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.

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.

Effect of antiretroviral therapy on hemostasis in Brazilian pregnant women with HIV infection.

Clinical observation shows pregnant women under antiretroviral therapy present bleeding episodes at delivery, although this therapy promotes a decrease in fibrinolysis in nonpregnant patients, suggesting a prothrombotic state in the former. Since these drugs provoke hepatic disorders, they can cause bleeding disturbances. We investigated effects of antiretroviral therapy on hemostasis in pregnant women. Two groups were studied: pregnant women with HIV (n = 11), and (control) pregnant women without HIV (n = 7). Four blood samples were collected from each individual in both groups: one at the beginning of pregnancy before treatment, two during pregnancy and therapy, and one 6 weeks after delivery. Treatment was performed according to recommendations of the Brazilian Health Department for the evaluation of the prothrombin time, activated partial thromboplastin time, factors VII, X, and XII, fibrinogen concentration, protein C, protein S, tissue-type plasminogen activator (t-PA) antigen, plasminogen activator inhibitor-1, and fibrin degradation products (FbDPs). Statistical analysis demonstrated pregnancy caused increased factor VII (P = 0.0313), factor X (P = 0.0156) and factor XII (P = 0.0156) activity, fibrinogen concentration (P = 0.0156), t-PA (P = 0.0313), plasminogen activator inhibitor-1 (P = 0.0156) and FbDP levels (P = 0.0313). HIV infection caused increased factor XII (P = 0.0114), t-PA (P = 0.0346) and FbDPs (P = 0.0003), and decreased protein S levels (P = 0.0441). Antiretroviral therapy reduced the activated partial thromboplastin time (P = 0.0114) and protein S (P = 0.0012), and increased t-PA (P = 0. 0204) and FbDP levels (P = 0.0154). The results suggest a prothrombic state developing during pregnancy, maintenance of hemostatic equilibrium in HIV infection and occurrence of hyperfibrinolysis, not due to hepatotoxicity, during antiretroviral therapy, causing the clinically observed bleeding episodes.

The environmental cofactors in carcinogenesis in high risk HPV/HIV-positive women.

The objective of the present study was to assess the presence of human papilloma virus (HPV) in HIV-infected women, with comparison between the Papanicolaou cytologic technique and the molecular PCR technique, as well as to determine the type of HPV, to measure cellular immunocompetence and to identify the presence of risk factors for the acquisition of HPV infection. Thirty HIV-infected women were selected. Vaginal and endocervical samples were collected from 27 of them. The smears were examined by 3 experienced cytologists to diagnose the presence of HPV by the Papanicolaou technique and the results were compared to HPV detection and typing by PCR. HPV-infected patients were interviewed in order to identify the presence of risk factors for the acquisition of the virus. Eight of the 27 patients analyzed (29%) presented HPV in endocervical samples submitted to PCR, 6 of them (75%) presented HPV involving a high risk of development of cervical cancer. For 5 of these patients, the cytologic diagnosis was not confirmed by PCR. When cellular immunocompetence was related to HPV infection, PCR revealed a diagnosis of HPV in 37.50% of the patients at intermediate risk for HPV infection and in 83.33% of the patients at high risk for HPV infection. These immunologically compromised HPV-infected patients are at higher risk of developing cervical neoplasia. We showed here that PCR is adequate for HPV detection and that, if only the Papanicolaou method is used for the follow-up of these patients, we will not provide good prevention of cervical cancer.

The environmental cofactors in carcinogenesis in high risk HPV/HIV-positive women

The objective of the present study was to assess the presence of human papilloma virus (HPV) in HIV-infected women, with comparison between the Papanicolaou cytologic technique and the molecular PCR technique, as well as to determine the type of HPV, to measure cellular immunocompetence and to identify the presence of risk factors for the acquisition of HPV infection. Thirty HIV-infected women were selected. Vaginal and endocervical samples were collected from 27 of them. The smears were examined by 3 experienced cytologists to diagnose the presence of HPV by the Papanicolaou technique and the results were compared to HPV detection and typing by PCR. HPV-infected patients were interviewed in order to identify the presence of risk factors for the acquisition of the virus. Eight of the 27 patients analyzed (29 percent) presented HPV in endocervical samples submitted to PCR, 6 of them (75 percent) presented HPV involving a high risk of development of cervical cancer. For 5 of these patients, the cytologic diagnosis was not confirmed by PCR. When cellular immunocompetence was related to HPV infection, PCR revealed a diagnosis of HPV in 37.50 percent of the patients at intermediate risk for HPV infection and in 83.33 percent of the patients at high risk for HPV infection. These immunologically compromised HPV-infected patients are at higher risk of developing cervical neoplasia. We showed here that PCR is adequate for HPV detection and that, if only the Papanicolaou method is used for the follow-up of these patients, we will not provide good prevention of cervical cancer.

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.

Hemoglobinopatias em crianças com alteraçöes eritrocitárias / Hemoglobinopathies in children with hematological changes

Um estudo sobre hemoglobinopatias em crianças atendidas em Postos de Saúde Municipais da cidade de Ribeiräo Preto revelou dados bastante significativos em relaçäo a sua freqüência. A faixa etária dos pacientes variou de 0 a 7 anos, onde a principal suspeita clínica era a anemia ferropriva, em virtude da baixa condiçäo sócio-econômica dos pacientes. Inicialmente foi feito o eritrograma de cada paciente e, em seguida, a triagem eletroforética, como também testes complementares para identificar hemoglobinas anormais. Dos pacientes estudados, a maioria apresentava alteraçöes hematológicas das mais variadas. Foram observadas 61 casos de hemoglobinopatias nos 216 pacientes estudados com as seguintes hemoglobinas anormais: A/S (36), A/ß talassemia heterozigota (18), A/C (3), S/C (1), C/C (2) e Persistência Hereditária de Hemoglobina Fetal (PHHF) (1). Estes resultados confirma a importância da identificaçäo de hemoglobinopatias que necessitam de um acompanhamento e conduta médica apropriados, além de um perfeito aconselhamento genético