Impact of the new coronavirus (SARS-CoV-2) pandemic on climacteric women's health: Websurvey.

OBJECTIVE: The menopausal transition is an important milestone in female reproductive life. Many studies have been conducted to assess the impact of the COVID-19 pandemic on women, but few of them focus on the climacteric population. This study aimed to investigate changes in the health and health care of climacteric women aged 40-70 years residing in Brazil during the pandemic period. METHOD: A cross-sectional study was carried out using an electronic form with questions related to sociodemographic, clinical and gynecological data, treatments, access to health services and changes in behavior. RESULTS: A total of 419 women answered the questionnaire. Sixty percent reported weight gain and 50.8% reported reduced physical activity practice. More than 80% reported worsening mental health and 66.1% had a change in their sleep pattern. More than half reported having difficulty accessing gynecological consultations and routine examinations. Women living in capital cities reported a greater change in alcohol consumption (p = 0.002). Income change was associated with a higher prevalence of weight gain (p = 0.033) and changes in sleep quality (p = 0.018). CONCLUSION: We observed an important reduction in the health care of climacteric women during the pandemic period, such as a decrease in medical consultations and preventive examinations, worsening of life habits and deterioration in mental health.

Efficacy and safety of ultra-low-dose estradiol and norethisterone in postmenopausal Brazilian women.

OBJECTIVE: This study aimed to evaluate the efficacy and safety of oral ultra-low-dose continuous combination of 17ß-estradiol (17ß-E2) and norethisterone acetate (NETA) in postmenopausal Brazilian women. METHODS: Postmenopausal women (age 45-60 years) with amenorrhea >12 months and intact uterus, with moderate to severe vasomotor symptoms, were included. The vasomotor symptoms and endometrial bleeding were evaluated by a daily diary for 24 weeks, and the women were assessed at baseline and endpoint. RESULTS: A total of 118 women were included. The group treated with 0.5 mg 17ß-E2/0.1 mg NETA (n = 58) showed a percentage reduction of 77.1% in the frequency of vasomotor symptoms versus 49.9% in the placebo group (n = 60) (p = 0.0001). The severity score showed a reduction in the treatment group when compared to the placebo (p < 0.0001). The adverse events were comparable between the groups; however, in the 0.5 mg 17ß-E2/0.1 mg NETA group there were more complaints of vaginal bleeding; despite that, in most cycles in both treatment groups, more than 80% of women experienced amenorrhea. CONCLUSIONS: The combination of 0.5 mg 17ß-E2/0.1 mg NETA in a continuous combination regimen was shown to be effective in reducing the frequency and severity of vasomotor symptoms in Brazilian postmenopausal women.

Early decrease in lean mass and bone mass in postmenopausal women: a cross-sectional study.

OBJECTIVE: The effect of menopause transition in body composition was evaluated in a cross-sectional study. METHOD: The study was carried out in an outpatient clinic of Brazil enrolling premenopausal (n = 64) and postmenopausal (n = 42) women aged between 44 and 52 years, with weight stability (±2 kg) for at least 6 months before evaluation. Participants answered a sociodemographic semi-structured questionnaire, the Menopause Rating Scale, the International Physical Activity Questionnaire, 24-h dietary recall and a visual analogue scale of appetite. Blood biochemical, anthropometry and densitometry measurements were used for body composition estimation. RESULTS: Most participants were overweight (31.4%) or obese (45.7%) and categorized as 'high active' in physical activity (65.7%). Lean mass and bone mass decreased in the first few years of menopause. A metabolic turn to an increase of lipids was observed, represented by greater total cholesterol and high-density lipoprotein cholesterol levels. Menopause transition did not alter body fat distribution. Total body fat, android fat and gynoid fat were positively related to smoking habit, and android fat was also positively related to waist circumference. CONCLUSION: Taken together, early postmenopause can be considered a time window of opportunity for preventing ailments such as atherogenic profile, obesity, increased cardiovascular risk and osteoporosis.

Impact of postmenopausal vaginal discomfort on sex and relationships in Brazil: the CLOSER survey.

OBJECTIVE: The CLOSER (CLarifying Vaginal Atrophy's Impact On SEx and Relationships) survey investigated how postmenopausal vaginal atrophy (VA) affects relationships between Brazilian women and male partners. METHODS: Postmenopausal women (age 55-65 years) with VA, and male partners of women with the condition, completed an online survey on the impact of VA and local estrogen treatment on intimacy and relationships. RESULTS: A total of 360 women and 352 men from Brazil were included. Women (83%) and men (91%) reported that they were comfortable discussing VA with their partners. Women's key source of information on VA was health-care providers (HCPs), but 44% felt that not enough information is available. VA caused 70% of women to avoid sexual intimacy and resulted in less satisfying sex. VA had a negative impact on women's feelings and self-esteem. Women (76%) and men (70%) both reported that treatment with vaginal estrogen improved their sexual relationship, primarily by alleviating women's pain during sex. Women (56%) and men (59%) felt closer to each other after treatment. CONCLUSIONS: VA had a negative impact on sexual relationships for both women and men in Brazil, and reduced women's self-confidence. Vaginal hormone therapy improved couples' sexual relationships. A proactive attitude of HCPs is essential to educate women on VA and the potential benefits of treatment.

Vaginal Health: Insights, Views & Attitudes survey in Latin America (VIVA-LATAM): focus on Brazil.

OBJECTIVE: A previous survey investigated postmenopausal vaginal atrophy in a sample of women across Latin America. To help implement a tailored approach to improve postmenopausal care and outcomes in Brazil, we consider results from the survey for this country. METHODS: A total of 2509 postmenopausal women resident in Argentina, Brazil, Chile, Colombia, or Mexico completed an online questionnaire. The Brazilian cohort comprised 504 women. RESULTS: Over half of the Brazilian cohort (56%) reported experiencing symptoms of vaginal atrophy; most described them as moderate or severe (76%), and almost half (48%) experienced symptoms for at least 1 year. Three-quarters of the Brazilian cohort (75%) were unaware of the chronic nature of the condition. Upon experiencing symptoms of vaginal atrophy, 92% had visited a health-care provider to discuss treatment options. Overall, 56% were aware of some form of local hormone therapy and 40% of those affected by vaginal atrophy had used such treatment. CONCLUSION: Postmenopausal women in Brazil are likely to benefit from increased awareness of the symptoms of vaginal atrophy. Health-care providers can potentially improve outcomes by helping women to understand the chronic nature of the condition and available treatment options. Women may be open to education pre menopause, before symptoms occur.

Metabolic syndrome in type 1 diabetes mellitus. Does it have any impact on the course of pregnancy?

UNLABELLED: To determine whether the symptoms of metabolic syndrome (MS), if accompanied by oxidative stress (OS), in type 1 diabetes mellitus (DM) patients could affect the course of pregnancy and the perinatal outcome. Oxidized low density lipoproteins (ox-LDL) and total lipid peroxides (TLP) were studied in 98 pregnant women with type 1 DM in the I(st) and III(rd) trimesters. 24% of the participants met the criteria of MS. Vascular complications were significantly more frequent in the MS-group (41.9% vs. 17.4% in the non-MS group, p<0.05). No differences in the markers of OS between the MS and the non-MS groups were noted in either the I(st) or the III(rd) trimester. A significant gestational rise in Per-Ox was found in both groups. Chronic hypertension was associated with significant differences in ox-LDL levels in both the I(st) and III(rd) trimester. No differences in perinatal outcome, as measured by abnormal birth weight or poor neonatal status (Apgar score<6, umbilical venous and/or arterial pH<7.20), were found. CONCLUSIONS: 1) MS in type 1 DM is associated with some changes in markers of oxidative stress, but it poses no additional risk to the course of pregnancy and perinatal outcome in properly controlled and treated pregnant women with type 1 DM. 2) Maternal hypertension is the only component of MS in diabetic pregnancy that is associated with significant changes in markers of oxidative stress. 3) MS is significantly more frequent in diabetic pregnant women with co-existing vascular complications and obesity.

Concentration of chemokines in peripheral blood in first trimester of diabetic pregnancy.

BACKGROUND: Several types of regulators (i.e. chemokines and metalloproteinases) are considered to play a crucial role in pregnancy by local modulation of the immune system at the level of peripheral leukocytes. The aim of this study was to determine whether changes in chemokines (interferon-gamma-inducible protein (IP-10), monocyte chemotactic peptide-1(MCP-1), cytokines regulated upon activation normal T cell expressed and secreted (RANTES) and matrix metalloproteinase-9 (MMP-9)) concentrations in diabetic patients could affect the course of pregnancy. METHODS: The study group consisted of 65 diabetics in the first trimester of pregnancy. Some 47 pregnancies were successfully continued to delivery, 18 were terminated with spontaneous miscarriages. Twenty healthy women matched for gestational age served as a control group. RESULTS: Glycated haemoglobin (HbA1C), vascular complications and lipoproteins (cholesterol, HDL-cholesterol, low density lipoprotein (LDL)-cholesterol and triglicerides) concentrations in maternal blood did not influence the chemokines concentrations. Lower RANTES level and higher MMP-9 concentrations were found in diabetic women. MCP-1 and RANTES levels differed significantly between pregnancies with good and poor perinatal outcome. A logistic regression model revealed that not only duration of diabetes, age of patients, HbA1C and insulin requirements, but also MMP-9,RANTES, MCP-1 and LDL-cholesterol levels seem to be involved in first trimester metabolism. CONCLUSIONS: Our results suggest the possible role of chemokines in early pregnancy development, especially in well-controlled diabetic patients, when hyperglycaemia is unlikely to be the main reason for an unfavourable outcome. Our results show that MCP-1 and RANTES might serve as predictive factors for an unfavourable outcome in diabetic pregnancy, whereas MMP-9 seems to be a marker of immunological changes related to mild hyperglycaemia. However, the open question of how the modulation of chemokines concentrations might be applied to prevent miscarriage in diabetic patients remains.

Survival and prognostic factors of patients treated for Stage I to Stage III endometrial carcinoma in a reference cancer center in Southern Brazil.

PURPOSE: To describe two- and five-year survival of patients with Stage I to III endometrial carcinoma and to identify prognostic factors. STUDY DESIGN: Concurrent cohort study. PATIENTS AND METHODS: Seventy-two patients were operated on by the same surgeon and followed up for at least two years. All the histopathological examinations were performed by the same pathologist. Survival was analyzed by the Kaplan-Meier method. Age, body mass index, tumor grade, myometrial invasion, histological type and stage were correlated with death. RESULTS: Overall survival at two and five years was 90.2% and 81.4%, respectively. By bivariate analysis, FIGO stage, myometrial invasion, tumor grade, histology, adnexal and/or lymph node metastasis and age were significant predictors of death (p < 0.05). Multivariate analysis revealed significant associations with death: FIGO Stage III (p = 0.001), histological type other than endometrioid (p = 0.027) and age 70 or more (p = 0.04). CONCLUSION: Endometrial carcinoma Stage III patients, histological types other than endometrioid and age 70 years or more are at significant risk for death.

Estrogen-metabolizing gene polymorphisms and lipid levels in women with different hormonal status.

Endogenous and exogenous sex steroid hormones have multiple effects on lipid and lipoprotein metabolism. It is also known that estrogen has antiatherogenic actions, therefore we considered examining whether there was any association between polymorphisms in estrogen-metabolizing genes and lipid levels in women. We investigated the association between variants in genes related to estrogen biosynthesis (CYP19-TTTA(n)) and estrogen catabolism (CYP1A1*2A, CYP1A1*2C, CYP1A2-Asn516Asn, CYP3A4*1B, and COMT-Val158Met) with serum lipid levels in a cross-sectional study with 472 Brazilian women of European descent. They were divided into three subgroups according to their hormonal status: premenopausal women (n=187), postmenopausal women exposed to hormonal replacement therapy (HRT) (n=118), and postmenopausal women unexposed to HRT (n=167). The postmenopausal women receiving HRT who were carriers of the CYP3A4*1B variant showed lower low-density lipoprotein cholesterol levels than wild-type homozygotes. Premenopausal women homozygous for the CYP1A1*2C allele had higher high-density lipoprotein cholesterol levels than heterozygotes. While the CYP1A1*2C variant probably has a higher catalytic activity, the functional implications of the CYP3A4 polymorphism are still uncertain. These data are the first attempt to associate estrogen metabolism genes to lipid levels in women.

Estrogen receptor 2 and progesterone receptor gene polymorphisms and lipid levels in women with different hormonal status.

Sex steroid hormones have multiple effects on lipid metabolism. We investigated the association between two common single nucleotide polymorphisms of the estrogen receptor 2 gene (ESR2), 1082G>A and 1730A>G, and PROGINS polymorphism of the progesterone receptor gene (PGR) with lipoprotein levels in a cross-sectional study with 472 women of European descent. The women were classified into three subgroups according to hormonal status, premenopausal women (n=187; mean age=34+/-9.7 years), postmenopausal women exposed to hormone replacement therapy (HRT) (n=118; 56+/-6.7 years) and postmenopausal women unexposed to HRT (n=167; 58+/-9.8 years). The premenopausal and postmenopausal women exposed to HRT, both carriers of G/A genotype, exhibited LDL-C (P=0.027 and 0.001, respectively) and T-chol levels (P=0.035 and 0.001, respectively) lower than carriers of G/G genotype. This association was not observed in postmenopausal women unexposed to HRT. These results suggest that ESR2 1082G>A genotype may influence LDL-C levels in women with abundant estrogen levels, due to either endogenous or exogenous sources.

Endometrial response to a cyclic regimen of percutaneous 17beta-estradiol and low-dose vaginal micronized progesterone in women with mild-to-moderate hypertension.

Endometrial response to natural estradiol and low-dose vaginal progesterone replacement therapy was evaluated in 20 postmenopausal women with chronic, mild-to-moderate hypertension. A cyclic hormone replacement therapy (HRT) regimen was used (21/28 days) with percutaneous estradiol (1.5 mg/day) and vaginal micronized progesterone (100 mg/day). Menopausal symptoms decreased and estradiol concentrations increased substantially and remained in the physiological range throughout treatment. Serum gonadotropin concentrations decreased significantly (p < 0.001, Friedman's ANOVA). Bone mineral density increased by 2.1% (p = 0.029) only at the lumbar spine. Endometrial thickness remained unchanged. Breakthrough bleeding or spotting occurred in 18% of cycles in the first 3 months of HRT, 30% in months 4-9 and 22% in months 10-12. Withdrawal bleeding occurred in 40% of cycles in the first 3 months and decreased to 25% in months 10-12. At month 12, there were 11 women with amenorrhea due to endometrial atrophy. Nine women had active endometria (proliferative or secretory) and thus reported vaginal bleeding. No severe bleeding, hyperplasia, or carcinoma was found. Vaginal bleeding was tolerated, and no subject withdrew from the study. Results suggest that this regimen confers endometrial protection and is well tolerated, and can therefore safely be used for at least 1 year by postmenopausal women with hypertension and menopausal symptoms.

One year follow-up of hormone replacement therapy with percutaneous estradiol and low-dose vaginal natural progesterone in women with mild to moderate hypertension.

OBJECTIVE: The effects of natural estradiol and progesterone replacement therapy on lipoprotein and cardiovascular parameters were assessed in 20 postmenopausal women with mild to moderate systemic arterial hypertension. DESIGN: After confirming hypertension in the absence of antihypertensive treatment, blood pressure control was achieved by administration of amlodipine at individually adjusted doses. Hormone replacement therapy (HRT) was introduced in a cyclic regimen (21 of 28 days) with percutaneous estradiol (1.5 mg/day) and vaginal micronized progesterone (100 mg/day). RESULTS: Blood pressure and mean heart rate remained unchanged during HRT. Serial echocardiograph scans showed no change in left ventricle mass, but a significant reduction in the thickness of the left ventricular posterior wall was observed. During treatment, patients showed little variation in total cholesterol levels (baseline: 199+/-10 mg/dl, 12 months: 202+/-11 mg/dl), as well as in high-density lipoprotein (53+/-2 to 50+/-3 mg/dl), low-density lipoprotein (122+/-10 to 118+/-11 mg/dl), and triglycerides (111+/-13 to 126+/-13 mg/dl). A subgroup of 10 patients with initial total cholesterol levels >200 mg/dl responded to HRT with a slight but significant decrease of cholesterol levels after 12 months (265+/-10 to 237+/-12 mg/dl, p<0.05, repeated measures ANOVA). HRT did not change mean antithrombin III levels and affected neither plasma renin activity nor aldosterone levels. CONCLUSION: These results suggest that the proposed HRT regimen with percutaneous estradiol associated with low-dose vaginal micronized progesterone could be a safe alternative for postmenopausal women with hypertension at least during the period required to treat menopausal symptoms.

[Changes of regional cerebral blood flow in stroke patients assessed by SPECT]. / Zmiany regionalnego przeplywu krwi u chorych z udarem mózgu badane przy pomocy tomografii emisyjnej pojedynczego fotonu.

UNLABELLED: The aim of our work was to evaluate changes in regional cerebral blood flow (rCBF) in patients with TIA and/or completed stroke and localisation of fotopenic foci in basal conditions and, in some cases, after stimulation pharmacological trial with acetazolamide. One hundred and fifty three patients participated in the study--105 with completed stroke and 48 with TIA. Regional CBF (rCBF) was evaluated using a single-headed rotating gamma camera (Diacam, Siemens) with high resolution collimator, after injection of 740 MBq 99mTc-HMPAO (Ceretec, Amersham). Sixteen patients with TIA underwent SPECT at baseline and after injection of acetazolamide (ACZ). Relative regional perfusion was expressed as the ratio of cerebral/cerebellar activity. In the completed stroke population, the perfusion ratios were significantly lower than those of controls and TIA at baseline (p < 0.001) and TIA after ACZ (p < 0.01). CONCLUSIONS: This study shows a significant difference in rCBF in patients with completed stroke and/or TIA and controls. In patients with TIA and rCBF similar to that observed in controls, perfusion deficits may be visible after ACZ injection.

The effect of short-term treatment with interferon beta 1a on acute experimental allergic encephalomyelitis.

The clinical and histological picture and immunocytochemical expression of some cytokines on infiltrates in the central nervous system of Lewis rats were studied in adult rats in the course of short-term therapy of acute experimental allergic encephalomyelitis with interferon beta 1a (IFN beta 1a). There was established the beneficial effect of the short-term treatment of EAE with IFN beta 1a, applied at the early onset of the experimental disease. The effect of IFN beta 1a on EAE seems likely to be associated with the inhibition of proinflammatory cytokines and stimulation of anti-inflammatory ones.

Biological markers to confirm diagnosis and monitor the therapy in multiple sclerosis patients.

In patients suspected of multiple sclerosis (MS), even in the case of MRI positive changes, cerebrospinal fluid (CSF) analysis is of great practical value. Until now, however, only IgG index, restricted oligoclonal IgG bands and the examination of IgG subclasses have been of practical value. The determination of other immunological markers is too expensive to be introduced into laboratory diagnostic standards in MS. However, the clinical trials should be monitored by a large set of markers of MS activity, including the estimation of anti MBP antibodies, presence of MBP material in the CSF and concentration of sVCAM-1, ICAM-1, PECAM-1 in CSF and serum.

[Chemokines MIP-1 and MCP-1 and patients with multiple sclerosis treated with interferon beta-1a]. / Chemokiny: MIP-1 alpha oraz MCP-1 u pacjentów ze stwardnieniem rozsianym leczonych interferonem beta-1a.

Chemokines: MCP-1 and MIP-1 alpha may play an important role in the pathogenesis of multiple sclerosis, influencing migration of lymphocytes to the CNS. One of possible mechanisms of interferon beta action may be an effect on chemokines. We measured MCP-1 and MIP-1 alpha chemokines in sera of 24 patients with MS treated with interferon beta-1a before and after 3 months of therapy and in 15 control patients. There was a significant increase of MIP-1 alpha concentration in sera of MS patients in comparison with control group. After 3 months of therapy with interferon beta-1a, MIP-1 alpha and MCP-1 levels did not differ from the values before therapy. Investigations will be continued after longer time of treatment with interferon beta.

[New data concerning the significance of immunoglobulins and B cells in the pathogenesis of multiple sclerosis]. / Rola immunoglobulin i komórek B w patogenezie stwardnienia rozsianego w swietle nowych danych.

Contemporary studies concerning the significance of immunoglobulins in the mechanism of multiple sclerosis are based on the analysis on the genome level. It was found that genes encoding immunoglobulins are restricted to active gene segments and showed a great frequency of mutations in sequences encoding the complementarity-determining regions (CDR s). The above presented results led to the conclusion, that synthesis of immunoglobulins and activation of B cells are not only the result of nonspecific reaction but are the antigen-driven response, related to the immunological mechanism of the disease.

[Actual clinical and immunological problems of neurosyphilis and neurotuberculosis]. / Aktualne zagadnienia kliniczne i immunologiczne kily i gruzlicy ukladu nerwowego.

In the past neurosyphilis and tuberculosis of the nervous system were the basic clinical problems in neurology. The decrease of the incidence rate has changed the situation. However, in the last few years, especially in connection with HIV infection, the incidence has even started to increase. In Poland the epidemiological situation is not alarming, but there exists some concern connected with the epidemic of syphilis and tuberculosis in countries near the Polish eastern border. In the laboratory diagnosis of syphilis the highest specificity and sensitivity has the TPHA test. In the therapy till now the best results are obtained with megadoses of penicillin. Early diagnosis of tuberculous meningitis, what is the decisive factor for positive results of the treatment can be obtained by PCR technique for detection of DNA genome of mycobacterium. In the treatment the method of choice is the concomitant use of four antimycobacterial drugs. However, there exists the serious problem of often observed drug resistance of mycobacterium.