Quality of life in women with microprolactinoma treated with dopamine agonists.

OBJECTIVES: To evaluate QOL in women with microprolactinomas treated with dopamine agonists, comparing the patients with normal versus those with elevated prolactin levels, and to identify clinical and biochemical influences on patients' QOL. MATERIAL AND METHODS: A cross-sectional evaluation was performed in two University referral centers. Fifty women with microprolactinoma answered the SF-36 questionnaire by the time of their clinical evaluation. Their biochemical analysis included PRL, estradiol, testosterone, and SHBG. Fifty women of similar age distribution served as controls. RESULTS: Patients had lower scores than controls in all SF-36 categories: physical functioning, physical role, pain, general health, vitality, social functioning, emotional aspect, and mental health. Within the patients' group, the ones with normal PRL levels had higher scores than those with high PRL levels in all categories but the physical role. The physical functioning score correlated with the free androgen index, while the pain, vitality, social functioning, emotional aspect, and mental health scores were associated with the prolactin levels obtained at study entry. CONCLUSIONS: QOL is impaired in women with microprolactinoma treated with dopamine agonists, and was inversely associated with the PRL levels. This latter finding reinforces the importance of providing adequate disease control for these patients in order to avoid the adverse consequences of hyperprolactinemia on QOL.

Bone density in women with prolactinoma treated with dopamine agonists.

OBJECTIVES: (1) to evaluate bone density in women with prolactinoma treated with dopamine agonists and healthy controls, using dual energy x-ray absorptiometry (DXA), (2) to classify the results according to the current International Society for Clinical Densitometry (ISCD) criteria, and (3) to correlate bone density with lean and fat masses, biochemical data and clinical aspects of prolactinomas. MATERIALS AND METHODS: A cross-sectional study was performed in two University referral centers. Forty-five premenopausal women with prolactinoma were submitted to DXA and blood analysis (prolactin, estradiol, testosterone, SHBG, calcium, phosphorus, PTH, C-telopeptides of type 1 collagen, and osteocalcin) by the time of their clinical evaluation. They were compared with 25 control women of similar age and body mass index distribution. RESULTS: Women with prolactinoma had lower lumbar spine Z-score than controls. Femoral neck, trochanter, and total proximal femur Z-scores were similar in patients and controls. Twenty-two percent of the patients had Z-scores below the expected age range vs. 4% in the control group. Lumbar spine, femoral neck, and total proximal femur Z-scores were mainly correlated with the amenorrhea duration. The trochanter Z-score was associated with the gynoid lean/fat mass ratio. CONCLUSIONS: Based on the current ISCD criteria, bone density evaluation in women with prolactinoma reveals bone loss, especially of trabecular type. Bone density in these patients was particularly associated with the duration of amenorrhea, which reinforces the importance of the adequate disease control in women with prolactinoma in order to avoid complications of this disease.

Body fat in nonobese women with prolactinoma treated with dopamine agonists.

OBJECTIVES: To evaluate body fat in nonobese women with prolactinoma treated with dopamine agonists, using whole body dual energy X-ray absorptiometry (DXA) and to correlate DXA results with biochemical data and clinical aspects of the prolactinoma. DESIGN, PATIENTS AND MEASUREMENTS: A cross-sectional study was performed in two University referral centres. Thirty-one nonobese premenopausal women with prolactinoma were subjected to DXA and blood analysis at clinical evaluation. They were compared with 21 control women of similar age and body mass index (BMI). RESULTS: Women with prolactinoma treated with dopamine agonists and controls had similar body fat percentages in all sites evaluated with DXA (arms, legs, trunk, android, gynoid and total body). Patients with normal PRL levels at study entry had lower body fat percentages in all sites. In the patient group, arm, leg, truncal, android, gynoid and total body fat were positively associated with PRL levels. CONCLUSION: Body fat percentage is similar in nonobese women with prolactinoma and in controls. The lower body fat content in patients with normal PRL levels is likely to be due to the metabolic effects of adequate dopamine receptor type 2 (DR2) activation as a result of regular dopamine agonist treatment. This finding reinforces the importance of the appropriate treatment with dopamine agonists in women with prolactinoma, which, besides normalizing PRL levels, reduces body fat content and the consequent risk of developing Metabolic Syndrome and its complications.

Training-related accidents during teacher-student-assistance activities of medical students

Este estudo transversal foi realizado para avaliar acidentes com material biologicamente contaminado entre estudantes de medicina da Universidade Federal de Minas Gerais. Foi aplicado um questionário individual de resposta espontânea e sigilosa, em 694 (43,4%) estudantes do quinto ao décimo segundo semestres do curso médico. Foram relatados 349 acidentes, com aumento progressivo de 33,9 até 52,3% entre os estudantes do quinto ao décimo primeiro períodos, respectivamente. Cerca de 63% dos acidentes foram com agulha ou objeto cortante; 18,3% afetando mucosas; 16,6% a pele; 1,7% simultaneamente a pele e a mucosa. Os contaminantes principais foram sangue (88,3%) e secreção vaginal (1,7%). As regiões do corpo mais freqüentemente afetadas foram as mãos (67%), olhos (18,9%), boca (1,7%) e outras (6,3%). Os procedimentos realizados no momento em que o acidente ocorreu foram sutura (34,1%), administração de anestesia (16,6%), participação em cirurgia como observador (8,9%), punção de veia com agulha (8,6%), observação de parto (6,3%) e outros (25,9%). O setor de biossegurança da instituição foi procurado por 49% dos acidentados para a busca de providências pertinentes à cada caso. Destes estudantes, 29,2% não receberam assistência médica considerada adequada e esclarecedora para sua situação. Cerca de 8 % dos estudantes receberam antiretrovirais, destes 86% descontinuaram o tratamento com o resultado do exame Elisa rápido feito no paciente fonte (VIH-negativo); 6,4% descontinuaram o tratamento devido aos efeitos colaterais das drogas usadas e 16% completaram corretamente o tratamento.

Training-related accidents during teacher-student-assistance activities of medical students.

A survey was done to determine the most common hospital accidents with biologically contaminated material among students at the Medical College of the Federal University of Minas Gerais. Six hundred and ninety-four students (between fifth and twelfth semesters of the college course) answered the questionnaire individually. Three-hundred and forty-nine accidents were reported. The accident rate was found to be 33.9% in the third semester of the course, and increased over time, reaching 52.3% in the last semester. Sixty-three percent of the accidents were needlestick or sharp object injuries; 18.3% mucous membrane exposure; 16.6% were on the skin, and 1.7% were simultaneously on the skin and mucous membrane exposure. The contaminating substances were: blood (88.3%), vaginal secretion (1.7%), and others (9.1%). The parts of the body most frequently affected were: hands (67%), eyes (18.9%), mouth (1.7%), and others (6.3%). The procedures being performed when the accidents occurred were: suture (34.1%), applying anesthesia (16.6%), assisting surgery (8.9%), disposing of needles (8.6%), assisting delivery (6.3%), and others (25.9%). Forty-nine percent of those involved reported the accident to the accident control department. Of these 29.2% did not receive adequate medical assistance. Eight percent of those involved used antiretroviral drugs and of these 86% discontinued the treatment on receiving the Elisa method applied to the patient (HIV-negative); 6.4% discontinued the treatment due to its side-effects; and 16% completed the treatment.

Epidemia da síndrome de imunodeficiência adquirida no Brasil e em Minas Gerais dados atuais / Acquired immunodeficiency syndrome epidemic in Brasil and Minas Gerais state: an update

A epidemia da Sida no Brasil apresenta, nos últimos anos, importantes mudanças em seu perfil epidemiológico. Houve aumento significativo de transmissão pelo contato heterossexual, o que favoreceu a interiorização da epidemia e a diminuição do número de excesso de casos do sexo masculino. Aumentou a transmissão vertical e a participação dos grupos expostos ao uso de drogas injetáveis. Essas mudanças se concentram especialmente entre os setores mais oprimidos e marginalizados da sociedade. Há risco de soroconversão dos profissionais e estudantes da área da saúde expostos a pacientes infectados, que decorre de acidentes por procedimentos com contaminação com o sangue de pacientes infectados pelo VIH. As ações para a prevenção da Sida devem considerar os diversos grupos populacionais em relação à sua vulnerabilidade e risco e levar em conta seus aspectos epidemiológicos, culturais e sociais.

The epidemic of Aids presents, in Brazil, important changes in its epidemiological profile in the last years. There was significant increase of transmission from heterosexual contact what it favored the "interiorization" and the increase of cases among women There were increase in the vertical transmission and the participation of the intravenous drug users. Those changes specially concentrate among the most oppressed sections and low income groups of the society. Health care workers and students who are exposed to infected patients present risk for seroconvertion current of exposure patients' blood infected by HIV through accidents. The actions for the prevention of Aids should consider the several population groups in relation to its vulnerability and risk and their epidemic, cultural and social aspects.

Abordagem do paciente com exposição acidental no trabalho a material biológico potencialmente contaminado pelo vírus da imunodeficiência humana / Management of the patient with occupational exposure to human fluids potentially contaminated with HIV

Acidentes envolvendo material biológico são frequentes entre os profissionais da área da saúde, tendo por isto risco de infecção pelo vírus da imunodeficiência humana (VIH) através de exposição ocupacional a sangue ou outros fluidos contaminados. O aumento do número de portadores do VIH toma este risco ainda mais significativo. Alem disso, muitos profissionais de saúde não adotam a conduta correta após exposição ocupacional a material biológico de risco. Este trabalho enfoca a profilaxia da transmissão ocupacional do VIH através de medidas para prevenção dos acidentes ocupacionais e condutas que devem ser adotadas após exposição a material potencialmente contaminado por sangue.

Accidents involving biological fluids are frequent among health-care workers. These workers are potentially at risk for human immunodeficiency virus (HIV) infection through occupacional exposures to blood or other contaminated fluids. The increasing number of HIV carriers makes the risk of HIV transmission from occupacional exposure more significant. Furthermore, many of the health-care workers do not adopt the correct procedures after an occupacional exposure. This report approaches the prophylaxis for HIV occupational transmitting through procedures to caution occupational accidents and recommendations for post-exposure prophylaxis.