Contracepção em situações especiais / Contraception in special situations

A decisão de escolha do método contraceptivo em situações clínicas especiais é desafiadora tanto para médicos quanto para pacientes. Em parte, isso se deve às contraindicações reais que alguns contraceptivos apresentam. Porém, há uma estreita relação com a falta de conhecimento e medo de muitos profissionais em prescrever métodos que, na realidade, são seguros. A má escolha do método contraceptivo para pacientes portadoras de condições específicas pode levar a diversos desfechos ruins, como piora da condição de base, ocorrência de eventos adversos indesejáveis e preveníveis e ocorrência de gravidez de alto risco indesejada. Dessa forma, foi realizada uma revisão na literatura com o objetivo de auxiliar profissionais médicos na decisão contraceptiva de pacientes portadoras de doenças reumatológicas e musculoesqueléticas, epilepsia, esclerose múltipla, transtornos alimentares, anemia falciforme e obesidade, e que já foram submetidas a cirurgia bariátrica.(AU)

The decision to choose the contraceptive method in special clinical situations is challenging for both physicians and patients. In part, this is due to the real contraindications that some contraceptives present. However, there is a close relationship with the lack of knowledge and fear of many professionals in prescribing methods that are actually safe. The poor choice of contraceptive method in patients with specific conditions can lead to several bad outcomes, such as worsening of the baseline condition, occurrence of undesirable and preventable adverse events and occurrence of an unwanted high-risk pregnancy. Thus, a literature review was carried out in order to assist medical professionals in the contraceptive decision of patients with rheumatological and musculoskeletal diseases, epilepsy, multiple sclerosis, eating disorders, sickle cell anemia, obesity and who have already undergone bariatric surgery.(AU)

Levels of Folate and Vitamin B12, and Genetic Polymorphisms Involved in One-Carbon Metabolism May Increase the Risk of Cervical Cytological Abnormalities.

To analyze the association of cervical cytological abnormalities with genetic polymorphisms of enzymes involved in folate metabolism, and the effect of micronutrients on association of polymorphisms with cervical carcinogenesis. Our samples were divided in Control (120 women with normal cytology), and Cases: 37 women with Atypical Squamous Cells of Undetermined Significance(ASC-US), 33 participants presenting Low-Grade Squamous Intraepithelial Lesion(LSIL), and 24 women presenting High-Grade cervical lesions(HSIL/ASC-H). We obtained cervical samples for cytological analysis, HPV detection, and analysis of polymorphisms and cervical cell folate. Blood samples were obtained for serum folate and vitamin B12 evaluation. To analyze all polymorphisms simultaneously, we calculated Genetic Risk Score(GRS). Median concentrations were used as cutoff for determination of micronutrient levels. We observed no differences of genotype or allelic frequencies of polymorphisms according to cervical lesions. However, high levels of cervical cell folate and high number of genetic alterations increased risk of High-Grade lesions [OR(IC95%):1.85(0.42-8.11)]. Instead, women with vitamin B12 ≤ 274 pg/ml and GRS ≥ 3 presented even greater risk of HSIL/ASC-H [OR(IC95%):2.91(0.46-18.62)]. High frequency of genetic polymorphisms involved in one-carbon metabolism associated with high levels of cell folate or low levels of serum vitamin B12, increased the risk of High-Grade lesion in uterine cervix.

Síndrome de Behçet ou úlcera de Lipschütz: desafio diagnóstico / Behçet's syndrome or Lipschütz ulcer: diagnostic challenge

A ocorrência de úlceras genitais em adolescentes e mulheres jovens tem impacto emocional para as pacientes e seus familiares, pela frequente associação com uma possível etiologia de transmissão sexual. Porém, úlcera de Lipschütz e síndrome de Behçet não têm etiologia infecciosa e devem ser lembradas como possíveis diagnósticos diferenciais. O diagnóstico dessas duas patologias é clínico e pode ser desafiador. Dessa forma, foi realizada uma revisão na literatura com o objetivo de comparar as duas entidades. A úlcera de Lipschütz é causada por uma vasculite local e caracteriza-se pelo surgimento súbito de úlceras na vulva ou vagina inferior. Já a doença de Behçet é causada por vasculite sistêmica, com episódios de remissão e exacerbação, que pode envolver quase todos os sistemas orgânicos. Em ambos os casos, é essencial o referenciamento para reumatologia. O tratamento objetiva suprimir exacerbações, controlar a dor e prevenir infecção secundária.(AU)

The occurrence of genital ulcers in adolescents and young women have an emotional impact for the patient and their families, due to the frequent association of its etiology with a sexually transmitted disease. However, Lipschütz ulcer and Behçet's syndrome do not have an infectious etiology and should be remembered as a possible differential diagnoses. As the diagnosis of these two pathologies is clinical and can be challenging, a review of literature was carried out. The objective of this review of literature was to compare both diseases. Lipschütz ulcer is caused by local vasculitis and is characterized by the sudden appearance of ulcers in the vulva or lower vagina. Behçet's syndrome is caused by systemic vasculitis, with episodes of remission and exacerbation, which can affect almost all organ systems. In both cases, referral to rheumatology is essential. Treatment aims to suppress exacerbations, control pain and prevent secondary infection.(AU)