RESUMO
Introdução: Endometriose é uma patologia pélvica crônica de caráter inflamatório e estrogênio-dependente. Manifesta-se em quatro tipos de estágio (EI, EII, EIII e EIV), caracterizados pelos números de lesões. Tem indicações farmacológicas recomendadas se baseadas nos estágios, sendo EI/EII sintomático com AINES e/ou uso de anticonceptivos de uso contínuo; e EIII/EIV com fármacos análogos de GnRH. O estilo de vida dessas mulheres é impactado pela dor, que altera a rotina e vida afetivo/sexual contribuindo para quadros de ansiedade. O presente estudo se norteia pela questão "qual impacto na ansiedade de mulheres com endometriose, quando não ocorrem indicações farmacológicas recomendadas para os estágios que se encontra? Logo, o objetivo deste estudo é avaliar os efeitos do tratamento medicamentoso não recomendado e risco de ansiedade. Metodologia: Levantamento de pacientes com diagnóstico de Endometriose, cadastradas no Banco de Dados do Projeto agrupadas em estágios de tratamentos farmacológicos similares (EI/EII e EIII/EIV). O relato de ansiedade, com diagnóstico médico e pós endometriose foi a variável dependente em estudo. As variáveis independentes (ou influenciadoras) foram [1] Estágio da doença, [2] Farmacoterapia recomendada (FR) ou não (FNR) e [3] esquema medicamentoso empregado (classes e combinações). Estatística feitas por chi quadrado e Fischer. Resultados: Do total de 375 mulheres, 274 apresentavam ansiedade. Destas, 170 estavam no grupo IFR; sendo 141 no agrupamento EI/EII, e 29 mulheres no EIII/EIV. No que se refere ao grupo IFNR, teve se um n=104 mulheres, sendo apenas 1 nos EI/EII e 103 nos EIII/EIV. Os casos de FNR estão mais presentes em EIII/EIV, com 90% dos casos (IC 95%, p<0,05). O esquema terapêutico mais presente foi AINEs em monoterapia, sendo 65% (IC 95%, p<0,05) em Estágio inadequado. Notou-se uma correlação positiva entre FNR e quadros de ansiedade, principalmente quando se empregava a monoterapia com AINEs (IC 95%, p<0,05). Conclusão: Dificuldades de acesso a especialistas para diagnóstico e aos medicamentos do EIII/EIV podem ser as causas, que serão investigadas em estudos futuros.
Introduction: Endometriosis is a chronic pelvic pathology with an inflammatory and estrogen-dependent nature. It manifests itself in four types of stages (EI, EII, EIII and EIV), characterized by the number of lesions. It has recommended pharmacological indications based on the stages, being symptomatic EI/EII with NSAIDs and/or use of continuous contraceptives; and EIII/EIV with GnRH analogue drugs. The lifestyle of these women is impacted by pain, which alters their routine and emotional/sexual life, contributing to anxiety. The present study is guided by the question "what impact on the anxiety of women with endometriosis, when there are no recommended pharmacological indications for the stage they are in?" Therefore, the objective of this study is to evaluate the effects of non-recommended drug treatment and the risk of anxiety. Methodology: Survey of patients diagnosed with Endometriosis, registered in the Project Database grouped into stages of similar pharmacological treatments (EI/EII and EIII/EIV). The report of anxiety, with medical diagnosis and post-endometriosis was the dependent variable under study. The independent (or influencing) variables were [1] Stage of the disease, [2] Pharmacotherapy recommended (FR) or not (FNR) and [3] medication regimen used (classes and combinations). Statistics made by chi square and Fischer. Results: Of the total of 375 women, 274 had anxiety. Of these, 170 were in the IFR group; 141 in the EI/EII group, and 29 women in the EIII/EIV group. Regarding the IFNR group, there were n=104 women, with only 1 in EI/EII and 103 in EIII/EIV. FNR cases are more present in EIII/EIV, with 90% of cases (95% CI, p<0.05). The most common therapeutic regimen was NSAIDs as monotherapy, with 65% (95% CI, p<0.05) in an inadequate stage. A positive correlation was noted between FNR and anxiety, especially when using monotherapy with NSAIDs (95% CI, p<0.05). Conclusion: Difficulties in accessing specialists for diagnosis and EIII/EIV medications may be the causes, which will be investigated in future studies.
Introducción: La endometriosis es una patología pélvica crónica de naturaleza inflamatoria y estrógeno-dependiente. Se manifiesta en cuatro tipos de estadios (EI, EII, EIII y EIV), caracterizados por el número de lesiones. Tiene indicaciones farmacológicas recomendadas según los estadios, siendo EI/EII sintomática con AINE y/o uso de anticonceptivos continuos; y EIII/EIV con fármacos análogos de GnRH. El estilo de vida de estas mujeres se ve impactado por el dolor, lo que altera su rutina y su vida emocional/sexual, contribuyendo a la ansiedad. El presente estudio se guía por la pregunta "¿qué impacto tiene en la ansiedad de las mujeres con endometriosis, cuando no existen indicaciones farmacológicas recomendadas para las etapas en las que se encuentra? Por tanto, el objetivo de este estudio es evaluar los efectos del tratamiento farmacológico no recomendado y el riesgo de ansiedad. Metodología: Encuesta a pacientes diagnosticadas de Endometriosis, registradas en la Base de Datos del Proyecto agrupadas en etapas de tratamientos farmacológicos similares (EI/EII y EIII/EIV). El reporte de ansiedad, con diagnóstico médico y post-endometriosis fue la variable dependiente en estudio. Las variables independientes (o influyentes) fueron [1] Estadio de la enfermedad, [2] Farmacoterapia recomendada (FR) o no (FNR) y [3] régimen de medicación utilizado (clases y combinaciones). Estadística realizada por chi cuadrado y Fischer. Resultados: Del total de 375 mujeres, 274 presentaron ansiedad. De ellos, 170 estaban en el grupo IFR; 141 en el grupo EI/EII y 29 mujeres en el grupo EIII/EIV. En cuanto al grupo IFNR, hubo n=104 mujeres, siendo sólo 1 en EI/EII y 103 en EIII/EIV. Los casos de FNR están más presentes en EIII/EIV, con un 90% de los casos (IC 95%, p<0,05). El régimen terapéutico más común fue el de AINE en monoterapia, con un 65% (IC 95%, p<0,05) en estadio inadecuado. Se observó una correlación positiva entre la FNR y la ansiedad, especialmente cuando se utilizaba monoterapia con AINE (IC del 95%, p<0,05). Conclusión: Las dificultades para acceder a especialistas para el diagnóstico y a los medicamentos EIII/EIV pueden ser las causas, que serán investigadas en futuros estudios.
RESUMO
In the present study, we investigated the in vitro effect of hypoxanthine on the activities of antioxidant enzymes such as catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase, as well as on thiobarbituric-acid-reactive substances (TBA-RS), in the renal cortex and medulla of rats. Results showed that hypoxanthine, at a concentration of 10.0 µM, enhanced the activities of CAT and SOD in the renal cortex of 15-, 30- and 60-day-old rats, enhanced SOD activity in the renal medulla of 60-day-old rats and enhanced TBA-RS levels in the renal medulla of 30-day-old rats, as compared with controls. Furthermore, we also verified the influence of allopurinol (an inhibitor of xanthine oxidase), as well as of the antioxidants, trolox and ascorbic acid on the effects elicited by hypoxanthine on the parameters tested. Allopurinol and/or administration of antioxidants prevented most alterations caused by hypoxanthine in the oxidative stress parameters evaluated. Data suggest that hypoxanthine alters antioxidant defences and induces lipid peroxidation in the kidney of rats; however, in the presence of allopurinol and antioxidants, some of these alterations in oxidative stress were prevented. Our findings lend support to a potential therapeutic strategy for this condition, which may include the use of appropriate antioxidants for ameliorating the damage caused by hypoxanthine.
Assuntos
Alopurinol/farmacologia , Antioxidantes/farmacologia , Ácido Ascórbico/farmacologia , Hipoxantina/farmacologia , Córtex Renal/efeitos dos fármacos , Medula Renal/efeitos dos fármacos , Oxidantes/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Vitamina E/farmacologia , Animais , Córtex Renal/metabolismo , Medula Renal/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Ratos WistarRESUMO
We herein investigated the in vitro effect of hypoxanthine on the activities of antioxidant enzymes such as catalase (CAT), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) in erythrocytes, as well as on thiobarbituric acid-reactive substances (TBA-RS), in the plasma of rats. Results showed that hypoxanthine, when added to the incubation medium, enhanced CAT (10.0 µM), GSH-Px and SOD (8.5 µM and 10.0 µM) activities in erythrocytes of 15-day-old rats, reduced CAT activity (10.0 µM) and enhanced GSH-Px activity (10.0 µM) in erythrocytes of 30-day-old rats, reduced CAT activity (10.0 µM) and enhanced GSH-Px activity (8.5 µM and 10.0 µM) in erythrocytes of 60-day-old rats, as compared to controls. In addition, hypoxanthine (10.0 µM) enhanced TBA-RS levels in the plasma of 30- and 60-day old rats. Furthermore, we also tested the influence of allopurinol, trolox, and ascorbic acid on the effects elicited by hypoxanthine on the antioxidant enzymes and TBA-RS. Allopurinol and/or administration of antioxidants prevented most alterations caused by hypoxanthine in the oxidative stress parameters evaluated. Findings suggest that hypoxanthine alters antioxidant defenses and induces lipid peroxidation in the blood of rats; however, in the presence of allopurinol and antioxidants, some of these alterations in oxidative stress caused are prevented. Data indicate that, in humans, antioxidant administration might serve as a potential adjuvant therapy for ameliorating the damage caused by hypoxanthine.