Evaluation of Sexual Function of Transgender Individuals.

PURPOSE: The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors. METHODS: Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life. RESULTS: Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life. CONCLUSIONS: The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life.

Characteristics of a Population with Gender Incongruence Assisted at a Specialized Outpatient Service in the City of Ribeirão Preto / Características de uma população com incongruência de gênero assistida em ambulatório especializado em Ribeirão Preto

Abstract Objective To identify the age when individuals first perceive gender incongruence (GI) and to compare sociodemographic data of female-to-male (FtM) and male-tofemale (MtF) transgender individuals assisted at an outpatient service. Methods The present cross-sectional study was conducted through a review of the medical records of individuals diagnosed with GI at a single specialized outpatient service in the city of Ribeirão Preto, state of São Paulo, Brazil. Results A total of 193 medical records from 2010 to 2018 were evaluated, and 109 (56.5%) patients had GI since childhood. The FtM transgender individuals perceived GI in childhood more often than the MtF transgender individuals (odds ratio [OR]: 2.06, 95% confidence interval [95%CI]: 1.11-3.81) Unattended hormone use was highest among the MtF group (69.6% versus 32.3%; OR: 4.78, 95%CI: 2.53-9.03). All of the individuals who were engaged in prostitution or were diagnosed with a sexuallytransmitted infection, including HIV, were in the MtF group. Conclusion Despite the more prevalent perception of GI in childhood among the FtM group, social issues were more prevalent among the MtF group, which may be the result of social marginalization.

Resumo Objetivo Identificar o período da vida emque indivíduos indentificaram pela primeira vez sua incongruência de gênero (IG), e comparar os dados sociodemográficos de homens e mulheres transgêneros (trans) atendidos em um ambulatório. Métodos Estudo transversal realizado por meio de revisão dos prontuários de pessoas com IG em ambulatório especializado de Ribeirão Preto, São Paulo, Brasil. Resultados Foram avaliados 193 prontuários de 2010 a 2018, e 109 (56.5%) pacientes apresentavamIG desde a infância. Homens trans perceberam a IG na infância com mais frequência do que as mulheres trans (razão de probabilidades [RP]: 2.06, intervalo de confiança de 95% [IC95%]: 1.11-3.81). O uso de hormônio sem supervisão foi maior entre as mulheres trans (69.6% versus 32.3%; RP: 4.78; IC95%: 2.53-9.03). Todos as pessoas que estavam inseridas na prostituição ou que apresentavam algum diagnóstico de infecção sexualmente transmissível, incluindo o HIV, eram mulherestrans. Conclusão Apesar da percepção mais prevalente da IG na infância entre homens trans, os agravos sociais foram mais prevalentes entre as mulheres trans, o que pode ser resultado da marginalização social.

Characteristics of a Population with Gender Incongruence Assisted at a Specialized Outpatient Service in the City of Ribeirão Preto.

OBJECTIVE: To identify the age when individuals first perceive gender incongruence (GI) and to compare sociodemographic data of female-to-male (FtM) and male-to-female (MtF) transgender individuals assisted at an outpatient service. METHODS: The present cross-sectional study was conducted through a review of the medical records of individuals diagnosed with GI at a single specialized outpatient service in the city of Ribeirão Preto, state of São Paulo, Brazil. RESULTS: A total of 193 medical records from 2010 to 2018 were evaluated, and 109 (56.5%) patients had GI since childhood. The FtM transgender individuals perceived GI in childhood more often than the MtF transgender individuals (odds ratio [OR]: 2.06, 95% confidence interval [95%CI]: 1.11-3.81) Unattended hormone use was highest among the MtF group (69.6% versus 32.3%; OR: 4.78, 95%CI: 2.53-9.03). All of the individuals who were engaged in prostitution or were diagnosed with a sexually-transmitted infection, including HIV, were in the MtF group. CONCLUSION: Despite the more prevalent perception of GI in childhood among the FtM group, social issues were more prevalent among the MtF group, which may be the result of social marginalization.

OBJETIVO: Identificar o período da vida em que indivíduos indentificaram pela primeira vez sua incongruência de gênero (IG), e comparar os dados sociodemográficos de homens e mulheres transgêneros (trans) atendidos em um ambulatório. MéTODOS: Estudo transversal realizado por meio de revisão dos prontuários de pessoas com IG em ambulatório especializado de Ribeirão Preto, São Paulo, Brasil. RESULTADOS: Foram avaliados 193 prontuários de 2010 a 2018, e 109 (56.5%) pacientes apresentavam IG desde a infância. Homens trans perceberam a IG na infância com mais frequência do que as mulheres trans (razão de probabilidades [RP]: 2.06, intervalo de confiança de 95% [IC95%]: 1.11­3.81). O uso de hormônio sem supervisão foi maior entre as mulheres trans (69.6% versus 32.3%; RP: 4.78; IC95%: 2.53­9.03). Todos as pessoas que estavam inseridas na prostituição ou que apresentavam algum diagnóstico de infecção sexualmente transmissível, incluindo o HIV, eram mulheres trans. CONCLUSãO: Apesar da percepção mais prevalente da IG na infância entre homens trans, os agravos sociais foram mais prevalentes entre as mulheres trans, o que pode ser resultado da marginalização social.

Long-Acting Reversible Contraception.

Unwanted pregnancy is a major public health problem both in developed and developing countries. Although the reduction in the rates of these pregnancies requires multifactorial approaches, increasing access to long-acting contraceptive methods can contribute significantly to change this scenario. In Brazil, gynecologists and obstetricians play a key role in contraceptive counseling, being decisive in the choice of long-acting reversible methods, characterized by intrauterine devices (IUDs) and the contraceptive implant. The vast scope due to the reduced number of situations to indicate long-acting methods should be emphasized in routine contraceptive counseling. On the other hand, gynecologists and obstetricians should adapt the techniques of insertion of long-acting methods, and engage in facilitating conditions to access these contraceptives through public and private health systems in Brazil. This study is part of a project called Diretrizes e Recomendações FEBRASGO (Guidelines and Recommendations of the FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations from the Portuguese acronym). It aims to review the main characteristics of long-acting contraceptives and critically consider the current situation and future prospects to improve access to these methods, proposing practical recommendations of interest in the routine of gynecologists and obstetricians.

A gravidez não planejada representa importante problema de saúde pública tanto em países desenvolvidos quanto naqueles em desenvolvimento. Embora a redução das taxas dessas gestações requeira abordagens multifatoriais, o aumento no acesso aos métodos contraceptivos de longa ação pode contribuir de forma expressiva na mudança desse cenário. No Brasil, os ginecologistas e obstetras têm papel fundamental no aconselhamento contraceptivo, sendo decisivos na escolha dos métodos reversíveis de longa ação, caracterizados pelos dispositivos intrauterinos (DIUs) e pelo implante anticoncepcional. A grande abrangência decorrente do pequeno número de situações que contraindicam os métodos de longa ação deve ser enfatizada no aconselhamento contraceptivo de rotina. Por outro lado, os ginecologistas e obstetras devem se adaptar às técnicas de inserção dos métodos de longa ação, bem como se engajar na facilitação de condições para o acesso a esses contraceptivos por meio do sistema de saúde pública e privada no Brasil. Este estudo, parte do projeto denominado "Diretrizes e Recomendações FEBRASGO", tem por objetivo revisar as principais características dos contraceptivos de longa ação, além de considerar de forma crítica o panorama atual e as perspectivas futuras, visando melhorar o acesso a esses métodos, com recomendações práticas de interesse na rotina do ginecologista e obstetra.

Long-Acting Reversible Contraception / Contracepção reversível de longa ação

Abstract Unwanted pregnancy is a major public health problem both in developed and developing countries. Although the reduction in the rates of these pregnancies requires multifactorial approaches, increasing access to long-acting contraceptive methods can contribute significantly to change this scenario. In Brazil, gynecologists and obstetricians play a key role in contraceptive counseling, being decisive in the choice of long-acting reversible methods, characterized by intrauterine devices (IUDs) and the contraceptive implant. The vast scope due to the reduced number of situations to indicate long-acting methods should be emphasized in routine contraceptive counseling. On the other hand, gynecologists and obstetricians should adapt the techniques of insertion of long-acting methods, and engage in facilitating conditions to access these contraceptives through public and private health systems in Brazil. This study is part of a project called Diretrizes e Recomendações FEBRASGO (Guidelines and Recommendations of the FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations from the Portuguese acronym). It aims to review the main characteristics of long-acting contraceptives and critically consider the current situation and future prospects to improve access to these methods, proposing practical recommendations of interest in the routine of gynecologists and obstetricians.

Resumo A gravidez não planejada representa importante problema de saúde pública tanto em países desenvolvidos quanto naqueles em desenvolvimento. Embora a redução das taxas dessas gestações requeira abordagens multifatoriais, o aumento no acesso aos métodos contraceptivos de longa ação pode contribuir de forma expressiva na mudança desse cenário. No Brasil, os ginecologistas e obstetras têm papel fundamental no aconselhamento contraceptivo, sendo decisivos na escolha dos métodos reversíveis de longa ação, caracterizados pelos dispositivos intrauterinos (DIUs) e pelo implante anticoncepcional. A grande abrangência decorrente do pequeno número de situações que contraindicam os métodos de longa ação deve ser enfatizada no aconselhamento contraceptivo de rotina. Por outro lado, os ginecologistas e obstetras devem se adaptar às técnicas de inserção dos métodos de longa ação, bem como se engajar na facilitação de condições para o acesso a esses contraceptivos por meio do sistema de saúde pública e privada no Brasil. Este estudo, parte do projeto denominado "Diretrizes e Recomendações FEBRASGO", tem por objetivo revisar as principais características dos contraceptivos de longa ação, além de considerar de forma crítica o panorama atual e as perspectivas futuras, visando melhorar o acesso a esses métodos, com recomendações práticas de interesse na rotina do ginecologista e obstetra.

Does the Access to Sun Exposure Ensure Adequate Levels of 25-Hydroxyvitamin D?

Objectives To assess the prevalence of hypovitaminosis D, altered arterial blood pressure, and serum levels of glucose and lipids in community-dwelling women in the city of Ribeirão Preto, in the southeast of Brazil. Methods This was a cross-sectional study of women aged 40-70 years old. Calcium intake and level of sun exposure were assessed by means of a questionnaire. A blood sample was used to determine glucose, lipid profile and 25-hydroxyvitamin D (25[OH]D) concentration. Results Ninety-one women were enrolled (age = 54.2 ± 7.1 years). The mean serum 25(OH)D concentration was 25.7 ± 8.9 ng/mL. A total of 24 (26.4%) women had 25(OH)D levels < 20 ng/mL. Seventy women (76.9%) had 25(OH)D levels < 30 ng/mL. Seventy-five women (90.4%) had inadequate calcium intake, and 61 women (67%) had appropriate sun exposure, 49 of whom (80.3%) had serum 25(OH)D levels < 30 ng/mL. Conclusion This study indicates that even in community-dwelling women, living in a city with high sun exposure, serum levels of 25(OH)D > 30 ng/ml are hardly reached. Thus, it is probable that other intrinsic factors besides sun exposure may regulate the levels of vitamin D.

Does the Access to Sun Exposure Ensure Adequate Levels of 25-Hydroxyvitamin D? / A exposição ao sol assegura níveis adequados de 25-hidroxivitamina D?

Abstract Objectives To assess the prevalence of hypovitaminosis D, altered arterial blood pressure, and serum levels of glucose and lipids in community-dwelling women in the city of Ribeirão Preto, in the southeast of Brazil. Methods Thiswas a cross-sectional studyof women aged40-70years old.Calciumintake and level of sun exposure were assessed by means of a questionnaire. A blood sample was used to determine glucose, lipid profile and 25-hydroxyvitaminD(25[OH]D) concentration. Results Ninety-one women were enrolled (age = 54.2 ± 7.1 years). Themean serum 25(OH)D concentration was 25.7 ± 8.9 ng/mL. A total of 24 (26.4%) women had 25 (OH)D levels < 20 ng/mL. Seventy women (76.9%) had 25(OH)D levels < 30 ng/mL. Seventy-five women (90.4%) had inadequate calcium intake, and 61 women (67%) had appropriate sun exposure, 49 of whom (80.3%) had serum 25(OH)D levels < 30 ng/mL. Conclusion This study indicates that even in community-dwelling women, living in a city with high sun exposure, serum levels of 25(OH)D > 30 ng/ml are hardly reached. Thus, it is probable that other intrinsic factors besides sun exposure may regulate the levels of vitamin D.

Resumo Objetivos Estimar a prevalência de hipovitaminose D, hipertensão arterial, e níveis séricos de glicose e perfil lipídico em uma comunidade de mulheres de Ribeirão Preto, no Sudeste brasileiro. Métodos Estudo transversal com mulheres de 40 a 70 anos de idade, submetidas a um questionário para determinar ingestão diária de cálcio e nível de exposição solar, e coleta de sangue para determinar glicose, perfil lipídico e concentração de 25- hidroxivitamina D (25[OH]D). Resultados Noventa e uma mulheres foram incluídas (idade = 54,2 ± 7,1 anos). O nível sérico médio de 25(OH)D foi 25,7 ± 8,9 ng/mL. Um total de 24 (26,4%) mulheres teve níveis de 25(OH)D < 20 ng/mL. Setenta mulheres (76.9%) tiveram níveis de 25 (OH)D < 30 ng/mL. Setenta e uma mulheres (90.4%) tiveram uma ingesta inadequada de cálcio e 61 mulheres (67%) tiveram exposição solar adequada; 49 das quais (80.3%) tiveram níveis séricos de 25(OH)D < 30 ng/mL. Conclusão Este estudo indica que mesmo morando em uma cidade com exposição solar adequada, níveis séricos de 25(OH)D > 30 ng/mL dificilmente são atingidos por mulheres climatéricas. Logo, é provável que outros fatores intrínsecos podem regular o nível de vitamina D.

Effects of combined oral contraceptives containing levonorgestrel or chlormadinone on the endothelium.

BACKGROUND: Although the use of combined oral contraceptives (COCs) is associated with an increased risk of arterial and venous thromboembolic events, less is known about the impact of COCs on endothelial function. The present study evaluated the effects on the endothelium of healthy women of combinations of 30 mcg ethinylestradiol (EE)/2 mg chlormadinone acetate (CMA) and 30 mcg EE/150 mcg levonorgestrel (LNG). STUDY DESIGN: Sixty-four healthy women were evaluated, 21 using a nonhormonal contraceptive method (control) and 43 using COCs, randomized to EE 30 mcg /CMA 2 mg or to EE 30 mcg/LNG 150 mcg. Anthropometric parameters, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), ultrasound markers of endothelial function, flow-mediated dilation (FMD) of the brachial artery, intima-media thickness (IMT) and common carotid artery stiffness were measured at randomization and 6 months later. RESULTS: Relative to baseline, EE/CMA users showed a significant reduction in mean DAP at 6 months (p=.02), and EE/LNG users showed a significant increase in mean IMT (p=.02) and a significant reduction in mean FMD (p=.01) at 6 months. DAP at 6 months was significantly lower in COC users than in controls (p=.01). Intergroup evaluations showed that, at 6 months, mean SAP (p=.02) was significantly lower in EE/LNG users than in controls (p=.02) and that mean DAP was significantly lower in EE/CMA (p<.01) and EE/LNG (p=.01) users than in controls. EE/LNG users experienced a mean FMD reduction almost threefold greater than that of EE/CMA users. Compared to controls, EE/LNG users experienced a 7.5-fold greater reduction in mean FMD. CONCLUSIONS: COC containing LNG is associated with more pronounced changes in the FMD and IMT of healthy women than a COC containing CMA and nonhormonal contraception. Further studies are needed to determine whether these differences may lead to higher risk of arterial thromboembolic events.

Drospirenone and levonorgestrel in combination with either 30 or 20 mcg ethinylestradiol reduce soluble adhesion molecules in Brazilian women; cross-sectional study.

BACKGROUND: The objective of this study was to evaluate the effect of three contraceptive pills containing ethinylestradiol (EE) (20 or 30 mcg) in combination with drospirenone (DRSP) and levonorgestrel (LNG) on plasma concentration of adhesion molecules vascular cell adhesion molecule -1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) and E-selectin. STUDY DESIGN: A cross-sectional study was conducted with 72 participants (18-30 years old) distributed into three groups that used oral contraceptives containing EE 20 or 30 mcg combined with DRSP 3 mg or EE 30 mcg/LNG 150 mcg for at least 6 months. The control group was comprised of nonusers of contraceptives. Soluble VCAM-1, soluble ICAM-1 and soluble E-selectin were evaluated by enzyme-linked immunosorbent assay. RESULTS: Compared to the control group, a significant decrease was found in VCAM-1 and ICAM-1 concentrations with use of DRSP/20 EE and LNG/30 EE. CONCLUSIONS: DRSP/20 EE and LNG/30 EE induce favorable changes in endothelial function.

Ethinylestradiol and estradiol have different effects on oxidative stress and nitric oxide synthesis in human endothelial cell cultures.

STUDY OBJECTIVE: To compare the effects of ethinylestradiol (EE) and 17ß-estradiol (E(2)) on nitric oxide (NO) production and protection against oxidative stress in human endothelial cell cultures. DESIGN: Experimental study. SETTINGS: Research laboratory. MATERIAL: Human ECV304 endothelial cell cultures. INTERVENTION(S): The NO synthesis was determined by flow cytometry, and oxidative stress was determined by a cell viability assay, after exposure to hydrogen peroxide (H(2)O(2)) and stimulation of endothelial cells with EE at concentrations similar to those of a contraceptive containing 30 µg EE. MAIN OUTCOME MEASURE(S): The effects of EE were compared with those of E(2) at concentrations similar to those occurring during the follicular phase. RESULT(S): Ethinylestradiol did not increase NO synthesis and did not protect cells against oxidative stress. The viability of the cells incubated with E(2) in combination with H(2)O(2) was greater than the viability obtained with H(2)O(2) only or with H(2)O(2) in combination with EE. The cells stimulated with E(2) presented a significant increase in NO production compared with control. CONCLUSION(S): In contrast to the effects of E(2), EE did not protect human ECV304 endothelial cells against oxidative stress and did not increase their production of NO.

Effect of isoflavone extracts from Glycine max on human endothelial cell damage and on nitric oxide production.

OBJECTIVE: In this study, we determined the protective effect of isoflavones from Glycine max on human umbilical vein endothelial cell (ECV304) damage induced by hydrogen peroxide (H2O2) and on nitric oxide (NO) production. METHODS: We studied the regulation of NO synthesis in cultured human endothelial cells by phytoestrogens contained in soy extracts in the presence or absence of ICI 182,780 or N(omega)-nitro-L-arginine methyl esther and determined the protective effect of these isoflavones on ECV304 damage induced by H2O2. RESULTS: We show that soy extracts activate NO synthesis in endothelial cells and protect against cell damage. CONCLUSIONS: In conclusion, soy isoflavones markedly protect ECV304 cells against H2O2 damage and promote NO synthesizing. Therefore, these isoflavones can potentially act as an NO promoter and as an antioxidant.

Increased arterial stiffness in nonobese women with polycystic ovary syndrome (PCOS) without comorbidities: one more characteristic inherent to the syndrome?

BACKGROUND: Polycystic ovary syndrome (PCOS) is associated with adverse metabolic effects. Some cardiovascular disease (CVD) risk markers are increased in women with PCOS. However, early markers of atherosclerosis are also associated with obesity and insulin resistance, which are related to PCOS. These markers may result either directly from PCOS or indirectly as a consequence of the comorbidities associated with the syndrome. CONTEXT: To assess the presence of early CVD markers in young, nonobese women with PCOS. PATIENTS: Forty women with PCOS and 50 healthy women with regular menstrual cycles, matched for age and body mass index (BMI). MEASUREMENTS: The following CVD markers were assessed by ultrasonography: common carotid artery (CCA) stiffness index (beta), distensibility and intima-media thickness (IMT), and brachial artery flow-mediated dilatation (FMD). Inflammatory markers, including interleukin (IL)-6, tumour necrosis factor (TNF)-alpha, homocysteine, C-reactive protein (CRP), glycaemia, lipid profile and insulin, were also assessed. RESULTS: CCA beta was higher in PCOS than in control women (3.72 +/- 0.96 vs. 3.36 +/- 0.96, P = 0.04) and CCA distensibility was lower (0.31 +/- 0.08 vs. 0.35 +/- 0.09 mmHg(-1), P = 0.02). Waist circumference, total testosterone and the Free Androgen Index (FAI) were higher in PCOS patients than in controls (78.2 +/- 10.0 vs. 71.5 +/- 7.2 cm, P = 0.001; 88.1 +/- 32.4 vs. 57.1 +/- 21.2 ng/dl, P < 0.01; 12.7 +/- 15.7%vs. 4.7 +/- 2.3%, P < 0.01, respectively), while SHBG was reduced (37.9 +/- 19.1 vs. 47.8 +/- 18.3 nmol/l, P = 0.01). The remaining variables did not differ between the groups. CONCLUSIONS: Young women with PCOS exhibit changes in vascular elasticity even in the absence of classical risk factors for CVD, such as hypertension and obesity.

Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women.

BACKGROUND: The study was conducted to determine whether the use of a combined oral contraceptive (COC) or depot medroxyprogesterone acetate (DMPA) interferes with endothelial function. STUDY DESIGN: The study was conducted on 100 women between the ages of 18 and 30 years. Fifty women had not used hormonal contraception (control group) for at least 12 months, 25 were current users of a COC (ethinylestradiol 30 mcg+levonorgestrel 150 mcg) and 25 were current users of DMPA (150 mg) for at least a 6-month period. All women were evaluated for brachial flow-mediated dilation (FMD), intima-media thickness, carotid distensibility and stiffness index, arterial pressure, body mass index, waist circumference, heart rate and lipid profile. RESULTS: A significant difference in FMD was observed between the COC and control groups (6.4+/-2.2% vs. 8.7+/-3.4%, p<.01) and between the DMPA and control groups (6.2+/-2.1% vs. 8.7+/-3.4%, p<.01). The DMPA group had lower values of total cholesterol (TC) and low-density lipoprotein (LDL-C) than COC users and the control group (TC: DMPA=139.9+/-21.5 mg/dL vs. controls=167.1+/-29.2 mg/dL vs. COC=168.2+/-37.5, p=.001; LDL-C: DMPA=85.3+/-20.1 mg/dL vs. controls=102+/-24.5 mg/dL vs. COC=106.7+/-33.3 mg/dL, p=.01). The control group had higher levels of high-density lipoprotein (HDL-C) than the DMPA and COC groups (controls=52.4+/-14.1 mg/dL vs. DMPA=42.2+/-7.2 mg/dL vs. COC=45.4+/-9.1 mg/dL, p=.001). No significant differences were observed regarding the other variables. CONCLUSIONS: FMD was lower among COC and DMPA users, suggesting that these hormonal contraceptives may promote endothelial dysfunction.

Performance of selective and differential media in the primary isolation of yeasts from different biological samples.

In view of the increase in yeast infections, especially polymicrobial ones, differential culture media have acquired increasing importance. The present study evaluated the Sabouraud chloramphenicol, Biggy agar, Pagano Levin agar and CHROMagar Candida media in terms of isolation, number of yeast colony forming units per plate, and inhibition of bacteria and filamentous fungi. To this end, we used 223 biological samples, including feces, and oral, vaginal and anal mucosae from 86 patients presenting or not symptoms of fungal infections. The four media did not differ significantly in terms of detection of yeast-positive cultures. The number of colony forming units per plate ranged from zero to 2.380, with a predominance of counts of 1 to 9 colonies per plate. No significant differences were observed among the four culture media in terms of number of colonies counted, for each kind of biological material. Fifteen species belonging to the genera Candida, Saccharomyces, Cryptococcus, Trichosporon and Rhodotorula were isolated, with C. albicans being the predominant species, followed by C. parapsilosis and R. rubra. CHROMagar Candida and Biggy agar were complementary in the isolation of the different species and favored a greater recovery of polymicrobial cultures. Pagano Levin agar isolated the smallest variety of species. Sabouraud chloramphenicol agar was the least effective in terms of bacterial inhibition and favored a greater development of filamentous fungi. The results suggest that more than one culture medium should be used for an adequate primary isolation.

Efeito da terapia de reposição hormonal sobre o estado férrico / Effect of hormone replacement therapy in iron status

Introdução: Na literatura, numerosas publicações relatam a determinação do estado férrico em crianças, adolescentes e mulheres em fase reprodutiva, no entanto são raras as pesquisas quanto às alterações do ferro em estoque e eritrograma pós-terapia de reposição hormonal (TRH) em pré-menopausadas e menopausadas. O aumento dos estoques de ferro em mulheres pré-menopausadas e menopausadas pode conduzir à elevação do estresse oxidativo e, conseqüentemente, ao risco de desenvolvimento de câncer e doenças cardiovasculares. Objetivo: Avaliar o efeito da TRH sobre o eritrograma e o estado férrico em mulheres na pré-menopausa e na menopausa. Métodos: Foram determinados os eritrogramas e as dosagens de ferro, capacidade total de ligação do ferro a transferrina (CTLF) e ferritina séricas em 30 mulheres no climatério antes e após seis meses de TRH com medroxiprogesterona e estradiol. Os eritrogramas, as dosagens de ferro e CTLF foram determinados por meio da utilização de métodos clássicos, e a ferritina, por quimiluminescência. Resultados: Após o uso da TRH, constataram-se significante redução do número de eritrócitos, elevação dos índices hematimétricos e tendência à diminuição nos níveis de ferro sérico e CTLF. Nenhuma alteração significante nos níveis de ferritina e no índice de saturação de transferrina foi detectada após a TRH. Discussão e conclusão: No presente estudo não foram encontradas alterações nos paramêtros hematimétricos e no estado férrico que impeçam a utilização da TRH no climatério e na menopausa. Os resultados sugerem que a TRH exerceu efeito benéfico sobre o estado férrico nas mulheres no climatério deste estudo, mantendo os estoques de ferro normais e promovendo a elevação dos índices hematimétricos.

Presença de leveduras em mucosas e fezes de indivíduos aparentemente saudáveis e de pessoas com sintomas de infecçäo fúngica / Presence of yeasts in the mucosae and feces of apparenty healthy indiviuals and subjects with sympotoms of ungal infection

As leveduras estäo amplamente distribuídas no ambiente sendo também habitantes normais do corpo humano. Säo consideradas patógenas oportunistas causando infecçöes que variam desde superficiais até profundas e fatais. O conhecimento da microbiota normal pode ajudar o médico a ter perspectiva sobre uma possível fonte e a importância de microrganismos isolados de infecçöes. O estudo teve como objetivo verificar a presença de leveduras em amostras de mucosas bucal, vaginal, anal e de fezes de indivíduos aparentemente saudáveis ou que apresentavam algum sintoma de infecçäo fúngica. Foram utilizados para isolamento os meios de ágar Sabouraud cloranfenicol, Biggy agar, CHROM agar Candida e Pagano Levin agar. Isolou-se leveduras em 40.7 por cento (35/86) das amostras bucais, 26.2 por cento (11/42) das amostras vaginais de pacientes assintomáticos, 44.8 por cento (13/29) das amostras vaginais provenientes de mulheres com desconforto vaginal, 34.6 por cento (9/26) das amostras anais, 77.5 por cento (31/40) das amostras de fezes. C. albicans foi a espécie prevalente em todos os tipos de amostras. As fezes apresentaram diversidade de espécies representadas pelos gêneros Candida, Saccharomyces, Rhodotorula, Trichosporon, Cryptococcus, e Hansenula atualmente, Pichia

The yeasts are widely distributed in our environment, being also normal inhabitants of ourbodies. Yeasts are considered to be opportunistic pathogens causing infectious processes ranging fromsuperficial to deep and fatal ones. The knowledge of the normal microbiota can help physicians to obtaina perspective about the possible source and importance of microorganisms isolated from infections. Theobjective of the present study was to determine the presence of yeasts in samples of the oral, vaginal, andanal mucosae and in fecal samples from apparently healthy individuals or individuals who presentedsymptoms of fungal infection. The media used for isolation were Sabouraud chloramphenicol agar, Biggyagar,CHROM agar Candida and Pagano Levin agar. Yeasts were isolated from 40.7% (35/86) of the oralsamples, 26.2% (11/42) of the vaginal samples from asymptomatic individuals, 44.8% (13/29) of the vaginalsamples from women with vaginal discomfort, from 34.6% (9/26) of the anal samples, and 77.5% (31/40) ofthe fecal samples. C. albicans was the predominant species in all sample types. Feces presented speciesdiversity represented by the genera Candida, Saccharomyces, Rhodotorula, Trichosporon, Cryptococcus,and Hansenula nowadays Pichia

Vaginal candidiasis: risk factors

La candidiasis vaginal es uno de los diagnósticos más comunes que hacen los ginecólogos. Han sido estudiados numerosos factores de riesgo para esta infección. En este trabajo fueron evaluados los factores de riesgo e implicancia clínica de la candidiasis vaginal. Se realizó el estudio en 102 mujeres entre 18-59 años con actividad sexual a las cuales se les realizó un Pap. Posteriormente, respondieron un cuestionario sobre los factores de riesgo que incluyeron los siguientes preguntas: anticonceptivos orales (OC), otras drogas, dispositivos intrauterinos, stress, hipertensión, fumadores, embarazos, vestuarios, patologías previas, higiene personal, comportamiento sexual, presencia de diabetes mellitus, hábitos alimenticios y prácticas de protección sanitaria. Los resultados demostraron 45 casos (44 por ciento) de Candidiasis vaginal, algunos de ellos asociados con otras patologías vaginales como: papillomavirus humano, Gardnerella vaginalis, trichomonas vaginalis, patología cervical y candidiasis. Estos casos de candidiasis vaginal están asociados con factores de riesgo como: OC,20.44 por ciento; jeans, 10.22 por ciento candidiasis vaginal previa, 9.2 por ciento y hábitos higiénicos en 6.14 por ciento

Seguimento de pacientes climatéricas em uma Unidade Básica e Distrital de Saúde / Follow-up of climacteric women at a basic and District Health Unit

Apesar dos reconhecidos benefícios da terapia de reposiçäo hormonal (TRH) nas mulheres climatéricas, há dificuldades em se manter a aderência ao uso da TRH por tempo prolongado. Identificar as causas de abandono de seguimento ambulatorial e da TRH em pacientes climatéricas em uma Unidade Básica e Distrital de Saúde. Foram estudadas 158 pacientes climatéricas no período de abril de 1995 a julho de 1997. Destas 79 (50,0 por cento) usavam vários esquemas de TRH e outras 79 (50,0 por cento) näo usavam. Foi considerado abandono de seguimento a falta de retorno por mais de 6 meses após a primeira consulta, ou mais de um ano após o último retorno. As pacientes que abandonaram o seguimento ambulatorial foram submetidas a um questionário pré-estabelecido para apurar as causas do abandono. A média da idade das pacientes foi de 54,1 anos ñ 7,6 (39-74). Entre as usuárias de TRH, 74,7 por cento näo apresentaram nenhum efeito colateral e 17,7 por cento apresentaram sangramento vaginal. Onze (13,9 por cento) usuárias de TRH abandonaram o seguimento ambulatorial e também o uso da TRH. Nesse grupo os principais motivos relacionados para o abandono foram: particulares n=7 (63,6 por cento) e efeitos colaterais n=6 (54,5 por cento) especialmente sangramento vaginal. Entre as pacientes näo usuárias de TRH, 17 (21,5 por cento) abandonaram o serviço, apresentando como causa mais importante os motivos particulares n=10 (58,8 por cento). Esses dados sugerem que a falta de aderência a TRH deve-se principalmente a motivos de ordem particular, além dos efeitos colaterais. Para as pacientes näo usuárias de TRH os motivos particulares também foram os mais importantes como causa de abandono ao seguimento ambulatorial

Fosfolipasa, proteinasa y morfotipos de candida albicans aisladas de vagina y ano / Phospholipase, proteinase and morphotypes of candida albicans isolated from vagina and anus

La vulvovaginitis por Candida albicans y otras especies, es uno de los diagnósticos frecuentes de los ginecólogos. Las especies del género presentan varios determinantes de patogenicidad que, junto a otros métodos de morfotificación, permiten realizar estudios epidemiológicos. Se estudian 12 cepas de Candida albicans aisladas de vagina y ano, por el método morfotificación y detección de fosfolipasa y proteinasa. El 75 por ciento de las cepas presentó proteinasa y el 83 por ciento fosfolipasa. Se encontraron 8 morfotipos diferentes, siendo el más frecuente el 0000, lo que demostraría una colonización vaginal de cepas provenientes del ano