Marcadores ultrassonográficos de risco cardiovascular em crianças obesas / Ultrasonographic markers of cardiovascular disease risk in obese children

RESUMO Objetivo: Avaliar se a obesidade altera os marcadores ultrassonográficos de risco metabólico e cardiovascular em crianças. Métodos: Estudo transversal com 80 crianças entre 6 e 10 anos, comparando 40 crianças obesas com 40 crianças normais. Foram avaliados os seguintes parâmetros: peso; altura; índice de massa corporal; pressão arterial; massa gorda; taxa metabólica basal; HDL-colesterol, LDL-colesterol e colesterol total; insulina de jejum e glicose; índice quantitativo de verificação da sensibilidade à insulina (QUICKI); Homeostase Modell Assessment (HOMA-IR); Diâmetro basal da artéria braquial; Dilatação mediada pelo fluxo da artéria braquial (FMD) e variação do índice de pulsatilidade (PI-C). Resultados: Entre obesos e não obesos, observaram-se diferenças significativas na pressão arterial sistólica (97,7±8,4 vs. 89,0±5,8 mmHg; p<0,01), pressão arterial diastólica (64,3±7,9 vs. 52,9±5.1 mmHg; p<0,01), gordura corporal (45,1±5,9 vs. 21,3±6,0%; p<0,01), taxa metabólica basal (1216,1±102,1 vs. 1072,9±66,4 Kcal; p<0,01), colesterol (164,7±25,2 vs. 153,4±15,8 mg/dL; p=0,03), insulina de jejum (7,1±5,2 vs. 2,8±1,8 pIU/mL; p<0,01), HOMA-IR (1,5±1,1 vs. 0,6±0,4; p<0.01), diâmetro basal da artéria braquial (2,5±0,3 vs. 2,1±0,3 mm; p<0,01); PI-C (-15,5±27,2 vs. -31,9±15,5%; p<0,01), redução de QUICKI (0,4±0,05 vs. 0,4±0,03; p<0,01) e FMD (6,6±3,2 vs. 15,6±7,3%; p<0,01). Conclusões: A obesidade piora os marcadores ultrassonográficos e laboratoriais de risco metabólico e cardiovascular em crianças.

ASTRACT Objective: To evaluate whether the obesity alters ultrasonographical markers of metabolic and cardiovascular disease risk in children. Methods: A cross-sectional study evaluated 80 children aged between 6 and 10 years, comparing 40 obese with 40 normal children. The following parameters were assessed: weight; height; body mass index; arterial blood pressure; body fat; basal metabolic rate; HDL-cholesterol, LDL-cholesterol and total cholesterol; fasting insulin and glucose; quantitative insulin sensitivity check index (QUICKI); homeostasis model of assessment - insulin resistance (HOMA-IR); basal diameter of the brachial artery; brachial artery flow mediated dilation (FMD) and of pulsatility index change (PI-C). Results: Significant differences were observed between obese vs. non-obese children: systolic blood pressure (97.7±8.4 vs. 89.0±5.8 mmHg; p<0.01), diastolic blood pressure (64.3±7.9 vs. 52.9±5.1 mmHg; p<0.01), proportion of body fat (45.1±5.9 vs. 21.3±6.0%; p<0.01), basal metabolic rate (1216.1±102.1 vs. 1072.9±66.4 Kcal; p<0.01), total cholesterol (164.7±25.2 vs. 153.4±15.8 mg/dL; p=0.03), fasting insulin (7.1±5.2 vs. 2.8±1.8 pIU/mL; p<0.01), HOMA-IR (1.5±1.1 vs. 0.6±0.4; p<0.01), basal diameter of the brachial artery (2.5±0.3 vs. 2.1±0.3 mm; p<0.01); PI-C (-15.5±27.2 vs. -31.9±15.5%; p<0.01), decreased QUICKI (0.4±0.05 vs. 0.4±0.03; p<0.01), and FMD (6.6±3.2 vs. 15.6±7.3%; p<0.01). Conclusions: Obesity worsens ultrasonographical and laboratorial markers of metabolic and cardiovascular disease risk in children.

ULTRASONOGRAPHIC MARKERS OF CARDIOVASCULAR DISEASE RISK IN OBESE CHILDREN. / MARCADORES ULTRASSONOGRÁFICOS DE RISCO CARDIOVASCULAR EM CRIANÇAS OBESAS.

OBJECTIVE: To evaluate whether the obesity alters ultrasonographical markers of metabolic and cardiovascular disease risk in children. METHODS: A cross-sectional study evaluated 80 children aged between 6 and 10 years, comparing 40 obese with 40 normal children. The following parameters were assessed: weight; height; body mass index; arterial blood pressure; body fat; basal metabolic rate; HDL-cholesterol, LDL-cholesterol and total cholesterol; fasting insulin and glucose; quantitative insulin sensitivity check index (QUICKI); homeostasis model of assessment - insulin resistance (HOMA-IR); basal diameter of the brachial artery; brachial artery flow mediated dilation (FMD) and of pulsatility index change (PI-C). RESULTS: Significant differences were observed between obese vs. non-obese children: systolic blood pressure (97.7±8.4 vs. 89.0±5.8 mmHg; p<0.01), diastolic blood pressure (64.3±7.9 vs. 52.9±5.1 mmHg; p<0.01), proportion of body fat (45.1±5.9 vs. 21.3±6.0%; p<0.01), basal metabolic rate (1216.1±102.1 vs. 1072.9±66.4 Kcal; p<0.01), total cholesterol (164.7±25.2 vs. 153.4±15.8 mg/dL; p=0.03), fasting insulin (7.1±5.2 vs. 2.8±1.8 pIU/mL; p<0.01), HOMA-IR (1.5±1.1 vs. 0.6±0.4; p<0.01), basal diameter of the brachial artery (2.5±0.3 vs. 2.1±0.3 mm; p<0.01); PI-C (-15.5±27.2 vs. -31.9±15.5%; p<0.01), decreased QUICKI (0.4±0.05 vs. 0.4±0.03; p<0.01), and FMD (6.6±3.2 vs. 15.6±7.3%; p<0.01). CONCLUSIONS: Obesity worsens ultrasonographical and laboratorial markers of metabolic and cardiovascular disease risk in children.

OBJETIVO: Avaliar se a obesidade altera os marcadores ultrassonográficos de risco metabólico e cardiovascular em crianças. MÉTODOS: Estudo transversal com 80 crianças entre 6 e 10 anos, comparando 40 crianças obesas com 40 crianças normais. Foram avaliados os seguintes parâmetros: peso; altura; índice de massa corporal; pressão arterial; massa gorda; taxa metabólica basal; HDL-colesterol, LDL-colesterol e colesterol total; insulina de jejum e glicose; índice quantitativo de verificação da sensibilidade à insulina (QUICKI); Homeostase Modell Assessment (HOMA-IR); Diâmetro basal da artéria braquial; Dilatação mediada pelo fluxo da artéria braquial (FMD) e variação do índice de pulsatilidade (PI-C). RESULTADOS: Entre obesos e não obesos, observaram-se diferenças significativas na pressão arterial sistólica (97,7±8,4 vs. 89,0±5,8 mmHg; p<0,01), pressão arterial diastólica (64,3±7,9 vs. 52,9±5.1 mmHg; p<0,01), gordura corporal (45,1±5,9 vs. 21,3±6,0%; p<0,01), taxa metabólica basal (1216,1±102,1 vs. 1072,9±66,4 Kcal; p<0,01), colesterol (164,7±25,2 vs. 153,4±15,8 mg/dL; p=0,03), insulina de jejum (7,1±5,2 vs. 2,8±1,8 pIU/mL; p<0,01), HOMA-IR (1,5±1,1 vs. 0,6±0,4; p<0.01), diâmetro basal da artéria braquial (2,5±0,3 vs. 2,1±0,3 mm; p<0,01); PI-C (-15,5±27,2 vs. -31,9±15,5%; p<0,01), redução de QUICKI (0,4±0,05 vs. 0,4±0,03; p<0,01) e FMD (6,6±3,2 vs. 15,6±7,3%; p<0,01). CONCLUSÕES: A obesidade piora os marcadores ultrassonográficos e laboratoriais de risco metabólico e cardiovascular em crianças.

Oral dydrogesterone vs. vaginal progesterone capsules for luteal-phase support in women undergoing embryo transfer: a systematic review and meta-analysis.

OBJECTIVE: To identify, appraise, and summarize the evidence from randomized controlled trials (RCTs) comparing oral dydrogesterone to vaginal progesterone capsules for luteal-phase support (LPS) in women offered fresh or frozen embryo transfers following in vitro fertilization. METHODS: Two independent authors screened the literature for papers based on titles and abstracts, then selected the studies, extracted data, and assessed the risk of bias. Dydrogesterone and progesterone were compared based on risk ratios (RR) and the precision of the estimates was assessed through the 95% confidence interval (CI). RESULTS: An electronic search performed on June 7, 2017 retrieved 376 records, nine of which were papers deemed eligible and included in this systematic review and quantitative analysis. Good quality evidence indicates that oral dydrogesterone provided at least similar results than vaginal progesterone capsules on live birth/ongoing pregnancy (RR=1.08, 95%CI=0.92-1.26, I2=29%, 8 RCTs, 3,386 women) and clinical pregnancy rates (RR 1.10, 95% CI 0.95 to 1.27; I2=43%; 9 RCTs; 4,061 women). Additionally, moderate quality evidence suggests there is no relevant difference on miscarriage rates (RR=0.92, 95%CI=0.68-1.26, I2=6%, 8 RCTs, 988 clinical pregnancies; the quality of the evidence was downgraded because of imprecision). CONCLUSIONS: Good quality evidence from RCTs suggest that oral dydrogesterone provides at least similar reproductive outcomes than vaginal progesterone capsules when used for LPS in women undergoing embryo transfers. Dydrogesterone is a reasonable option and the choice of either of the medications should be based on cost and side effects.

Induction of Labor using Misoprostol in a Tertiary Hospital in the Southeast of Brazil / Indução de parto utilizando misoprostol em um hospital terciário no sudeste do Brasil

Abstract Purpose To assess cases of labor induction with vaginal 25-μg tablets of misoprostol and maternal outcomes in a tertiary hospital in southeastern Brazil. Methods This was a retrospective cohort study of 412 pregnant women with indication for labor induction. Labor induction was performed with vaginal 25-μg tablets ofmisoprostol in pregnant women with Bishop scores < 6. Stepwise regression analysis was used to identify the factors present at the beginning of induction that could be used as predictors of successful labor induction. Results A total of 69% of the pregnant women who underwent labor induction progressed to vaginal delivery, and 31% of the women progressed to cesarean section. One or two misoprostol tablets were used in 244 patients (59.2%). Of the 412 patients, 197 (47.8%) required oxytocin later on in the labor process, after induction with misoprostol. The stepwise regression analysis showed that only Bishop scores of 4 and 5 and previous vaginal delivery were independent factors with statistical significance in the prediction of successful vaginal labor induction (β = 0.23, p < 0.001, for a Bishop score of 4 and 5, and β = 0.22, p < 0.001, for previous vaginal delivery). Conclusion Higher Bishop scores and previous vaginal delivery were the best predictors of successful labor induction with vaginal 25-μg tablets of misoprostol.

Resumo Objetivo Avaliar os casos de indução do trabalho de parto com misoprostol 25 mcg por via vaginal e seus desfechos maternos em um hospital terciário do Sudeste do Brasil. Métodos Realizou-se um estudo retrospectivo de coorte com 412 gestantes com indicações para indução de trabalho de parto. A indução do trabalho de parto foi realizada com misoprostol 25 mcg vaginal em gestantes com índice de Bishop < 6. Realizou-se análise de regressão stepwise para identificar os fatores presentes ao início da indução que poderiam ser usados como prognosticadores do sucesso da indução do trabalho de parto. Resultados A indução de trabalho de parto determinou 69% de partos normais, sendo que 31% evoluíram para cesárea. Em relação ao número de comprimidos de misoprostol, 1 ou 2 comprimidos foram utilizados em 244 pacientes (59,2%). Das 412 pacientes, 197 (47,8%) necessitaramde ocitocina após a indução commisoprostol para dar continuidade ao trabalho de parto. Na análise de regressão stepwise, apenas a presença de índice de Bishop 4 e 5 e parto vaginal prévio foram fatores independentes com significância estatística na predição do sucesso da indução emobter parto vaginal (β = 0,23, p < 0,001, para índice de Bishop 4 e 5, e β = 0,22, p < 0,001, para parto vaginal prévio). Conclusão Maiores índices de Bishop e parto vaginal prévio são os maiores prognosticadores do sucesso de indução de trabalho de parto com misoprostol 25 mcg vaginal.

Induction of Labor using Misoprostol in a Tertiary Hospital in the Southeast of Brazil.

Purpose To assess cases of labor induction with vaginal 25-µg tablets of misoprostol and maternal outcomes in a tertiary hospital in southeastern Brazil. Methods This was a retrospective cohort study of 412 pregnant women with indication for labor induction. Labor induction was performed with vaginal 25-µg tablets of misoprostol in pregnant women with Bishop scores < 6. Stepwise regression analysis was used to identify the factors present at the beginning of induction that could be used as predictors of successful labor induction. Results A total of 69% of the pregnant women who underwent labor induction progressed to vaginal delivery, and 31% of the women progressed to cesarean section. One or two misoprostol tablets were used in 244 patients (59.2%). Of the 412 patients, 197 (47.8%) required oxytocin later on in the labor process, after induction with misoprostol. The stepwise regression analysis showed that only Bishop scores of 4 and 5 and previous vaginal delivery were independent factors with statistical significance in the prediction of successful vaginal labor induction (ß = 0.23, p < 0.001, for a Bishop score of 4 and 5, and ß = 0.22, p < 0.001, for previous vaginal delivery). Conclusion Higher Bishop scores and previous vaginal delivery were the best predictors of successful labor induction with vaginal 25-µg tablets of misoprostol.

Objetivo Avaliar os casos de indução do trabalho de parto com misoprostol 25 mcg por via vaginal e seus desfechos maternos em um hospital terciário do Sudeste do Brasil. Métodos Realizou-se um estudo retrospectivo de coorte com 412 gestantes com indicações para indução de trabalho de parto. A indução do trabalho de parto foi realizada com misoprostol 25 mcg vaginal em gestantes com índice de Bishop < 6. Realizou-se análise de regressão stepwise para identificar os fatores presentes ao início da indução que poderiam ser usados como prognosticadores do sucesso da indução do trabalho de parto. Resultados A indução de trabalho de parto determinou 69% de partos normais, sendo que 31% evoluíram para cesárea. Em relação ao número de comprimidos de misoprostol, 1 ou 2 comprimidos foram utilizados em 244 pacientes (59,2%). Das 412 pacientes, 197 (47,8%) necessitaram de ocitocina após a indução com misoprostol para dar continuidade ao trabalho de parto. Na análise de regressão stepwise, apenas a presença de índice de Bishop 4 e 5 e parto vaginal prévio foram fatores independentes com significância estatística na predição do sucesso da indução em obter parto vaginal (ß = 0,23, p < 0,001, para índice de Bishop 4 e 5, e ß = 0,22, p < 0,001, para parto vaginal prévio). Conclusão Maiores índices de Bishop e parto vaginal prévio são os maiores prognosticadores do sucesso de indução de trabalho de parto com misoprostol 25 mcg vaginal.

Há um momento ideal para uma mulher criopreservar seus oócitos? / Is there an ideal moment for a woman to cryopreserve her eggs?

A criopreservação de oócitos é hoje um procedimento cotidiano em clínicas de reprodução humana para preservação da fertilidade por motivos médicos ou pela simples decisão de adiar a maternidade. Felizmente, já se pode dizer com segurança que a chance de gravidez por fertilização in vitro de oócitos congelados é praticamente a mesma em relação aos gametas frescos. Da mesma forma, a técnica é igualmente segura para a saúde da prole. Entretanto, mesmo sabendo que a idade é um fator importante para o sucesso da preservação da fertilidade, não se pode apostar em um momento ideal para a criopreservação dos oócitos. Já há estudos conduzidos com a intenção de se definir tal momento, mas ainda restam dúvidas e cabe questionamentos acerca de que se os dados existentes hoje são suficientes para tal definição.(AU)

Egg freezing for preservation of fertility is already a routine procedure in centers for assistance in human reproduction, even for medical reasons or for the simple decision to postpone motherhood. Fortunately, one can already safely say that the chance of pregnancy by IVF of frozen eggs is practically the same in relation to fresh eggs. Likewise, the technique is also safe for the health of the offspring. However, even though age is an important success factor for fertility preservation, no one can bet on an ideal time for freezing eggs. Some studies conducted with the intent to define that time are already found in literature, but questions remain and it is up to ask whether data today are sufficient for such a definition.(AU)

Lower limb venous diameters and haemodynamics during pregnancy and postpartum period in healthy primigravidae.

Objective Analyse venous haemodynamics in healthy primigravidae during pregnancy and in the postpartum. Methods Cohort with primigravidae evaluated in the three trimesters of pregnancy and postpartum. Duplex evaluated venous diameters and reflux; air plethysmography evaluated venous filling index, ejection fraction, residual volume fraction and outflow fraction in both limbs. Results During pregnancy, diameters increased in bilateral common femoral and right infravalvar great saphenous, but returned to first trimester values after delivery. Reflux developed in one woman (5%) in the second trimester and in two more women (15%) in the third trimester. No reflux was detected in postpartum. Bilateral venous filling index was higher during pregnancy. Bilateral ejection fraction and residual volume fraction did not change. Bilateral outflow fraction increased progressively. The right limb outflow fraction in left lateral decubitus was similar. All changes returned to first trimester values after delivery. Conclusions Healthy primigravidae presented changes in lower limbs' veins during pregnancy: diameters in bilateral common femoral and infravalvar great saphenous veins increased; new reflux was developed in 15% of women, but there was no venous hypertension. Calf muscular pump function did not change. All changes returned to first trimester values after delivery.

Subclinical Hypothyroidism and Intracytoplasmic Sperm Injection Outcomes.

Purpose Whether preconception elevated concentrations of thyroid-stimulating hormone (TSH) compromises reproductive outcomes in patients undergoing assisted reproduction techniques (ARTs) remains unclear. This study therefore compared the reproductive outcomes in patients with TSH concentrations of < 2.5 mIU/L, 2.5-4.0 mIU/L, and 4.0-10.0 mIU/L undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods This retrospective cohort study evaluated the medical records of all women with measured TSH concentrations who underwent IVF/ICSI between January 2011 and December 2012. The patients were divided into three groups: TSH < 2.5 mIU/L (group 1); THS ≥2.5 and < 4.0 mIU/L (group 2); and THS ≥4 mIU/L and < 10.0 mIU/L (group 3). Patients who were administered levothyroxine for treating hypothyroidism were excluded from the analysis. The primary endpoints were clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. Results During the study period, 787 women underwent IVF/ICSI. Sixty were excluded because their TSH concentrations were unavailable, and 77 were excluded due to their use of levothyroxine. The prevalence of patients presenting elevated concentrations of TSH was of 5.07% (using a TSH threshold of 4.0 mIU/L) and of 29.99% (using a TSH threshold of 2.5 mIU/L). Patient characteristics, type of COS, and response to COS did not differ among the three groups, and there were no differences in clinical pregnancy (24.4% versus 25.9% versus 24.2%, p = 0.93); miscarriage (17.1% versus 14.3% versus 12.5%, p = 0.93); live birth (20.2% versus 22.2% versus 21.2%, p = 0.86); and multiple pregnancy rates (27.0% versus 21.4% versus 25.0%, p = 0.90) respectively. Conclusion Response to COS, live birth, and miscarriage rates were not altered in women with elevated concentrations of TSH undergoing IVF/ICSI, regardless of using a TSH threshold of 2.5 mIU/L or 4.0 mIU/L. These findings reinforce the uncertainties related to the impact of subclinical hypothyroidism on reproductive outcomes in women undergoing COS for ARTs.

Subclinical Hypothyroidism and Intracytoplasmic Sperm Injection Outcomes / Hipotireoidismo subclínico e resultados de Injeção intracitoplasmática de espermatozoide

Abstract Purpose Whether preconception elevated concentrations of thyroid-stimulating hormone (TSH) compromises reproductive outcomes in patients undergoing assisted reproduction techniques (ARTs) remains unclear. This study therefore compared the reproductive outcomes in patients with TSH concentrations of < 2.5 mIU/L, 2.5-4.0 mIU/L, and 4.0-10.0mIU/L undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods This retrospective cohort study evaluated the medical records of all women with measured TSH concentrations who underwent IVF/ICSI between January 2011 and December 2012. The patients were divided into three groups: TSH < 2.5mIU/L (group 1); THS ≥2.5 and < 4.0 mIU/L (group 2); and THS ≥4 mIU/L and < 10.0 mIU/L (group 3). Patients who were administered levothyroxine for treating hypothyroidism were excluded from the analysis. The primary endpoints were clinical pregnancy,miscarriage, live birth and multiple pregnancy rates. Results During the study period, 787 women underwent IVF/ICSI. Sixty were excluded because their TSH concentrations were unavailable, and 77 were excluded due to their use of levothyroxine. The prevalence of patients presenting elevated concentrations of TSHwas of 5.07% (using a TSH threshold of 4.0 mIU/L) and of 29.99% (using a TSH threshold of 2.5 mIU/L). Patient characteristics, type of COS, and response to COS did not differ among the three groups, and there were no differences in clinical pregnancy (24.4% versus 25.9% versus 24.2%, p = 0.93); miscarriage (17.1% versus 14.3% versus 12.5%, p = 0.93); live birth (20.2% versus 22.2% versus 21.2%, p = 0.86); and multiple pregnancy rates (27.0% versus 21.4% versus 25.0%, p = 0.90) respectively. Conclusion Response to COS, live birth, and miscarriage rates were not altered in women with elevated concentrations of TSH undergoing IVF/ICSI, regardless of using a TSH threshold of 2.5mIU/L or 4.0mIU/L. These findings reinforce the uncertainties related to the impact of subclinical hypothyroidism on reproductive outcomes in women undergoing COS for ARTs.

Resumo Objetivos Se concentrações elevadas de hormônio estimulante da tireoide (TSH) antes do parto comprometem resultados reprodutivos em pacientes submetidas a técnicas de reprodução assistida (TRA) é incerto. Este estudo comparou resultados reprodutivos de pacientes com concentrações de TSH < 2,5 mIU/L; 2,5-4,0 mIU/L e 4,0-10,0 mIU/L submetidas a estimulação ovariana controlada (EOC) para fertilização in vitro (FIV)/injeção intracitoplasmática de espermatozoide (ICSI). Métodos Este estudo de coorte retrospectiva avaliou prontuários médicos de todas as pacientes que tinham registro de concentrações de TSH submetidas a FIV/ICSI entre janeiro de 2011 e dezembro de 2012. As pacientes foram divididas em três grupos: aquelas com TSH < 2,5 mIU/L (grupo 1); entre 2,5 e 4,0 mIU/L (grupo 2) e entre 4,0 mIU/L e 10,0 mIU/L (grupo 3). As pacientes que estavam em uso de levotiroxina para tratamento de hipotireoidismo foram excluídas da análise. Os desfechos primários foram taxas de gravidez clínica, de abortamento, de nascido vivo e de gravidez múltipla. Resultados Durante o período do estudo, 787 mulheres foramsubmetidas a FIV/ICSI. Sessenta foram excluídas por causa da indisponibilidade das concentrações de TSH, e 77 foram excluídas porque estavam usando levotiroxina. A prevalência de pacientes apresentando elevação das concentrações de TSH foi de 5,07% (usando um limite de TSH de 4,0 mIU/L) e 29,99% (usando um limite de TSH de 2,5 mIU/L). As características das pacientes, tipo de EOC e reposta à EOC não diferiram entre os três grupos, nem houve diferenças nas taxas de gravidez clínica (24,4% versus 25,9% versus 24,2%, p = 0,93); abortamento (17,1% versus 14,3% versus 12,5%, p = 0,93); nascido vivo (20,2% versus 22,2% versus 21,2%, p = 0,86); e taxas de gestação múltipla (27,0% versus 21,4% versus 25,0%, p = 0,90), respectivamente. Conclusão Resposta à EOC, taxa de nascido vivo e de abortamento não foram alteradas em mulheres submetidas a FIV/ICSI com concentrações elevadas de TSH independente de usar um limite de 2,5 ou 4,0 mIU/L. Estes achados reforçam as incertezas relacionadas ao impacto do hipotireoidismo subclínico nos resultados reprodutivos de mulheres submetidas a EOC para TRA.

Association between Number of Formed Embryos, Embryo Morphology and Clinical Pregnancy Rate after Intracytoplasmic Sperm Injection.

Introduction Infertility has a high prevalence in the general population, affecting ∼ 5 to 15% of couples in reproductive age. The assisted reproduction techniques (ART) include in vitro manipulation of gametes and embryos and are an important treatment indicated to these couples. It is well accepted that the implantation rate is positively influenced by the morphology of transferred embryos. However, we question if, apart from the assessment of embryo morphology, the number of produced embryos per cycle is also related to pregnancy rates in the first fresh transfer cycle. Purpose To evaluate the clinical pregnancy rate according to the number of formed embryos and the transfer of top quality embryos (TQEs). Methods In a retrospective cohort study, between January 2011 and December 2012, we evaluated women who underwent intracytoplasmic sperm injection (ICSI), aged < 40 years, and with at least 1 formed embryo fresh transferred in cleavage stage. These women were stratified into 3 groups according to the number of formed embryos (1 embryo, 2-3 and ≥ 4 embryos). Each group was divided into 2 subgroups according to the presence or not of at least 1 transferred TQE (1 with TQE; 1 without TQE; 2-3 with TQE, 2-3 without TQE; ≥ 4 with TQE; ≥ 4 without TQE). The clinical pregnancy rates were compared in each subgroup based on the presence or absence of at least one transferred TQE. Results During the study period, 636 women had at least one embryo to be transferred in the first fresh cycle (17.8% had 1 formed embryo [32.7% with TQE versus 67.3% without TQE], 42.1% of women had 2-3 formed embryos [55.6% with TQE versus 44.4% without TQE], and 40.1% of patients had ≥ 4 formed embryos [73.7% with TQE versus 26.3% without TQE]). The clinical pregnancy rate was significantly higher in the subgroup with ≥ 4 formed embryos with at least 1 transfered TQE (45.2%) compared with the subgroup without TQE (28.4%). Conclusions Having at least two available embryos and at least one TQE for embryo transfer are predictors of the pregnancy rates.

Neurological Outcome in Fetuses with Mild and Moderate Ventriculomegaly.

Introduction Ventriculomegaly (VM) is one the most frequent anomalies detected on prenatal ultrasound. Magnetic resonance imaging (MRI) may enhance diagnostic accuracy and prediction of developmental outcome in newborns. Purpose The aim of this study was to assess the correlation between ultrasound and MRI in fetuses with isolated mild and moderate VM. The secondary aim was to report the neurodevelopmental outcome at 4 years of age. Methods Fetuses with a prenatal ultrasound (brain scan) diagnosis of VM were identified over a 4-year period. Ventriculomegaly was defined as an atrial width of 10-15 mm that was further divided as mild (10.1-12.0 mm) and moderate (12.1-15.0 mm). Fetuses with VM underwent antenatal as well as postnatal follow-ups by brain scan and MRI. Neurodevelopmental outcome was performed using the Griffiths Mental Development Scales and conducted, where indicated, until 4 years into the postnatal period. Results Sixty-two fetuses were identified. Ventriculomegaly was bilateral in 58% of cases. A stable dilatation was seen in 45% of cases, progression was seen in 13%, and regression of VM was seen in 4.5% respectively. Fetal MRI was performed in 54 fetuses and was concordant with brain scan findings in 85% of cases. Abnormal neurodevelopmental outcomes were seen in 9.6% of cases. Conclusion Fetuses in whom a progression of VM is seen are at a higher risk of developing an abnormal neurodevelopmental outcome. Although brain scan and MRI are substantially in agreement in defining the grade of ventricular dilatation, a low correlation was seen in the evaluation of VM associated with central nervous system (CNS) or non-CNS abnormalities.

Neurological Outcome in Fetuses with Mild and Moderate Ventriculomegaly / Resultado neurológico em fetos com ventriculomegalia leve e moderada

Abstract Introduction Ventriculomegaly (VM) is one the most frequent anomalies detected on prenatal ultrasound. Magnetic resonance imaging (MRI) may enhance diagnostic accuracy and prediction of developmental outcome in newborns. Purpose The aim of this study was to assess the correlation between ultrasound and MRI in fetuses with isolated mild and moderate VM. The secondary aim was to report the neurodevelopmental outcome at 4 years of age. Methods Fetuses with a prenatal ultrasound (brain scan) diagnosis of VM were identified over a 4-year period. Ventriculomegaly was defined as an atrial width of 10- 15 mm that was further divided as mild (10.1-12.0 mm) and moderate (12.1-15.0 mm). Fetuses with VM underwent antenatal as well as postnatal follow-ups by brain scan and MRI. Neurodevelopmental outcome was performed using the Griffiths Mental Development Scales and conducted, where indicated, until 4 years into the postnatal period. Results Sixty-two fetuses were identified. Ventriculomegaly was bilateral in 58% of cases. A stable dilatation was seen in 45% of cases, progression was seen in 13%, and regression of VM was seen in 4.5% respectively. Fetal MRI was performed in 54 fetuses and was concordant with brain scan findings in 85% of cases. Abnormal neurodevelopmental outcomes were seen in 9.6% of cases. Conclusion Fetuses in whom a progression of VM is seen are at a higher risk of developing an abnormal neurodevelopmental outcome. Although brain scan and MRI are substantially in agreement in defining the grade of ventricular dilatation, a low correlation was seen in the evaluation of VM associated with central nervous system (CNS) or non-CNS abnormalities.

Resumo Introdução Ventriculomegalia (VM) é uma das anomalias mais frequente no ultrassom pre-natal. Ressonâncias magnéticas (RM) melhoram a precisão do diagnóstico e previsão do desenvolvimento em recém-nascidos. Objetivo A proposta deste estudo foi avaliar a correlação entre ultrassom e RM em fetos com leve e moderada VM isolada. O objetivo secundário foi reportar o resultado neurológico na idade de 4 anos. Métodos Fetos com diagnóstico pré-natal pelo ultrassom de VM foram identificados na idade de 4 anos. Ventriculomegalia foi definida como medida do átrio do ventrículo lateral entre 10-15 mm, a qual foi subdividida em leve (10,1-12,0 mm) e moderada (12,1-15,0 mm). Fetos com VM foram seguidos nos períodos pré-natal e pós-natal por ultrassom e RM. O resultado neurológico foi realizado usando a escala de desenvolvimento mental de Griffiths, quando indicada, até a idade de 4 anos. Resultados Sessenta e dois fetos foram identificados. Ventriculomegalia bilateral ocorreu sem 58% dos casos. Uma dilatação estável foi observada em 45%, progressiva em 13% e regressiva em 4,5% dos casos, respectivamente. Ressonância magnética fetal foi realizada em 54 fetos, e foi concordante com os achados do ultrassom em 85% dos casos. Desenvolvimento neurológico anormal foi observado em 9,6% dos casos. Conclusão Fetos nos quais ocorreu progressão da VM são de alto risco para desenvolvimento neurológico anormal. Apesar do ultrassom e da RM mostrarem substancial concordância na definição do grau de dilatação ventricular, uma baixa correlação foi vista na avaliação da VM associada ou não com anomalias do sistema nervoso central.

Association between Number of Formed Embryos, Embryo Morphology and Clinical Pregnancy Rate after Intracytoplasmic Sperm Injection / Associação entre número de embriões formados, morfologia embrionária e taxa de gravidez clínica após injeção intracitoplasmática de espermatozoides

Abstract Introduction Infertility has a high prevalence in the general population, affecting 5 to 15% of couples in reproductive age. The assisted reproduction techniques ( ART ) include in vitro manipulation of gametes and embryos and are an important treatment indicated to these couples. It is well accepted that the implantation rate is positively influenced by the morphology of transferred embryos. However, we question if, apart from the assessment of embryo morphology, the number of produced embryos per cycle is also related to pregnancy rates in the first fresh transfer cycle. Purpose To evaluate the clinical pregnancy rate according to the number of formed embryos and the transfer of top quality embryos ( TQEs ). Methods In a retrospective cohort study, between January 2011 and December 2012 , we evaluated women who underwent intracytoplasmic sperm injection (ICSI), aged < 40 years, andwith at least 1 formed embryo fresh transferred in cleavagestage. These women were stratified into 3 groups according to the number of formed embryos (1 embryo, 2-3 and ≥ 4 embryos). Each group was divided into 2 subgroups according to the presence or not of at least 1 transferred TQE (1 with TQE; 1 without TQE; 2-3 with TQE, 2-3 without TQE; ≥4with TQE; ≥4withoutTQE). The clinicalpregnancy rateswerecomparedineach subgroup based on the presence or absence of at least one transferred TQE. Results During the study period, 636 women had at least one embryo to be transferred in thefirst fresh cycle (17.8% had 1 formed embryo [32.7% with TQEversus 67.3% without TQE], 42.1% of women had 2-3 formed embryos [55.6% with TQE versus 44.4% without TQE], and 40.1%ofpatientshad ≥4 formedembryos[73.7%withTQEversus26.3%withoutTQE]).The clinical pregnancy rate was significantly higher in the subgroup with ≥4 formed embryos with at least 1 transfered TQE (45.2%) compared with the subgroup without TQE (28.4%). Conclusions Having at least two available embryos and at least one TQE for embryo transfer are predictors of the pregnancy rates.

Resumo Introdução A infertilidade tem uma alta prevalência na população geral, afetando 5 a 15% dos casais em idade reprodutiva. As técnicas de reprodução assistida ( TRA ) incluem a manipulação in vitro de gametas e embriões e são um importante tratamento indicado para esses casais. Sabe-se que a taxa de implantação é positivamente influenciada pela morfologia dos embriões transferidos. No entanto, questiona-se, se além da avaliação da morfologia do embrião, o número de embriões produzidos por ciclo também está relacionado com as taxas de gravidez do primeiro ciclo de transferência fresco. Objetivo Avaliar a taxa de gravidez clínica de acordo com o número de embriões formados e a transferência de embrião com ótima morfologia ( EOM ). Métodos Em um estudo de coorte retrospectivo, entre janeiro de 2011 e dezembro de 2012, avaliamos mulheres submetidas a ICSI com idade < 40 anos e com pelo menos um embrião formado e transferido a fresco em estágio de clivagem. Estas mulheres foram estratificadas em 3 grupos de acordo com o número de embriões formados (1 embrião, 2-3 e ≥ 4 embriões). Cada grupo foi subdividido em 2 subgrupos de acordo com a presença ou não de EOM transferido (1 com EOM; 1 sem EOM; 2-3 com EOM; 2-3 sem EOM; 4 com EOM; ≥4 sem EOM). As taxas de gravidez clínica foram comparadas em cada subgrupo segundo a presença ou não de pelo menos um EOM transferido. Resultados Durante o período do estudo, 636 mulheres tiveram pelo menos 1 embrião para ser transferido no primeiro ciclo a fresco (17,8% possuíram 1 embrião formado [32,7% com EOM versus 67,3% sem EOM], 42,1% das mulheres apresentaram 2-3 embriões formados [55,6% com EOM versus 44,4% sem EOM], e 40,1% das pacientes formaram ≥4 embriões [73,7% com EOM versus 26,3% sem EOM]). A taxa de gravidez clínica foi significativamente maior no subgrupo com ≥4 embriões formados com transferência de pelo menos 1 EOM (45,2%) comparando-se ao subgrupo sem EOM (28,4 % ). Conclusões Ter pelo menos dois embriões e pelo menos um EOM para transferência são fatores preditivos da taxa de gravidez.

Assessment of Sexual Function in Infertile Women in a Gynecological Care Setting.

INTRODUCTION: Infertility has a high prevalence worldwide. There is also a high prevalence of sexual problems, mainly in gynecological care settings, but many women are unlikely to discuss sexual problems with their physicians. AIMS: To verify how second-year gynecology residents (SGRs) assess the sexual function of infertile women who are undergoing assisted reproductive techniques (ART) at a single infertility tertiary care center in Brazil. MAIN OUTCOME MEASURES: Medical records of patients. METHODS: This retrospective cohort study evaluated all medical records of women who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) between January 2011 and December 2012 at a fertility clinic of the Hospital das Clinicas of Ribeirão Preto Medical School, University of São Paulo. RESULTS: A total of 616 women underwent ART during the study period. The mean patient age was 34.5 ± 4.4 years, mean weight was 65.6 ± 12.4 kg, mean height was 163 ± 0.6 cm, and mean body mass index (BMI) was 24.8 ± 4.3 kg/m(2). We classified the methods that medical residents used to assess the sexual frequency of these women as a numerical method, by categorization, or none (no assessment). A total of 26.7% (n = 166) of the SGRs did not assess female sexual function and 26.2% (n = 163) made assessments using categorization. SGRs who used a numerical method rather than categorization to classify the sexual frequency of their female patients were more likely to record answers to other questions on sexual desire, arousal, and orgasm. CONCLUSION: SGRs typically do not assess female sexual function in infertile couples. There was considerable heterogeneity among SGRs in their assessment of coital frequency and female sexual function.

Endometriosis, Ovarian Reserve and Live Birth Rate Following In Vitro Fertilization/Intracytoplasmic Sperm Injection.

Purpose To evaluate whether women with endometriosis have different ovarian reserves and reproductive outcomes when compared with women without this diagnosis undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), and to compare the reproductive outcomes between women with and without the diagnosis considering the ovarian reserve assessed by antral follicle count (AFC). Methods This retrospective cohort study evaluated all women who underwent IVF/ICSI in a university hospital in Brazil between January 2011 and December 2012. All patients were followed up until a negative pregnancy test or until the end of the pregnancy. The primary outcomes assessed were number of retrieved oocytes and live birth. Women were divided into two groups according to the diagnosis of endometriosis, and each group was divided again into a group that had AFC ≤ 6 (poor ovarian reserve) and another that had AFC ≥ 7 (normal ovarian reserve). Continuous variables with normal distribution were compared using unpaired t-test, and those without normal distribution, using Mann-Whitney test. Binary data were compared using either Fisher's exact test or Chi-square (χ(2)) test. The significance level was set as p < 0.05. Results 787 women underwent IVF/ICSI (241 of which had endometriosis). Although the mean age has been similar between women with and without the diagnosis of endometriosis (33.8 ± 4 versus 33.7 ± 4.4 years, respectively), poor ovarian reserves were much more common in women with endometriosis (39.8 versus 22.7%). The chance of achieving live birth was similar between women with the diagnosis of endometriosis and those without it (19.1 versus 22.5%), and also when considering only women with a poor ovarian reserve (9.4 versus 8.9%) and only those with a normal ovarian reserve (25.5 versus 26.5%). Conclusions Women diagnosed with endometriosis are more likely to have a poor ovarian reserve; however, their chance of conceiving by IVF/ICSI is similar to the one observed in patients without endometriosis and with a comparable ovarian reserve.

Endometriosis, Ovarian Reserve and Live Birth Rate Following In Vitro Fertilization/Intracytoplasmic Sperm Injection / Endometriose, reserva ovariana e taxa de nascidos vivos após FIV/ICSI

Abstract Purpose To evaluate whether women with endometriosis have different ovarian reserves and reproductive outcomes when compared with women without this diagnosis undergoing in vitro fertilization/intracytoplasmic sperm injection ( IVF/ ICSI), and to compare the reproductive outcomes between women with and without the diagnosis considering the ovarian reserve assessed by antral follicle count ( AFC ). Methods This retrospective cohort study evaluated all women who underwent IVF/ ICSI in a university hospital in Brazil between January 2011 and December 2012. All patients were followed up until a negative pregnancy test or until the end of the pregnancy. The primary outcomes assessed were number of retrieved oocytes and live birth. Women were divided into two groups according to the diagnosis of endometriosis, and each group was divided again into a group that had AFC 6 (poor ovarian reserve) and another that had AFC 7 (normal ovarian reserve). Continuous variables with normal distribution were compared using unpaired t-test, and those without normal distribution, using Mann-Whitney test. Binary data were compared using either Fisher's exact test or Chi-square (2) test. The significance level was set as p < 0.05. Results 787 women underwent IVF/ICSI (241 of which had endometriosis). Although the mean age has been similar between women with and without the diagnosis of endometriosis (33.8 4 versus 33.7 4.4 years, respectively), poor ovarian reserves were much more common in women with endometriosis (39.8 versus 22.7%). The chance of achieving live birth was similar between women with the diagnosis of endometriosis and those without it (19.1 versus 22.5%), and also when considering only women with a poor ovarian reserve (9.4 versus 8.9%) and only those with a normal ovarian reserve (25.5 versus 26.5%). Conclusions Women diagnosed with endometriosis are more likely to have a poor ovarian reserve; however, their chance of conceiving by IVF/ICSI is similar to the one observed in patients without endometriosis and with a comparable ovarian reserve.

Resumo Objetivo Avaliar se mulheres com endometriose possuem diferenças quanto a reserva ovariana (RO) e a resultados de reprodução assistida quando comparadas a mulheres sem este diagnóstico submetidas IVF/ICSI (in vitro fertilization/intracytoplasmic sperm injection), e comparar resultados reprodutivos entre mulheres com e sem o diagnóstico, considerando a RO obtida pela contagem de folículos antrais ( CFA ). Métodos Este estudo de coorte retrospectivo avaliou todas as mulheres submetidas à FIV/ICSI em uma universidade do Brasil nos anos de 2011 e 2012. Todas as pacientes foram seguidas até um teste negativo de gravidez ou até o final da gestação. Os desfechos primários analisados foram o número do oócitos captados e nascidos vivos. As mulheres foram divididas em 2 grupos de acordo com o diagnóstico de endometriose e subdivididas de acordo com a CFA 6 (baixa RO) e 7 (RO normal). As variáveis contínuas com distribuição normal foram comparadas pelo teste t não pareado e sem distribuição normal pelo teste de Mann-Whitney. Os dados binários foram comparados por ambos os testes Qui-quadrado (2) e exato de Fisher. O nível de significância foi definido como p < 0,05. Resultados 787 mulheres foram submetidas a IVF/ICSI (241 com endometriose). Embora a média de idade tenha sido similar entre as mulheres com e sem o diagnóstico de endometriose (33,8 4 versus 33,7 4.4 anos, respectivamente), a baixa RO é muito mais comum em mulheres com endometriose (39,8 versus 22,7%). A chance de obter um nascido vivo foi similar entre as mulheres com e sem endometriose (19,1 versus 22,5%), e também quando consideradas apenas as mulheres com baixa RO (9 , 4 versus 8,9%), e apenas com RO normal (25,5 versus 26 ,5% ). Conclusões Mulheres diagnosticadas com endometriose são mais susceptíveis a ter baixa RO; no entanto, suas chances de conceber por IVF/ICSI são similares às observadas em pacientes sem endometriose e com uma RO comparável.

Ultrasound scan as a potential source of nosocomial and crossinfection: a literature review.

The authors review the main concepts regarding the importance of cleaning/disinfection of ultrasonography probes, aiming a better comprehension by practitioners and thus enabling strategies to establish a safe practice without compromising the quality of the examination and the operator productivity. In the context of biosafety, it is imperative to assume that contact with blood or body fluids represents a potential source of infection. Thus, in order to implement cleaning/disinfection practice, it is necessary to understand the principles of infection control, to consider the cost/benefit ratio of the measures to be implemented, and most importantly, to comprehend that such measures will not only benefit the health professional and the patient, but the society as a whole.

Os autores revisam os principais conceitos relativos à importância da limpeza/desinfecção das sondas ecográficas, visando sua melhor compreensão e possibilitando, assim, estabelecer estratégias para uma prática segura sem comprometer a qualidade do exame e a produtividade do operador. No contexto da biossegurança, é imperativo assumir que o contato com sangue ou fluidos corporais representa uma potencial fonte de infecção. Dessa forma, para que as práticas de limpeza/desinfecção possam ser instituídas, é necessário entender os princípios do controle de infecção, ponderar se os benefícios das medidas a serem instituídas são compatíveis com seus custos e consequências, e principalmente compreender que tais medidas não beneficiam apenas o profissional de saúde e o paciente, mas a sociedade como um todo.

Ultrasound scan as a potential source of nosocomial and cross-infection: a literature review / O exame ultrassonográfico como potencial fonte de infecção cruzada e nosocomial: uma revisão da literatura

AbstractThe authors review the main concepts regarding the importance of cleaning/disinfection of ultrasonography probes, aiming a better comprehension by practitioners and thus enabling strategies to establish a safe practice without compromising the quality of the examination and the operator productivity. In the context of biosafety, it is imperative to assume that contact with blood or body fluids represents a potential source of infection. Thus, in order to implement cleaning/disinfection practice, it is necessary to understand the principles of infection control, to consider the cost/benefit ratio of the measures to be implemented, and most importantly, to comprehend that such measures will not only benefit the health professional and the patient, but the society as a whole.

ResumoOs autores revisam os principais conceitos relativos à importância da limpeza/desinfecção das sondas ecográficas, visando sua melhor compreensão e possibilitando, assim, estabelecer estratégias para uma prática segura sem comprometer a qualidade do exame e a produtividade do operador. No contexto da biossegurança, é imperativo assumir que o contato com sangue ou fluidos corporais representa uma potencial fonte de infecção. Dessa forma, para que as práticas de limpeza/desinfecção possam ser instituídas, é necessário entender os princípios do controle de infecção, ponderar se os benefícios das medidas a serem instituídas são compatíveis com seus custos e consequências, e principalmente compreender que tais medidas não beneficiam apenas o profissional de saúde e o paciente, mas a sociedade como um todo.

Body composition characteristics predict sexual functioning in obese women with or without PCOS.

Polycystic ovary syndrome is frequently related to obesity and hyperandrogenism that potentially may impair sexual function. This case-control study aimed to determine the effect of the polycystic ovary syndrome on the sexual functioning of obese women and to determine which body measures can predict sexual functioning among 87 sexually active women obese women with and without polycystic ovary syndrome, 18-40 years old, divided in two groups; obese women (n = 44) or obese women with polycystic ovary syndrome (n = 43). The groups were compared using the Sexual Quotient-Female version and Hospital Anxiety and Depression scales, and by serum tests. No significant difference between groups was observed in weight, waist-hip ratio, body mass index, serum glucose, cholesterol, triglycerides, total testosterone, sex hormone binding globulin, total Sexual Quotient-Female version score, and the total score of ≤ 60 for subjects (risk for sexual dysfunction) and Hospital Anxiety and Depression. Significant difference was observed in age, parity, and Free Androgen Index. Each unit increase in waist-hip ratio conferred a greater chance of score of ≤ 60. A height of less than 161 cm and the presence of depression were found to be risk factors with a score of ≤ 60. Women with a score of ≤ 60 had significantly smaller hip measurements and waist-hip ratio. The presence of polycystic ovary syndrome was not a risk factor for decreased sexual functioning.