RESUMO
BACKGROUND: Histoplasmosis is a major AIDS-defining illness in Latin America. Liposomal amphotericin B (L-AmB) is the drug of choice for treatment, but access is restricted due to the high drug and hospitalization costs of the conventional long regimens. METHODS: Prospective randomized multicenter open-label trial of 1- or 2-dose induction therapy with L-AmB versus control for disseminated histoplasmosis in AIDS, followed by oral itraconazole therapy. We randomized subjects to: (i) single dose 10 mg/kg of L-AmB; (ii) 10 mg/kg of L-AmB on D1, and 5 mg/kg of L-AmB on D3; (iii) 3 mg/kg of L-AmB daily for 2 weeks (control). The primary outcome was clinical response (resolution of fever and signs/symptoms attributable to histoplasmosis) at day 14. RESULTS: A total of 118 subjects were randomized, and median CD4+ counts, and clinical presentations were similar between arms. Infusion-related toxicity, kidney toxicity at multiple time-points, and frequency of anemia, hypokalemia, hypomagnesemia, and liver toxicity were similar. Day 14 clinical response was 84% for single-dose L-AmB, 69% 2-dose L-AmB, and 74% for control arm (P = .69). Overall survival on D14 was 89.0% (34/38) for single-dose L-AmB, 78.0% (29/37) for 2-dose L-AmB, and 92.1% (35/38) for control arm (P = .82). CONCLUSIONS: One day induction therapy with 10 mg/kg of L-AmB in AIDS-related histoplasmosis was safe. Although clinical response may be non-inferior to standard L-AmB therapy, a confirmatory phase III clinical trial is needed. A single induction dose would markedly reduce drug-acquisition costs (>4-fold) and markedly shorten and simplify treatment, which are key points in terms of increased access.
Assuntos
Síndrome da Imunodeficiência Adquirida , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Histoplasmose , Humanos , Histoplasmose/tratamento farmacológico , Antifúngicos/efeitos adversos , HIV , Estudos Prospectivos , Síndrome da Imunodeficiência Adquirida/tratamento farmacológicoRESUMO
Infections are a frequent complication and a major cause of death among patients with cirrhosis. The important impact of infections in general and especially spontaneous bacterial peritonitis on the course of disease and prognosis of patients with cirrhosis has been recognized for many years. Nevertheless, such importance has recently increased due to the comprehension of infection as one of the most prominent risk factors for patients to develop acute-on-chronic liver failure. Furthermore, the issue of infections in cirrhosis is a focus of increasing attention because of the spreading of multidrug resistant bacteria, which is an emerging concern among physicians assisting patients with cirrhosis. In the present paper, we will review the current epidemiology of infections in patients with cirrhosis and particularly that of infections caused by resistant bacteria, demonstrating the relevance of the subject. Besides, we will discuss the current recommendations on diagnosis and treatment of different kinds of infections, including spontaneous bacterial peritonitis, and we will highlight the importance of knowing local microbiological profiles and choosing empirical antibiotic therapy wisely. Finally, we will debate the existing evidences regarding the role of volume expansion with albumin in patients with cirrhosis and extraperitoneal infections, and that of antibiotic prophylaxis of spontaneous bacterial peritonitis.
Assuntos
Infecções Bacterianas/microbiologia , Cirrose Hepática/complicações , Peritonite/microbiologia , Albuminas/uso terapêutico , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/mortalidade , Farmacorresistência Bacteriana Múltipla , Hidratação , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Peritonite/diagnóstico , Peritonite/tratamento farmacológico , Peritonite/mortalidade , Substitutos do Plasma/uso terapêutico , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
Patients with cirrhosis have an increased risk of infection and differently from other complications, that over the years are improving in their outcomes, infections in cirrhotic patients are still a major cause of hospitalization and death (up to 50% in-hospital mortality). Infections by multidrug-resistant organisms (MDRO) have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related impact. About one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent years. MDR infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection resolution. An adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects, such as the type of infection (spontaneous bacterial peritonitis, pneumonia, urinary tract infection and spontaneous bacteremia), bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition (community acquired, healthcare associated or nosocomial). Furthermore, regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological epidemiology. Antibiotic treatment is the most effective measure to treat infections caused by MDRO. Therefore, optimizing antibiotic prescribing is critical to effectively treat these infections. Identification of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce mortality. On the other hand, the supply of new agents to treat these infections is very limited. Thus, specific protocols that include preventive measures must be implemented in order to limit the negative impact of this severe complication in cirrhotic patients.
RESUMO
OBJECTIVE: This study aimed to evaluate the correlation between Nonalcoholic fatty liver disease and cardiac abnormalities. METHODS: Patients with Nonalcoholic fatty liver disease who attended an outpatient clinic in Southern Brazil were prospectively evaluated. Patients should be older than 18 years and have steatosis. RESULTS: A total of 174 patients were evaluated. The mean age was 63±12 years, 65% were women, 71% white, 82.2% hypertensive, 52.3% diabetic, 56.3% obese, and 30% dyslipidemic. There was no association between Nonalcoholic fatty liver disease and cardiac abnormalities, even after adjusting for age, sex, and metabolic syndrome. CONCLUSIONS: The present study did not show a direct correlation between Nonalcoholic fatty liver disease and cardiac abnormalities, regardless of metabolic syndrome.
Assuntos
Cardiopatias Congênitas , Hipertensão , Síndrome Metabólica , Hepatopatia Gordurosa não Alcoólica , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Hepatopatia Gordurosa não Alcoólica/complicações , Síndrome Metabólica/complicações , ObesidadeRESUMO
BACKGROUND: Liver transplantation is a complex treatment that demands a high workload from the nursing team. This study evaluated the nursing workload and its relationship with the severity of patients after liver transplantation. MATERIAL AND METHODS: A retrospective cohort study, with a review of 286 medical records of liver transplant patients from January 2014 to June 2018 in a hospital in southern Brazil was performed. Demographic and clinical characteristics were analyzed, as well as the outcome and the scores Model for End-Stage Liver Disease (MELD), Nursing Activity Score (NAS), and Acute Physiology and Chronic Health Evaluation IV (APACHE IV). RESULTS: Men represented 68.9% of the sample, the mean age was 57.6 years (±10), and the MELD and APACHE IV scores respectively showed means of 24.3 (±5.6) and 58.9 (±23.7). The length of stay in the intensive care unit was 5 days (range, 3-7) and mortality was 9.1%. There was a gradual reduction in the mean NAS in 24 hours (94.9 ± 18.5), 48 hours (87.2 ± 17.0), 72 hours (83.3 ± 19.6) and at discharge (82.3 ± 18.0). Associations of NAS with MELD (P Ë .05), APACHE IV (P Ë .001), length of stay in the intensive care unit (P Ë .001), and death outcome (P Ë .001) were observed. The greatest workload was in checking vital signs, water balance, and administrative tasks (P Ë .001). CONCLUSIONS: The nursing workload in the postoperative period of liver transplantation exceeds what is recommended and is related to the severity of the patients.
Assuntos
Doença Hepática Terminal , Transplante de Fígado , Masculino , Humanos , Pessoa de Meia-Idade , APACHE , Carga de Trabalho , Transplante de Fígado/efeitos adversos , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/cirurgia , Estudos de Coortes , Estudos Retrospectivos , Índice de Gravidade de Doença , Unidades de Terapia Intensiva , Tempo de InternaçãoRESUMO
The aim of the present study was to assess the effects of a high protein (HP) and a normal protein (NP) diet on patients with polycystic ovary syndrome (PCOS) and body mass index-matched controls in a sample of southern Brazilian women. This 8-week randomized trial was carried out at a university gynecological endocrinology clinic and included 18 patients with PCOS and 22 controls. Changes in weight, body composition, hormone, and metabolic profile were analyzed in women randomized to receive HP (30% protein, 40% carbohydrate, and 30% lipid) or NP (15% protein, 55% carbohydrate, and 30% lipid). The energy content was estimated for each participant at 20-25 kcal/kg current weight/day. Physical activity, blood pressure, homeostasis model assessment (HOMA) index, and fasting and 2-h glucose and insulin remained stable during the intervention in PCOS and controls, even in the presence of weight loss. There were no changes in lipid profile in either group. In contrast, body weight, body mass index (BMI), waist circumference, percent of body fat, and sum of trunk skinfolds decreased significantly after both diets in both groups. Total testosterone also decreased in PCOS and controls regardless of diet. In conclusion, calorie reduction, rather than protein content, seemed to affect body composition and hormonal profile in this short-term study. These findings emphasize the role of non-pharmacological interventions to reduce weight and ameliorate the anthropometric and clinical phenotype in PCOS.
Assuntos
Proteínas Alimentares/administração & dosagem , Síndrome do Ovário Policístico/dietoterapia , Adulto , Glicemia , Composição Corporal , Brasil , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Hormônios/sangue , Humanos , Hormônio Luteinizante/sangue , Síndrome do Ovário Policístico/sangue , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento , Triglicerídeos/sangue , Redução de Peso , Adulto JovemRESUMO
Background: The role of liver function tests (LFT) as prognostic factors in patients admitted with COVID-19 has not been fully investigated, particularly outside resource-rich countries. We aimed at evaluating the prognostic value of abnormal LFT on admission and during hospitalization of patients with COVID-19. Methods: We performed a retrospective study that included 298 adult patients hospitalized for COVID-19, between 05/2020 and 02/2021, in 6 hospitals from 5 countries in South America. We analyzed demographic and comorbid variables and laboratory tests on admission and during hospitalization. LFT over twice the upper limit of normal (ALEx2) were also evaluated in relation to a variety of factors on admission and during hospitalization. De novo-ALEx2 was defined as the presence of ALEx2 at one week of hospitalization in patients without ALEx2 on admission. Patients were followed until hospital discharge or death. Multivariable analysis was used to evaluate the association between ALEx2 on admission and during hospitalization and mortality. Results: Of the total of 298 patients, 60% were male, with a mean age of 60 years, and 74% of patients had at least one comorbidity. Of those, 137 (46%) patients were transferred to the intensive care unit and 66 (22.1%) patients died during hospitalization. ALEx2 on admission was present in 87 (29.2%) patients and was found to be independently associated with 1-week mortality (odds ratio (OR) = 3.55; 95% confidence interval (95%CI) 1.05-12.05). Moreover, 84 (39.8%) out of 211 patients without ALEx2 at admission developed de novo-ALEx2, which was independently associated with mortality during second week of hospitalization (OR = 6.09; 95%CI 1.28-29) and overall mortality (OR = 2.93, 95%CI 1.05-8.19). Conclusions: A moderate elevation of LFT during admission was associated with a poor short-term prognosis in patients hospitalized with COVID-19. In addition, moderate elevation of LFT at one week of hospitalization was an independent risk factor for overall mortality in these patients.
Assuntos
COVID-19 , Adulto , Comorbidade , Mortalidade Hospitalar , Hospitalização , Humanos , Unidades de Terapia Intensiva , Fígado , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2RESUMO
BACKGROUND: Acute kidney injury (AKI) is a common and severe complication of cirrhosis. OBJECTIVE: To evaluate the impact of AKI staging on 30-day mortality of patients with cirrhosis. METHODS: We performed a retrospective cohort study of hospitalized patients with cirrhosis. Acute kidney injury (AKI) was diagnosed according to the International Club of Ascites recommendations and staged according to the European Association for the Study of the Liver guidelines. Comparisons between groups were made by one-way analysis of variance and Tukey test. Chi-square was calculated for dichotomous variables. Comparisons of renal impairment status among patients were performed using Kaplan-Meier statistics and differences between groups were analyzed using the log-rank test. A P-value <0.05 was considered to be statistically significant. RESULTS: Two hundred and thirty-two patients were included in the study. The diagnosis of AKI was performed in 98 (42.2%) of them. The overall 30-day mortality was 19.8% (46/232). Mortality increased as the degree of AKI progressed. Among patients who did not have AKI, mortality was 5.2% (7/134). When compared to patients without AKI, patients diagnosed with AKI stage 1a had mortality of 12.1% (4/33, P=0.152); patients with AKI stage 1b had mortality of 45% (18/40, P<0.001); and patients with AKI stages 2 or 3 had mortality of 68% (17/25, P<0.001). Moreover, it is noteworthy that full response to treatment was associated to a decreased mortality when compared to patients who did not show complete recovery of renal function (14.3% vs 57.9%, P<0.001). CONCLUSION: AKI stages 1b or greater, but not AKI stage 1a, are associated to higher 30-day mortality of patients with cirrhosis.
Assuntos
Injúria Renal Aguda , Cirrose Hepática , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Ascite , Humanos , Cirrose Hepática/complicações , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND AND AIMS: Experience in the region shows that in some countries there is very good surveillance of Healthcare-associated infections (HAIs) in health services, but there is no national data consistently in all countries. Therefore, we set to estimate the total burden of HAIs and antimicrobial use in acute care hospitals in Brazil, Venezuela, Mexico, and Colombia using the one-day point prevalence methodology. METHODS: The survey was conducted between June and July 2016. In each ward or unit, HAIs and antimicrobial use data were collected on a single day by a trained team of researchers. Also, for each patient, we collected data on risk factors for infections. RESULTS: One out of ten individuals surveyed had at least one healthcare-associated infection (HAI). Pneumonia and surgical site infections were the most relevant among the surveyed countries. Most of the surveyed participants, regardless of their HAI status, received antibiotics except the individuals managed in Brazil. Carbapenems and third-generation Cephalosporins were among the most frequently used antibiotics. CONCLUSION: Our results add to WHO's recent efforts to understand HAIs prevalence and antibiotic consumption in low and middle-income countries, of which we studied three that were not included in their last report.
Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/epidemiologia , Adulto , Infecção Hospitalar/etiologia , Revisão de Uso de Medicamentos , Métodos Epidemiológicos , Feminino , Hospitais/estatística & dados numéricos , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Inquéritos e QuestionáriosRESUMO
SUMMARY OBJECTIVE: This study aimed to evaluate the correlation between Nonalcoholic fatty liver disease and cardiac abnormalities. METHODS: Patients with Nonalcoholic fatty liver disease who attended an outpatient clinic in Southern Brazil were prospectively evaluated. Patients should be older than 18 years and have steatosis. RESULTS: A total of 174 patients were evaluated. The mean age was 63±12 years, 65% were women, 71% white, 82.2% hypertensive, 52.3% diabetic, 56.3% obese, and 30% dyslipidemic. There was no association between Nonalcoholic fatty liver disease and cardiac abnormalities, even after adjusting for age, sex, and metabolic syndrome. CONCLUSIONS: The present study did not show a direct correlation between Nonalcoholic fatty liver disease and cardiac abnormalities, regardless of metabolic syndrome.
RESUMO
Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women on reproductive age. PCOS is characterized by the presence of anovulation, infertility and hyperandrogenism and is associated with obesity and insulin resistance. A major risk for neoplasms of the reproductive tract, like endometrial, breast and ovary cancer seems to be related to PCOS. While several studies have shown an increased risk for endometrial hyperplasia and cancer in PCOS patients, the variability of the selection criteria for PCOS has been recognized as a potential bias for these data. PCOS women also present clinical characteristics that are related to risk factors for breast cancer and some epidemiological evidences have been described on this issue. However, until now, a clear association between the presence of PCOS and breast carcinoma has yet not been found. Finally, high local steroid and growth factor concentrations are considered risk factors for ovary carcinoma, and are frequently observed in PCOS women. In turn, few studies have addressed the possibility of a link between PCOS and ovarian cancer and the results are conflicting but suggest that this association is unlikely.
Assuntos
Neoplasias da Mama/etiologia , Neoplasias do Endométrio/etiologia , Neoplasias Ovarianas/etiologia , Síndrome do Ovário Policístico/complicações , Feminino , Humanos , Fatores de RiscoRESUMO
ABSTRACT BACKGROUND: Acute kidney injury (AKI) is a common and severe complication of cirrhosis. OBJECTIVE: To evaluate the impact of AKI staging on 30-day mortality of patients with cirrhosis. METHODS: We performed a retrospective cohort study of hospitalized patients with cirrhosis. Acute kidney injury (AKI) was diagnosed according to the International Club of Ascites recommendations and staged according to the European Association for the Study of the Liver guidelines. Comparisons between groups were made by one-way analysis of variance and Tukey test. Chi-square was calculated for dichotomous variables. Comparisons of renal impairment status among patients were performed using Kaplan-Meier statistics and differences between groups were analyzed using the log-rank test. A P-value <0.05 was considered to be statistically significant. RESULTS: Two hundred and thirty-two patients were included in the study. The diagnosis of AKI was performed in 98 (42.2%) of them. The overall 30-day mortality was 19.8% (46/232). Mortality increased as the degree of AKI progressed. Among patients who did not have AKI, mortality was 5.2% (7/134). When compared to patients without AKI, patients diagnosed with AKI stage 1a had mortality of 12.1% (4/33, P=0.152); patients with AKI stage 1b had mortality of 45% (18/40, P<0.001); and patients with AKI stages 2 or 3 had mortality of 68% (17/25, P<0.001). Moreover, it is noteworthy that full response to treatment was associated to a decreased mortality when compared to patients who did not show complete recovery of renal function (14.3% vs 57.9%, P<0.001). CONCLUSION: AKI stages 1b or greater, but not AKI stage 1a, are associated to higher 30-day mortality of patients with cirrhosis.
RESUMO CONTEXTO: A lesão renal aguda (LRA) é uma complicação comum e grave na cirrose. OBJETIVO: Avaliar o impacto dos estágios da LRA na mortalidade em 30 dias de pacientes com cirrose. MÉTODOS: Realizou-se um estudo de coorte retrospectivo com pacientes com cirrose hospitalizados. LRA foi diagnosticada de acordo com as recomendações do International Club of Ascites e o estadiamento foi feito de acordo com as recomendações da European Association for the Study of the Liver. Comparações entre os grupos foram feitas por análise de variância unidirecional e teste de Tukey. O teste do qui-quadrado foi calculado para variáveis categóricas. Comparações quanto à lesão renal entre os pacientes foram realizadas com estatísticas de Kaplan-Meier, e diferenças entre os grupos foram analisadas pelo teste de log-rank. Um P-valor <0,05 foi considerado estatisticamente significativo. RESULTADOS: Duzentos e trinta e dois pacientes foram incluídos no estudo. O diagnóstico de LRA foi realizado em 98 (42,2%) deles. A mortalidade geral em 30 dias foi de 19,8% (46/232). A mortalidade aumentou de acordo com a progressão dos estágios de LRA. Entre pacientes sem LRA, a mortalidade foi de 5,2% (7/134). Quando comparados aos pacientes sem LRA, pacientes diagnosticados com LRA estágio 1a tiveram mortalidade de 12,1% (4/33, P=0,152); pacientes com LRA estágio 1b tiveram mortalidade de 45% (18/40, P<0,001); e pacientes com LRA estágios 2 ou 3 tiveram mortalidade de 68% (17/25, P<0,001). Além disso, é importante ressaltar que a resposta completa ao tratamento associou-se à menor mortalidade quando comparada à ausência de recuperação completa da função renal (14,3% vs 57,9%, P<0,001). CONCLUSÃO: LRA estágios 1b ou superior, mas não estágio 1a, estão associadas à maior mortalidade em 30 dias de pacientes com cirrose.
Assuntos
Humanos , Ascite , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Cirrose Hepática/complicaçõesRESUMO
OBJECTIVE: To assess whether TCF7L2 single nucleotide polymorphisms rs7903146 C/T and rs11196236 C/T are associated with polycystic ovary syndrome (PCOS) in South Brazilian women. DESIGN: Cross-sectional study. METHODS: Two hundred PCOS patients and 102 non-hirsute, ovulatory controls were genotyped by real-time PCR. Haplotypes were constructed from the combination of both polymorphisms. Frequencies were inferred using the PHASE 2.1.1 software. RESULTS AND CONCLUSIONS: The distribution of rs7903146 (PCOS, 54.4% CC; 28.5% CT; 17.1% TT; controls, 51.0% CC; 37.0% CT; 12.0% TT) and rs11196236 (PCOS, 4.3% CC; 33.5% CT; 62.2% TT; controls, 3.2% CC; 35.5% CT; 61.3% TT) was similar between the groups. rs7903146 and rs11196236 were not in linkage disequilibrium (|D'|=0.34; r(2)=0.07). PCOS participants were younger, with higher age-adjusted BMI, waist circumference, blood pressure, triglycerides, insulin, homeostasis model assessment index to estimate insulin resistance and total testosterone, and lower HDL-C and sex hormone binding globulin vs controls. In PCOS, no differences between genotypes and haplotypes were found for clinical and metabolic variables. However, for each T (rs7903146) and T (rs11196236) allele added to the haplotypes, a variation of 5.87 cm in waist (P trend=0.01), 10.7 mg/dl in total cholesterol (P trend=0.03), and 10.3 mg/dl in LDL-C (P trend=0.01) was recorded. TCF7L2 variants are probably not implicated in PCOS development in South Brazilian women.
Assuntos
Síndrome do Ovário Policístico/genética , Proteína 2 Semelhante ao Fator 7 de Transcrição/genética , Adulto , Antropometria , População Negra , Glicemia/análise , Glicemia/metabolismo , Brasil/epidemiologia , Colesterol/sangue , Estudos Transversais , Feminino , Frequência do Gene , Genótipo , Haplótipos , Humanos , Síndrome do Ovário Policístico/epidemiologia , Polimorfismo Genético/genética , Polimorfismo de Nucleotídeo Único , Reação em Cadeia da Polimerase em Tempo Real , Tamanho da Amostra , Triglicerídeos/sangue , Circunferência da Cintura , População BrancaRESUMO
OBJECTIVE: To assess whether heart rate variability (HRV) at rest and during sympathetic stimulation is disturbed in patients with different polycystic ovary syndrome (PCOS) phenotypes in comparison to healthy controls. DESIGN: Cross-sectional study. SETTING: University hospital. PATIENT(S): Thirty women with classic, anovulatory PCOS, 16 women with ovulatory PCOS, and 23 age-paired women with regular and proven ovulatory cycles. INTERVENTION(S): Anthropometric and hormonal evaluation and analysis of HRV (time and frequency domain HRV indices) at rest and after a mental stress test. MAIN OUTCOME MEASURE(S): Difference between HRV components during rest and stress. RESULT(S): Mean age was 22.80 ± 5.80 years in patients with classic PCOS, 19.81 ± 6.43 years in ovulatory PCOS, and 22.65 ± 5.89 years in controls. During mental stress, patients with classic PCOS showed lower HRV response when compared with the control group, even after adjustment for body mass index (BMI) and age. When patients with classic and ovulatory PCOS were considered together, total T levels were inversely associated with the low frequency component, low frequency/high frequency ratio, and the difference between high frequency response at rest and after the stress test. CONCLUSION(S): Young patients with the classic PCOS phenotype have an impaired autonomic modulation in response to sympathetic stimulation that is typical of considerably older women, or of advanced age.
Assuntos
Sistema Nervoso Autônomo/fisiologia , Frequência Cardíaca/fisiologia , Coração/inervação , Síndrome do Ovário Policístico/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Coração/fisiologia , Coração/fisiopatologia , Humanos , Fenótipo , Descanso/fisiologia , Estresse Psicológico/fisiopatologia , Adulto JovemRESUMO
The aim of this study was to compare clinical, hormonal, and metabolic variables in women with classic polycystic ovary syndrome (PCOS), in ovulatory women presenting hirsutism, normal androgen levels, and polycystic ovaries (H+PCO), and in a group with isolated hirsutism (IH) presenting with normal ovaries and androgen levels. Waist circumference, triglycerides, and homeostasis model assessment values were significantly higher in classic PCOS even after adjustment for body mass index, and metabolic syndrome was three times more frequent in classic PCOS than in H+PCO or IH (31.3% vs. 11.9% vs. 9%), but no differences were observed regarding metabolic profile and cardiovascular risk factors between the H+PCO and IH groups, which presented with significantly more metabolic syndrome than normal controls when only overweight and obese women were considered.
Assuntos
Doenças Cardiovasculares/etiologia , Doenças Metabólicas/etiologia , Síndrome do Ovário Policístico/complicações , Adolescente , Adulto , Androgênios/sangue , Doenças Cardiovasculares/epidemiologia , Feminino , Hirsutismo/sangue , Hirsutismo/complicações , Hirsutismo/epidemiologia , Humanos , Doenças Metabólicas/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Fenótipo , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/classificação , Síndrome do Ovário Policístico/epidemiologia , Prevalência , Fatores de Risco , Adulto JovemRESUMO
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder with individual susceptibility determined by genetic and environmental risk factors. Recently, studies have evaluated the CAPN10 gene in PCOS patients, suggesting that different alleles may play a role in PCOS susceptibility. We performed a cross-sectional study with 88 southern Brazilian hirsute patients with PCOS or idiopathic hirsutism (IH) to assess the influence of CAPN10 genetic variants on clinical and biochemical features of metabolic syndrome. PCOS patients were defined by oligo/amenorrheic cycles (<9 cycles/year), increased levels of serum testosterone and/or free androgen index, and exclusion of other disorders associated with hyperandrogenism. IH was diagnosed in hirsute patients with regular ovulatory cycles (luteal-phase progesterone levels >3.8 ng/ml), normal androgen levels, and without any known underlying disease (n = 29). Metabolic syndrome was defined according to the 2001 criteria of the National Cholesterol Education Program, Adult Treatment Panel III. UCSNP-43 polymorphism of CAPN10 was related to metabolic syndrome (p = 0.047) in PCOS; UCSNP-19 and UCSNP-63 were not associated with phenotypic traits in PCOS. These results provide evidence that CAPN10 gene UCSNP-43 polymorphisms may influence the PCOS metabolic phenotype. This should be further confirmed in large population-based studies.
Assuntos
Calpaína/genética , Hirsutismo/genética , Síndrome Metabólica/genética , Síndrome do Ovário Policístico/genética , Polimorfismo de Nucleotídeo Único/genética , Adulto , Glicemia , Índice de Massa Corporal , Brasil , Feminino , Humanos , Síndrome Metabólica/complicações , Fenótipo , Síndrome do Ovário Policístico/complicaçõesAssuntos
Antifúngicos/uso terapêutico , Candida glabrata/isolamento & purificação , Candidíase/epidemiologia , Fluconazol/uso terapêutico , Fungemia/epidemiologia , Brasil/epidemiologia , Candida/classificação , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candida glabrata/efeitos dos fármacos , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Humanos , Incidência , Testes de Sensibilidade Microbiana/normasRESUMO
A síndrome dos ovários policísticos (PCOS) é a endocrinopatia mais comum em mulheres em idade reprodutiva, caracterizada pela presença de anovulação, infertilidade e hiperandrogenismo, e freqüentemente associada à obesidade e resistência insulínica. Postula-se que, a longo prazo, estas pacientes possam apresentar maior risco de neoplasias do trato reprodutivo como carcinoma (CA) de endométrio, mama e ovário. Um risco aumentado de hiperplasia e CA endometrial nessas pacientes tem sido demonstrado em vários estudos, embora seja reconhecido que a variabilidade dos critérios de seleção para o diagnóstico de PCOS em alguns destes estudos limite o valor dos dados. Apesar das pacientes com PCOS apresentarem características clínicas associadas com um aumento de risco de CA de mama, até o momento não foi possível relacionar com certeza a presença da síndrome per se com maior prevalência desta neoplasia. Finalmente, quanto ao CA do ovário, considera-se que altas concentrações locais de hormônios esteróides e fatores de crescimento representam fatores de risco para esta neoplasia. Apesar destas alterações serem comumente observadas nas pacientes PCOS não tratadas ou em tratamento para infertilidade, ainda são poucos os estudos que avaliam uma possível relação entre PCOS e CA de ovário, mas seus resultados, embora conflitantes, sugerem ausência de associação.
Assuntos
Feminino , Humanos , Neoplasias da Mama/etiologia , Neoplasias do Endométrio/etiologia , Neoplasias Ovarianas/etiologia , Síndrome do Ovário Policístico/complicações , Fatores de RiscoRESUMO
A síndrome dos ovários policísticos (PCOS) tem sido associada à resistência insulínica/hiperinsulinemia compensatória e a uma maior prevalência de intolerância aos carboidratos (ICH) e diabetes mellitus tipo 2 (DM2). Há controvérsia na literatura sobre se a hiperinsulinemia, presente nas pacientes com PCOS, é independente ou näo da obesidade. No presente estudo, avaliaram-se as características hormonais e o perfil metabólico glicoinsulínico e lipídico em mulheres hirsutas com o diagnóstico de PCOS em comparaçäo com pacientes com hirsutismo idiopático (HI), estratificadas de acordo com o índice de massa corporal (IMC 5 ou > 25kg/m2). Foram dosados androgênios, SHBG, gonadotrofinas, além de glicose, lipídeos e lipoproteínas, insulina e pró-insulina. Foi também realizado o teste de tolerância oral á glicose (75g) para avaliaçäo da curva de glicose e insulina. Concluímos que as pacientes com PCOS e IMC > 25kg/m2 apresentam maior prevalência de obesidade abdominal, de hiperinsulinemia, hipertrigliceridemia e curvas glicêmicas alteradas em relaçäo ás pacientes PCOS e IMC =_ 25kg/m2 e ao grupo controle estudado de pacientes com hirsutismo idiopático.