Determining the cost-effectiveness of follitropin alfa biosimilar compared to follitropin alfa originator in women undergoing fertility treatment in France.

Objective: The study assessed cost-effectiveness of follitropin alfa biosimilar versus the originator in terms of cost per cumulative live-birth (CLB) for the French healthcare system based on real-world evidence. Follitropin alfa biosimilars have been shown to have comparable clinical outcomes to the originator, in both clinical studies and real-world settings, in terms of oocyte retrieval and cumulative live-birth rate (CLBR). Previous health economic studies comparing the cost-effectiveness of follitropin alfa biosimilars against the originator utilised clinical trial data, leaving ambiguity over cost-effectiveness in real-world settings. Additionally, previous cost-effectiveness analysis has been performed for live-births following only fresh embryo transfers, whereas, fresh and frozen transfers are common in clinical practice. This study investigates the cost per CLB, which more closely models clinical practice. Study design: A decision-tree cost-effectiveness model was developed based on the total costs and CLBR per ovarian stimulation (OS) for a follitropin alfa biosimilar (Bemfola®, Gedeon Richter Plc, Budapest, Hungary) and the originator (Gonal-f®, Merck KGaA, Darmstadt, Germany). A time horizon of one year from oocyte retrieval to embryo transfer was used but costs from resulting transfers were also included. Clinical inputs were taken from the REOLA real-world study or clinician insights, while acquisition costs were taken from French public databases. The output was cost per CLB following one OS. One-way sensitivity analysis was performed to determine the largest model drivers. Results: Cost per CLB was €18,147 with follitropin alfa biosimilar and €18,834 with the originator, saving €687 per CLB following OS with the biosimilar. When wastage estimates were considered the biosimilar cost saving is estimated to be between €796 and €1155 per CLB further increasing cost savings. Irrespective of wastage, if used ubiquitously throughout France for ART, the biosimilar could save the French health system €13,994,190 or lead to 771 more births when compared to its higher-cost originator. Sensitivity analysis showed that the originator's relative CLBR had the greatest impact on the model. Conclusion: This analysis demonstrates that the follitropin alfa biosimilar, Bemfola®, is a more cost-effective option for OS compared with the originator from a French healthcare payer perspective, in terms of cost per CLB.

Investigating the medical journey of endometriosis-affected women: Results from a cross-sectional web-based survey (EndoVie) on 1,557 French women.

OBJECTIVE: To investigate the medical journey and the quality of life of French endometriosis-affected women, from the onset of the symptoms to the therapeutic management. STUDY DESIGN: Between January 15th 2020 and February 3rd 2020, a prospective cross-sectional web-based survey was conducted among women diagnosed with endometriosis. The questionnaire included 52 questions distributed in five sections (screening, sociodemographic characteristics, impacts on quality of life, SF36 questionnaire, management of endometriosis and proposals for care improvement). RESULTS: One thousand five hundred fifty-seven endometriosis-affected women aged of 42±12.8 years answered the questionnaire. On average, 7 years elapsed between the first symptoms (at 23.8 ± 10.2 years) and the diagnosis (31.0 ± 8.9 years). The mean number of symptoms was 4.6 ± 2.3, with 82 % of women experiencing pain scores between 7 and 10/10. Following diagnosis, 66 % women received a medical treatment, mostly hormonal treatments (45 %), with a significant decrease in pain intensity (VAS scores after treatment = 4.9 ± 2.7, p < 0.001). Most women (62 %) had already been operated, among whom 22 % by laparotomy. Finally, patients reported numerous impacts on their daily lives, particularly on the sexual, psychological, and physical fields. The overall mean score of quality of life was 4.3 ± 2.6 /10. CONCLUSION: This large prospective web-based survey underlines that the journey of women with endometriosis is long and difficult until diagnosis and efficient treatment. It emphasizes the urgent need to reduce the diagnostic delay and thereby the burden of endometriosis on women's lives. Moreover, the creation of referral multidisciplinary centers appears to be crucial to improve the management of the disease.

Does paternal age affect the live birth rate in donor oocyte cycles? A systematic review and meta-analysis.

PURPOSE: While delayed parenthood is increasing worldwide, the effect of paternal age on in vitro fertilization (IVF) outcomes remains unclear. The egg donation model appears to be relevant to studying the independent impact of paternal age on clinical outcome, but the available studies are heterogeneous and contradictory. This systematic review and meta-analysis aimed to assess the relationship between paternal age and live birth rate (LBR) in egg donation cycles. METHODS: A systematic search of the literature was conducted in PubMed, Embase, and the Cochrane Library from inception to June 30, 2021. All studies on egg donation cycles where LBR is reported according to male age were included. Study selection, bias assessment, and data extraction were performed by two independent reviewers according to the Cochrane methods. RESULTS: Eleven studies involving 10,527 egg donation cycles were finally included. The meta-analysis showed a slight but significant and linear decrease in LBR with increasing paternal age (estimate - 0.0055; 95% CI (- 0.0093; - 0.0016), p = 0.006), with low heterogeneity (I2 = 25%). No specific threshold was identified. A similar trend toward decreased clinical pregnancy rate with advancing paternal age was found but did not reach statistical significance (p = 0.07). CONCLUSION: This meta-analysis demonstrates that increasing paternal age is associated with a slight but significant and linear decrease in the live birth rate in egg donation cycles, with no apparent threshold effect. Although this requires further confirmation, this information is important for counseling men who are considering delayed childbearing.

A real-world study of ART in France (REOLA) comparing a biosimilar rFSH against the originator according to rFSH starting dose.

BACKGROUND: Since the first launch of a biosimilar recombinant follicle stimulating hormone (rFSH), Bemfola®, in Europe in 2014, it has been possible to study in routine clinical care throughout France the effectiveness of a biosimilar rFSH including according to different rFSH starting doses. METHODS: REOLA was a non-interventional, retrospective, real world study using anonymized data from 17 Assisted Reproductive Technology (ART) centres' data management systems across France including 2,319 ART ovarian stimulation cycles with Bemfola® and 4,287 ART ovarian stimulation cycles with Gonal-f®. For both products, four populations were studied according to starting dose of rFSH: < 150 IU, 150 - 224 IU, 225 - 299 IU and ≥ 300 IU. The primary endpoint was the cumulative live birth rate (cLBR) per commenced ART ovarian stimulation cycle including all subsequent fresh and frozen-thawed embryo transfers starting during a follow up period of at least 1 year following oocyte retrieval. RESULTS: A direct relationship of increasing rFSH starting dose with increasing age, increasing basal FSH, decreasing AMH and increasing body mass index was noted. No clinically relevant differences were seen in all outcomes reported, including the cLBR, between Bemfola® and Gonal-f®, but for both drugs, an association was seen with increasing rFSH starting dose and decreasing cLBR. CONCLUSIONS: The REOLA study demonstrates that the cLBR with Bemfola® is very similar to Gonal-f® across all patient subpopulations. The cLBR is inversely related to the rFSH starting dose irrespective of the drug used, and the REOLA study provides reassurance of the clinical effectiveness of a biosimilar rFSH used in a real world setting.

Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey.

OBJECTIVE: To evaluate the impact of infertility and Medically Assisted Reproduction (MAR) throughout all aspects of life among infertile women and men. MATERIALS AND METHODS: An online survey included 1 045 French patients (355 men, 690 women) who were living or had lived the experience of infertility and MAR. The questionnaire included 56 questions on several domains: global feelings, treatment burden, rapport with medical staff, psychosocial impact, sexual life and professional consequences. RESULTS: Respondents had experienced an average of 3.6 (95% CI: 3.3-3.9) MAR cycles: 5% (n = 46) were pregnant, 4% (n = 47) were waiting to start MAR, 50% (n = 522) succeeded in having a live birth following MAR, 19% (n = 199) were currently undergoing ART, and 21% (n = 221) dropped out of the MAR process without a live birth. Satisfaction rates regarding the received medical care were above 80%, but 42% of patients pointed out the lack of information about non-medical support. An important impact on sexual life was reported, with 21% of patients admitted having not had intercourse for several weeks or even several months. Concerning the impact on professional life, 63% of active workers currently in an MAR program (n = 185) considered that MAR had strong repercussions on the organization of their working life with 49% of them reporting a negative impact on the quality of their work, and 46% of them reporting the necessity to lie about missing work during their treatment. CONCLUSION: Despite a high overall level of satisfaction regarding medical care, the burden of infertility and MAR on quality of life is strong, especially on sexuality and professional organization. Clinical staff should be encouraged to develop non-medical support for all patients at any stage of infertility treatment. Enterprises should be warned about the professional impact of infertility and MAR to help their employees reconcile personal and professional life.

Day 5 versus Day 6 blastocyst transfers: a systematic review and meta-analysis of clinical outcomes.

STUDY QUESTION: Is there a difference in clinical pregnancy and live birth rates (LBRs) between blastocysts developing on Day 5 (D5) and blastocysts developing on Day 6 (D6) following fresh and frozen transfers? SUMMARY ANSWER: D5 blastocyst transfers (BTs) present higher clinical pregnancy and LBRs than D6 in both fresh and frozen transfers. WHAT IS KNOWN ALREADY: BT is increasingly popular in assisted reproductive technology (ART) centers today. To our knowledge, no meta-analysis has focused on clinical outcomes in both fresh and frozen BT. Concerning frozen blastocysts, one meta-analysis in 2010 found no significant difference in pregnancy outcomes between D5 and D6 BT. Since then, ART practices have evolved particularly with the wide use of vitrification, and more articles comparing D5 and D6 BT cycles have been published and described conflicting results. STUDY DESIGN, SIZE, DURATION: Systematic review and meta-analysis of published controlled studies. Searches were conducted from 2005 to February 2018 on MEDLINE and Cochrane Library and from 2005 to May 2017 on EMBASE, Eudract and clinicaltrials.gov, using the following search terms: blastocyst, Day 5, Day 6, pregnancy, implantation, live birth and embryo transfer (ET). PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 47 full-text articles were preselected from 808 references, based on title and abstract and assessed utilizing the Newcastle-Ottowa Quality Assessment Scales. Study selection and data extraction were carried out by two independent reviewers according to Cochrane methods. Random-effect meta-analysis was performed on all data (overall analysis) followed by subgroup analysis (fresh, vitrified/warmed, slow frozen/thawed). MAIN RESULTS AND THE ROLE OF CHANCE: Data from 29 relevant articles were extracted and integrated in the meta-analysis. Meta-analysis of the 23 studies that reported clinical pregnancy rate (CPR) as an outcome, including overall fresh and/or frozen ET cycles, showed a significantly higher CPR following D5 ET compared with D6 ET (risk ratio (RR) = 1.27, 95% CI: 1.15-1.39, P < 0.001). For CPR, calculated subgroup RRs were 2.38 (95% CI: 1.74-3.24, P < 0.001) for fresh BT; 1.27 (95% CI: 1.16-1.39, P < 0.001) for vitrified/warmed BT; and 1.15 (95% CI: 0.93-1.41, P = 0.20) for slow frozen/thawed BT. LBR was also significantly higher after D5 BT (overall RR = 1.50 (95% CI: 1.32-1.69), P < 0.001). The LBR calculated RRs for subgroups were 1.74 (95% CI: 1.37-2.20, P < 0.001) for fresh BT; 1.38 (95% CI: 1.23-1.56, P < 0.001) for vitrified/warmed BT; and 1.44 (95% CI: 0.70-2.96, P = 0.32) for slow frozen/thawed BT. Sensitivity analysis led to similar results and conclusions: CPR and LBR were significantly higher following D5 compared to D6 BT. LIMITATIONS, REASONS FOR CAUTION: The validity of meta-analysis results depends mainly on the quality and the number of the published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). Slow frozen/thawed subgroups showed substantial heterogeneity. WIDER IMPLICATIONS OF THE FINDINGS: In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts in both fresh and frozen cycles. Further RCTs are needed to address the question of whether D6 embryos should be transferred in a fresh or a frozen cycle. STUDY FUNDING/COMPETING INTEREST(S): This work was sponsored by an unrestricted grant from GEDEON RICHTER France. The authors have no competing interests to declare. REGISTRATION NUMBER: CRD42018080151.

Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis.

BACKGROUND: A worldwide increase in the prevalence of obesity has been observed in the past three decades, particularly in women of reproductive age. Female obesity has been clearly associated with impaired spontaneous fertility, as well as adverse pregnancy outcomes. Increasing evidence in the literature shows that obesity also contributes to adverse clinical outcomes following in vitro fertilization (IVF) procedures. However, the heterogeneity of the available studies in terms of populations, group definition and outcomes prevents drawing firm conclusions. A previous meta-analysis published in 2011 identified a marginal but significant negative effect of increased female body mass index (BMI) on IVF results, but numerous studies have been published since then, including large cohort studies from national registries, highlighting the need for an updated review and meta-analysis. OBJECTIVE AND RATIONALE: Our systematic review and meta-analysis of the available literature aims to evaluate the association of female obesity with the probability of live birth following IVF. Subgroup analyses according to ovulatory status, oocyte origin, fresh or frozen-embryo transfer and cycle rank were performed. SEARCH METHODS: A systematic review was performed using the following key words: ('obesity', 'body mass index', 'live birth', 'IVF', 'ICSI'). Searches were conducted in MEDLINE, EMBASE, Cochrane Library, Eudract and clinicaltrial.gov from 01 January 2007 to 30 November 2017. Study selection was based on title and abstract. Full texts of potentially relevant articles were retrieved and assessed for inclusion by two reviewers. Subsequently, quality was assessed using the Newcastle-Ottawa Quality Assessment Scales for patient selection, comparability and assessment of outcomes. Two independent reviewers carried out study selection and data extraction according to Cochrane methods. Random-effect meta-analysis was performed using Review Manager software on all data (overall analysis), followed by subgroup analyses. OUTCOMES: A total of 21 studies were included in the meta-analysis. A decreased probability of live birth following IVF was observed in obese (BMI ≥ 30 kg/m2) women when compared with normal weight (BMI 18.5-24.9 kg/m2) women: risk ratio (RR) (95% CI) 0.85 (0.82-0.87). Subgroups analyses demonstrated that prognosis was poorer when obesity was associated with polycystic ovary syndrome, while the oocyte origin (donor or non-donor) did not modify the overall interpretation. WIDER IMPLICATIONS: Our meta-analysis clearly demonstrates that female obesity negatively and significantly impacts live birth rates following IVF. Whether weight loss can reverse this deleterious effect through lifestyle modifications or bariatric surgery should be further evaluated.

Early versus late hCG administration to trigger ovulation in mild stimulated IUI cycles: a randomized clinical trial.

OBJECTIVES: To verify non-inferiority of the clinical pregnancy rate of Early hCG administration (leading follicle sizes within 16.0-16.9 mm in diameter) compared to Late hCG administration (leading follicle sizes within 18.0-18.9 mm in diameter). STUDY DESIGN: Prospective randomized trial. Six hundred and twelve infertile women candidates for intrauterine insemination (IUI) received HP-hMG 75 IU/day SC from cycle days 4 to 8 and then as per ovarian response. Ovulation was randomly triggered (hCG 5000 IU, IM) when the leading follicle diameter ranged between either 16.0 and 16.9 mm (Early hCG group, n=227) or 18.0 and 18.9 mm (Late hCG group, n=207) and IUI was performed approximately 36 h later. RESULTS: Whereas population and sperm characteristics were comparable in both groups, the number of follicles ≥ 14 mm in diameter (P<0.007) and serum estradiol levels (P<0.001) on the day of hCG were lower in the Early versus the Late hCG groups. Clinical (11.9% versus 12.1%) and ongoing (11.0% versus 8.6%) pregnancy rates per randomized women were similar in the two groups and statistical non-inferiority of clinical and ongoing pregnancy rates was demonstrated. CONCLUSION: These results suggest that hCG administered when the largest follicle size reaches 16.0-16.9 mm leads to similar clinical and ongoing pregnancy rates as when it reaches 18.0-18.9 mm in IUI cycles.

Reliability of automated volumetric measurement of multiple growing follicles in controlled ovarian hyperstimulation.

OBJECTIVE: To evaluate the reliability of a computer-assisted approach for automatically measuring ovarian follicles during controlled ovarian hyperstimulation (COH). DESIGN: Prospective, comparative study. SETTING: Hospital Béclère, Clamart, France. PATIENT(S): Twenty-seven infertile IVF-ET candidates undergoing COH. INTERVENTION(S): Just before the oocyte retrieval, growing follicles (n=72) had their mean diameters measured and their volumes determined semimanually by virtual organ computer-aided analysis (VOCAL) and automatically by SonoAVC. Follicles were sorted in small (12-16 mm; n=35) and large (>16 mm; n=37) growing follicles. Measures were compared with the follicular fluid volume. MAIN OUTCOME MEASURE(S): Concordance of results using intraclass correlation coefficient and limits of agreement methods, respectively. RESULT(S): Overall, VOCAL (median: 3.42 mL; range: 0.98-9.68 mL) and SonoAVC (3.25 mL; 0.98-8.63 mL) measurements were equivalent to the corresponding actual follicle volume (3.20 mL; 0.80-10.20 mL). The intraclass correlation coefficient values between follicular fluid volume and mean diameter, VOCAL, and SonoAVC were 0.51, 0.95, and 0.98, respectively, for small follicles, and 0.80, 0.93, and 0.92, respectively, for large follicles. 95% limits of agreement between actual volume and VOCAL (-1.09 to +1.07 mL) and SonoAVC (-1.08 to +0.84 mL) measurements were comparable in both groups. CONCLUSION(S): Automated measurement of multiple follicular volumes using SonoAVC is a simple technique, which reliability is superior to usual diameter measurements and comparable to VOCAL. This technologic refinement invites us to switch toward volumetric monitoring of follicle growth during COH.

Reproducibility and reliability of automated volumetric measurement of single preovulatory follicles using SonoAVC.

OBJECTIVE: To evaluate the reproducibility and the reliability of an innovative, computer-assisted approach for automatically measuring ovarian follicles. DESIGN: Prospective, comparative study. SETTING: Hospital Béclère, Clamart, France. PATIENT(S): Fifteen infertile women undergoing IVF-ET in monodominant follicle cycles. INTERVENTION(S): Just before oocyte retrieval, follicles were three-dimensionally reconstructed from transvaginal ultrasonographic images. Volumes were determined both manually by visual outlining of inner follicle borders (VOCAL) and automatically using SonoAVC. Each procedure was repeated three times. Follicular fluid volume indicated the actual follicle volume. MAIN OUTCOME MEASURE(S): Reproducibility and concordance of results were assessed by the intraclass correlation coefficient (ICC) and the limits of agreement method, respectively. RESULT(S): At any time, VOCAL (3.68, 2.41-8.29 mL; 3.73, 2.70-7.16 mL; 3.89, 2.96-7.83 mL; median, ranges, respectively) and SonoAVC (3.57, 2.41-8.19 mL; 3.71, 2.49-8.90 mL; 4.07, 3.12-8.16 mL, respectively) volume measurements failed to be statistically different from the corresponding actual follicle volume (3.60, 2.90-8.00 mL). Reproducibility (ICC, 95% confidence intervals) of repeated VOCAL (0.95, 0.87-0.98) and SonoAVC (0.97, 0.94-0.99) measurements as well as 95% limits of agreement between actual volumes and VOCAL (-0.48 to +0.80 mL) and SonoAVC (-0.61 to +0.99 mL) measurements were comparable. CONCLUSION(S): Automatic measurement of ovarian follicle volumes from three-dimensionally reconstructed ultrasound images (SonoAVC) is a rapid and simple technique, which reproducibility and reliability are comparable to the semimanual technique (VOCAL). It opens new perspectives for the accurate and objective assessment of ovarian function by ultrasound.

The effect of the levonorgestrel-releasing intrauterine system and the copper intrauterine device on subendometrial microvascularization and uterine artery blood flow.

OBJECTIVE: To evaluate the effect of the levonorgestrel intrauterine system (LNG-IUS) and TCU 380A on the subendometrial vascularization and the uterine artery blood flow during the midluteal phase. DESIGN: Prospective clinical trial. SETTING: Teaching hospital. PATIENT(S): The trial included 27 patients who received the LNG-IUS compared with 25 patients who received the TCU 380A. INTERVENTION(S): The subendometrial blood flow was evaluated using power Doppler analysis, uterine artery pulsatility index (PI), and resistance index (RI) just before inserting the intrauterine device in the midluteal phase and 3 months after. MAIN OUTCOME MEASUREMENT(S): Power Doppler analysis, PI, RI, and endometrial thickness. RESULT(S): There were no significant differences in subendometrial vascularization between the groups. Pulsatility index and RI variability (before and after) increased and endometrial thickness reduced in LNG-IUS users. We used the multiple logistic regression model to examine the potential confounding bias (age and parity). The LNG-IUS was independently associated with increased PI. CONCLUSION(S): No subendometrial microvascularization difference was found between the groups. It is the first direct evidence that LNG-IUS reduced uterine artery blood flow, even after controlling for age and parity.

Decreased anti-Müllerian hormone and altered ovarian follicular cohort in infertile patients with mild/minimal endometriosis.

OBJECTIVE: To evaluate the ovarian reserve and follicular cohort of infertile patients with minimal/mild endometriosis. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Patients were divided into two groups: group I, minimal/mild endometriosis and group II, tubal obstruction. The following exclusion criteria were established: [1] patients with previous endocrine disorders; and [2] cases in which the cause for infertility was other than endometriosis (except for patients with tubal obstruction, in the control group). INTERVENTION(S): Serum FSH and anti-Müllerian hormone were measured on day 3. On the same day all patients were submitted to transvaginal ultrasound to evaluate the antral follicular count and the ovarian follicular cohort. MAIN OUTCOME MEASURE(S): Serum FSH, anti-Müllerian hormone, and the follicular cohort with the respective antral follicular count. RESULT(S): Serum FSH were not different between the groups. However, infertile patients with endometriosis have a decreased serum anti-Müllerian hormone (1.26 +/- 0.7 ng/mL) compared to the control group (2.02 +/- 0.72 ng/mL). The analysis of follicular cohort showed that the number of selectable follicles were similar, but the follicular diameter was different. CONCLUSION(S): Minimal/mild endometriosis is associated with a decrease in the follicular ovarian reserve. In addition, the follicular cohort of these patients is more heterogeneous in comparison to the control group.

Effect of the copper-intrauterine device (TCu 380A) on subendometrial microvascularization and uterine artery blood flow.

During this cohort study, the copper-intrauterine device (IUD) did not modify subendometrial microvascularization. However, subendometrial blood flow increased in patients who experienced IUD-induced side effects.

Vaginal Müllerian papilloma in a 2-year-old child.

Papillomas of the lower genital tract are rare benign lesions, which cause vaginal bleeding in girls. We report a case in a 2-year-old girl. Few cases have been described in children and adolescents. However, it should be considered as a possible diagnosis in girls with sanguineous vaginal discharge.

[Drug use prevalence at FEBEM, Porto Alegre]. / Prevalência do consumo de drogas na FEBEM, Porto Alegre.

OBJECTIVE: This study aimed to determine the prevalence of drug use among institutionalized children and adolescents; to assess the degree of associated use of illicit drugs with alcohol and tobacco; and to determine which is the gateway drug to illicit drug use. METHODS: A cross-sectional study was carried out in the Fundação Estadual do Bem-Estar do Menor, in Porto Alegre (FEBEM) Southern Brazil. A questionnaire developed by the World Health Organization to determine prevalence off drug use was answered anonymously by a population of literate minors who were in FEBEM because of delinquency or due to social risk. The analysis aimed to describe the frequency of use of each drug and relate it to gender, age of beginning, and reason of institutionalization. RESULTS: A total of 382 participants answered the questionnaire. The substances most frequently used on an experimental basis were: alcohol (81,3%), tobacco (76,8%), marijuana (69,2%), cocaine (54,6%), inhalants (49,2%), anxiolytic drugs (13,4%), hallucinogens (8,4%), amphetamines (6,5%) and barbiturates (2,4%). Overall, around 80% of the respondents reported having used some illicit drug at least once in the past. Licit drugs, like alcohol and tobacco, were used mainly by males, while medicines were used mostly by females. Adolescents with delinquency records showed a significantly higher frequency of alcohol, marijuana, cocaine, and solvent use. The mean age of beginning was under 12 years for alcohol and tobacco use, under 13 years for marijuana and inhalants, and under 14 years for cocaine. Concomitant use of illicit and licit drugs was found to be high in this population. CONCLUSIONS: A high prevalence of precocious drug use was found among institutionalized children and adolescent, with alcohol and tobacco being used earlier than illicit drugs. Delinquent males were more likely to have used illicit drugs.

Prevalência do consumo de drogas na FEBEM, Porto Alegre / Drug use prevalence at FEBEM, Porto Alegre

OBJETIVO: Identificar a prevalência do uso de drogas entre crianças e adolescentes institucionalizados e avaliar o uso associado das substâncias lícitas, álcool e tabaco, com drogas ilícitas; e verificar qual a droga de uso inicial para o consumo das substâncias psicoativas ilícitas. MÉTODOS: Realizou-se um estudo transversal na Fundação Estadual do Bem-Estar do Menor do Rio Grande do Sul, na cidade de Porto Alegre. Um questionário elaborado pela Organização Mundial da Saúde, anônimo, sobre o uso de drogas e sua quantificação, auto-aplicado em salas de aula, foi respondido pela população de crianças e adolescentes alfabetizados que cumpriam medidas socioeducativas ou medidas protetivas. A análise visou descrever o uso de drogas entre os dois subgrupos levando em conta gêneros e idades de início de uso. RESULTADOS: Os resultados foram obtidos a partir de 382 indivíduos. As substâncias mais experimentadas foram: álcool (81,3 por cento), tabaco (76,8 por cento), maconha (69,2 por cento), cocaína (54,6 por cento), solventes (49,2 por cento), ansiolíticos (13,4 por cento), alucinógenos (8,4 por cento), anorexígenos (6,5 por cento) e barbitúricos (2,4 por cento). Em torno de 80 por cento afirmaram ter usado experimentalmente alguma droga ilícita. As meninas usaram principalmente medicamentos e os meninos drogas ilícitas, álcool e tabaco. As crianças albergadas por atos infracionais mostraram uso significativamente mais freqüente de álcool, maconha, cocaína e solventes. A idade de início do álcool e tabaco ocorreu antes dos 12 anos; maconha e solventes, antes dos 13, e cocaína, antes de completar 14, em média. Verificou-se alta freqüência de uso concomitante de drogas lícitas e ilícitas por esta população. CONCLUSÕES: A prevalência de experimentação e uso de drogas entre crianças e adolescentes institucionalizados é alta e precoce. As drogas lícitas foram usadas mais precocemente que as ilícitas. Indivíduos do sexo masculino e albergados por atos infracionais apresentam maior probabilidade de já terem utilizado drogas ilícitas.

Hysteroscopy and three-dimensional ultrasonography in uterine diverticulum diagnosis: a case report.

The authors describe a case report of a uterine diverticulum in a postmenopausal woman with abnormal uterine bleeding, confirmed by 3-dimensional ultrasonography and hysteroscopy. They comment on the clinical significance of this rare lesion.

Aspectos clínicos e farmacológicos do uso dos solventes / Clinical and pharmacological aspects about the use of solvents

O uso abusivo de solventes é universal. No Brasil é um problema de saúde pública, tanto entre estudantes, quanto em jovens e adolescentes em situaçäo de rua. O número de usuários tem permanecido elevado ao longo dos últimos anos, mesmo após mudanças na legislaçäo para coibir a venda para crianças e adolescentes. Isto sugere que apenas as medidas restritivas näo apresentaram efetividade, sem que haja, também, programas de prevençäo primários e secundários mais abrangentes. Nesse estudo fez-se uma revisäo bibliográfica sobre os solventes ou inalantes, enfocando-se aspectos básicos para melhorar o diagnóstico e tratamento do uso abusivo de tais substâncias. Säo descritas as substâncias mais utilizadas e o seu mecanismo de açäo, no sentido de justificar as manifestaçöes clínicas e alteraçöes patológicas geradas pelo seu uso a curto ou a médio prazo. Também säo abordados os principais aspectos em relaçäo ao abuso, incluindo os métodos de inalaçäo e a epidemiologia do uso no Brasil. Finalmente, propöe-se um protocolo de exame clínico sumário que visa facilitar o diagnóstico clínico de intoxicaçäo aguda e crônica de solventes entre crianças