Prevalência e severidade de sintomas em mulheres na menopausa: um estudo descritivo / Prevalence and severity of symptoms in women in the menopause: a cross-sectional study

Introdução: Muitas mulheres sofrem com sintomas associados à menopausa, que podem apresentar diferentes graus de intensidade e afetar sua qualidade de vida. Objetivo: Identificar a prevalência e severidade dos principais sintomas nas diferentes fases do climatério. Métodos: Foram selecionadas mulheres com idades entre 40 e 65 anos, que responderam a um questionário on-line com dados sociodemográficos, de saúde, alimentação e características menstruais e de menopausa. Para avaliar os sintomas da menopausa e sua intensidade, foi aplicado o questionário internacional validado Menopause Rating Scale (MRS). Resultados: Foram incluídas 283 mulheres (36,8% na pré-menopausa, 24% na perimenopausa e 39,2% na pós-menopausa). Excesso de peso foi mais prevalente na perimenopausa do que na pré-menopausa (P=0,012). Sintomas como diminuição da libido, secura vaginal, incontinência urinária, dores musculares e articulares, alterações lipídicas e ondas de calor, calorões, foram mais prevalentes em valores absolutos nas mulheres pós-menopausa. As mulheres no período de perimenopausa apresentaram maior prevalência, em valores absolutos, de estresse, irritabilidade, dor de cabeça, problemas na pele, falta de concentração/memória, distúrbios do sono e fadiga. De acordo com o MRS, não houve diferença no domínio psicossocial (P=0,265) e os sintomas somato-vegetativos e urogenitais são mais intensos nas mulheres na perimenopausa e pós-menopausa, quando comparadas com as mulheres na pré-menopausa (P<0,001). O escore global do questionário também demonstra essa intensidade menor no grupo pré-menopausa (P=0,001). Conclusões: Este estudo demonstrou uma prevalência e severidade maior de sintomas em mulheres na perimenopausa e pós-menopausa, o que pode prejudicar a qualidade de vida dessas mulheres nessa fase da vida

Introduction: Many women experience symptoms associated with menopause that present with different degrees of intensity and affect their quality of life. Objective: To identify the prevalence and severity of the main symptoms during different climacteric phases. Methods: Women aged 40­65 years answered an online questionnaire on sociodemographic data, health, diet, menstrual, and menopausal characteristics. The internationally validated Menopause Rating Scale (MRS) questionnaire was used to assess menopausal symptoms and their intensities. Results: 283 women were included (36.8% pre-menopausal, 24% peri-menopausal, and 39.2% post-menopausal). Excess weight was more prevalent in the peri-menopausal group than in the pre-menopausal group (P=0.012). Symptoms such as decreased libido, vaginal dryness, urinary incontinence, muscle and joint pain, lipid alterations, and hot flashes were more prevalent in the absolute values of post-menopausal women. Women in the peri-menopausal period had a higher prevalence, in absolute values, of stress, irritability, headache, skin problems, lack of concentration/memory, sleep disorders, and fatigue. According to the MRS, there was no difference in the psychosocial domain (P=0.265) but somato-vegetative and urogenital symptoms are more intense in peri-menopausal and post-menopausal women when compared to pre-menopausal women (P<0.001). The global score on the questionnaire also demonstrated a lower intensity in the pre-menopausal group's symptoms (P=0.001). Conclusions: This study demonstrated a higher prevalence and severity of symptoms in peri-menopausal and post-menopausal women, which may impair the quality of life of these women at this stage of life.

Low bone mineral density in pre-menopausal women one year after gastric bypass / Baixa densidade mineral óssea em mulheres pré-menopausadas um ano após bypass gástrico

Introduction: Nutritional deficiencies, hormonal changes and severe weight loss after Roux-en-Y Gastric Bypass (RYGB) can promote changes in bone metabolism which may lead to a reduction in bone mineral density (BMD). Objective: to investigate the prevalence of osteopenia/osteoporosis and factors associated with BMD in pre-menopausal women who underwent RYGB. Methodology: a cross-sectional study conducted with secondary data of patients followed-up in a specialized center for obesity treatment. Variables studied: biochemical and anthropometric data, body composition by multifrequency bioimpedance and BMD of the lumbar spine (LS), total femur (TF) and femur neck (FN) by dual-energy X-ray absorptiometry. For statistical analysis, the SPSS® software and a 5% significance level were utilized. Results: seventy-two (72) pre-menopausal women were evaluated. Mean age, BMI and mean post-surgery time was 38.7±6.5 years, 25.8±2.5 kg/m² and 13.1±1.7 months, respectively. The prevalence of osteopenia in at least one of the densitometry sites was 13.9%, with LS being the most frequent site. A lower LS BMD was associated with greater weight loss, higher percentage of body fat before surgery and lower post-surgery serum vitamin D levels. There was a positive correlation between skeletal muscle mass index adjusted for height in the pre-surgery period and LS BMD (r=0.361; p=0.010) and TF (r=0.404; p=0.004). Conclusion: a relevant prevalence of osteopenia was detected in pre-menopausal women after RYGB, mainly in the LS.

Introdução: o Bypass Gástrico em Y de Roux (BPGYR) pode promover mudanças no metabolismo ósseo decorrentes de deficiências nutricionais, alterações hormonais e perda severa de peso, podendo acarretar redução da Densidade Mineral Óssea (DMO). Objetivo: investigar a prevalência de osteopenia/osteoporose e fatores associados à DMO em mulheres pré-menopausadas submetidas à BPGYR. Metodologia: estudo transversal com dados secundários de pacientes acompanhadas em um serviço especializado no tratamento da obesidade. Variáveis estudadas: dados bioquímicos e antropométricos, composição corporal por bioimpedância multifrequencial e DMO de coluna lombar (CL), fêmur total (FT) e colo do fêmur (CF) por Absorciometria por Dupla Emissão de Raios X. Para análise estatística foi utilizado o programa SPSS®, com o nível de significância de 5%. Resultados: foram avaliadas 72 mulheres pré-menopausadas, com média de idade e de IMC de 38,7±6,5 anos e 25,8±2,5 kg/m², respectivamente, e tempo médio de pós-operatório de 13,1±1,7 meses. A prevalência de osteopenia em pelo menos um dos sítios densitométricos foi de 13,9%, sendo a CL o sítio mais frequente. Uma menor DMO na CL se associou a maior perda de peso, maior percentual de massa gorda antes da cirurgia e níveis séricos menores de vitamina D pós-operatória. Observou-se correlação positiva entre o índice de massa muscular esquelética ajustada pela altura no pré-operatório e a DMO da CL (r=0,361; p=0,010) e do FT (r=0,404; p= 0,004). Conclusão: detectou-se prevalência relevante de osteopenia em mulheres pré-menopausadas após BPGYR, principalmente na CL.

Effect of ribociclib on productivity losses due to breast cancer in young women in Brazil

ABSTRACT OBJETIVE To evaluate the effect of ribociclib versus endocrine therapy on productivity losses due to advanced breast cancer. METHODS Productivity data from the MONALEESA-7 trial, obtained from the results of the application of the Work Productivity and Activity Impairment (WPAI) questionnaire on progression-free survival state (43-month follow-up), were extrapolated to the 10,936 Brazilian prevalent cases of premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer. Productivity loss was determined by quantifying the economic costs of workforce dropout over time in both treatment arms and by discounting the economic costs of absenteeism and presenteeism from workforce retention. A human capital approach was used. RESULTS Net productivity gains in the ribociclib arm were estimated at USD 4,285,525.00, representing 316,609 added work hours over 43 months and a mean of 2,009 added work weeks per year. CONCLUSIONS The phase III MONALEESA-7 trial productivity results applied to the Brazilian premenopausal prevalent cases of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer showed that treatment with ribociclib + endocrine therapy improves workforce participation compared with endocrine therapy alone in premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer, with potential economic gains for the Brazilian society.

Epidemiología de las alteraciones ponderales / epidemiology of alterations ponderal

Introducción: La obesidad es un problema de salud pública a nivel mundial, que compromete a población de altos y bajos recursos por igual y presenta un efecto deletéreo de alto impacto en la fisiopatogenia de la enfermedad cardiovascular. Objetivo: Determinar la prevalencia de sobrepeso y obesidad en nuestra población. Materiales y métodos: Estudio descriptivo, retrospectivo, de corte transversal, incluyó 1024 mujeres de 25 a 65 años residentes de CABA y GBA, que concurrieron a la "Campaña de Prevención del cáncer cervicouterino y detección temprana del cáncer de mama" realizada entre el 9 y 13 de Marzo de 2020 a cargo del Servicio de Ginecología del Hospital de Clínicas "José de San Martín". Se registraron talla y peso. Se calculó el índice de masa corporal (IMC) a través de una fórmula predeterminada. Se excluyeron las pacientes con insuficiencia ovárica prematura y menopausia temprana. Resultados: Se dividió a las pacientes en premenopáusicas y postmenopáusicas. Del grupo de mujeres premenopáusicas (70,61% n=723), el IMC promedio fue de 28,18 kg/m2 (DS 5,86); 0,42% presentó bajo peso (IMC promedio 17,65 kg/m2 DS 0,05), 32,37% normopeso (IMC promedio 22,32 kg/m2 DS 1,68), 32,09% sobrepeso (IMC promedio 27,26 kg/m2 DS 0,22) y 35,13% presentó obesidad (IMC promedio 34,53 kg/m2 DS 4,38). Del grupo de mujeres postmenopáusicas (29,39% n=301) el IMC promedio fue de 29,47 kg/m2 (DS 5,76); ninguna presentó bajo peso, 20,27% presentó normopeso (IMC promedio 22,71 kg/m2 DS 1,6), 40,53% sobrepeso (IMC promedio 27,47 kg/m2 DS 1,43) y 39,2% fueron obesas (IMC promedio 35,04 kg/m2 DS 4,72). Conclusiones: Se observó un aumento en la prevalencia de sobrepeso y obesidad en la postmenopausia que podría explicarse no sólo por el aumento de la edad sino también por los cambios hormonales que acompañan a la postmenopausia. Destaca la importancia del médico ginecólogo en prevención (AU)

Introduction: Obesity is a global public health challenge that affects both high- and low-income populations equally and has a high-impact deleterious effect on the physiopathological origin of cardiovascular disease. Objective: To determine the prevalence of overweight and obesity in our population.Material and methods: This descriptive, retrospective, cross-sectional study included 1024 women of 25 to 65 years old who were living in the Buenos Aires Metropolitan Area (AMBA) and were screened at the "Cervical Cancer Prevention and Breast Cancer Early Detection Campaign" conducted from March 9 to 13, 2020 in the Gynecology Department of Hospital de Clínicas "José de San Martín". Height and weight measurements were performed. Body mass index (BMI) was calculated using a predetermined formula. Patients with premature ovarian failure and early menopause were excluded from the study. Results: Patients were divided into premenopausal and postmenopausal. In the group of premenopausal women (70.61% n=723), the average BMI was 28.18 kg/m2 (SD 5.86); 0.42% were underweight (average BMI 17.65 kg/m2 SD 0.05); 32.37% had normal weight (average BMI 22.32 kg/m2 SD 1.68); 32.09% were overweight (average BMI 27.26 kg/m2 SD 0.22) and 35.13% had obesity (average BMI 34.53 kg/m2 SD 4.38). In the group of postmenopausal women (29.39% n=301) the average BMI was 29.47 kg/m2 (SD 5.76); none was underweight, 20.27% had normal weight (average BMI 22.71 kg/m2 SD 1.6), 40.53% were overweight (average BMI 27.47 kg/m2 SD 1.43) and 39.2% were obese (average BMI 35.04 kg/m2 SD 4.72). Conclusions: An increased prevalence of overweight and obesity has been observed in postmenopause, which could be explained not only by aging but also by the hormonal changes associated with postmenopause. Gynecologists play and important role in prevention (AU)

Caracterización de incontinencia urinaria en mujeres premenopáusicas con cáncer de mama en tratamiento con tamoxifeno por cinco años en el Instituto Nacional del Cáncer / Characterization of urinary incontinence in pre-menopausal women with breast cancer treated with tamoxifen for 5 years at the National Cancer Institute

INTRODUCCIÓN El cáncer de mama es el tipo de cáncer que se diagnostica con mayor frecuencia en mujeres y la segunda causa más común de muerte por cáncer en este género. Dentro de las indicaciones de tratamiento, se encuentran: cirugía, radioterapia, quimioterapia y terapia endocrina. Esta última se basa en el uso de tamoxifeno, cuyo uso de forma prolongada puede producir efectos secundarios como sequedad vaginal, ardor, irritación, picazón, disuria, incontinencia urinaria, entre otros OBJETIVO Caracterizar la incontinencia urinaria en mujeres premenopáusicas con cáncer de mama en tratamiento con tamoxifeno por 5 años en el Instituto Nacional del Cáncer MATERIAL Y MÉTODO Estudio descriptivo de corte transversal. Se incluyeron mujeres diagnosticadas con cáncer de mama inscritas y tratadas en el Instituto Nacional del Cáncer. Se aplicó cuestionario ICIQ ­SF a la población de estudio con el fin de caracterizar la presencia de incontinencia urinaria. Además, se calculó la proporción entre mujeres con incontinencia urinaria y nuliparidad/mujeres con incontinencia urinaria y paridad RESULTADOS Se evaluaron 15 pacientes. 93,33% presentaron incontinencia urinaria. El promedio de edad de mujeres con incontinencia urinaria fue de 51,21 (± 4,74) años. La razón de mujeres con nuliparidad/con paridad fue de 4:15 CONCLUSIÓN 99,33% de las pacientes presentaron incontinencia urinaria. Los resultados entregados en este estudio deben ser considerados como un elemento que contribuya a detectar la magnitud del problema en la población inscrita y tratada en el Instituto Nacional del Cáncer.

BACKGROUND Breast cancer is the type of cancer diagnosed most frequently in women, and the second most common cause of death from cancer in this gender. Within the indications of treatment, they are: surgery, radiotherapy, chemotherapy and endocrine therapy. The last is based on the use of tamoxifen, whose prolonged use can produce side effects such as vaginal dryness, burning, irritation, itching, dysuria, urinary incontinence, among others OBJECTIVE To characterize urinary incontinence in pre-menopausal women with breast cancer treated with tamoxifen for 5 years at the Instituto Nacional del Cáncer MATERIAL AND METHOD Descriptive cross-sectional study. We included women diagnosed with breast cancer enrolled and treated at the Instituto Nacional del Cáncer. The ICIQ -SF questionnaire was applied to the study population to characterize the presence of urinary incontinence. In addition, the proportion between women with urinary incontinence and nulliparity / women with urinary incontinence and parity was calculated RESULTS 93,33% presented urinary incontinence. The average age of women with urinary incontinence was 51,21 (± 4,74) years. The ratio of women with nulliparity / with parity was 4:15 CONCLUSION 99,33% of the patients presented urinary incontinence. The results delivered in this study should be considered as one element that helps to detect the magnitude of this problem in the population registered and treated in the Instituto Nacional del Cáncer. Keywords:

Tribulus terrestris for female sexual dysfunction: a systematic review / Tribulus terrestris para disfunção sexual feminina: uma revisão sistemática

Abstract Objective We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD). Data sources We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO,WHO-ICTR, Clinicaltrials.gov and OpenGrey databases. Selection of studies We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included. Data collection Data extraction was performed by two reviewers with a preestablished data collection formulary. Data synthesis Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, whichmeans that we have very little confidence in the effect estimates, and future studies are likely to change these estimates. Conclusion MoreRCTs are needed to supportor refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process. Number of Protocol registration in PROSPERO database: CRD42019121130

Resumo Objetivo Nós realizamos uma revisão sistemática para avaliar a efetividade e a segurança do Tribulus terrestris no tratamento da disfunção sexual feminina (DSF). Fontes de dados Nós realizados uma busca eletrônica irrestrita nas seguintes bases de dados: MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov, e OpenGrey. Seleção dos estudos Nós incluímos todos os ensaios clínico randomizados (ECR) que comparou T. terrestris com controles ativos/inativos. Após o processo de seleção, conduzido por 2 revisores, 5 ECRs (n = 279 participantes) foram incluídos. Extração de dados O processo de extração de dados foi realizado por dois revisores, utilizando-se um formulário de extração de dados pré-estabelecido. Síntese de dados Devido à falta de dados disponíveis e à heterogeneidade clínica entre os estudos incluídos, nós não realizamos meta-análises. O risco de viés foi avaliado pela tabela de risco de viés da Cochrane e, a certeza do corpo da evidência foi avaliada pelo Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Resultados Após 1 a três 3 meses de tratamento, mulheres na pré e pós-menopausa randomizadas ao T. terrestris tiveram um aumento significante nos escores de função sexual. O grupo com 3 meses de tratamento com T. terrestris exibiu um aumento significante dos níveis séricos de testosterona emmulheres pré-menopausa. Não houve relato de eventos adversos graves, e nenhum estudo avaliou qualidade de vida das participantes. A certeza da evidência foi considerada muito baixa, o que significa que existe pouca certeza na estimativa dos efeitos e que é provável que futuros estudos mudem estas estimativas. Conclusão Mais ECRs são importantes para apoiar ou refutar o uso do T. terrestris. A decisão de usar essa intervenção deve ser compartilhada com pacientes, e as incertezas sobre seus efeitos devem ser discutidas durante o processo de decisão clínica.

Enfermedad coronaria en mujeres pre y postmenopáusicas y su relación con la diabetes mellitus tipo 2 / Coronary artery disease in pre and postmenopausal women. The influence of type 2 diabetes mellitus

Background: Postmenopausal women have higher severity of coronary heart disease (CHD) than premenopausal women and type 2 diabetes mellitus (T2DM) is an independent risk factor. Aim: To assess the severity of CHD in pre and postmenopausal patients undergoing coronary angiography and the impact of T2DM in both groups. Material and Methods: A coronary angiography was performed to 707 women due to suspected CHD during 2013 and 2014. Of these, 579 were older than 55 years and were considered as postmenopausal. Factors such as hypertension, obesity, smoking, creatinine and T2DM were registered. The severity of CHD in coronary angiography was evaluated according to the number of vessels with more than 50% stenosis. Results: Compared to their postmenopausal counterparts, premenopausal women had less frequency of T2DM (31% and 42% p < 0.033), hypertension (52 and 78%, p < 0.001) and alteration of renal function (11 vs. 39%, p < 0.001). Absence of coronary lesions was found in 44 and 32% of premenopausal and postmenopausal women, respectively (p < 0.01). Premenopausal women with T2DM had a higher frequency of multi-vessel disease than those without the disease (25 and 4.5%, p < 0.001). The frequency of multi-vessel disease was higher in postmenopausal than premenopausal women (24 and 11%, p < 0.01). Hypertension, T2DM and renal involvement were associated with a higher frequency multiple vessel disease. Conclusions: The severity of CHD is higher in postmenopausal women and T2DM is associated with the disease.

Characteristics of non-small cell lung cancer: differences by sex and hormonal status in a Mexican population / Características del cáncer de pulmón de células no pequeñas: diferencias por sexo y estado hormonal en una población mexicana

Abstract: Objective: To analyze the differences in the clinico-pathological and molecular characteristics of non-small cell lung cancer (NSCLC) as well as the clinical outcome of patients by sex and hormonal status. Materials and methods: We performed a retrospective study among 1 104 NSCLC patients. Clinic-pathologic data was recorded and survival outcomes were compared between male and female sex patients, and further by pre and postmenopausal status in females. Results: Women were significantly more likely to be non-smokers (p<0.001), had higher frequency of wood-smoke exposure (p<0.001), EGFR-sensitizing mutations (p<0.001), had better performance status (p=0.020) and had a better overall survival (OS) compared to men (p=0.021). Differences were found also by hormonal status, postmenopausal women had a longer OS compared to premenopausal women (31.1 vs. 19.4 months p=0.046). Conclusion: Our results support the differences in lung cancer presentation by sex and also by hormonal status.

Resumen: Objetivo: Analizar las diferencias en las características clínico-patológicas, moleculares y en la evolución del cáncer de pulmón de células no pequeñas (CPCNP) por sexo y estadio hormonal. Material y métodos: Estudio retrospectivo (N=1 104) en pacientes con CPCNP. Se recabaron datos clínico-patológicos y desenlaces de sobrevida y se compararon entre hombres y mujeres, y entre mujeres pre y postmenopáusicas. Resultados: Las mujeres de este estudio tuvieron significativamente mayor probabilidad de ser no fumadoras (p<0.001), tener exposición a humo de leña (p<0.001), mutaciones en EGFR (p<0.001), mejor estado funcional (p=0.020), y una mejor sobrevida global (SG) en comparación con los hombres (p=0.021). Estas diferencias también se encontraron en cuestión al estatus hormonal, con las mujeres postmenopáusicas presentando una mayor sobrevida en comparación con las premenopáusicas (31.1 vs. 19.4 meses; p=0.046). Conclusión: Los presentes resultados apoyan las diferencias en la presentación del CPCNP de acuerdo con el sexo y estatus hormonal.

Paraoxonase 1 serum activity in women: the effects of menopause, the C(-107)T polymorphism and food intake

ABSTRACT Objective The aims of this study were to investigate changes in serum paraoxonase 1 (PON1) activity in women at the pre and postmenopausal stages and its association with the PON1 C(-107)T polymorphism and food intake profile. Subjects and methods A cross-sectional study with female patients aged between 35 and 59 years old was conducted. Women were divided into two groups: premenopausal (n = 40) and postmenopausal (n = 36). Women enrolled in the study had serum PON1, total cholesterol, HDL, LDL, glucose and HbA1c, as well as the BMI measured. Additionally, women were genotyped for the PON1 T(-107)C polymorphism and the food intake profile was obtained through interview. Results Glucose (p = 0.03), HbA1c (p = 0.002) and total cholesterol (p = 0.002)concentrations were higher in post than premenopausal women, however PON1 activity was not different (p > 0.05). Carriers of the C allele had higher PON1 activity (CC: 88.9 ± 6.5 U/mL and CT: 79.9 ± 4.7 U/mL) than women of the TT genotype (66.6 ± 5.9 U/mL) (p < 0.05). However, the model predicting PON1 activity was slightly better when genotype, total fat and cholesterol content in the diet were all included. Conclusion In sum, we observed that the PON1 C(-107)T genotype was the major regulator of PON1 activity, and menopause had no effect on PON1 activity. The lipid and glycemic profile were altered in postmenopausal women.

Serum PTH reference values in an adult Brazilian population: implications for the diagnosis of hyperparathyroidism

ABSTRACT Objective: To define serum parathyroid hormone (PTH) reference values in carefully selected subjects following the recommended pre-analytical guidelines. Subjects and methods: First, 676 adults who would be submitted to thyroidectomy were evaluated. Patients using interfering medications or with malabsorption syndrome, hypomagnesemia, hyper- or hypophosphatemia, hypo- or hypercalcemia, 25-hydroxyvitamin D < 30 ng/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, urinary calcium/creatinine ratio ≥ 0.25, thyroid dysfunction, parathyroid adenoma detected during surgery were excluded. The sample consisted of 312 subjects. Results: The median, minimum, maximum, and 2.5th and 97.5th percentiles of the PTH values obtained were 30, 7.2, 78, 10.1, and 52 pg/mL, respectively. Thus, the reference range was 10 to 52 pg/mL. PTH > 65 pg/mL, the upper limit of normal according to the manufacturer of the kit, was observed in only one subject (0.3%). Considering the upper limit proposed by the kit's manufacturer, 1/6 hypercalcemic patients and 4/8 normocalcemic patients with PHPT had normal PTH. Using the upper limit established in this study, only one normocalcemic patient had normal PTH. Thus, the sensitivity of PTH in detecting asymptomatic primary hyperparathyroidism (PHPT) using the values recommended by the kit and established in this study was 64% and 93%, respectively (50% versus 87.5% for normocalcemic PHPT). Conclusion: The upper reference limit of PTH obtained for a rigorously selected sample was 20% lower than that provided by the assay, which increased its sensitivity in detecting PHPT.

Aterosclerose de carótidas em mulheres na pré e pós-menopausa com antecedentes de hipertensão na gestação: estudo de caso-controle / Carotid atherosclerosis in pre-and-post-menopausal women with a history of pregnancy-induced hypertension: case-control study

A mortalidade por doença cardiovascular entre as mulheres permanece elevada. Estudos observacionais são controversos sobre a participação dos antecedentes de distúrbio hipertensivo gestacional no risco cardiovascular. Verificar a associação entre aterosclerose de carótidas em mulheres no climatério que tiveram hipertensão na gestação. Estudo de caso-controle, sendo os casos compostos por mulheres com aterosclerose de carótida, definida como espessura íntima-média carotídea > 1 mm e/ou presença de placas de carótidas; os controles não apresentavam estas alterações. Adotou-se nível de significância de 95%. Foram avaliadas 504 mulheres sem doença cardiovascular prévia, sendo 126 casos e 378 controles. Eram hipertensas 67% delas; 76% eram dislipidêmicas; e 16%, diabéticas. Cerca de 10% referiram antecedentes de hipertensão na gestação. As mulheres com aterosclerose de carótidas apresentaram valores maiores dos níveis de pressão arterial sistólica (134,18 mmHg vs. 128,59 mmHg; p = 0,008) e de LDL-colesterol (156,52 mg% vs. 139,97 mg%; p = 0,0005). Não foi encontrada diferença estatística em relação à presença de aterosclerose de carótidas e ao antecedente de hipertensão na gestação (OR 1,672; IC 95% 0,893-3,131). O antecedente de hipertensão na gestação não foi associado à aterosclerose subclínica de carótidas em mulheres na pré e pós-menopausa. No entanto, verificou-se a associação entre a aterosclerose de carótida e os fatores de risco clássicos, como pressão arterial sistólica elevada e altos níveis de LDL-colesterol

Cardiovascular disease mortality among women remains high. Observational studies are controversial about the participation of a history of gestational hypertensive disorder in cardiovascular risk. To verify the association between carotid atherosclerosis in menopausal women who had pregnancy-induced hypertension. Case-control study, with cases consisting of women with carotid atherosclerosis, defined as carotid intima-media thickness > 1 mm and/or presence of carotid plaques; the controls did not have these alterations. The significance level was set at 95%. A total of 504 women without previous cardiovascular disease were assessed, 126 cases and 378 controls. Of the total, 67% were hypertensive; 76% were dyslipidemic; and 16% were diabetic. Approximately 10% reported a history of hypertension during pregnancy. Women with carotid atherosclerosis had higher values of systolic blood pressure (134.18 mmHg vs. 128.59 mmHg, p = 0.008) and LDL-cholesterol(156.52 mg% vs. 139.97 mg%; p = 0.0005). No statistical difference was found regarding the presence of carotid atherosclerosis and history of hypertension during pregnancy (OR 1.672, 95% CI: 0.883-3.131). The history of hypertension during pregnancy was not associated with subclinical carotid atherosclerosis in menopausal women. However, an association was observed between carotid atherosclerosis and classic risk factors, such as elevated systolic blood pressure and LDL-cholesterol levels

Utilidad de la Proteína Epididimal Humana 4 (HE4) en la detección de Cáncer de ovario / Usefulness of the Human Epididymis protein 4 (HE4) in the detection of ovarian cancer

Introducción: El cáncer de ovario epitelial aunque tiene baja prevalencia está considerado entre las malignidades ginecológicas más letales por su alta mortalidad. El interés en la detección temprana del cáncer de ovario como mecanismo para lograr la reducción de la mortalidad ha crecido con el descubrimiento de biomarcadores tumorales séricos asociados a tumores malignos. El presente estudio plantea determinar la eficacia del uso del biomarcador HE4 para la detección precoz de cáncer epitelial de ovario en estadios tempranos. Métodos: Se evaluaron pacientes con masas pélvicas entre abril de 2015 y marzo de 2016. Valores de sensibilidad, especificidad, predictivo positivo y negativo, razón de probabilidad positiva y negativa, y pruebas estadísticas fueron calculados para determinar la relación entre los estados menopáusicos, y los grupos de acuerdo con el resultado histológico (benigno, maligno y control) de HE4, CA125 y ROMA. Resultados: Ingresaron al estudio 53 pacientes. La proteína epididimal humana 4 - HE4 presentó un valor medio diferenciable que permite distinguir masas pélvicas malignas (HE4:7,19 (maligno) vs. 5,71 (benigno)), igualmente la combinación HE4 + ROMA presentan mayor sensibilidad y especificidad (S: 100 %; E: 94.29 %) que las combinaciones CA125 + HE4 y CA125 + ROMA (S: 80 % y 88.89 %; E: 75.76 % y 77.14 %). Conclusión: Los resultados sugieren que HE4 serviría como un biomarcador eficiente para la diferenciación de masas pélvicas en estadios tempranos y si se adiciona el estatus menopaúsico, e índice ROMA afianzaría los resultados, permitiendo la diferenciación del cáncer de ovario epitelial en estadios tempranos en el país.

Introduction: Although epithelial ovarian cancer (EOC) has a low prevalence, it is considered among the most lethal gynecological malignancies due to its high mortality. The interest in the early detection of ovarian cancer as a mechanism to achieve the reduction of mortality has grown with the discovery of serum tumor biomarkers associated with malignant tumors. The present study proposes to determine the efficacy of the use of the HE4 biomarker for the early detection of ovarian epithelial cancer in early stages. Methods: We evaluated 53 patients with pelvic masses between April 2015 and March 2016. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratio, and statistical tests were calculated to determine the relationship between menopausal states, and groups according to the histological result (benign, malignant and control) of HE4, CA125 and ROMA. Results: The human epididymal protein 4 - HE4 presented a differentiable mean value that allows to distinguish malignant pelvic masses (HE4: 7.19 (malignant) vs. 5.71 (benign)), likewise the combination HE4 + ROMA present greater sensitivity and specificity (S: 100%; E: 94.29 %) than combinations CA125 + HE4 and CA125 + ROMA (S: 80% and 88.89 %; E: 75.76 % and 77.14 %). Conclusion: The results suggest that HE4 would serve as an efficient biomarker for the differentiation of pelvic masses in early stages and if menopausal status is added, and ROMA index would strengthen the results, allowing the differentiation of epithelial ovarian cancer in early stages in the country.

Mutational analysis of selected high-grade malignancies in a premenopausal gynecologic cancer population: a potential for targeted therapies?

Background: In 2017, there will be 107,000 cases of gynecologic cancer diagnosed in the US with an overall survival of around 70%-most occurring in post-menopausal individuals. In this study, we have examined a younger (≤ 40 years of age) subpopulation of these women with high grade/ high stage gynecologic malignancies, attempting to identify unique genetic abnormalities or combinations thereof through tissue block specimens. This information was then analyzed in light of known target therapies to see if genetic analysis in this setting would yield significant therapeutic advantage. Methods: We retrospectively evaluated patients with high grade/high stage gynecologic cancers (≤ 40 years of age), examined the presence and status of 400 oncogenes and tumors suppressor genes from Formalin-fixed, Paraffin-embedded (FFPE) tissue and functionally classified mutations by SIFT and Polyphen. Results: Twenty women were identified and stratified into positive and negative outcomes. No demographic, clinicopathologic or treatment factors were significant between these groups. Of the 400 genes evaluated, twelve mutations were significant between the groups, six with targeted therapies. Mutations associated with negative outcomes within histologies/locations were evaluated: ERBB3 in epithelial (ovarian), ALK/GPR124/KMT2D in neuroendocrine (ovarian/endometrial), ROS1/EGFR, ROS1/ERBB3/KMT2D/NIRK1 and GPR124 in sarcoma. All negative outcomes were void of mutations in APC/ABL2. A predictive model for negative outcomes in our cohort was developed from these data: AKAP9-/MBD1-/APC-/ABL2- with a mutation load of > 20.5. Conclusions: Unique multi-gene and mutational outcome correlations were identified in our cohort. Resulting complex mutational profiles in distinctly aggressive gynecologic cancers suggested potential for novel therapeutic treatment. Future larger scale studies will be needed to correlate the genotypic and phenotypic features identified here (AU)

When an unexpected diagnosis occurs: a vaginal premenopausal sarcoma / Quando um diagnóstico inesperado ocorre: um sarcoma vaginal na pré-menopausa

Abstract Vaginal cancer is a rare entity. The evidence on its management resides mostly in clinical cases or small case series. Of the histological types, the most frequent is the squamous cell carcinoma, followed by adenocarcinoma. But what to do when identifying an even more infrequent sarcoma in a premenopausal woman? In this study, we describe the case of a 53-year-old woman presenting with metrorrhagia for two months, who was evaluated after an intense episode. A necrotic and ulcerative vaginal swelling was documented and then submitted to biopsy, which revealed a vaginal sarcoma. The patient was referred to radiation therapy with 50 Gy (aiming to control the symptoms and to cause tumor reduction for posterior pelvic exenteration with intraoperative radiotherapy) and developed an extra-pelvic metastization at the end of the treatment, which caused a fast negative outcome. Despite the initial poor prognosis, a chemo-irradiation or primary surgery regimen might have achieved (although with greater side effects) a better survival. This case-report entails a discussion about the strategies to manage vaginal sarcoma in advanced stage and in premenopausal women.

Resumo O cancro vaginal é uma doença rara. A evidência para a sua abordagem reside fundamentalmente em casos clínicos ou pequenas séries de casos. Dentre os tipos de cancro histológicos, o mais frequente é o carcinoma espinocelular, seguido do adenocarcinoma. Mas o que fazer em presença de um sarcoma ainda mais raro numa mulher pré-menopáusica? No presente estudo, descrevemos o caso de uma mulher de 53 anos apresentando metrorragia por dois meses, avaliada após um episódio intenso. Foi então documentada uma tumefacção vaginal necrótica e ulcerativa, submetida a biópsia, que revelou um sarcoma vaginal. A paciente foi encaminhada para radioterapia com50 Gy (comos objetivos de controlo da sintomatologia e de redução tumoral para posterior exenteração pélvica com radioterapia intraoperatória) e desenvolveu, ao final do tratamento, umquadro demestastização extra pélvica, que ocasionou um desfecho negativo rápido. Apesar do mau prognóstico inicial, um esquema de quimiorradiação ou cirurgia primária poderiam ter alcançado (ainda que com maiores efeitos laterais) uma maior sobrevivência. Este estudo de caso aborda uma discussão sobre as estratégias de abordagem do sarcoma vaginal em estádios avançados e na mulher pré-menopáusica.

Fatores associados à obesidade geral e ao percentual de gordura corporal em mulheres no climatério da cidade de São Paulo, Brasil / Factors associated with general obesity and the percentage of body fat of women during the menopause in the city of São Paulo, Brazil

Resumo Para verificar a associação entre obesidade e variáveis demográficas, clínicas e relacionadas ao estilo de vida em mulheres no climatério, foi realizado um estudo transversal com 469 mulheres de 40 a 65 anos em dois ambulatórios públicos da cidade de São Paulo. As variáveis dependentes foram: obesidade, segundo índice de massa corporal (IMC) e obesidade, segundo percentual de gordura corporal (%GC). A variável explanatória principal foi: fase do climatério (pré ou pós-menopausa); e as variáveis de controle foram: idade; anos de estudo; paridade; uso de terapia hormonal da menopausa; prática de atividade física e hábito de fumar. Realizou-se análise de regressão "glm" múltipla, utilizando para as análises o software Stata 9.2. Segundo o IMC, a obesidade associou-se positivamente, à paridade (RP = 1,62; IC 95% = 1,11-2,37) e, negativamente, aos anos de estudo (RP = 0,71; IC 95% = 0,55-0,91) e à prática de atividade física (RP = 0,45; IC 95% = 0,33-0,61). De acordo com o %GC, a obesidade associou-se positivamente à paridade (RP = 1,60; IC 95% = 1,03-2,49) e, negativamente, à prática de atividade física (RP = 0,43; IC 95% = 0,29-0,63). Enquanto a prática de atividade física foi um fator protetor, a multiparidade constituiu-se como fator de risco para a prevalência de obesidade no grupo de mulheres deste estudo.

Abstract To verify the association between obesity and demographic, clinical and lifestyle variables in climacteric women, a cross-sectional study was conducted in outpatient clinics, with 469 women aged 40 to 65 years in the city of São Paulo, Brazil. The dependent variables were: obesity according to body mass index (BMI) and obesity according to percentage of body fat (% BF). The main explanatory variable was: climacteric phase (pre or postmenopausal); and control variables were: age; years of formal study; parity; menopausal hormone therapy (MHT) use; physical activity practice and smoking habit. Multiple regression analysis was performed using the Stata 9.2 software. According to the BMI, obesity was positively associated with parity (RR = 1.62, 95% CI = 1.11-2.37) and, negatively, with years of formal study (RP = 0.71, CI 95% = 0.55-0.91) and with physical activity practice (PR = 0.45, 95% CI = 0.33-0.61). According to the % BF, obesity was positively associated with parity (PR = 1.60, 95% CI = 1.03-2.49) and negatively with physical activity practice (PR = 0.43; 95% CI = 0.29-0.63). While being active physically was protective, multiparity was a risk factor for developing obesity for women in this study.

Mujeres premenopáusicas que van a ooforectomía bilateral tienen más riesgo de enfermedad renal crónica / Premenopausal women who go to bilateral oophorectomy have a higher risk of chronic kidney disease

Debido a los beneficios potenciales del estrógeno en la función renal, los investigadores estudiaron si las mujeres que se someten a ooforectomía bilateral podrían tener un mayor riesgo de enfermedad renal crónica (ERC). Realizaron un estudio de cohortes basado en la población de 1.653 mujeres que se sometieron a ooforectomía bilateral desde 1988 hasta 2007, cuando tenían menos de 50 años, y antes del inicio de la menopausia.

Because of the potential benefits of estrogen in kidney function, the researchers studied whether women who undergo bilateral oophorectomy might have an increased risk of chronic kidney disease (CKD). They conducted a cohort study based on the population of 1,653 women who underwent bilateral oophorectomy from 1988 to 2007, when they were less than 50 years old, and before the onset of menopause.

Vaginal evisceration related to genital prolapse in premenopausal woman

ABSTRACT Background Vaginal evisceration is a rare problem, usually related to a previous hysterectomy. We report a case of spontaneous rupture of the cul-de-sac in a premenopausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythematosus (SLE), with uterine prolapse that occurred during evacuation. Case Report A 40-year-old woman with SLE, using glucocorticoids, with uterine prolapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evisceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation. Case hypothesis This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.

Prevalencia de causas secundarias de baja masa ósea en una población de mujeres premenopáusicas / Prevalence of secondary causes in a population of premenopausal women with low bone mass

La osteoporosis es un trastorno común en las mujeres posmenopáusicas; sin embargo, también puede afectar a hombres y mujeres jóvenes premenopáusicas. El objetivo del presente trabajo fue evaluar la prevalencia de causas secundarias de baja masa ósea en un grupo de mujeres premenopáusicas que consultaron en una Institución especializada en Osteología. Material y métodos: se realizó un estudio retrospectivo, de corte transversal, descriptivo y observacional. Se analizaron las historias clínicas de 88 pacientes que consultaron por baja masa ósea durante un período de 19 meses, con la finalidad de encontrar posibles causas secundarias. A su vez, se definió como pacientes con diagnóstico de baja masa ósea idiopática aquellas en las cuales no se encontró ninguna causa secundaria de pérdida ósea. Resultados: de las 88 mujeres evaluadas, el 48,9% presentaba al menos una causa secundaria para baja masa ósea (amenorrea secundaria, hipercalciuria, tratamiento con glucorticoides, hipovitaminosis D y enfermedad celíaca) y el 51,1% fueron consideradas idiopáticas. Conclusiones: es esencial evaluar exhaustivamente a las mujeres premenopáusicas con baja masa ósea a fin de descartar posibles causas secundarias y tomar las medidas preventivas necesarias para mejorar esa condición. (AU)

Objective: osteoporosis is a common disorder in postmenopausal women, however it can also affect men and premenopausal young women. The purpose of this study was to evaluate the prevalence of secondary causes of low bone mass in premenopausal women that consulted physicians in an institution specialized in osteology for a period of 19 months. Material and methods: this is a retrospective, transversal, descriptive and observational study. The clinical history of 88 patients who consulted a physician due to low bone mass for a period of 19 months in an institution specialized in osteology. Were analyzed the patient's clinical history in order to find secondary causes. We define as suffering Low Bone Mass those patients who did not have secondary causes. Results: of the 88 women tested, 48,9% had one or more secondary causes or risks factors for low bone mass (secondary amenorrea, hypercalciuria, treatment with glucocorticoids, hypovitamiosis D and celiac disease) and 51,1% patients were considered idiopathic. Conclusions: we conclude that it is essential to exhaustively search for secondary causes of low bone mass in premenopausal women, due to the high prevalence of secondary osteoporosis in this population. (AU)