação da amostra (0,865) e significância estatística (p < 0,0001). Utilizar ou não método contraceptivo apresentou diferença nos domínios desejo, satisfação e dor. Contudo, as questões do histórico sexual foram as que mais apresentaram relevância estatística em relação aos domínios. Conclusão: Apesar de outros estudos serem necessários para provar a hipótese de que os contraceptivos orais têm impacto negativo na função sexual feminina, é clara a importância de os profissionais de saúde já estarem cientes dessa possibilidade e saberem como abordá-la.

Objective: To investigate the impact of hormonal oral contraceptives on women's sexual function. Methods: Cross-sectional study carried out using the translated and validated questionnaire "Index of Female Sexual Function", capable of estimating the risk of female sexual dysfunction. Sociodemographic, gynecological, medication and other data were evaluated and statistically correlated to this score, estimating possible causes of sexual dysfunction, with emphasis on the use of oral contraceptives. The study was based on a convenience sample, including women > 18 years of reproductive age, from 01/04/2021 to 01/04/2022, following inclusion and exclusion criteria. Results: The study included 105 women with a mean and standard deviation of (23.4 ± 3.8) years old, predominantly heterosexual (84.0%) and bisexual (13.2%). Most of them (93.4%) use contraceptive methods, these being (45.3%) oral contraceptives, (19.8%) hormonal IUDs and (17.0%) condoms. The most used hormonal composition was levonorgestrel (26.4%) and ethinylestradiol (25.5%). Eighty percent of the women are sexually active, 69.3% of them have a steady partner, 42.5% almost always had sex and 33.0% said that sex was always satisfactory. There was good sample adequacy (0.865) and statistical significance (p < 0.0001). Using or not using a contraceptive method showed a difference in the desire, satisfaction and pain domains. However, sexual history questions were the ones that showed the most statistical relevance in relation to the domains. Conclusion: Although further studies are needed to prove the hypothesis that oral contraceptives have a negative impact on female sexual function, it is clear that health professionals are already aware of this possibility and know how to approach it.

Anticoncepção oral e hipotrofia muscular: existe correlação? / Oral contraception and muscle atrophy: is there a correlation?

As pílulas anticoncepcionais consistem na formulação combinada de um estrogênio e um progestagênio ou em apresentações simples de progestagênio isolado com a finalidade de bloquear a ovulação e alterar as condições do útero e das tubas uterinas, bloqueando parcialmente a foliculogênese e a inibição do pico de gonadotrofinas. Desse modo, no que concerne à temática, diversas publicações na mídia de ampla divulgação afirmam que os anticoncepcionais orais têm papel importante na sarcopenia e na hipotrofia, incluindo perda de força muscular e redução do desempenho físico. Assim, o presente trabalho tem por objetivo avaliar, por meio de pesquisas de artigos, a correlação entre anticoncepcionais hormonais orais e hipotrofia muscular. Foi concluído que os artigos científicos especializados no tema são ainda bastante inconclusivos, sugerindo que há indicações de que usuárias de anticoncepcional oral sejam mais suscetíveis ao dano muscular induzido por exercícios, contudo ainda não há consenso.

Anticonception pills consist of a combined formulation of an estrogen and a progestogen or simple presentations of progestogen alone with the purpose of blocking ovulation and altering the conditions of the uterus and uterine tubes, partially blocking folliculogenesis and inhibiting the gonadotropin peak. Thus, with regard to the subject, several widely publicized media publications claim that oral contraceptives play an important role in sarcopenia and hypotrophy, including loss of muscle strength and reduced physical performance. So, the present work aims to evaluate through article searches the correlation between oral hormonal contraceptives and muscle hypotrophy. It was concluded that scientific articles specialized on the subject are still quite inconclusive, suggesting that there are indications that oral contraceptive users are more susceptible to exercise-induced muscle damage, however there is still no consensus.

La automedicación con anticonceptivos orales e inyectables en mujeres en edad fértil: resultados de un plan piloto / Self-medication with oral and injectable contraceptives in women of childbearing age: results of a pilot plan

La automedicación consiste en la selección y el uso de los medicamentos por parte de las personas, sin la participación del médico ni su prescripción, en este sentido es considerada como un fenómeno constante que se produce como consecuencia de necesidades y problemas de múltiples causas, sobre todo de índole económica. Materiales y métodos: Se realiza una investigación de campo, de corte transversal, tipo descriptiva. Se utilizó una prueba piloto para establecer la validez, pertinencia y coherencia para determinar el grado de confiabilidad del instrumento cuantitativo diseñado el cual fue validado por juicio de expertos. Se encuestó a 20 mujeres auto medicadas con anticonceptivo oral e inyectable, seleccionado de forma aleatoria. Resultados: en cuanto a la validación del instrumento se obtiene una puntuación de 99.4de validez, 99.2 de pertinencia y 99.4 de coherencia, en su totalidad de 298 dándonos como resultado final de 99.3 % de confiabilidad. Conclusión: el instrumento ha sido aprobado por su confiabilidad y validez, quedando apto para ser aplicados a la muestra que representa esta investigación(AU)

La automedicación consiste en la selección y el uso de los medicamentos por parte de las personas, sin la participación del médico ni su prescripción, en este sentido es considerado como un fenómeno constante que se produce como consecuencia de necesidades y problemas de múltiples causas, sobre todo de índole económica. Materiales y métodos: Se realiza una investigación de campo, de corte transversal, tipo descriptiva. Se obtuvo una prueba piloto para establecer la validez, pertinencia y coherencia para determinar el grado de confiabilidad del instrumento diseñado cuantitativamente el cual fue validado por juicio de expertos. Se encontró a 20 mujeres automedicadas con anticonceptivo oral e inyectable, seleccionadas de forma aleatoria. Resultados: en cuanto a la validación del instrumento se obtiene una puntuación de 99.4 de validez, 99.2 de pertinencia y 99.4 de coherencia, en su totalidad de 298 dándonos como resultado final de 99.3 % de confiabilidad. Conclusión: el instrumento ha sido aprobado por su confiabilidad y validez, quedando apto para ser aplicado a la muestra que representa esta investigación(AU)

ERICA: cardiovascular risks associated with oral contraceptive use among Brazilian adolescents

Abstract Objective: To investigate the association between oral contraceptive use and cardiovascular risks, including metabolic syndrome and their components in Brazilian adolescents. Method: This study used data from the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study with individuals aged 12-17 years. Sociodemographic variables and OC use were assessed by a self-administered questionnaire. International Diabetes Federation criteria were used to define metabolic syndrome. Descriptive statistics were reported as prevalence and their respective confidence interval of 95% of oral contraceptives according to variables. Logistic regression was performed. Crude and adjusted odds ratios were calculated. Results: This subsample was composed of 22,682 female adolescents, of which 12.65% reported using oral contraceptives and their use was associated with hypertension and hypertriglyceridemia. These associations remained statistically significant after adjusting for age, school region, race, and tobacco use with an increase of 2.68 (1.66 - 4.32) and 3.45 (2.56 - 4.65) times, respectively. Conclusion: The present study was the first to examine the association between the use of oral contraceptives and cardiovascular risk factors among the largest number of female Brazilian adolescents. This method was significantly associated with hypertension, hypertriglyceridemia. Teenagers using oral contraceptives should be monitored for side effects, including blood pressure measurements and advised to avoid smoking.

Estrogen receptor mRNA determined by Quantitative Real-Time PCR in the nasal mucosa of women taking oral contraceptives / Receptor ARNm de estrógeno determinado por PCR Cuantitativa en Tiempo Real en la mucosa nasal de mujeres tratadas con anticonceptivos orales

SUMMARY: Estrogen receptors (ER) have been identified in human nasal mucosa, but its physiologic and pathologic impacts are not totally established. ER have been demonstrated in nasal mucosa by several authors, mainly by immunohistochemical method in nasal mucosa samples surgically removed. The present study aimed to quantify ERα and ERβ mRNA concentration by using an absolute quantitative real-time PCR in cells from nasal mucosa smear of women under oral contraceptive therapy. Nasal epithelium smear samples were collected from 110 patients divided in two groups: 55 women who present regular menstrual cycle without using contraceptives and 55 women who present regular menstrual cycle and have been using oral contraceptives for more than 3 months. All the patients answered a rhinitis symptoms questionnaire. The current study showed the potential usefulness of nasal turbinate mucosa cell sourcing, collected through swab, for extracting useful RNA for gene expression. We have identified the predominant expression of ERα isoform in a ratio 10-15 times higher compared to ERβ isoform. There is a tendency for positive correlation between the ERb isoform and the rhinitis severity score.

RESUMEN: Se han identificado receptores de estrógeno (RE) en la mucosa nasal humana, sin embargo sus impactos fisiológicos y patológicos aún no están totalmente establecidos. Varios autores han demostrado RE en la mucosa nasal, principalmente por método inmunohistoquímico en muestras obtenidas quirúrgicamente. El presente estudio tuvo como objetivo cuantificar la concentración de ARNm de REa y REb mediante el uso de una PCR cuantitativa absoluta en tiempo real en células de frotis de mucosa nasal de mujeres bajo terapia anticonceptiva oral. Se recolectaron muestras de frotis de epitelio nasal de 110 pacientes divididas en dos grupos: 55 mujeres que presentan ciclo menstrual regular sin uso de anticonceptivos y 55 mujeres que presentan ciclo menstrual regular con uso de anticonceptivos orales durante más de 3 meses. Todas las pacientes respondieron un cuestionario de síntomas de rinitis. El estudio actual mostró la utilidad de la obtención de células de la mucosa de la concha nasal, recolectadas a través de un hisopo, para extraer ARN para la expresión génica. Hemos identificado la expresión predominante de la isoforma REμ en una proporción de 10 a 15 veces mayor en comparación con la isoforma REß. Hemos identificado la expresión predominante de la isoforma REα en una proporción de 10 a 15 veces mayor en comparación con la isoforma REß. Existe una tendencia a una correlación positiva entre la isoforma REß y la puntuación de gravedad de la rinitis.

Uso de testosterona en mujeres: un comentario sobre el consenso global sobre el uso de la terapia de testosterona para mujeres / Global consensus position statement on the use of testosterone therapy for women

Las mujeres han sido tratadas por décadas con testosterona intentando aliviar una gran variedad de síntomas con riesgos y beneficios inciertos. En la mayoría de los países, la testosterona se prescribe "off-label", de modo que las mujeres están utilizando compuestos y dosis ideadas para tratamientos en hombres. En este sentido, varias sociedades médicas de distintos continentes adoptaron recientemente por consenso una toma de posición sobre los beneficios y potenciales riesgos de la terapia con testosterona en la mujer, explorar las áreas de incertidumbre e identificar prácticas de prescripción con potencial de causar daño. Las recomendaciones con respecto a los beneficios y riesgos de la terapia con testosterona se basan en los resultados de ensayos clínicos controlados con placebo de al menos 12 semanas de duración. A continuación se comentan las recomendaciones. (AU)

There are currently no clear established indications for testosterone replacement therapy for women. Nonetheless, clinicians have been treating women with testosterone to alleviate a variety of symptoms for decades with uncertainty regarding its benefits and risks. In most countries, testosterone therapy is prescribed off-label, which means that women are using testosterone formulations or compounds approved for men with a modified dose for women. Due to these issues, there was a need for a global Consensus Position Statement on testosterone therapy for women based on the available evidence from placebo randomized controlled trials (RCTs). This Position Statement was developed to inform health care professionals about the benefits and potential risks of testosterone therapy intended for women. The aim of the Consensus was to provide clear guidance as to which women might benefit from testosterone therapy; to identify symptoms, signs, and certain conditions for which the evidence does not support the prescription of testosterone; to explore areas of uncertainty, and to identify any prescribing practices that have the potential to cause harm. (AU)

Efeitos adversos associados a uso de contraceptivos orais em discentes / Adverse effects associated with students' use of oral contraceptives

Objetivos: Investigar o número de mulheres, as causas que levam a fazer o uso e descrever os efeitos adversos mais comuns associados ao uso de contraceptivos orais de forma contínua. Métodos: Trata-se de estudo observacional, transversal ou de prevalência e quantitativo. A pesquisa teve população de 832 alunas do curso de Direito dos turnos matutino, vespertino e noturno, no período de agosto a setembro, tendo como amostra 248 participantes para esse estudo. O questionário versou sobre o uso de anticoncepcionais, o perfil das usuárias e os possíveis efeitos adversos observados ao longo do uso. Resultados: A prevalência de uso dos contraceptivos orais foi de 42,3%, justificada principalmente pelo desejo de evitar a concepção (42,9%), regular os níveis hormonais (25,7%) e tratar acne (15,2%). Cerca de 63,8% relataram que já sentiram algum desconforto associado ao uso destes medicamentos, sendo os mais frequentes aumento de peso corporal (32,4%), alterações de humor (24,3%), dor nas mamas (13,5%), cefaleia (4,1%), dor abdominal (2,7%). Conclusão: A prevalência de efeitos adversos decorrentes do uso contínuo de contraceptivos orais é alta, evidenciando-se a necessidade de conscientizar as usuárias a buscarem profissionais habilitados, para que elas façam uso do anticoncepcional mais adequado, minimizando o desconforto advindo dos efeitos adversos.

Objectives: To investigate the number of women, the causes that lead to making use, and to describe the most common adverse effects associated with oral contraceptive continuous use. Methods: This is an observational, cross-sectional, or prevalence and quantitative study. The research had a population of 832 students of the law course of the morning, afternoon and evening shifts, from August to September, with a sample of 248 participants for this study. The questionnaire was about contraceptive use, users' profile, and possible adverse effects observed during use. Results: The prevalence of oral contraceptive use was 42.3%, mainly explained by the desire to avoid conception (42.9%), regulate hormone levels (25.7%), and to treat acne (15.2%). About 63.8% reported already having some discomfort associated with the use of these medications, with the most frequent being body weight gain (32.4%), mood swings (24.3%), breast pain (13.5%), headache (4.1%), abdominal pain (2.7%). Conclusion: The prevalence of adverse effects resulting from the continued use of oral contraceptives is high, so there is a need to guide users to seek qualified professionals so that they make use of the most appropriate contraceptive, minimizing the discomfort arising from adverse effects.

Análise histomorfométrica da artéria aorta de ratas submetidas à administração repetida da associação de etinilestradiol e gestodeno / Histomorphometric analysis of the aorta of rats submitted to repeated administration of association of ethinylestradiol and gestodene

Introdução: Os anticoncepcionais orais vêm sofrendo alterações em suas concentrações de estrogênio e progestogênio, baseando-se no fato de que doses mais baixas estão associadas a menor incidência de alterações metabólicas e de efeitos adversos, como o comprometimento da morfologia e função da artéria aorta. O objetivo deste estudo é avaliar a influência dos anticoncepcionais nas propriedades morfofuncionais da artéria aorta, através do método histoquímico, demonstrando sua utilidade nas análises histopatológicas. Métodos: Para tanto, foram utilizadas 15 ratas divididas em 3 grupos; Grupo controle (GC), cujos animais não receberam tratamento hormonal; Grupo 2 (G2), onde os animais receberam tratamento diário de 15 µg de etinilestradiol + 60 µg de gestodeno; e Grupo 3 (G3), que recebeu 30 µg de etinilestradiol + 75 µg de gestodeno. Após o tratamento, os animais foram eutanasiados e as artérias retiradas para análise histológica. Resultados: Os valores encontrados com a técnica de coloração histológica de hematoxilina e eosina (HE), bem como na coloração específica em histoquímica com Alcian Blue, demonstram que no G3, tratados com uma dosagem superior de hormônio, 8% das ratas tem aumento relevante da espessura de suas artérias, ou seja, superior ao G2, que recebeu dosagem menor de hormônio, e GC, o qual não recebeu nenhum tipo de tratamento. Conclusão: Este estudo demonstra que existem relações entre o espessamento das artérias, de ratas submetidas a dosagens de etinilestradiol e gestodeno, com a grande quantidade de mucopolissacarídeos depositados entre as túnicas das artérias. (AU)

Introduction: Pharmacological development of hormonal contraceptives has been undergoing changes in estrogen and progesterone doses, based on the fact that lower doses are associated with a lower incidence of metabolic changes and adverse effects, such as impairment of morphology and function of the aortic artery. The aim of this study is to evaluate the influence of contraceptives on the morphofunctional properties of the aortic artery, using the histochemical method, demonstrating its usefulness in histopathological analyzes. Methods: For this purpose, 15 rats were divided into 3 groups; Control group (GC), whose animals did not receive hormonal treatment; Group 2 (G2), where the animals received a daily treatment of 15 µg of ethinylestradiol + 60 µg of gestodene; and Group 3 (G3), whose animals received 30 µg of ethinylestradiol + 75 µg of gestodene. After treatment, the animals were sacrificed and the arteries removed for histologic analysis. Results: The values found, with HE measurements and Alcian Blue histochemical staining, showed that in G3, treated with a higher hormone dosage, there are 8% of the rats with a relevant increase in the thickness of their arteries, that is, higher than that of G2, which received lower dosage of hormone and that of GC, which received no treatment. Conclusion: This study demonstrates that there are relations between the thickening of the arteries of rats submitted to dosages of ethinylestradiol and gestodene with the great amount of mucopolysaccharides deposited between the tunics of the arteries. (AU)

Association between asthma and female sex hormones / Associação entre asma e hormônios sexuais femininos

ABSTRACT CONTEXT AND OBJECTIVE: The relationship between sex hormones and asthma has been evaluated in several studies. The aim of this review article was to investigate the association between asthma and female sex hormones, under different conditions (premenstrual asthma, use of oral contraceptives, menopause, hormone replacement therapy and pregnancy). DESIGN AND SETTING: Narrative review of the medical literature, Universidade Federal do Tocantins (UFT) and Universidade Federal de São Paulo (Unifesp). METHODS: We searched the CAPES journal portal, a Brazilian platform that provides access to articles in the MEDLINE, PubMed, SciELO, and LILACS databases. The following keywords were used based on Medical Subject Headings: asthma, sex hormones, women and use of oral contraceptives. RESULTS: The associations between sex hormones and asthma remain obscure. In adults, asthma is more common in women than in men. In addition, mortality due to asthma is significantly higher among females. The immune system is influenced by sex hormones: either because progesterone stimulates progesterone-induced blocking factor and Th2 cytokines or because contraceptives derived from progesterone and estrogen stimulate the transcription factor GATA-3. CONCLUSIONS: The associations between asthma and female sex hormones remain obscure. We speculate that estrogen fluctuations are responsible for asthma exacerbations that occur in women. Because of the anti-inflammatory action of estrogen, it decreases TNF-α production, interferon-γ expression and NK cell activity. We suggest that further studies that highlight the underlying physiopathological mechanisms contributing towards these interactions should be conducted.

RESUMO CONTEXTO E OBJETIVO: A relação entre os hormônios sexuais e a asma tem sido investigada em diversos estudos. Esta revisão tem como objetivo descrever a relação entre hormônios sexuais (endógenos e exógenos) e a inflamação nas vias aéreas, especialmente na asma, em eventos diferentes (na asma pré-menstrual, durante o uso de anticoncepcionais, na menopausa, no uso de terapia hormonal e na gestação). TIPO DE ESTUDO E LOCAL: Revisão narrativa da literatura médica, Universidade Federal do Tocantins (UFT) e Universidade Federal de São Paulo (Unifesp). MÉTODO: Pesquisamos o Portal de Periódicos Capes, uma plataforma brasileira que fornece acesso a artigos nas bases de dados MEDLINE, PubMed, SciELO e LILACS. Os descritores utilizados foram asma, hormônios sexuais, mulheres e uso de anticoncepcionais, com base no "Medical Subject Headings". RESULTADOS: As associações entre hormônios sexuais e asma ainda permanecem obscuras. Em adultos, a asma é mais frequente em mulheres do que em homens. Além disso, a mortalidade por asma é significativamente maior no sexo feminino, destacando-se que o sistema imunológico sofre influência de hormônios sexuais, seja porque a progesterona estimula o fator bloqueador induzido pela progesterona e citocinas Th2 ou porque contraceptivos derivados de progesterona e estrógeno estimulam o fator de transcrição GATA-3. CONCLUSÕES: A associação entre asma e hormônios sexuais femininos permanece obscura. Nós especulamos que as flutuações do estrogênio são responsáveis pelas exacerbações da asma que ocorrem nas mulheres. Devido à ação anti-inflamatória do estrogênio há redução da produção de TNF-α, da expressão do interferon-γ e da atividade das células NK. Sugerimos que sejam realizados novos estudos para esclarecer os mecanismos fisiopatológicos dessas interações.

Tabagismo e uso de anticoncepcionais orais relacionados a fenômenos tromboembólicos: relato de caso e revisão de literatura / Smoking and the use of oral contraceptives related to thromboembolic events: a case report and literature review

Objetivo: Fazer revisão de literatura sobre tabagismo e uso de anticoncepcionais orais (ACO) relacionados a fenômenos tromboembólicos, com apresentação do caso clínico de trombose proximal de artéria mesentérica superior e extensa necrose de intestino delgado em paciente do sexo feminino com coagulopatia provável por associação de uso de anticoncepcional oral com tabagismo. Materiais e métodos: Revisão bibliográfica, com seleção de artigos científicos nacionais e internacionais por meio de busca no banco de dados do PubMed, Lilacs e SciELO. Resultados: A relação entre uso de contraceptivos orais combinados e risco aumentado de doenças tromboembólicas baseia­se na ação pró­coagulante dos ACO, torna­se fator de risco para a ocorrência de trombose arterial e venosa. Já o tabagismo, isoladamente, apresenta risco moderadamente aumentado de trombose venosa em comparação com não fumantes. Ademais, observou­se relação entre trombose de artéria mesentérica superior com uso de anticoncepcional oral associado ao tabagismo. Conclusões: Todos os estudos analisados confirmaram o uso de ACO e o tabagismo como fatores de risco para o desenvolvimento de doenças tromboembólicas. O estudo feito com base na história clínica da paciente sugere um caso de trombose arterial secundária a coagulopatia pela combinação de fumo com o uso de ACO combinado.(AU)

Purpose: Conduct a review of the literature on smoking and use of oral contraceptives related to thromboembolic events, with presentation of the case of proximal thrombosis of the superior mesenteric artery and extensive necrosis of the small intestine in a female patient with probable coagulopathy caused by the association of oral contraceptive with smoking. Materials and methods: This study consisted of a literature review, with selection of national and international scientific articles through research in PubMed, Lilacs and SciELO database. Results: The relationship between the use of combined oral contraceptives and increased risk of thromboembolic disease is based on the procoagulant action of OCs, which translates into a risk factor for the occurrence of arterial and venous thrombosis. Smoking alone has moderately increased risk of venous thrombosis compared with non­smokers. Besides that, there is a relation between the superior mesenteric artery thrombosis with the use of oral contraceptives associated with smoking. Conclusion: All analysed studies have confirmed the use of OCs and smoking as risk factors for the development of thromboembolic diseases. The study based on the clinical history of the patient suggests a case of secondary arterial thrombosis coagulopathy by combining smoking with the use of combined OCs.

Factors affecting visual loss and visual recovery in patients with pseudotumor cerebri syndrome / Fatores que influenciam na perda e na recuperação visual de pacientes com a síndrome do pseudotumor cerebral

ABSTRACT Purpose: To investigate the frequency of visual loss (VL), possible predictive factors of VL, and improvement in patients with pseudotumor cerebri (PTC) syndrome. Methods: We reviewed 50 PTC patients (43 females, seven males) who underwent neuro-ophthalmic examination at the time of diagnosis and after treatment. Demographic data, body mass index (BMI), time from symptom onset to diagnosis (TD), maximum intracranial pressure (MIP), occurrence of cerebral venous thrombosis (CVT), and treatment modalities were reviewed. VL was graded as mild, moderate, or severe on the basis of visual acuity and fields. Predictive factors for VL and improvement were assessed by regression analysis. Results: The mean ± SD age, BMI, and MIP were 35.2 ± 12.7 years, 32.0 ± 7.5 kg/cm2, and 41.9 ± 14.5 cmH2O, respectively. Visual symptoms and CVT were present in 46 and eight patients, respectively. TD (in months) was <1 in 21, 1-6 in 15, and >6 in 14 patients. Patients received medical treatment with (n=20) or without (n=30) surgery. At presentation, VL was mild in 16, moderate in 12, and severe in 22 patients. Twenty-eight patients improved and five worsened. MIP, TD, and hypertension showed a significant correlation with severe VL. The best predictive factor for severe VL was TD >6 months (p=0.04; odds ratio, 5.18). TD between 1 and 6 months was the only factor significantly associated with visual improvement (p=0.042). Conclusions: VL is common in PTC, and when severe, it is associated with a delay in diagnosis. It is frequently permanent; however, improvement may occur, particularly when diagnosed within 6 months of symptom onset. .

RESUMO Objetivo: Investigar a frequência de perda visual (PV) e os possíveis fatores preditivos para perda e para melhora visual em pacientes com a síndrome do pseudotumor cerebral (SPC). Métodos: Foram revisados 50 pacientes com SPC submetidos a exame neuroftalmológico no momento do diagnóstico e após o tratamento. Dados demográficos, índice de massa corpórea (IMC), tempo decorrido entre o início dos sintomas e o diagnóstico (TD), pressão intracraniana máxima (PIM), ocorrência de trombose venosa cerebral (TVC), e as modalidades de tratamento foram revisadas. PV foi graduada em discreta, moderada e grave, baseada na acuidade e no campo visual. Fatores preditivos para perda e melhora visual foram avaliados por análise de regressão linear. Resultados: Quarenta e três pacientes eram do sexo feminino. A média de idade, o IMC e a PIM (± desvio padrão) foram: 35,2 ± 12,7 anos, 32,0 ± 7,5 kg/cm2 e 41,9 ± 14,5 cmH2O, respectivamente. Sintomas visuais estavam presentes em 46 e TVC em 8 pacientes. TD (em meses) foi <1 em 21, 1-6 em 15 e >6 em 14 pacientes. Pacientes receberam tratamento clinico apenas (n=30) ou associado a tratamento cirúrgico (n=20). Na apresentação a PV era discreta em 16, moderada em 12 e grave em 22 pacientes. Vinte e oito pacientes melhoraram e 5 pioraram. PIM, TD e hipertensão arterial correlacionaram significativamente com PV grave. O melhor fator preditivo para PV grave foi o TD>6 meses (p=0,04; razão de chances 5,18). TD entre 1 e 6 meses foi o único fator significativamente associado com melhora visual após tratamento (p=0,042). Conclusões: Perda visual é comum na SPC e quando grave se mostra relacionado a atraso no diagnóstico. É usualmente permanente mas pode haver melhora visual especialmente quando a doença é diagnosticada nos primeiros 6 após o início dos sintomas. .

Percepción entre médicos bogotanos del riesgo de reacciones adversas a grupos de medicamentos de uso común / Physicians´ insight about adverse drug reaction to frequently used medication groups in Bogotá (Colombia)

Introducción. Las reacciones adversas a medicamentos son un problema de salud pública; sin embargo, todavía son muchos los médicos que no parecen reconocer el riesgo asociado al uso de medicamentos. Objetivo. Valorar la percepción del riesgo de reacciones adversas asociado a los grupos de medicamentos más frecuentemente utilizados por los profesionales de la medicina en la práctica clínica. Materiales y métodos. Se llevó a cabo un estudio descriptivo y transversal con 200 médicos con un mínimo de dos años de experiencia clínica, y vinculados a hospitales públicos o clínicas privadas de Bogotá. La percepción del riesgo asociado a las reacciones adversas a medicamentos de 31 grupos farmacológicos o terapéuticos, se valoró usando una escala analógica visual (0-10 puntos). Resultados. La percepción del riesgo fue baja (puntaje promedio <5) con relación a 19 (61 %) de los 31 grupos de medicamentos. Los tres grupos que se relacionaron con una mayor percepción de riesgo de reacciones adversas a medicamentos (puntaje promedio >7) fueron: (a) la quimioterapia para el cáncer (mediana=8,5; rango intercuartílico: 1,8), (b) la insulina (mediana=8; rango intercuartílico: 4,8) y (c) los anticoagulantes (mediana=7,5; rango intercuartílico: 4). Conclusiones. Aunque existe una relación adecuada entre la percepción del riesgo y la frecuencia de las reacciones adversas a los medicamentos asociada con los grupos de mayor puntaje, también existe una importante subestimación del riesgo en medicamentos de uso común a nivel hospitalario y ambulatorio, como es el caso de los antiinflamatorios no esteroideos, los antihipertensivos y los anticonceptivos orales.

Introduction: Adverse drug reactions are a public health problem; however, still many prescribers do not seem to recognize the risk associated with the use of medications. Objective: To assess the perception of the risk of adverse reactions associated with the groups of drugs most frequently used in clinical practice. Materials and methods: Descriptive study made in 200 physicians with at least 2 years of clinical experience in Bogota, Colombia. The risk of adverse drug reactions associated with the use of medications was assessed using a visual analog scale (0-10 points). Results: The perception of risk was <5 points for 19 of the 31 (61%) therapeutic groups. The therapeutic groups that were related to increased perception of risk were chemotherapy for cancer (median, 8.5, interquartile range: 1.8), insulin (median, 8, interquartile range: 4.8) and anticoagulants (median, 7.5, interquartile range: 4). Conclusions: Although there is a relationship between the perception of risk and the frequency of adverse drug reactions associated with therapeutic groups of higher score, there is also a strong underestimation of the risk of medicines in common use at hospital and ambulatory level such as NSAID, antihypertensive drugs and oral contraceptives.

Knowledge, attitude and practice of pharmacists and health-care workers regarding oral contraceptives correct usage, side-effects and contraindications

Despite the success of the Iranian family planning programme, the number of unwanted pregnancies remains high. To investigate whether health workers in Tabriz are providing correct information and counselling about OCP use, the current study was planned to examine the level of knowledge, attitude and practice of OCP providers. A sample of 150 health-care workers in health houses and 150 community/hospital pharmacists answered a questionnaire about knowledge of correct use of OCP, side-effects, contraindications, danger signs/symptoms and non-contraceptive benefits, and whether they counselled patients about these subjects. Knowledge of pharmacists and health workers was not as high as expected and in many topics they were counselling patients even when they had incorrect knowledge and in other areas they were not providing information to patients despite having the correct knowledge. Better continuing education for OCP providers and especially for pharmacists seems necessary

[Relationship between utrine cervical carcinoma and oral contraceptives]

The utrine cervical cancer is the third common cancer among women word-wide. Oral contraceptives [OCs] have characterized as one of the possible risk factors for cervical cancer which are daily used by millions of women. The objective of this study was to determine the relationship between utrine cervical carcinoma and oral contraceptives. This case - control study was done on 128 patients with utrine cervical cancer as cases and 128 healthy women as controls in Tehran, Iran during 2008. The cases matched with controls according to age, history of abortion, number of deliveries, and social-economical status. Data were analyzed using SPSS-11, student's t-test, Chi-Square, Pearson's correlation and Fisher's exat tests. Significant correlation was observed between utrine cervical cancer and the history of using and duration of oral contraceptives [P<0.05]. Eighty-one [66.3%] and 46 [35.9%] of subjects in case and control groups used oral contraceptives, respectively. The possibility of utrine cervical cancer through oral contraceptives consumption was 3.072 [95%CI: 1.05-2.91] and this rate increased to 5.2 times after consuming the oral contraceptives for longer than 8 years. This study showed that the usage of oral contraceptives increase the possibility of utrine cervical cancer by 3 times

Métodos de solo progestágenos: más allá de su uso en lactancias / Progestogen-only methods: beyond its use in lactating

Los anticonceptivos orales combinados (ACOC) son el método contraceptivo hormonal más utilizado en la actualidad. Sin embargo, los ACOC se asocian a algunos efectos adversos, especialmente relacionados al sistema vascular, como una mayor incidencia de eventos tromboembólicos en las usuarias. Además se asocian a náuseas, cefalea y dolor mamario lo que lleva a que algunas mujeres discontinúen su uso. Este riesgo se ha asociado al componente estrogénico del ACOC...