Uso de métodos contraceptivos e reincidência gestacional em mulheres adolescentes: uma revisão sistemática / The use of contraceptive methods and gestational reincidence in adolescent women: a systematic review

Introdução: A gravidez na adolescência é considerada um problema global de saú- de pública, visto que 11% dos nascimentos em todo o mundo são oriundos de gestações em mulheres adolescentes. A taxa de reincidência de gestação durante a adolescência é de 61%, no Brasil, em adolescentes entre 10 e 19 anos, e de 17% a 35%, nos Estados Unidos, sendo ainda maior em países subdesenvolvidos. Objeti- vo: Realizar um levantamento dos conteúdos científicos sobre o uso de métodos contraceptivos e da reincidência de gestações em mulheres adolescentes. Méto- dos: Trata-se de um artigo de revisão sistemática. A busca foi realizada nas bases de dados Cochrane, LILACS e PubMed, por meio das palavras-chave Adolescent e Contraception. Foram incluídos artigos em inglês, português e espanhol publica- dos entre 2010 e 2020. Resultados: Foram encontradas 526 publicações, tendo sido excluídas 113 por duplicidade, 234 após a leitura de título, 155 após a leitura de resumo e 14 após a leitura na íntegra. Fizeram parte desta revisão oito publicações. Discussão: A amostra total contou com 2.492 adolescentes, com idade majoritária entre 14 e 19 anos, as quais, em sua maioria, eram primíparas. Nos grupos de bai- xa escolaridade, havia menos conhecimento e uso de métodos contraceptivos de longa duração (LARCs) e mais tendência ao uso de métodos de curta duração ou a relações sexuais desprotegidas. Os métodos contraceptivos pós-parto mais uti- lizados apresentavam menos eficácia, principalmente o preservativo. Conclusão: A promoção do acesso aos métodos de alta eficácia, principalmente LARCs, e o acompanhamento por meio de entrevista motivacional são capazes de reduzir a reincidência gestacional em adolescentes.(AU)

Introduction: Adolescence pregnancy is considered a global public health problem since 11% of births worldwide are from pregnancies in adolescent women. The rate of a second pregnancy during adolescence is up to 61% in Brazil in adolescents bet- ween 10 and 19 years old and 17%-35% in the United States of America, being even higher in underdeveloped countries. Objective: To survey scientific content on the use of contraceptive methods and the recurrence of pregnancies in adolescent women. Methods: This is a systematic review article. The search was carried out in Cochrane, LILACS, and PubMed databases, using the keywords Adolescent and Contraception. Articles in En- glish, Portuguese and Spanish published between 2010 and 2020 were included. Results: We found 526 publications, of which 113 were excluded due to duplication, 234 excluded af- ter reading the title, 155 after reading the abstract, and 14 after reading the full text. Eight publications were part of this review. Discussion: The total sample was made of 2,492 ado- lescents, aged between 14 and 19 years old, most of whom were primiparous. In the less educated groups, there was less knowledge about contraception, less use of long-term con- traceptive methods (LARCs), and a greater tendency to use short-term methods or unprotected sex. The postpartum con- traceptive methods most used were those with the least ef- fectiveness, mainly the condom. Conclusion: The promotion of access to highly effective methods, mainly LARCs and follow- -ups through motivational interviews are capable of reducing gestational recurrence in adolescents.(AU)

Nefropatía por C1q: una rara variedad de síndrome nefrótico: caso clínico / C1q nephropathy: report of one case

C1q nephropathy is a rare glomerulopathy characterized by mesangial deposition of the complement component C1q. These deposits can be isolated or associated with immunoglobulins or complement fractions, which are observed by immunofluorescence or immunohistochemical microscopy. In ultramicroscopy, dense mesangial deposits and alterations of the podocyte are observed. Clinically it presents as a nephrotic syndrome (NS) or by alterations of the urinalysis such as proteinuria and/or hematuria in children and young adults. In light microscopy, it is expressed with a morphological pattern of minimal change disease (MCD), mesangial proliferative glomerulonephritis or focal segmental glomerulosclerosis (FSGS). The NS during its evolution usually evolve in steroid resistance or steroid dependency, often requiring the association of immunosuppressants to obtain remission. We report a 14 years old male with a history of NS and its evolution under various treatments during a 12-year follow-up.

[C1q nephropathy. Report of one case]. / Nefropatía por C1q: una rara variedad de síndrome nefrótico. Caso clínico.

C1q nephropathy is a rare glomerulopathy characterized by mesangial deposition of the complement component C1q. These deposits can be isolated or associated with immunoglobulins or complement fractions, which are observed by immunofluorescence or immunohistochemical microscopy. In ultramicroscopy, dense mesangial deposits and alterations of the podocyte are observed. Clinically it presents as a nephrotic syndrome (NS) or by alterations of the urinalysis such as proteinuria and/or hematuria in children and young adults. In light microscopy, it is expressed with a morphological pattern of minimal change disease (MCD), mesangial proliferative glomerulonephritis or focal segmental glomerulosclerosis (FSGS). The NS during its evolution usually evolve in steroid resistance or steroid dependency, often requiring the association of immunosuppressants to obtain remission. We report a 14 years old male with a history of NS and its evolution under various treatments during a 12-year follow-up.

Vector analysis of astigmatic changes and optical quality outcomes after wavefront-guided laser in situ keratomileusis using a high-resolution aberrometer.

PURPOSE: To assess the ocular optical quality results as well as the astigmatic changes after wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopic astigmatism. SETTING: Instituto Clínico-Quirúrgico Oftalmológico, Bilbao, Vizcaya, Spain. DESIGN: Prospective case series. METHODS: Thirty-three eyes having wavefront-guided LASIK with the Star S4IR excimer laser combined with the iDesign system were enrolled in the study. Changes in visual acuity, refraction, higher-order aberrations, and ocular scattering index (OSI) were evaluated during a 3-month follow-up. The Alpins method was used to analyze the astigmatic changes. RESULTS: A significant reduction was observed in refraction (P < .001), with significant improvement in uncorrected (UDVA) and corrected (CDVA) distance visual acuities (P < .001). All eyes had a spherical equivalent within ±0.50 diopter (D) and UDVA of 20/25 or better at 90 days after surgery. A total of 27.3% of eyes gained lines of CDVA. No significant changes were observed in primary coma and spherical aberration (P ≥ .551). Likewise, no significant changes were observed in OSI (P = .361), with a mean 90-day postoperative value of 0.66 ± 0.58 (SD). A significant change to negative values of the magnitude of error (P = .007) and a significant decrease in the correction index (P = .004) were observed during the follow-up, with mean 90-day postoperative values of -0.24 ± 0.28 D and 0.86 ± 0.17 D, respectively. CONCLUSION: Wavefront-guided LASIK using a high-resolution aberrometer provided safe and efficacious correction of myopic astigmatism, with preservation of the ocular optical quality.

"Living Adolescence in Family" parenting program: adaptation and implementation in social and school contexts / Programa "Vivir la adolescencia en familia": adaptación e implementación en servicios sociales y entorno escolar

Adolescence is a developmental period that implies a series of rapid changes that might complicate the role of parents. This study evaluates changes in parental monitoring and the strategies to solve family conflicts reported by parents who participated in the "Living Adolescence in Family" program in local social services and school centers. In addition, the study analyses the moderating role of family and facilitator variables that may affect the final results. The participants were 697 parents attending the social services (438 in the intervention group and 259 in the control group) and 1283 parents from school centers (880 in the intervention group and 403 in the control group). The results showed that families from local social services decreased the amount of control and improved monitoring in education and leisure spheres as well as self-disclosure whereas the families coming from school centers improved supervision in leisure and in self-disclosure. In addition, both groups of families improved their strategies for solving family conflicts, increasing the use of integrative strategies and decreasing the use of dominant strategies. There were differences across contexts: the results of the program in the social services context differed according to the participant and professional profiles whereas program results were more homogeneous in the school context. In sum, the program appears to be an efficient work tool, both for the professionals who work with at-risk families with adolescents and for the teachers who make use of the program for families with children at risk of early school dropout

La adolescencia es un período de desarrollo que implica una serie de cambios rápidos que podrían complicar el papel de los padres. Este estudio evalúa los cambios en la supervisión parental y en las estrategias de resolución de conflictos familiares reportados por los padres que participan en el programa 'Vivir la adolescencia en familia' en los servicios sociales locales y en los centros escolares. Además, el estudio analiza el papel moderador de la familia y las variables de los facilitadores que pueden afectar a los resultados finales. Los participantes fueron 697 padres que asistieron a los servicios sociales (438 en el grupo de intervención y 259 en el grupo control) y 1283 padres de los centros escolares (880 en el grupo de intervención y 403 en el grupo de control). Los resultados mostraron que las familias de los servicios sociales locales disminuyeron el control y mejoraron en supervisión educativa y en las esferas de ocio, así como en la apertura, mientras que las familias procedentes de centros escolares mejoraron la supervisión en el ocio y en la apertura. Además, ambos grupos de familias mejoraron las estrategias de resolución de conflictos familiares, aumentando el uso de estrategias integradoras y disminuyendo el uso de estrategias dominantes. Como signo de distinción, los resultados del programa en el contexto de los servicios sociales diferían según los participantes y los perfiles profesionales, mientras que los resultados del programa fueron más homogéneos en el contexto escolar. En resumen, el programa parece ser una herramienta de trabajo eficiente, tanto para los profesionales que trabajan con las familias con hijos adolescentes en situación de riesgo como para los profesores que han realizado el programa para familias con niños en riesgo de abandono escolar temprano

2,3-cis-2R,3R-(-)-epiafzelechin-3-O-p-coumarate, a novel flavan-3-ol isolated from Fallopia convolvulus seed, is an estrogen receptor agonist in human cell lines.

BACKGROUND: The plant genus Fallopia is well-known in Chinese traditional medicine and includes many species that contain bioactive compounds, namely phytoestrogens. Consumption of phytoestrogens may be linked to decreased incidence of breast and prostate cancers therefore discovery of novel phytoestrogens and novel sources of phytoestrogens is of interest. Although phytoestrogen content has been analyzed in the rhizomes of various Fallopia sp., seeds of a Fallopia sp. have never been examined for phytoestrogen presence. METHODS: Analytical chemistry techniques were used with guidance from an in vitro estrogen receptor bioassay (a stably transfected human ovarian carcinoma cell line) to isolate and identify estrogenic components from seeds of Fallopia convolvulus. A transiently transfected human breast carcinoma cell line was used to characterize the biological activity of the isolated compounds on estrogen receptors (ER) α and ß. RESULTS: Two compounds, emodin and the novel flavan-3-ol, (-)-epiafzelechin-3-O-p-coumarate (rhodoeosein), were identified to be responsible for estrogenic activity of F. convolvulus seed extract. Absolute stereochemistry of rhodoeosein was determined by 1 and 2D NMR, optical rotation and circular dichroism. Emodin was identified by HPLC/DAD, LC/MS/MS, and FT/ICR-MS. When characterizing the ER specificity in biological activity of rhodoeosein and emodin, rhodoeosein was able to exhibit a four-fold greater relative estrogenic potency (REP) in breast cells transiently-transfected with ERß as compared to those transfected with ERα, and emodin exhibited a six-fold greater REP in ERß-transfected breast cells. Cell type-specific differences were observed with rhodoeosein but not emodin; rhodoeosein produced superinduction of reporter gene activity in the human ovarian cell line (> 400% of maximum estradiol [E2] induction) but not in the breast cell line. CONCLUSION: This study is the first to characterize the novel flavan-3-ol compound, rhodoeosein, and its ability to induce estrogenic activity in human cell lines. Rhodoeosein and emodin may have potential therapeutic applications as natural products activating ERß, and further characterization of rhodoeosein is necessary to evaluate its selectivity as a cell type-specific ER agonist.

Test-retest reliability of self-report measures in a dually diagnosed sample.

Many individuals diagnosed with a substance use disorder are also diagnosed with another psychiatric disorder. Little is known regarding which treatments are efficacious for these dually diagnosed individuals (DDI). Characterizing the psychometric properties of assessments used with DDI samples is essential to efficacy studies with DDI. This study examined the internal consistency and test-retest reliability of self-report instruments among DDI. Most subscales demonstrated high test-retest reliability; one subscale demonstrated poor reliability. Internal consistency was similar to that of non-DDI samples. This exploratory study suggests that, while some instruments should be interpreted cautiously, DDI samples can be accurately assessed with self-report measures.

Enantioselective and regioselective indium(III)-catalyzed addition of pyrroles to isatins.

The indium(III)-catalyzed enantioselective and regioselective addition of pyrroles to isatins is described. The effects of metal and solvent on the reactivity and selectivity are compared and discussed, demonstrating that the indium(III)-indapybox complex provides the most effective catalyst. A case of divergent reactivity between pyrroles and indoles is presented.

Megauréter obstructivo primario en pediatría: serie clínica / Primary obstructive megaureter

Introducción: Según imágenes de la urografía excretora, megauréter fue definido como la dilatación ureteral congénita o adquirida. El megauréter obstructivo primario (MOP) se origina por un segmento estenótico y adinámico del uréter distal, produciendo dilatación proximal. Material y método: Estudio de serie de casos de MOP con resolución quirúrgica entre 1996 y 2006, en Hospital Dr. Gustavo Fricke de Viña del Mar. Se analizaron características generales, tipo de cirugía y evolución de función renal. Resultados: Se encontraron 14 casos. Se utilizó la clasificación de Filadelfia (1976) y se adaptó el diagrama de flujo para manejo del megauréter de González y Rodríguez (1996). Se llegó al diagnóstico con ecografía antenatal (6/14 casos), en seguimiento de una infección del tracto urinario (4/14), en estudio de masa abdominal (3/14), y como hallazgo incidental (1/14). Hubo 8 niños y 6 niñas. Diez casos en uréter izquierdo y cuatro en uréter derecho. Cinco niños tuvieron la condición de riñón único. Respecto a la cirugía, en 11 pacientes se efectuó una derivación transitoria (ureterostomía) y sólo en 3 pacientes neoimplante urétero-vesical primario. Seis pacientes fueron operados dentro de los primeros 3 meses de edad. La función renal se conservó en rangos normales excepto en un caso que evolucionó a insuficiencia renal Discusión: La evolución de un megauréter es dinámica e individual, y es difícil predecir el resultado de cada caso, por lo que se recomienda el análisis conjunto de la clínica y los exámenes para diagnosticar y evaluar el estado de cada paciente portador de megauréter.

Introduction: According to images of excretor urogram, megaureter is defined as a congenital or acquired ureteral dilatation. Primary Obstructive Megaureter (POM) originates from an estenotic and a dynamic distal segment of the ureter, generating proximal dilatation. Material and methods: Study of case series in Hospital Dr. Gustavo Fricke, Viña del Mar, Chile. We included totality of POM’s cases with surgical resolution between 1996 and 2006. General characteristics, type of surgery, and evolution of renal function were analyzed. Results: We report 14 cases (8 male). We used the Philadelphia classification system (1976), and we adapted the management flowchart according to González and Rodríguez (1996). Diagnosis was made with prenatal ultrasound (6/14 cases), during follow-up of a urinary tract infection (4/14), in study of abdominal mass (3/14), and as incidental find (1/14). Ten cases were left and four rights. Five cases had the condition in a solitary kidney. In eleven cases an ureterosthomy was used, and in only in three patients we performed a primary ureterovesical neoimplant. Six patients of the series were operated before 3 months of age. At follow-up, renal function was conserved normal except for one case that evolved to renal insufficiency. Conclusion: Megaureter evolution is dynamic and individual, and it‘s difficult to predict the result of every case. Thorough analysis of every patient is recommended.

[Irritable bowel syndrome and cardiac right-to-left shunt through a patent foramen ovale]. / Síndrome del intestino irritable y cortocircuito cardíaco derecha-izquierda por foramen oval permeable.

BACKGROUND AND OBJECTIVE: Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentage of venous blood bypasses the lung filter and may increase these substances in blood. PATIENTS AND METHOD: A phone interview was done to determine the presence of IBS in patients previously attended for detection of RLS with transcranial Doppler ultrasound. The presence and grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS. RESULTS: Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for other FGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p < 0.05 for other FGD). CONCLUSIONS: We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies.

Matrix metalloproteinase 9 is a mediator of epidermal growth factor-dependent e-cadherin loss in ovarian carcinoma cells.

Epidermal growth factor (EGF) receptor (EGFR) is frequently elevated in epithelial ovarian cancer, and E-cadherin expression is often reduced in advanced disease. In this study, we investigated a mechanism by which EGFR activation promotes disruption of adherens junctions through induction of matrix metalloproteinase 9 (MMP-9). We show that EGFR activation down-modulates E-cadherin, and broad spectrum MMP inhibition ameliorates EGF-stimulated junctional disruption and loss of E-cadherin protein. MMP-9 involvement in EGF-dependent down-regulation of E-cadherin was determined by siRNA specifically directed against MMP-9. Furthermore, treatment with recombinant MMP-9 or transient expression of MMP-9 is sufficient to reduce E-cadherin levels in differentiated ovarian tumor cells. Stable overexpression of MMP-9 led to a loss of E-cadherin and junctional integrity, and promoted a migratory and invasive phenotype. Thus, elevated MMP-9 protein expression is sufficient for junctional disruption and loss of E-cadherin in these cells. The associations between EGFR activation, MMP-9 expression, and E-cadherin were investigated in human ovarian tumors and paired peritoneal metastases wherein immunohistochemical staining for activated (phospho) EGFR and MMP-9 colocalized with regions of reduced E-cadherin. These data suggest that regulation of MMP-9 by EGFR may represent a novel mechanism for down-modulation of E-cadherin in ovarian cancer.

Síndrome del intestino irritable y cortocircuito cardíaco derecha-izquierda por foramen oval permeable / Irritable bowel syndrome and cardiac right-to-left shunt through a patent foramen oval

FUNDAMENTO Y OBJETIVO: El síndrome de intestino irritable (SII) y el foramen oval permeable(FOP) tienen una prevalencia similar en la población general, afectan más a mujeres y se relacionancon otras enfermedades como la migraña. La presencia de FOP con cortocircuito (shunt) derecha izquierda (CDI) podría alterar el metabolismo de ciertas sustancias como la serotonina, muy relacionadas con el SII. Sin embargo, hasta la fecha no se ha estudiado la posibleasociación entre ambas entidades.PACIENTES Y MÉTODO: Se ha realizado una encuesta telefónica para determinar la presencia de SII enpacientes atendidos previamente para detección de CDI mediante ultrasonografía Doppler transcraneal.Se analizó la presencia y el grado de CDI y se los comparó con los de sujetos sin síntomas gastrointestinales (NoGI). Se utilizaron los criterios de Roma II para el diagnóstico de SII u otra enfermedad funcional gastrointestinal (EFGI), y el consenso de Venecia-1999 para el CDI.RESULTADOS: De 180 pacientes encuestados, 33 (18,3%) tenían SII y 62 (34,4%), otra EFGI.Tenían CDI un 41% de los NoGI, un 64% de los pacientes con SII y un 68% de los pacientes con otra EFGI (odds ratio [OR] = 2,56; p < 0,05 para SII, y OR = 3,06; p < 0,01 para otra EFGI). Los patrones masivos de CDI se registraron en el 27% de los NoGI, en el 39% de lospacientes con SII y en el 45% de los afectados por otra EFGI (OR = 1,73; p = 1 para SII, y OR = 2,21; p < 0,05 para otra EFGI).CONCLUSIONES: Se encontró mayor prevalencia de CDI cardíaco por FOP en pacientes con SII y otros trastornos funcionales digestivos. Su posible relación etiopatogénica debería considerarse en futuros estudios

BACKGROUND AND OBJECTIVE: Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentageof venous blood bypasses the lung filter and may increase these substances in blood.PATIENTS AND METHOD: A phone interview was done to determine the presence of IBS in patientspreviously attended for detection of RLS with transcranial Doppler ultrasound. The presenceand grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS.RESULTS: Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for otherFGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p <0.05 for other FGD).CONCLUSIONS: We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies

Valores de filtración glomerular obtenidos con 99mTc-DTPA v/s mediciones de clearance de creatinina y cálculo del filtrado glomerular por formula de Schwartz en una población pediátrica / Glomerular filtration rate by 99mTC-DTPA v/s creatinine clearance measurement and Glomerular filtration rate from Schwartz formula in a pediatric population

Comparamos la filtración glomerular obtenida del Renograma con DTPA (DTPA-GFR) con el clearance de creatinina (CC) y con la filtración glomerular calculada por formula de Schwartz (Schwartz-GFR). El interés por la (DTPA-GFR) deriva de la dificultad de obtener un resultado confiable de (CC) en la población pediátrica. Se estudiaron 47 pacientes, edad promedio 7 a 3m (1m - 18a7m), entre sep-2001 y mayo-2005. En todos se obtuvo (DTPA-GFR), (Schwartz-GFR) y en 18 de ellos se realizó además (CC). Se compararon las tres mediciones, separando grupos etarios. La mejor correlación se obtuvo al comparar el (DTPA-GFR) con el (CC) Pearson = 0,895. La correlación de (Schwartz) con (CC) mostró valores algo menores Pearson = 0,857 y la menor correlación se encontró al comparar (DTPA-GFR) con (Schwartz-GFR) en menores de 3 años Pearson = 0,560. Se concluye que la medición de (DTPA-GFR), muestra una leve mejor correlación con el clearance de creatinina que la estimación por el método de Schwartz y que podría considerarse un parámetro adicional de utilidad para evaluar la función renal en lactantes en los cuales es difícil realizar un Clearance de Creatinina.

Procura de órganos: no hay trasplantes sin donantes / Organ procurement: there are not transplantations without donors

No hay trasplantes de órganos y no hay órganos si no hay donantes. Esta es la conclusión fundamental tras analizar la experiencia en la procura de órganos para transplante, llevada a cabo por un médico especificamente destinado a esta función, en el Hospital Dr, Gustavo Fricke de Viña del Mar, entre el 1 de Enero de 1997 y el 30 de Junio de 1998. Con una casuística de 44 casos de donantes potenciales, se analizan los conceptos utilizados en la procura, estableciendo sus etapas, las patologías que permiten su iniciación y las contraindicaciones para ser donante, además de sus características de ocurrencia, horario, lugar dentro del Hospital y causales de pérdida de la donación. La falta de motivación y participación de los equipos médicos que laboran en los servicios en los que se producen los potenciales donantes, reafirma la necesidad de mejor información y coordinación, actividad que es mucho más productiva cuando es llevada a cabo por un médico especializado en la procura de órganos