Sexual orientation and gynecologic medical care: A cross-sectional study with Brazilian women.

OBJECTIVE: To study a sample of Brazilian lesbian, bisexual, and heterosexual women concerning their gynecologic history and their experience with gynecologic care. METHODS: An internet-based survey for women aged 18 years or older was conducted to gather epidemiologic data on sexual habits, primary gynecologic diseases, and patient-gynecologist relationships. RESULTS: The survey was answered by 1201 women, with 571 reporting being heterosexual, 272 lesbian, and 358 bisexual. The lesbian/bisexual (LB) group contained fewer Caucasian individuals, used more public health resources, and had more individuals consuming tobacco, alcohol, and recreational drugs. No significant differences were found in the number of individuals with diabetes mellitus, obesity, hypertension, and sexually transmitted diseases. Depression was more common in the LB group. Endometriosis and vaginismus were more common in bisexual women, whereas polycystic ovary syndrome was more frequent in lesbians. Questions on the patient-gynecologist relationship revealed that most LB women felt uncomfortable and dissatisfied with the treatment received. CONCLUSION: The LB group had different epidemiologic characteristics from the heterosexual group. Differences in morbid antecedents were found only in endometriosis, vaginismus, and polycystic ovary syndrome. Most LB Brazilian women are dissatisfied with treatment received from gynecologists.

[Ovarian function in systemic lupus erythematosus patients undergoing the use of cyclophosphamide in two major rheumatologic care centers in Curitiba, Paraná State]. / Função ovariana em mulheres lúpicas submetidas ao uso de ciclofosfamida em dois grandes centros de atendimento reumatológico de Curitiba, Estado do Paraná.

PURPOSE: To evaluate the ovarian response after cyclophosphamide use (CPM) in patients with systemic lupus erythematosus (SLE) and to correlate the age and cumulative dose findings with changes in menstrual cycle and/or progression to ovarian failure (OF). METHODS: This was a cross-sectional, retrospective study of 50 patients with a diagnosis of SLE who used CFM with a clinical follow-up of at least 1 year. Included were patients aged 12-40 years, who had undergone chemotherapy for SLE control and who had regular menstrual cycles before the beginning of CPM treatment. Patients who discontinued follow-up, who were followed up for less than one year or who had irregular/absent menses before the beginning of CPM treatment were excluded. All women studied were submitted to an interview and a questionnaire containing questions about the pattern of the menstrual cycle before and after therapy, and about the gestational periods and contraception. We asked if the patients had been instructed about the side effects and consequences of CFM. Statistical analysis was performed using the Student t-test and the Mann Whitney, χ2 and nonparametric Kolmogorov-Smirnov tests. RESULTS: The mean age of the patients included in the study was 30.8 years and the mean age at the time of use of CPM was 25.3 years. After CFM, 24% of patients stopped menstruating, 28% returned to regular cycles and 48% continued to have irregular cycles. It was found that the patients who developed OF had longer disease duration (12.3 years) than those who did not develop it (8.9 years). Thirteen patients became spontaneously pregnant after CFM; however, 66% progressed to abortion. The mean age of the patients who used CFM and developed OF was 28.1 years. Amenorrhea occurred in 50% of those aged 31-40 years, in 22.2% of those aged 21-30 years and in 7.7% of those aged 12-20 years. Our study showed no statistical correlation between cumulative dose and OF, although cumulative doses greater than 11 grams tended to promote some type of menstrual irregularity. CONCLUSION: SLE disease duration, age at the time of treatment and the highest cumulative doses are important predictors of OF after therapy with CFM. Pregnancy in lupus patients is more likely to evolve with abortion after the use of chemotherapy. It was seen that a small proportion of patients were aware of all the implications of the drug. Therefore, additional studies should be conducted for further knowledge and awareness of the importance of contraception and the preservation of ovarian tissue on the part of the medical community.

Função ovariana em mulheres lúpicas submetidas ao uso de ciclofosfamida em dois grandes centros de atendimento reumatológico de Curitiba, Estado do Paraná / Ovarian function in systemic lupus erythematosus patients undergoing the use of cyclophosphamide in two major rheumatologic care centers in Curitiba, Paraná State

OBJETIVO: Avaliar a resposta ovariana após uso de ciclofosfamida (CFM) em pacientes com lúpus eritematoso sistêmico (LES) e correlacionar os achados de tempo de doença e idade no período de utilização de CFM e dose cumulativa com alterações no ciclo menstrual e/ou evolução para insuficiência ovariana (IO). MÉTODOS: Foi um estudo transversal, retrospectivo, com 50 pacientes com diagnóstico de LES e que fizeram tratamento com CFM com seguimento clínico de, pelo menos, 1 ano. Foram incluídas pacientes com idade entre 12 e 40 anos e que apresentavam ciclos menstruais regulares prévios ao tratamento. Foram excluídas pacientes que descontinuaram o seguimento, ou este foi menor do que um ano, além daquelas que apresentaram irregularidade/ausência menstrual antes do uso do fármaco. Todas as mulheres estudadas foram submetidas à entrevista e à aplicação de questionário. Neste foram abordadas questões relevantes de padrão de ciclo menstrual antes e posterior à terapia, assim como períodos gestacionais e método contraceptivo. Foi questionado se as pacientes foram orientadas sobre os efeitos colaterais e as consequências da CFM. Para análise estatística, foram utilizados os testes t de Student, Mann-Whitney, do χ2 e o não paramétrico de Kolmogorov-Smirnov. RESULTADOS: A média de idade das pacientes incluídas no do estudo foi de 30,8 anos, e a média de idade no momento do uso de CFM, de 25,3 anos. Após a CFM, 24% das pacientes não menstruaram mais, 28% voltaram a ter ciclos regulares e 48% delas permaneceram com ciclos irregulares. Verificou-se que as pacientes que evoluíram com falência ovariana tinham maior tempo de doença (12,3 anos) do que aquelas que não evoluíram (8,9 anos). Treze pacientes tiveram gestação após a CFM, em todas ocorreu de forma espontânea; no entanto, 66% evoluíram com abortamento. A média de idade das pacientes que fizeram uso de CFM e evoluíram com falência ovariana foi de 28,1 anos. A amenorreia ocorreu em 50% das pacientes ...

PURPOSE: To evaluate the ovarian response after cyclophosphamide use (CPM) in patients with systemic lupus erythematosus (SLE) and to correlate the age and cumulative dose findings with changes in menstrual cycle and/or progression to ovarian failure (OF). METHODS: This was a cross-sectional, retrospective study of 50 patients with a diagnosis of SLE who used CFM with a clinical follow-up of at least 1 year. Included were patients aged 12-40 years, who had undergone chemotherapy for SLE control and who had regular menstrual cycles before the beginning of CPM treatment. Patients who discontinued follow-up, who were followed up for less than one year or who had irregular/absent menses before the beginning of CPM treatment were excluded. All women studied were submitted to an interview and a questionnaire containing questions about the pattern of the menstrual cycle before and after therapy, and about the gestational periods and contraception. We asked if the patients had been instructed about the side effects and consequences of CFM. Statistical analysis was performed using the Student t-test and the Mann Whitney, χ2 and nonparametric Kolmogorov-Smirnov tests. RESULTS: The mean age of the patients included in the study was 30.8 years and the mean age at the time of use of CPM was 25.3 years. After CFM, 24% of patients stopped menstruating, 28% returned to regular cycles and 48% continued to have irregular cycles. It was found that the patients who developed OF had longer disease duration (12.3 years) than those who did not develop it (8.9 years). Thirteen patients became spontaneously pregnant after CFM; however, 66% progressed to abortion. The mean age of the patients who used CFM and developed OF was 28.1 years. Amenorrhea occurred in 50% of those aged 31-40 years, in 22.2% of those aged 21-30 years and in 7.7% of those aged 12-20 years. Our study showed no statistical correlation between cumulative dose and OF, although cumulative ...

Gender effects of acute malathion or zinc exposure on the antioxidant response of rat hippocampus and cerebral cortex.

Gender is one of the most important factors in mammalian development and response to exogenous agents. Although there is increasing evidence that health effects of toxic xenobiotics differ in prevalence or are manifested differently in male and female, the molecular mechanisms related to these events remain unclear. In order to investigate the possible influence of gender, male and female Wistar rats from the same litter were exposed to zinc chloride (5 mg/kg, i.p.) or malathion (250 mg/kg, i.p.) 24 hr prior to the analyses of biochemical parameters related to the cholinergic and glutathione-antioxidant systems in cerebral cortex and hippocampus. After treatments, acetylcholinesterase (AChE) activity was reduced in the hippocampus and cerebral cortex of male and female rats treated with malathion, but the effect was more pronounced in the male group. Glutathione reductase (GR) and γ-glutamyl-transpeptidase activities were reduced in the hippocampus of males and females and a gender-specific effect of malathion was seen for glutathione S-transferase (GST), which was decreased only in male hippocampus and cortex, and for male cortical GR. Zinc chloride treatment decreased AChE activity in male and female cerebral cortex, with no obvious effect in the hippocampus. Male-specific antioxidant-related enzyme activity reductions were seen after zinc treatment for cortical GR, GST, glutathione peroxidase and glucose-6-phosphate dehydrogenase; and hippocampal GR. These results clearly demonstrate a greater detrimental effect on antioxidant-related enzyme activities in male hippocampus and cerebral cortex when rats were acutely exposed to malathion and zinc, demonstrating that the research on gender-related differences in health effects caused by xenobiotic and/or essential elements requires further attention.

Reinforcing a medical hypothesis with a new question: is there a subgroup of shrinking lungs syndrome that is induced by pleurisy in systemic lupus erythematosus and is this subgroup marked by anti-Ro/SSA?

Shrinking lungs syndrome (SLS) is a rare entity associated with autoimmune diseases and its underlying pathogenesis is still unclear. We describe a series of seven consecutive cases of SLS in systemic lupus erythematosus, all of them with serositis and six (85.7%) with anti-Ro/SSA antibodies. Our findings reinforce the hypothesis that SLS may be, in some cases, a consequence of diaphragmatic restriction due to pleuritic pain, and we suggest anti-Ro/SSA as a marker of this subgroup of SLS.