The use of contraceptives and their nutritional impact on medical students.

OBJECTIVE: This study aimed to analyze the impact of contraceptives on medical students at the Federal University of Paraná and verify adherence, consequences, and lifestyle effects of the contraceptive method used. METHODS: This is an observational, cross-sectional study in which 214 participants answered an online questionnaire composed of 30 questions. For statistical analysis, the Stata® 16.0 software was used, and the mean and standard deviation were estimated to characterize continuous variables with a normal distribution and percentages for categorical variables. For group-to-group comparisons, a one-way ANOVA was used for normal continuous variables and Fisher's exact test for categorical variables. RESULTS: Almost 10% (9.3%) of women used condoms only, and double protection (condom+oral contraceptives) corresponds to 23.4%. Of the 214 participants, 38 reported making exclusive use of long-acting reversible contraception, and 13.6% of the interviewees used oral contraceptives exclusively. More than 88% of the interviewees believe that the medical course provided adequate education on contraception. Regarding lifestyle habits, 71.5% of the students reported alcohol intake, tobacco use, and/or other drug use. CONCLUSION: There was a great diversity of combinations between contraceptive methods used by the medical student at Federal University of Paraná, the most prevalent being the oral contraceptive associated with male condoms. There was a greater association in the use of long-acting reversible contraception in married students. Although 88.3% of the participants believed that they had a good education about contraception at university, only half of them use condoms in sexual relationships. The rate of adherence to alcohol and tobacco among students is considerable, and such practices can negatively affect a nutritional profile, a healthy lifestyle, and safe sexual practices. Brazilian medical schools are fundamental for the advancement of medical education in contraception and for the creation of public policies on family planning.

The use of contraceptives and their nutritional impact on medical students

SUMMARY OBJECTIVE: This study aimed to analyze the impact of contraceptives on medical students at the Federal University of Paraná and verify adherence, consequences, and lifestyle effects of the contraceptive method used. METHODS: This is an observational, cross-sectional study in which 214 participants answered an online questionnaire composed of 30 questions. For statistical analysis, the Stata® 16.0 software was used, and the mean and standard deviation were estimated to characterize continuous variables with a normal distribution and percentages for categorical variables. For group-to-group comparisons, a one-way ANOVA was used for normal continuous variables and Fisher's exact test for categorical variables. RESULTS: Almost 10% (9.3%) of women used condoms only, and double protection (condom+oral contraceptives) corresponds to 23.4%. Of the 214 participants, 38 reported making exclusive use of long-acting reversible contraception, and 13.6% of the interviewees used oral contraceptives exclusively. More than 88% of the interviewees believe that the medical course provided adequate education on contraception. Regarding lifestyle habits, 71.5% of the students reported alcohol intake, tobacco use, and/or other drug use. CONCLUSION: There was a great diversity of combinations between contraceptive methods used by the medical student at Federal University of Paraná, the most prevalent being the oral contraceptive associated with male condoms. There was a greater association in the use of long-acting reversible contraception in married students. Although 88.3% of the participants believed that they had a good education about contraception at university, only half of them use condoms in sexual relationships. The rate of adherence to alcohol and tobacco among students is considerable, and such practices can negatively affect a nutritional profile, a healthy lifestyle, and safe sexual practices. Brazilian medical schools are fundamental for the advancement of medical education in contraception and for the creation of public policies on family planning.

Antenatal screening of depressive and manic symptoms in south Brazilian childbearing women: A transversal study in advance of the pandemic scenario.

BACKGROUND: The diagnosis of mood disorders (MD) during pregnancy is challenging and may bring negative consequences to the maternal-fetal binomial. The long waitlist for specialized psychiatric evaluation in Brazil contributes to the treatment omission. Almost 20.0% of women treated with antidepressants have a positive screening for bipolar disorder. Therefore, it has been recommended the investigation of depressive and bipolar disorder during prenatal care. Unfortunately, the screening for mood disorders is not a reality in Brazil and many childbearing women remain undiagnosed. The objective of this study is to observe the frequency of MD and the effectiveness of screening scales for routine use by health professionals during prenatal care in high-risk pregnancies. METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study included 61 childbearing women in their second trimester who were interviewed using the Edinburgh Postnatal Depression Scale (EPDS) and the Mood Disorder Questionnaire (MDQ). The cut-off point was EPDS ≥ 13 and MDQ ≥ 7 and the SCID-5 was the gold standard diagnosis. MD were diagnosed in 24.6% of the high-risk pregnancies. EDPS was positive in 19.7% and the frequency of major depression was 8.2%. 16.4% of the childbearing women were diagnosed with bipolar disorder, while MDQ was positive in 36.1%. 11.5% of the women had EPDS and MDQ positive. EPDS sensitivity was 80.0% and specificity 92.1%, whereas MDQ presented a sensitivity of 70.0% and specificity of 70.6%. CONCLUSION/SIGNIFICANCE: There is a high prevalence of MD in high-risk pregnancies. The routine use of EPDS simultaneously to MDQ during antenatal care is effective and plays an important role in early diagnosis, counselling, and promotion of perinatal mental health.

The Effect of Mesenchymal Stem Cells on Fertility in Experimental Retrocervical Endometriosis / O efeito das células-tronco mesenquimais na fertilidade em endometriose retrocervical experimental

Abstract Purpose To evaluate the effect of mesenchymal stem cells (MSCs) on fertility in experimental retrocervical endometriosis. Methods A total of 27 New Zealand rabbits were divided into three groups: endometriosis, in which endometrial implants were created; mesenchymal, in which MSCs were applied in addition to the creation of endometrial implants; and control, the group without endometriosis. Fisher's exact test was performed to compare the dichotomous qualitative variables among the groups. The quantitative variables were compared by the nonparametric Mann-Whitney and Kruskal-Wallis tests. The MannWhitney test was used for post-hoc multiple comparison with Boniferroni correction. Results Regarding the beginning of the fertile period, the three groups had medians of 14±12.7, 40±5, and 33±8.9 days respectively (p = 0.005). With regard to fertility (number of pregnancies), the endometriosis and control groups showed a rate of 77.78%, whereas the mesenchymal group showed a rate of 11.20% (p = 0.015). No differences in Keenan's histological classification were observed among the groups (p = 0.730). With regard to the macroscopic appearance of the lesions, the mesenchymal group showed the most pelvic adhesions. Conclusion The use of MSCs in endometriosis negatively contributed to fertility, suggesting the role of these cells in the development of this disease.

Resumo Objetivo Avaliar o efeito das células-tronco mesenquimais sobre a fertilidade na endometriose retrocervical experimental. Métodos Um total de 27 coelhas da raça Nova Zelândia foram divididas em três grupos: endometriose, em que os implantes endometriais foram criados; mesenquimal, em que as células-tronco mesenquimais foram aplicadas complementarmente à criação implantes endometriais; e controle, sem endometriose. O teste exato de Fisher foi realizado para comparar variáveis dicotômicas qualitativas entre os grupos. As variáveis quantitativas foram comparadas pelos testes não paramétricos de MannWhitney e Kruskal-Wallis. O teste de Mann-Whitney foi utilizado para a comparação múltipla pós-hoc com correção de Boniferroni. Resultados em relação ao início do período fértil, os grupos endometriose, mesenquimal e controle tiveram medianas de 14±12,7; 40±5; e 33±8,9 dias, respectivamente (p = 0,005). Sobre a taxa de fertilidade (número de gravidezes), os grupos endometriose e controle mostraram uma taxa de 77,78%, enquanto o grupo mesenquimal mostrou uma taxa de 11,20% (p = 0,015). Não foram observadas diferenças na classificação histológica de Keenan entre os grupos (p = 0,730). No que diz respeito à aparência macroscópica das lesões, o grupo mesenquimal mostrou maiores adesões pélvicas. Conclusão O uso de células-tronco mesenquimais na endometriose contribuiu negativamente para a fertilidade, sugerindo o papel dessas células no desenvolvimento da doença.

The Effect of Mesenchymal Stem Cells on Fertility in Experimental Retrocervical Endometriosis.

Purpose To evaluate the effect of mesenchymal stem cells (MSCs) on fertility in experimental retrocervical endometriosis. Methods A total of 27 New Zealand rabbits were divided into three groups: endometriosis, in which endometrial implants were created; mesenchymal, in which MSCs were applied in addition to the creation of endometrial implants; and control, the group without endometriosis. Fisher's exact test was performed to compare the dichotomous qualitative variables among the groups. The quantitative variables were compared by the nonparametric Mann-Whitney and Kruskal-Wallis tests. The Mann-Whitney test was used for post-hoc multiple comparison with Boniferroni correction. Results Regarding the beginning of the fertile period, the three groups had medians of 14 ± 12.7, 40 ± 5, and 33 ± 8.9 days respectively (p = 0.005). With regard to fertility (number of pregnancies), the endometriosis and control groups showed a rate of 77.78%, whereas the mesenchymal group showed a rate of 11.20% (p = 0.015). No differences in Keenan's histological classification were observed among the groups (p = 0.730). With regard to the macroscopic appearance of the lesions, the mesenchymal group showed the most pelvic adhesions. Conclusion The use of MSCs in endometriosis negatively contributed to fertility, suggesting the role of these cells in the development of this disease.

Objetivo Avaliar o efeito das células-tronco mesenquimais sobre a fertilidade na endometriose retrocervical experimental. Métodos Um total de 27 coelhas da raça Nova Zelândia foram divididas em três grupos: endometriose, em que os implantes endometriais foram criados; mesenquimal, em que as células-tronco mesenquimais foram aplicadas complementarmente à criação implantes endometriais; e controle, sem endometriose. O teste exato de Fisher foi realizado para comparar variáveis dicotômicas qualitativas entre os grupos. As variáveis quantitativas foram comparadas pelos testes não paramétricos de Mann-Whitney e Kruskal-Wallis. O teste de Mann-Whitney foi utilizado para a comparação múltipla pós-hoc com correção de Boniferroni. Resultados em relação ao início do período fértil, os grupos endometriose, mesenquimal e controle tiveram medianas de 14 ± 12,7; 40 ± 5; e 33 ± 8,9 dias, respectivamente (p = 0,005). Sobre a taxa de fertilidade (número de gravidezes), os grupos endometriose e controle mostraram uma taxa de 77,78%, enquanto o grupo mesenquimal mostrou uma taxa de 11,20% (p = 0,015). Não foram observadas diferenças na classificação histológica de Keenan entre os grupos (p = 0,730). No que diz respeito à aparência macroscópica das lesões, o grupo mesenquimal mostrou maiores adesões pélvicas. Conclusão O uso de células-tronco mesenquimais na endometriose contribuiu negativamente para a fertilidade, sugerindo o papel dessas células no desenvolvimento da doença.

Evaluation of the prevalence of stress and its phases in acute myocardial infarction in patients active in the labor market.

INTRODUCTION: Acute myocardial infarction is a social health problem of epidemiological relevance, with high levels of morbidity and mortality. Stress is one of the modifiable risk factors that triggers acute myocardial infarction. Stress is a result of a set of physiological reactions, which when exaggerated in intensity or duration can lead to imbalances in one's organism, resulting in vulnerability to diseases. OBJECTIVE: To identify the presence of stress and its phases in hospitalized and active labor market patients with unstable myocardial infarction and observe its correlation with the life of this population with stress. METHODS: The methodology used was a quantitative, descriptive and transversal research approach conducted with a total of 43 patients, who were still active in the labor market, presenting or not morbidities. Data collection occurred on the fourth day of their hospitalization and patients responded to Lipp's Stress Symptom Inventory for adults. RESULTS: Thirty-one patients (72.1%) presented stress and twelve (27.8%) did not. In patients with stress, the identified phases were: alert - one patient (3.2%); resistance -twenty-two patients (71.0%); quasi-exhaustion - six patients (19.4%) and exhaustion - two patients (6.5%). All women researched presented stress. CONCLUSION: The results suggest a high level of stress, especially in the resistance phase, in the male infarcted population, hospitalized and active in the labor market.

Evaluation of the prevalence of stress and its phases in acute myocardial infarction in patients active in the labor market / Avaliação da prevalência do estresse e suas fases no infarto agudo do miocárdio em pacientes atuantes no mercado de trabalho

Introduction: Acute myocardial infarction is a social health problem of epidemiological relevance, with high levels of morbidity and mortality. Stress is one of the modifiable risk factors that triggers acute myocardial infarction. Stress is a result of a set of physiological reactions, which when exaggerated in intensity or duration can lead to imbalances in one's organism, resulting in vulnerability to diseases. Objective: To identify the presence of stress and its phases in hospitalized and active labor market patients with unstable myocardial infarction and observe its correlation with the life of this population with stress. Methods: The methodology used was a quantitative, descriptive and transversal research approach conducted with a total of 43 patients, who were still active in the labor market, presenting or not morbidities. Data collection occurred on the fourth day of their hospitalization and patients responded to Lipp's Stress Symptom Inventory for adults. Results: Thirty-one patients (72.1%) presented stress and twelve (27.8%) did not. In patients with stress, the identified phases were: alert - one patient (3.2%); resistance -twenty-two patients (71.0%); quasi-exhaustion - six patients (19.4%) and exhaustion - two patients (6.5%). All women researched presented stress. Conclusion: The results suggest a high level of stress, especially in the resistance phase, in the male infarcted population, hospitalized and active in the labor market. .

Introdução: O infarto agudo do miocárdio é um problema de saúde coletiva com altos índices de morbimortalidade com relevância epidemiológica. O estresse é um dos fatores de risco modificáveis desencadeantes do infarto agudo do miocárdio. O estresse é composto por um conjunto de reações fisiológicas que, se exageradas em intensidade ou duração, podem levar a um desequilíbrio do organismo, propiciando vulnerabilidade às doenças. Objetivo: Identificar a presença ou não do estresse e as fases do mesmo, em pacientes com infarto agudo do miocárdio, ativos no mercado de trabalho. Métodos: Pesquisa de abordagem quantitativa, descritiva e transversal que analisou 43 pacientes com diagnóstico de infarto agudo do miocárdio entre 21 e 65 anos, ativos no mercado de trabalho com ou sem comorbidades. A coleta de dados ocorreu no quarto dia de hospitalização; os pacientes responderam ao Inventário de Sintomas de Stress para adultos de Lipp. Resultados: A média de idade foi de 50,3 anos. A incidência de infarto agudo do miocárdio nos homens foi de 91% e nas mulheres de 9%. Em relação à escolaridade até o segundo grau entre homens e mulheres foi de 16% e com segundo grau completo ou mais, de 84%. Apresentaram estresse 31 pacientes (72,1%), não apresentaram estresse 12 (27,9%). Nos pacientes com estresse, as fases identificadas foram: alerta: 1 paciente (3,2%); resistência: 22 pacientes (71,0%); quase-exaustão: 6 pacientes (19,4%) e exaustão: 2 pacientes (6,5%). Todas as mulheres da pesquisa apresentaram estresse. Conclusão: Os resultados encontrados sugerem um elevado nível de estresse, principalmente na fase de resistência, na população de cardiopatas em infarto agudo do miocárdio ativos no mercado de trabalho. .

Myocardial regeneration after implantation of porcine small intestinal submucosa in the left ventricle.

INTRODUCTION: Most cardiomyocytes do not regenerate after myocardial infarction. Porcine small intestinal submucosa has been shown to be effective in tissue repair. OBJECTIVE: To evaluate myocardial tissue regeneration and functional effects of SIS implantation in pigs after left ventriculotomy. METHODS: Fifteen pigs were assigned to two groups: porcine small intestinal submucosa (SIS) (N=10) and control (N=5). The SIS group underwent a mini sternotomy, left ventriculotomy and placement of a SIS patch. The control group underwent a sham procedure. Echocardiography was performed before and 60 days after the surgical procedure. Histological analysis was performed with hematoxylin-eosin stain and markers for actin 1A4, anti sarcomeric actin, connexin43 and factor VIII. RESULTS: Weight gain was similar in both groups. Echocardiography analysis revealed no difference between groups regarding end diastolic and systolic diameters and left ventricular ejection fraction, both pre (P=0.118, P=0.313, P=0.944) and post procedure (P=0.333, P=0.522, P=0.628). Both groups showed an increase in end diastolic (P<0,001 for both) and systolic diameter 60 days after surgery (P=0.005, SIS group and P=0.004, control group). New cardiomyocytes, blood vessels and inflammatory reactions were histologically identified in the SIS group. CONCLUSION: SIS implantation in pigs after left ventriculotomy was associated with angiomuscular regeneration and no damage in cardiac function.

Myocardial regeneration after implantation of porcine small intestinal submucosa in the left ventricle / Regeneração miocárdica após implante de submucosa intestinal suína no ventrículo esquerdo

Introduction: Most cardiomyocytes do not regenerate after myocardial infarction. Porcine small intestinal submucosa has been shown to be effective in tissue repair. Objective: To evaluate myocardial tissue regeneration and functional effects of SIS implantation in pigs after left ventriculotomy. Methods: Fifteen pigs were assigned to two groups: porcine small intestinal submucosa (SIS) (N=10) and control (N=5). The SIS group underwent a mini sternotomy, left ventriculotomy and placement of a SIS patch. The control group underwent a sham procedure. Echocardiography was performed before and 60 days after the surgical procedure. Histological analysis was performed with hematoxylin-eosin stain and markers for actin 1A4, anti sarcomeric actin, connexin43 and factor VIII. Results: Weight gain was similar in both groups. Echocardiography analysis revealed no difference between groups regarding end diastolic and systolic diameters and left ventricular ejection fraction, both pre (P=0.118, P=0.313, P=0.944) and post procedure (P=0.333, P=0.522, P=0.628). Both groups showed an increase in end diastolic (P<0,001 for both) and systolic diameter 60 days after surgery (P=0.005, SIS group and P=0.004, control group). New cardiomyocytes, blood vessels and inflammatory reactions were histologically identified in the SIS group. Conclusion: SIS implantation in pigs after left ventriculotomy was associated with angiomuscular regeneration and no damage in cardiac function. .

Introdução: A grande maioria dos cardiomiócitos não tem capacidade de regeneração após o infarto do miocárdio. A submucosa do intestino porcino tem-se mostrado eficiente como reparador tecidual. Objetivo: Analisar a capacidade de regeneração tecidual miocárdica e o efeito funcional do implante da submucosa do intestino porcino após ventriculotomia esquerda em porcos. Métodos: Quinze porcos foram separados em dois grupos: submucosa (N=10) e controle (N=5). Os animais do grupo submucosa foram submetidos a uma mini esternotomia inferior e ao implante da submucosa porcina na ventriculotomia esquerda. No grupo controle, foi realizada apenas a mini-esternotomia. Foi realizada análise ecocardiográfica no pré-operatório e 60 dias após o procedimento cirúrgico. A análise histológica foi feita com hematoxilina-eosila e marcadores para Actina 1A4, anti-actina sarcomérica, conexina43 e fator VIII. Resultados: O ganho de peso foi semelhante entre os grupos. Considerando a análise ecocardiográfica, não foi identificada diferença estatisticamente significativa entre os grupos com relação ao diâmetro sistólico final, diâmetro diastólico final e fração de ejeção ventricular esquerda, tanto no pré (P=0.118, P=0.313, P=0.944) quanto no pós-operatório (P=0.333, P=0.522, P=0.628). Ambos os grupos mostraram um aumento no diâmetro sistólico final (P=0.005, grupo submucosa e P=0.004, grupo controle) e diâmetro diastólico final (P<0,001 para ambos) 60 dias após a cirurgia. À histologia, identificou-se a presença de novos cardiomiócitos, fibras musculares lisas, vasos sanguíneos e reação inflamatória no grupo submucosa. Conclusão: O implante de submucosa intestinal porcina após ...

Efeito do exercício associado ao transplante de células-tronco sobre a função ventricular de ratos pós-infarto agudo do miocárdio / Effect of exercise associated with stem cell transplantation on ventricular function in rats after acute myocardial infarction

OBJETIVO: Avaliar o efeito da associação terapêutica entre o transplante autólogo de células-tronco e o exercício físico aquático, sobre a fração de ejeção do ventrículo esquerdo (FEVE) de ratos com disfunção ventricular pós-infarto agudo do miocárdio (IAM). MÉTODOS: Foram induzidos ao IAM, por ligadura da artéria coronária esquerda, 21 ratos Wistar. Os animais foram submetidos à ecocardiografia para avaliação da FEVE (%) e dos volumes diastólico e sistólico finais do ventrículo esquerdo (VDF, VSF, ml), randomizados e ao transplante das células-tronco mononucleares. Os animais foram divididos em quatro grupos: grupo sedentário sem células (n=5), sedentário com células (n=5), treinado sem células (n=5) e treinado com células (n=6). O treinamento físico foi iniciado 30 dias após o IAM e realizado em piscina adaptada durante 30 dias. No início e no final do protocolo de treinamento físico, foram realizadas dosagens de lactato. Os animais foram submetidos a nova ecocardiografia após 60 dias do IAM. RESULTADOS: Comparação dos valores de FEVE 30 dias e 60 dias pós-IAM, respectivamente: sedentário sem (35,20 ± 7,64% vs. 22,39 ± 4,56% P=0,026), com células (25,18 ± 7,73% vs. 23,85 ± 9,51% P=0,860) e no treinado sem (21,49 ± 2,70% vs. 20,71 ± 7,14% P=0,792), treinado com células (28,86 ± 6,68 vs. 38,43 ±7,56% P=0,062). Identificou-se a diminuição de fibras colágenas, nas regiões de fibrose miocárdica no grupo treinado com e sem células. CONCLUSÃO: A associação terapêutica entre exercício físico e o transplante autólogo de células-tronco foi benéfica contra as ações do remodelamento ventricular.

OBJECTIVE: To analyze the functional and anatomical-pathological effect of transplantation of bone marrow mononuclear cells associated to aquatic physical activity after myocardial infarction in rats. METHODS: Twenty-one rats were induced by myocardial infarction, through left coronary artery ligation. After a week, the animals were subjected to echocardiography for evaluation of left ventricle ejection fraction (LVEF, %) and dyastolic and end systolic volume of the left ventricle (EDV, ESV, ml), randomized and the transplantation of mononuclear stem cells. The animals were divided into four groups: sedentary group without cells (n=5), sedentary with cells (n=5), trained without cells (n=5) and trained with cells (n=6). The physical training was started 30 days after infarction and held in swimming during 30 days. At the beginning and at the end of the physical training protocol were held assay of lactate. The animals have been subjected to new echocardiography after 60 days of myocardial infarction. RESULTS: Two months after the transplant, were observed decrease in FE in the control group (35.2 to 23.54 P=0.022) and addition of LVEF and stabilization of ventricular remodeling in the group trained with cells (29.85 to 33.43% P=0.062 and 0.71 to 0.73 ml, P=0.776, respectively). Identified the reduction of collagen fibers, myocardial fibrosis regions in the group trained with and without cells. CONCLUSION: The group trained with cells improves ventricular function compared to the control group, suggesting the benefit of associated cell therapy will physical activity.

The functional effect of soybean extract and isolated isoflavone on myocardial infarction and ventricular dysfunction: the soybean extract on myocardial infarction.

BACKGROUND: Myocardial infarction is a public health problem. Functional food is an alternative treatment for cardiovascular diseases. OBJECTIVE: The objective was to analyze the functional and anatomopathological post-myocardial-infarction effects of soybean extract (SE) and isoflavone (IF). METHODS: Myocardial infarction was induced in adult Wistar rats. After 5 days, an echocardiogram was performed to determine heart rate (HR), ejection fraction (EF), systolic volume (LVESV) and diastolic volume (LVEDV). Animals with ventricular dysfunction (EF<45%) were selected for study. The animals were divided into three groups: control (n=14), SE (n=15) and IF (n=12). The IF group received 120 mg/kg/day isolated IF, and the SE group received 12.52 g/day. After 30 days, a new echocardiogram was performed. A histological exam was carried out to determine the collagen. Activity of biochemical markers [arginase, lactate dehydrogenase (LDH) and malate dehydrogenase] was measured. RESULTS: The animals of the control, IF and SE groups showed a reduction in EF after the infarction (P=.432, P=.017 and P=.320, respectively). An increase of LVESV and LVEDV was observed in all groups (P=.009, P=.001 and P=.140; and P=.003, P=.008 and P=.205, respectively). A reduction of HR was found in the SE group (P=.020). There was a greater activity of LDH in the SE group. A smaller quantity of mature collagen was found in the region proximal to the myocardial infarction in the SE group. CONCLUSION: A protective effect in the SE group was observed 30 days after the myocardial infarction.

Endometriose: impacto econômico e suas perspectivas / Endometriosis: economic impact and its outlook

A endometriose é uma doença crônica e benigna que afeta mulheres em idade reprodutiva e está associada à alta ocorrência de comorbidades, ocasionando aumento nos seus custos financeiros. Objetivou-se analisar os impactos econômicos devido as despesas correspondentes ao diagnóstico tardio, consultas, exames, procedimentos cirúrgicos e tratamento da endometriose, e como isso se reflete nos sistemas de saúde público, privado e sociedade. A metodologia consistiu de uma Revisão Sistemática da Literatura nas bases de dados Biblioteca Virtual em Saúde em todos os índices e todas as fontes e Pubmed a partir do ano de 1991 até 2010. Dos 67 artigos selecionados, foram utilizados 19, com análise descritiva,quantitativa e qualitativa referente aos valores que mostravam os custos diretos e indiretos comparados aos fatores biológicos, psicológicos, sociais e econômicos consequentes da endometriose. O impacto econômico existe e é considerável, sendo necessária a realização de futuras pesquisas para reduzir os custos, muitas vezes desnecessários. Mesmo que a literatura mostre grande relevância no diagnóstico e nos diversos tratamentos, existem poucos estudos publicados, principalmente nos últimos anos, que tenham uma abordagem sistemática sobre o impacto econômico da endometriose

Endometriosis is a benign chronic disease that affects women of reproductive age and is associated with high incidence of comorbidities, which increase their financing costs. This study aimed to analyze the economic impact caused due to expenses related to late diagnosis, consultations, tests, surgeries and treatment of endometriosis, and how they are reflected to the public and private health systems and society. The methodology consisted of a Systematic Review databases in the Virtual Health Library in all indices and all sources and Pubmed, from 1991 to 2010. 19 out of the 67 articles were used, with descriptive, quantitative and qualitative analysis referring to the values that showed the direct and indirect costs compared to the biological, psychological, social and economic consequents of endometriosis. Even though the literature shows great relevance in the diagnosis and various treatments, there are few studies published, especially in recent years, that have a systematic approach on the economic impact of endometriosis. Future researches to reduce unnecessary costs are necessary due to the relevance of the economic impact

Effect of exercise associated with stem cell transplantation on ventricular function in rats after acute myocardial infarction.

OBJECTIVE: To analyze the functional and anatomical-pathological effect of transplantation of bone marrow mononuclear cells associated to aquatic physical activity after myocardial infarction in rats. METHODS: Twenty-one rats were induced by myocardial infarction, through left coronary artery ligation. After a week, the animals were subjected to echocardiography for evaluation of left ventricle ejection fraction (LVEF, %) and dyastolic and end systolic volume of the left ventricle (EDV, ESV, ml), randomized and the transplantation of mononuclear stem cells. The animals were divided into four groups: sedentary group without cells (n=5), sedentary with cells (n=5), trained without cells (n=5) and trained with cells (n=6). The physical training was started 30 days after infarction and held in swimming during 30 days. At the beginning and at the end of the physical training protocol were held assay of lactate. The animals have been subjected to new echocardiography after 60 days of myocardial infarction. RESULTS: Two months after the transplant, were observed decrease in FE in the control group (35.2 to 23.54 P=0.022) and addition of LVEF and stabilization of ventricular remodeling in the group trained with cells (29.85 to 33.43% P=0.062 and 0.71 to 0.73 ml, P=0.776, respectively). Identified the reduction of collagen fibers, myocardial fibrosis regions in the group trained with and without cells. CONCLUSION: The group trained with cells improves ventricular function compared to the control group, suggesting the benefit of associated cell therapy will physical activity.

Effect of anti-TNF-α on peritoneal endometrial implants of rats.

OBJECTIVE: To evaluate the effect of anti-TNF-α in the treatment of endometrial implants in the peritoneum of rats. METHODS: Endometrial implants were surgically induced in 120 female Wistar-Albino rats. The animals were randomly divided into four groups. Group C (n = 36) received an intraperitoneal injection of 0.2 ml of saline. Group L (n = 41) received a subcutaneous injection of 1mg/kg of leuprolide. Group I5 (n = 20) received a subcutaneous injection of 5mg/kg of monoclonal anti-tumor necrosis factor (TNF) a (infliximab). Group I10 (n = 20) received a subcutaneous injection of 10mg/kg of infliximab. The rats were sacrificed after 21 days to assess the size of the implants and the expression of TNF. RESULTS: Treatment with leuprolide (group L) promoted an absolute reduction in the surface area of the implant when compared with group C (+14 mm vs. 0mm, p = 0.013) and group I10 (+14 mm vs. +5 Mm, p = 0.018). Likewise, a percentage reduction of surface area of the implant was observed comparing group L with group C (+33.3% vs. 0%, p = 0.005) and group I10 (+33.3% vs. +18.3%, p = 0.027). Treatment with infliximab was not able to decrease the surface area of the implants when compared with group C. The expression of TNF-α in groups L, I5 and I10 was lower than in group C (505.6 mm(2) vs. 660.5 mm(2) vs. 317.2 mm(2) vs. 2519.3 mm(2), respectively; p <0.001). CONCLUSION: The anti-TNF-α therapy reduced the expression of TNF-α in endometriotic implants, but did not reduce the surface area of the lesion.

Efeito do anti-TNF-α em implantes endometriais no peritônio de ratas / Effect of anti-TNF-α on peritoneal endometrial implants of rats

OBJETIVO: Avaliar o efeito da terapia anti-TNF-α no tratamento de implantes endometriais no peritônio de ratas. MÉTODOS: Os implantes endometrióticos foram induzidos cirurgicamente em 120 ratas Wistar-Albino. Os animais foram aleatoriamente distribuídos em 4 grupos. O grupo C (n=36) recebeu uma injeção intraperitoneal de 0,2ml de solução salina. O grupo L (n=41) recebeu uma injeção subcutânea de 1mg/kg de leuprolide. O grupo I5 (n=20) recebeu uma injeção subcutânea de 5mg/kg de anticorpo monoclonal anti-fator de necrose tumoral (TNF) a (infliximab). O grupo I10 (n=20) recebeu uma injeção subcutânea de 10mg/kg de infliximab. As ratas foram sacrificadas após 21 dias para se avaliar o tamanho dos implantes e a expressão do TNF-α. RESULTADOS: O tratamento com leuprolide promoveu uma redução absoluta na área de superfície do implante comparado com o grupo C (+14mm vs. 0mm; p=0,013) e com o grupo I10 (+14mm vs. +5mm; p=0,018). Da mesma forma, uma redução percentual da area de superfície do implante foi observada comparando o grupo L com o grupo C (+33,3 por cento vs. 0 por cento; p=0,005) e com o grupo I10 (+33,3 por cento vs. +18,3 por cento; p=0,027). O tratamento com infliximab não foi capaz de diminuir a área de superfície do implante comparado com o grupo C. A expressão de TNF-α reduziu nos grupos L, I5 e I10 comparado com o grupo C (505,6µm² vs. 660,5µm² vs. 317,2µm² vs. 2519,3µm², respectivamente; p<0,001). CONCLUSÃO: A terapia anti-TNF-α reduziu a expressão de TNF-α nos implantes endometrióticos mas não reduziu a área de superfície da lesão.

OBJECTIVE: To evaluate the effect of anti-TNF-α in the treatment of endometrial implants in the peritoneum of rats. METHODS: Endometrial implants were surgically induced in 120 female Wistar-Albino rats. The animals were randomly divided into four groups. Group C (n = 36) received an intraperitoneal injection of 0.2 ml of saline. Group L (n = 41) received a subcutaneous injection of 1mg/kg of leuprolide. Group I5 (n = 20) received a subcutaneous injection of 5mg/kg of monoclonal anti-tumor necrosis factor (TNF) a (infliximab). Group I10 (n = 20) received a subcutaneous injection of 10mg/kg of infliximab. The rats were sacrificed after 21 days to assess the size of the implants and the expression of TNF. RESULTS: Treatment with leuprolide (group L) promoted an absolute reduction in the surface area of the implant when compared with group C (+14 mm vs. 0mm, p = 0.013) and group I10 (+14 mm vs. +5 Mm, p = 0.018). Likewise, a percentage reduction of surface area of the implant was observed comparing group L with group C (+33.3 percent vs. 0 percent, p = 0.005) and group I10 (+33.3 percent vs. +18.3 percent, p = 0.027). Treatment with infliximab was not able to decrease the surface area of the implants when compared with group C. The expression of TNF-α in groups L, I5 and I10 was lower than in group C (505.6 mm² vs. 660.5 mm² vs. 317.2 mm² vs. 2519.3 mm², respectively; p <0.001). CONCLUSION: The anti-TNF-α therapy reduced the expression of TNF-α in endometriotic implants, but did not reduce the surface area of the lesion.

Effect of the bone marrow derived-mononuclear stem cells transplantation in the growth, VEGF-R and TNF-alpha expression of endometrial implants in Wistar rats.

OBJECTIVE: To study the effect of bone marrow derived-mononuclear stem cells transplantation in the growth, VEGF-R and TNF-alpha expression of surgically induced endometriosis in an experimental model. STUDY DESIGN: This is an experimental study conducted in the Center for Health and Biological Sciences at the Pontifical Catholic University of Parana, Brazil. Endometriotic implants were surgically induced in 120 female Wistar rats. The animals with viable endometrial implant (larger than 25 mm(2)) were randomically divided into 3 groups to receive an intraperitoneal injection of 0.2 cc of saline solution (C group; n=30), a subcutaneous injection of 1mg/kg of leuprolide (L group; n=34), or an intraperitoneal injection of 5×10(6) bone marrow derived-mononuclear stem cells (SC group; n=36). They were sacrificed after 21 days to assess the implants' size and the tissue expression of vascular endothelial growth factor receptor (VEGF-R) and tumor necrosis factor-alpha (TNF-alpha). RESULTS: Treatment with leuprolide decreased the surface area of the endometriotic implant compared to the SC group and the C group. The absolute reduction in the surface area of the implant was 16.5mm, 0mm, and 0mm (p=0.007), respectively, and the percent reduction was 40.2%, 0%, and 0% (p=0.001). VEGF-R expression in the endometriotic implant decreased after treatment in the L and SC groups compared to the C group (409.6 µm(2) vs. 465 µm(2) vs. 920.9 µm(2), respectively; p=0.021). TNF-alpha expression also reduced in the L and SC groups compared to the C group (585.7 µm(2) vs. 549.3 µm(2) vs. 2402.1 µm(2), respectively; p<0.001). CONCLUSION: Bone marrow derived-mononuclear stem cells transplantation decreased the expression of VEGF-R and TNF-alpha in the endometriotic implant but did not reduce the surface area of the lesion.

Tratamento cirúrgico da endometriose baseado em evidências / Evidence-based surgical treatment of endometriosis

A endometriose é uma doença benigna crônica de mulheres em idade reprodutiva que leva à diminuição da qualidade de vida, à infertilidade e a altos custos sociais. O manejo atual da endometriose é baseado em tratamento clínico e intervenção cirúrgica. O tratamento cirúrgico é indicado para confirmar o diagnóstico da doença e para manejar as pacientes não responsivas ao tratamento clínico. A dor pélvica associada à endometriose pode ser reduzida pela remoção completa das lesões, nos casos de doença infiltrativa profunda e severa. Os resultados da cirurgia na infertilidade associada à endometriose são mais controversos. A ablação de lesões endometrióticas associada à liberação de aderências para melhorar a fertilidade em endometriose mínima e leve parece ser efetiva se comparada à laparoscopia diagnóstica isolada. Alguns estudos mostram que a excisão cirúrgica de endometriose moderada a severa pode melhorar a taxa de gravidez. Nos casos de endometriomas maiores do que 4 cm, a cistectomia ovariana laparoscópica é superior à drenagem e à coagulação em termos de melhora da fertilidade.

Endometriosis is a chronic benign disease of reproductive-aged women that leads to a decreased quality of life, infertility, and increased societal costs. Current management of endometriosis is based on medical treatment and surgical intervention. Surgical treatment is indicated to confirm the diagnosis of the disease and to manage those patients who are not responsive to medical treatment. Endometriosis associated pain can be reduced by removing the entire lesions in severe and deeply infiltrating disease. The results of surgery in the endometriosis-associated infertility are controversial. Ablation of endometriotic lesions plus adhesiolysis to improve fertility in minimal-mild endometriosis seems to be effective compared to diagnostic laparoscopy alone. Some studies demonstrate that the surgical excision of moderate to severe endometriosis can enhance the pregnancy rate. In those cases of ovarian endometriomas bigger than 4 cm of diameter, laparoscopic cystectomy improves fertility compared to drainage and coagulation.

Evaluation of urinary incontinence in pregnancy and postpartum in Curitiba Mothers Program: a prospective study.

INTRODUCTION AND HYPOTHESIS: The objective of this study was to evaluate the prevalence of urinary incontinence (UI), the pelvic floor, and the quality of life during pregnancy and in the postpartum. METHODS: Three hundred and forty-three women in the third trimester of pregnancy were submitted to physiotherapeutic evaluation for UI and evaluation of pelvic floor muscle function and were asked to fill out the King's Health Questionnaire (KHQ). Of these, 236 returned for postpartum evaluation (65.31 ± 22.63 days). RESULTS: The prevalence of UI was 30.61% during pregnancy and 6.78% postpartum (p < 0.001), with mean vaginal pressure of 3.60 ± 5.35 and 2.56 ± 3.24 mmHg, respectively (p = 0.008). UI was associated with multiparity (p = 0.028). No associations were found between intrapartum variables and UI. CONCLUSIONS: UI and vaginal pressure decreased in the postpartum. UI was found to be associated with multiparity. Results of the KHQ indicated impaired quality of life in the symptoms and domains evaluated.

Síndrome pré-menstrual e transtorno disfórico pré-menstrual: atualização / Premenstrual syndrome and premenstrual dysphoric disorder: an update

A síndrome pré-menstrual é um conjunto de sinais e sintomas físicos, emocionais e comportamentais que ocorre durante a fase lútea do ciclo menstrual e atinge cerca de 40% das mulheres em idade fértil. O transtorno disfórico pré-menstrual afeta 5,8% das mulheres e é definido quando os sintomas pré-menstruais são suficientemente severos a ponto de afetar a qualidade de vida dessas pacientes em âmbito social, familiar e profissional. Há diversas opções de tratamento descritas na literatura para ambas as patologias, incluindo mudança no estilo de vida, suplementação alimentar, fitoterapia, medicamentos hormonais, supressores da ovulação, ansiolíticos, antidepressivos, entre outros. O objetivo deste artigo de revisão foi fornecer uma atualização acerca dessas doenças tão prevalentes entre as mulheres, pontuando aspectos clínicos relevantes e avaliando os tratamentos atualmente disponíveis sob a ótica da Medicina baseada em evidências.

Premenstrual syndrome is a group of physical, emotional and behavioral symptoms that happens during the luteal phase of the menstrual cycle and affects about 40% of women in their reproductive age. Premenstrual dysphoric disorder affects 5.8% of women and is defined when the premenstrual symptoms are severe enough to affect quality of life of patients in the social, familial and professional scopes. The treatment options described in literature for both diseases are vast, including change in lifestyle, diet supplementation, phytotherapy, hormonal drugs, ovulation suppressors, anxiolytics, antidepressant medications and others. The objective of this review article was to provide an update about these diseases which are among women, pointing out relevant clinical aspects and evaluating the current treatments available, according to evidence-based medicine.

Assoalho pélvico e endometriose profunda / Pelvic floor and deep endometriosis

A endometriose profunda infiltrativa é uma forma complexa de endometriose que infiltra a profundidade do peritônio em mais de 5 mm e afeta cerca de 20% das mulheres com endometriose. O seu tratamento objetiva remover os implantes e, em muitos casos de acometimento do trato genital, urinário e/ou gastrointestinal, o tratamento radical é necessário e pode acarretar danos ao assoalho pélvico, cuja função é manter a continência urinária, os órgãos pélvicos e a atividade sexual. As principais disfunções do assoalho pélvico que podem ocorrer após a cirurgia são: a sua hipertonia, disfunções urinárias e anorretais. O tratamento conservador com abordagem multidisciplinar visa à recuperação cinética-funcional do assoalho pélvico, contribuindo para a qualidade de vida das pacientes.

Deep endometriosis is a complex form of endometriosis that infiltrates below the surface of the peritoneum in over 5 mm and affects approximately 20% of women with endometriosis. The goal of the treatment is to remove these implants and, in many cases of affection of urinary or gastrointestinal tracts, the radical treatment is required and can cause damage to the pelvic floor, whose function is to keep the urinary continence, the pelvic organs and the sexual function. The main pelvic floor dysfunctions that can occur after surgery are: pelvic floor hypertrophy, urinary and colorectal dysfunctions. The conservative treatment with multiprofessional care aims to the recovery of the pelvic floor functional kinetics, thus helping to improve the patient’s quality of life.