Hormonal, metabolic and inflammatory circulating biomarker profiles in obese and non-obese Brazilian middle-aged women.

AIM: To investigate circulating hormonal, metabolic and inflammatory biomarker profiles in obese and non-obese middle-aged women. METHODS: A total of 110 women, aged 40-60 years, were included in this cross-sectional study. Patients were allocated, according to the occurrence of menopause and body mass index (BMI), into four groups: PM0 (premenopausal non-obese), PM1 (premenopausal obese), M0 (postmenopausal non-obese), and M1 (postmenopausal obese). Serum levels of gonadotropins, sex hormones, lipid markers, leptin, hs-CRP and interleukin-6 were obtained using either colorimetric or immunoenzymatic assays. Univariate and correlation analyses were performed among all clinical and laboratorial parameters. Principal component analysis was used to characterize subsets of biomarkers, which had their discriminatory capacity tested using discriminant function analysis. RESULTS: Levels of gonadotropins and female sex hormones were similar between PM0 and PM1 and between M0 and M1 (p > 0.05), all of them varied between PM0 and M0 (p < 0.05), but only estradiol was significantly altered in the comparison between PM1 and M1 (p = 0.027). Regarding metabolic markers, leptin was lower in PM0 than in M0 (p = 0.010) and higher in M1 than in M0 (p = 0.046). In premenopausal women, BMI correlated only to leptin, while it correlated to several other markers in postmenopausal women. A combination of FSH and leptin serum levels significantly discriminated the four groups (Wilks's lambda < 0.001, in canonical functions 1 and 2). CONCLUSION: A combined analysis of hormonal biomarkers may potentially distinguish obese from non-obese women with distinct menopause status. Further research is thus required to clarify the clinical significance of such findings.

Osteoporosis in primary care: an opportunity to approach risk factors.

INTRODUCTION: Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. OBJECTIVES: Identify risk factors related to osteoporosis in women attending PROPIS/PROEX/UFMA, tracing a socio-demographic characterization and considering community lifestyles. MATERIAL AND METHODS: This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís-MA with 107 women treated at the Programa de Práticas de Integralidade em Saúde (PROPIS - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info(®) software, version 3.4.1. RESULTS: The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p<0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p<0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. CONCLUSION: The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high.

Osteoporosis in primary care: an opportunity to approach risk factors / Osteoporose na atenção primária: uma oportunidade para abordar os fatores de risco

ABSTRACT Introduction: Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. Objectives: Identify risk factors related to osteoporosis in women attending Propis/Proex/UFMA, tracing a socio-demographic characterization and considering community lifestyles. Material and methods: This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís (MA) with 107 women treated at the Programa de Práticas de Integralidade em Saúde (Propis - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info® software, version 3.4.1. Results: The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p < 0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p < 0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. Conclusion: The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high.

RESUMO Introdução: As mulheres no climatério estão suscetíveis a uma série de mudanças, entre elas a osteoporose. A osteoporose é uma doença caracterizada por uma baixa massa óssea e susceptibilidade à fratura. Atualmente, essa doença é um problema de saúde pública e é necessário reconhecer seus fatores de risco. Objetivos: Identificar os fatores de risco relacionados com a osteoporose em mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis)/Proex/UFMA, traçar uma caracterização sociodemográfica e considerar o estilo de vida da comunidade. Material e métodos: Trata-se de um estudo transversal retrospectivo clínico com uma abordagem quantitativa, feito entre março e junho de 2013, em São Luís (MA), com 107 mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis). O estudo foi aprovado pelo Comitê de Ética do Hospital Universitário da UFMA, sob parecer nº 362/07. Os dados foram tabulados e analisados com o software epidemiológico Epi-Info®, versão 3.4.1. Resultados: A etnia parda foi predominante, a união estável mostrou ser um fator protetor e a baixa escolaridade foi um fator de risco. A idade média do grupo com menopausa foi de 54,1 anos e a do sem menopausa de 31,3 anos (p < 0,0001). A idade média da menopausa foi de 43,7 anos. O ciclo menstrual irregular foi um fator protetor. O número médio de gestações foi de 4,56 para o grupo com menopausa e 2,45 para o grupo sem menopausa, com a maior parte dos partos normal (p < 0,0001). O tabagismo, a inatividade física e o consumo de cafeína foram fatores de risco, enquanto a ausência de alcoolismo e de ingestão de refrigerante foram fatores de proteção para a doença. Conclusão: Os pacientes seguiram o perfil socioeconômico e demográfico do Maranhão. A maior parte teve a menarca e a menopausa em períodos apropriados, não apresentava antecedentes familiares de osteoporose, não costumava ingerir bebida alcoólica, era sedentária e consumia uma elevada quantidade de cafeína.

Family history in breast cancer in São Luís, Maranhão, Brazil.

BACKGROUND: Familial cancer includes some types of cancer aggregation without a well-defined inheritance pattern. Cancer genetics is an essential component of clinical practice in oncology. In Brazil, breast cancer is the leading cause of death in women. In Maranhão, studies on genetic predisposition are necessary to investigate the incidence and mortality rates. The aim of this study was to investigate familial cancer among relatives of women who died of breast cancer in São Luís, Brazil, constructing a pedigree to identify families with a hereditary predisposition, an important step in the early diagnosis of malignant tumors. METHODS: The city of São Luís is located on the Island of Maranhão, northeastern Brazil, with a population of 997,098 inhabitants mainly comprising blacks and mulattoes, including descendants of runaway slaves from the Amazon region itself. Data for pedigree construction were obtained from the records of 54 patients seen at the Aldenora Bello Institute of Oncology, São Luís, between 2000 and 2007, as well as by interview with relatives of the patients. RESULTS: The mean patient age at diagnosis was 39.5 years. Most women were mulattoes (36/54, 66.6%). A history of cancer was observed in 18 families, with 16 families possessing cases of cancer among first-degree relatives and five among second-degree relatives. CONCLUSION: A concentration of cancer cases was found in families of patients diagnosed until the age of 40, a finding demonstrating the importance of a family history prior to genetic counseling.

Cerebral aspergillosis in a patient with leprosy and diabetes: a case report.

BACKGROUND: Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system. CASE PRESENTATION: The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm(3) and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya-Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole. CONCLUSION: This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.

Respiratory allergy to airborne fungi in São Luís--MA: clinical aspects and levels of IgE in a structured asthma program.

INTRODUCTION: Respiratory allergies are becoming increasingly frequent, especially based on studies of asthma and rhinitis. It is estimated that 20-30% of the world's population is affected. Allergic reactions are caused by the production of IgE antibodies specific to inhaled allergens, such as fungi in the air. This study aimed to analyze the level of specific IgE against airborne fungi in patients with a clinical diagnosis of asthma and rhinitis/sinusitis. METHODS: In total, 158 patients enrolled in the Program of Support for Asthmatic Patient, and 20 controls were studied. Clinical data from the period of 2007-2008 were surveyed using a protocol form. ELISAs were performed to quantify the levels of total and specific IgE. RESULTS: Of the 158 patients diagnosed with asthma, 71 had rhinitis and 32 had sinusitis. There was a predominance of females and residents of urban areas. The main symptoms reported were dyspnea, cough, wheezing and nasal obstruction. There was a statistically significant relationship between dyspnea and seropositivity for Fusarium (p = 0.01) and Penicillium (p = 0.005) and between cough and seropositivity for Aspergillus (p = 0.007). CONCLUSIONS: Anti-Penicillium (79.7%) and anti-Fusarium IgE (77.8%) were found to have the highest prevalence of seropositivity in individuals with asthma and rhinitis/sinusitis. Sensitivity to fungi was higher in symptomatic individuals. The identification of environmental fungi is essential for the diagnosis of respiratory allergy.