Polycystic ovary syndrome and abdominal fat: is there a relationship?

OBJECTIVE: The aim of this study was to compare the distribution of fat tissue in non-obese women with polycystic ovary syndrome and those without the syndrome using dual-energy radiological densitometry. METHODS: This was a case-control study in which we enrolled women aged 14-39 years with polycystic ovary syndrome according to the Rotterdam criteria with a body mass index between 18.5 and 30 kg/m2. The control group comprised women with the same profile, but without polycystic ovary syndrome. Patients were treated at the Endocrinological Gynecology Outpatient Clinic of the Department of Obstetrics and Gynecology of the Irmandade da Santa Casa de Misericórdia de São Paulo between 2019 and 2022. Anthropometric measurements were taken and the assessment of body composition was performed using dual-energy radiological densitometry. RESULTS: The sample comprised 57 women: 37 in the polycystic ovary syndrome group and 20 in the control group. The mean age of the polycystic ovary syndrome group was 24.9 years (±6.9) with a mean body mass index of 60.8 kg/m2 (±8.5), and for the control group, it was 24.2 years (±6.9) with a mean body mass index of 58 kg/m2 (±8.4). Body composition was evaluated using dual-energy radiological densitometry and showed a higher value of trunk fat in the polycystic ovary syndrome group (44.1%, ±9.0) compared to the control group (35.2%, ±11.4), which was statistically significant (p=0.002). CONCLUSION: Our study showed that non-obese polycystic ovary syndrome patients have a higher concentration of abdominal fat, which is a risk factor for increased cardiovascular risk and insulin resistance.ClinicalTrials.gov ID: NCT02467751.

Time series of cases and treatment outcomes from tuberculosis in Sergipe, 2012-2021.

OBJECTIVE: The objectives of this study were: (1) to analyze the temporal trend of tuberculosis treatment outcomes in the state of Sergipe; (2) to identify the existence of seasonality of tuberculosis; (3) to verify the influence of the rapid molecular test (MTB-RIF) in the time series of tuberculosis and its treatment outcomes in the state of Sergipe; and (4) to verify treatment outcomes. METHODS: Ecological study on tuberculosis and three treatment outcomes (cure, interruption of treatment, and death) extracted from Datasus. Incidence and mortality rates were calculated for the crude occurrences of cases and deaths and the proportions of cure and interruption of treatment (%). The time series was analyzed using Prais-Winsten regression from Jan to Dec/2021. RESULTS: The total incidence rate was 36.35 cases per 100,000 inhabitants, with an increase of 0.44% per month (95%CI 0.35; 0.54). The cure rate was 64.0% with a steady trend (p>0.05). The percentage of treatment interruption was 13.3%, with a reduction of -0.73%/month (95%CI -1.11; -0.34). The total mortality rate was 1.92 deaths/100,000 inhabitants with a stationary trend. After the implementation of the MTB-RIF, there was an increase in the incidence rate of 0.65% per month. Seasonality was not identified in any of the analyses performed (p>0.05). CONCLUSION: There was an increase in incidence rates, reduction in treatment interruption and mortality in the state of Sergipe. Seasonality was not identified. The rapid molecular test showed a growth effect on the incidence rate.

Hepatitis mortality in Brazil and regions, 2001-2020: temporal trend and spatial analysis.

OBJECTIVE: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. METHODS: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). RESULTS: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was -8.11% per year (95%CI -9.38; -6.82), while for Hepatitis B it was -4.13% (95%CI -6.03; -2.20), of Other viral hepatitis of -7.84% (95%CI -14.11; -1.11) and of Unspecified Hepatitis -5.67% per year (95%CI -6.22; -5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). CONCLUSION: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.

Qualidade de vida e sobrecarga de mães de crianças com microcefalia / Quality of life and caregiver burden in mothers of children with microcephaly

Introdução: Devido a infecção congênita, a criança com microcefalia possui grandes limitações de sua condição de saúde. Estas limitações fazem com que a criança necessite de maior atenção de saúde e domiciliar. Geralmente, a mãe torna-se cuidadora principal desta criança, esse papel pode levar a sobrecarga com prejuízos em sua qualidade de vida. Objetivo: Analisar sobrecarga do cuidado e a qualidade de vida de mães ou cuidadoras principais de crianças com microcefalia relacionada à infecção congênita. Método: Estudo transversal, correlacional, realizado com 105 participantes do estado de Sergipe, Brasil, durante o período de outubro de 2017 a abril de 2018, através da aplicação questionários: sociodemográfico, WHOQOL-Bref e Sobrecarga do cuidador. Para análise estatística foram utilizados testes ANOVA, teste t e Person (r). Resultados: A totalidade dos participantes era do sexo feminino, 39 % foram classificadas com sobrecarga severa e 30,5% com sobrecarga intensa. A média total da sobrecarga (49,47) indica classificação de moderada à severa. Houve uma forte associação (p<0,0001) entre os níveis de sobrecarga e os domínios da qualidade de vida, sendo o de maior prejuízo o ambiental (36,57) e o físico (38,53). Foi observada uma correlação significativa e inversamente proporcional (r=-0,547, p<0,0001) entre a qualidade de vida e a sobrecarga do cuidador. Conclusão: As mães sofrem sobrecarga severa e intensa que pode levar a repercussões negativas em sua qualidade de vida. A enfermagem pode contribuir na criação e implementação de linhas de cuidados específicas para estas mulheres com ênfase na promoção da saúde física, mental e melhora da qualidade de vida.

Introducción: Debido a la infección congénita, las niñas y los niños con microcefalia tienen grandes limitaciones en su estado de salud. Estas limitaciones hacen que necesiten más atención sanitaria y domiciliaria. Generalmente, la madre se convierte en la principal cuidadora y este papel puede llevar a la sobrecarga, con perjuicio para su calidad de vida. Objetivo: Analizar la sobrecarga de cuidado y la calidad de vida de las madres o personas cuidadoras primarias de niñas o niños con microcefalia, relacionada con infección congénita. Método: Estudio transversal, correlacional realizado con 105 participantes del estado de Sergipe, Brasil, de octubre de 2017 a abril de 2018, a través de la aplicación de los siguientes cuestionarios: sociodemográfico, el WHOQOL-Bref y escala de sobrecarga del cuidador. Para el análisis estadístico, se utilizaron ANOVA, prueba t y prueba Person (r). Resultados: Población totalmente femenina. El 39 % se clasificó con sobrecarga severa y el 30.5 % con sobrecarga intensa. La sobrecarga media total (49.47) indica una clasificación de moderada a grave. Hubo una fuerte asociación (p<0.0001) entre los niveles de carga y los dominios de la calidad de vida, siendo los mayores daños ambientales (36.57) y físicos (38.53). Se observó una correlación significativa e inversamente proporcional (r=-0.547, p<0.0001) entre la calidad de vida y la sobrecarga de la persona cuidadora cuidador. Conclusión: Las madres sufren una sobrecarga severa e intensa que influye negativamente en su calidad de vida. La enfermería puede contribuir para la creación e implementación de líneas de atención específicas para estas mujeres con énfasis en la promoción de la salud física y mental y la mejora de la calidad de vida.

Introduction: Due to congenital infection, children with microcephaly have great limitations due to this condition. These limitations make the child need more health and home care. Generally, the mother becomes the main caretaker for this child, this role can lead to overload feelings that affect their quality of life. Objective: To analyze the role overload and the quality of life of mothers or primary caregiver of children with microcephaly related to congenital infection. Method: Cross-sectional, correlational study carried out with 105 participants from the state of Sergipe, Brazil, during the period from October 2017 to April 2018, through the application of questionnaires: sociodemographic, WHOQOL-Bref, and caregiver burden. For statistical analysis, ANOVA, t-test, and Pearson (r) tests were used. Results: All of the participants were females, 39 % were classified with severe role overload and 30.5% with intense role overload. The total average of this caregiver burden (49.47) presents a moderate to severe classification. There was a strong correlation (p<0.0001) between the levels of their role overload and the domains of their quality of life, where the greatest damage was in the environmental (36.57) and physical (38.53) aspects. A significant and inversely proportional correlation (r=-0.547, p<0.0001) was observed between the quality of life and the caregiver burden. Conclusion: Mothers suffer severe and intense caregiver overload that has a negative influence on their quality of life. Nursing can contribute to the creation and implementation of specific lines of care for these women emphasizing the promotion of physical and mental health to improve their quality of life.

Evaluation of quality of life (QOL) of young patients with primary hyperhidrosis (PH) before and after endoscopic thoracic sympathectomy (ETS).

BACKGROUND: Primary hyperhidrosis (PH) affects young patients and may cause emotional distress and a negative quality of life (QOL). OBJECTIVE: We sought to evaluate the QOL of children and adolescents with PH treated by endoscopic thoracic sympathectomy. METHODS: A study of 220 patients was performed, based on submitted QOL questionnaires from their first consultation. Patients were evaluated within 1 week and 24 months after surgery. RESULTS: Before endoscopic thoracic sympathectomy, the QOL in relation to PH was declared very poor by 141 patients, and poor by the remaining 79 (P = .552). Postoperative cure was reported in 100% of palmar and axillary PH cases, and in 91.7% of facial PH. After 24 months, the QOL was described as much better by 212 patients, a little better by 6 patients, and 2 patients reported no change. LIMITATIONS: Convenience sampling was used and patients were taken from private practice only, raising the possibility of bias in gathering the data. CONCLUSION: Onset of PH symptoms was mainly before the age of 10 years and substantially affected daily activities. Endoscopic thoracic sympathectomy cured PH and promoted significant improvement in the QOL of these young patients.

Cryopreservation as a strategy for prevention of ovarian hyperstimulation syndrome in a public assisted reproduction service in São Paulo - Brazil.

OBJECTIVE: This study aimed to evaluate the prevalence of ovarian hyperstimulation syndrome (OHSS) and associated risk factors in patients undergoing fertilization cycles at risk of OHSS (≥15 antral follicles or ≥15 oocytes aspirated) and submitted to cryopreservation of all embryos in the Human Reproduction Service of the Pérola Byington Hospital (Referral Center for Women's Health) in São Paulo, SP, Brazil. METHODS: This cross-sectional, institutional, descriptive study of secondary data from patients' charts enrolled in the Assisted Reproduction Service of the Pérola Byington Hospital at risk of OHSS after controlled ovarian stimulation and submitted to cryopreservation of all embryos was conducted between January 2015 and September 2017. RESULTS: OHSS occurred in 47.5% of cycles, all with mild severity, and there were no moderate or severe cases of OHSS. CONCLUSION: The cryopreservation of all embryos is associated with a reduction in moderate and severe forms of OHSS. Risk factors for OHSS should be evaluated prior to initiation of treatment, with less intense stimulation protocols accordingly.

Cryopreservation as a strategy for prevention of ovarian hyperstimulation syndrome in a public assisted reproduction service in São Paulo - Brazil

SUMMARY OBJECTIVE: This study aimed to evaluate the prevalence of ovarian hyperstimulation syndrome (OHSS) and associated risk factors in patients undergoing fertilization cycles at risk of OHSS (≥15 antral follicles or ≥15 oocytes aspirated) and submitted to cryopreservation of all embryos in the Human Reproduction Service of the Pérola Byington Hospital (Referral Center for Women's Health) in São Paulo, SP, Brazil. METHODS: This cross-sectional, institutional, descriptive study of secondary data from patients' charts enrolled in the Assisted Reproduction Service of the Pérola Byington Hospital at risk of OHSS after controlled ovarian stimulation and submitted to cryopreservation of all embryos was conducted between January 2015 and September 2017. RESULTS: OHSS occurred in 47.5% of cycles, all with mild severity, and there were no moderate or severe cases of OHSS. CONCLUSION: The cryopreservation of all embryos is associated with a reduction in moderate and severe forms of OHSS. Risk factors for OHSS should be evaluated prior to initiation of treatment, with less intense stimulation protocols accordingly.

Hepatitis mortality in Brazil and regions, 2001-2020: temporal trend and spatial analysis / Mortalidade por hepatites no Brasil e regiões, 2001-2020: tendência temporal e análise espacial

ABSTRACT Objective: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. Methods: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). Results: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was −8.11% per year (95%CI −9.38; −6.82), while for Hepatitis B it was −4.13% (95%CI −6.03; −2.20), of Other viral hepatitis of −7.84% (95%CI −14.11; −1.11) and of Unspecified Hepatitis −5.67% per year (95%CI −6.22; −5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). Conclusion: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.

RESUMO Objetivo: Analisar a distribuição espacial e a tendência temporal da taxa de mortalidade por hepatites no Brasil no período de 2001 a 2020. Métodos: Estudo ecológico, temporal e espacial sobre a mortalidade por hepatites no Brasil com dados do Sistema de Informações sobre Mortalidade (SIM/Datasus). As informações foram estratificadas por ano do diagnóstico, região do país, municípios (de residência). Foram calculadas as taxas padronizadas de mortalidade (TPM). A tendência temporal foi estimada pela regressão de Prais-Winsten e a distribuição espacial pelo Índice Global de Moran (IGM). Resultados: As maiores médias da TPM no Brasil foram para hepatite viral crônica, com 0,88 mortes para cada 100 mil habitantes (desvio padrão — DP=0,16), seguida de outras hepatites virais, com 0,22/100 mil (DP=0,11). No Brasil, a tendência temporal da mortalidade por hepatite A foi de −8,11% ao ano (intervalo de confiança de 95% — IC95% −9,38; −6,82), enquanto por hepatite B foi de −4,13% (IC95% −6,03; −2,20); de outras hepatites virais, foi de −7,84% (IC95% −14,11; −1,11) e de hepatite não especificada, de −5,67% ao ano (IC95% −6,22; −5,10). A mortalidade por hepatite viral crônica cresceu 5,74% (IC95%3,47; 8,06) no norte e 4,95% no nordeste (IC95% 0,27; 9,85). O Índice de Moran (I) para hepatite A foi de 0,470 (p<0,001), para hepatite B de 0,846 (p<0,001), hepatite viral crônica=0,666 (p<0,001), outras hepatites virais=0,713 (p<0,001) e hepatites não especificadas=0,712 (p<0,001). Conclusão: A tendência temporal das hepatites A, B, de outras hepatites virais e das não especificadas foi de diminuição no Brasil, enquanto a mortalidade por hepatites crônicas foi de crescimento nas Regiões Norte e Nordeste.

Polycystic ovary syndrome and abdominal fat: is there a relationship?

SUMMARY OBJECTIVE: The aim of this study was to compare the distribution of fat tissue in non-obese women with polycystic ovary syndrome and those without the syndrome using dual-energy radiological densitometry. METHODS: This was a case-control study in which we enrolled women aged 14-39 years with polycystic ovary syndrome according to the Rotterdam criteria with a body mass index between 18.5 and 30 kg/m2. The control group comprised women with the same profile, but without polycystic ovary syndrome. Patients were treated at the Endocrinological Gynecology Outpatient Clinic of the Department of Obstetrics and Gynecology of the Irmandade da Santa Casa de Misericórdia de São Paulo between 2019 and 2022. Anthropometric measurements were taken and the assessment of body composition was performed using dual-energy radiological densitometry. RESULTS: The sample comprised 57 women: 37 in the polycystic ovary syndrome group and 20 in the control group. The mean age of the polycystic ovary syndrome group was 24.9 years (±6.9) with a mean body mass index of 60.8 kg/m2 (±8.5), and for the control group, it was 24.2 years (±6.9) with a mean body mass index of 58 kg/m2 (±8.4). Body composition was evaluated using dual-energy radiological densitometry and showed a higher value of trunk fat in the polycystic ovary syndrome group (44.1%, ±9.0) compared to the control group (35.2%, ±11.4), which was statistically significant (p=0.002). CONCLUSION: Our study showed that non-obese polycystic ovary syndrome patients have a higher concentration of abdominal fat, which is a risk factor for increased cardiovascular risk and insulin resistance. ClinicalTrials.gov ID: NCT02467751.

Time series of cases and treatment outcomes from tuberculosis in Sergipe, 2012-2021 / Série temporal dos casos e dos desfechos do tratamento contra tuberculose em Sergipe, 2012-2021

ABSTRACT Objective: The objectives of this study were: (1) to analyze the temporal trend of tuberculosis treatment outcomes in the state of Sergipe; (2) to identify the existence of seasonality of tuberculosis; (3) to verify the influence of the rapid molecular test (MTB-RIF) in the time series of tuberculosis and its treatment outcomes in the state of Sergipe; and (4) to verify treatment outcomes. Methods: Ecological study on tuberculosis and three treatment outcomes (cure, interruption of treatment, and death) extracted from Datasus. Incidence and mortality rates were calculated for the crude occurrences of cases and deaths and the proportions of cure and interruption of treatment (%). The time series was analyzed using Prais-Winsten regression from Jan to Dec/2021. Results: The total incidence rate was 36.35 cases per 100,000 inhabitants, with an increase of 0.44% per month (95%CI 0.35; 0.54). The cure rate was 64.0% with a steady trend (p>0.05). The percentage of treatment interruption was 13.3%, with a reduction of −0.73%/month (95%CI −1.11; −0.34). The total mortality rate was 1.92 deaths/100,000 inhabitants with a stationary trend. After the implementation of the MTB-RIF, there was an increase in the incidence rate of 0.65% per month. Seasonality was not identified in any of the analyses performed (p>0.05). Conclusion: There was an increase in incidence rates, reduction in treatment interruption and mortality in the state of Sergipe. Seasonality was not identified. The rapid molecular test showed a growth effect on the incidence rate.

RESUMO Objetivo: Os objetivos deste estudo são, no estado de Sergipe: (1) analisar a tendência temporal da tuberculose e os desfechos do tratamento; (2) identificar a existência de sazonalidade da tuberculose; (3) verificar a influência do teste rápido molecular (TRM-TB) na série temporal da tuberculose e seus desfechos de tratamento; e (4) verificar os desfechos do tratamento. Métodos: Estudo ecológico sobre tuberculose e três desfechos do tratamento (cura, interrupção do tratamento e óbito) extraídos do Datasus. Foram calculadas as taxas de incidência e de mortalidade para as ocorrências brutas de casos e as proporções de cura e interrupção do tratamento (%). A série temporal foi analisada pela regressão de Prais-Winsten no período de janeiro de 2012 a dezembro de 2021. Resultados: A taxa de incidência total foi de 36,35 casos por 100 mil habitantes, com aumento de 0,44% ao mês (IC95% 0,35; 0,54). A proporção de cura foi de 64,0%, com tendência estacionária (p>0,05). O percentual de interrupção do tratamento foi de 13,3%, com redução de 0,73% ao mês (IC95% −1,11; −0,34). A taxa de mortalidade total foi de 1,92 morte por100 mil habitantes, com tendência estacionária. Posteriormente à implementação do TRM-TB, a taxa de incidência cresceu 0,65% ao mês. A sazonalidade não foi identificada em nenhuma das análises realizadas (p>0,05). Conclusão: Cresceram as taxas de incidência, redução da interrupção do tratamento e mortalidade no estado de Sergipe. Não foi identificado sazonalidade. O teste rápido molecular apresentou efeito de crescimento na taxa de incidência.

Deficiência de zinco na doença de Alzheimer: um estudo transversal com grupo comparação / Zinc deficiency in alzheimer's disease: a cross-sectional study with a control group

Resumo Objetivo Identificar se há diferença na concentração plasmática e eritrocitária de zinco na pessoa idosa com e sem a doença de Alzheimer. Métodos Estudo transversal com grupo comparação, realizado com pessoas idosas com e sem doença de Alzheimer, pareadas por sexo, escolaridade e idade. A concentração de zinco foi medida através de espectrofotometria de absorção atômica em forno grafite. Resultados Total de 102 pessoas, 68 no grupo saudável (NDA-g) e 34 o grupo com doença (DA-g). O grupo DA-g apresentou menores concentrações plasmáticas e maior frequência no primeiro quartil para concentrações intraeritrocitárias de zinco. As concentrações plasmáticas e eritrocitárias não apresentaram correlação com tempo de diagnóstico e a idade em ambos os grupos. Na análise de regressão logística, a concentração plasmática esteve associada à DA-g (OR=0,964; p=0,028). Conclusão Pessoas idosas com doença de Alzheimer apresentam menores concentrações plasmáticas e eritrocitárias de zinco.

Abstract Objective To identify whether there is a difference in plasma and erythrocyte zinc concentration in older adults with and without Alzheimer's disease. Methods Crosssectional study with a comparative group, conducted with older adults with and without Alzheimer's disease, matched by sex, education, and age. Zinc concentration was measured by atomic absorption spectrophotometry in a graphite furnace. Results There were 102 people, 68 in the healthy group (NDA-g) and 34 in the group with disease (AD-g). The AD-g group had lower plasma zinc concentrations and higher frequency in the first quartile for intraerythrocyte zinc concentrations. Plasma and erythrocyte concentrations did not correlate with the time of diagnosis and age in both groups. In the logistic regression analysis, plasma concentration was associated with AD-g (OR=0.964; p=0.028). Conclusion Older people with Alzheimer's disease have lower plasma and erythrocyte zinc concentrations.

Avaliação dos óbitos por COVID-19 em médicos no Brasil / Evaluation of deaths by COVID-19 in doctors in Brazil

Introdução: a pandemia da doença do coronavírus 2019 (COVID-19) afetou a população mundial, especialmente os profissionais que atuam na linha de frente, como os médicos. Objetivo: avaliar os óbitos na população médica brasileira pela COVID-19. Metodologia: trata-se de um estudo ecológico e analítico sobre os óbitos por COVID-19 em médicos, no Brasil. Realizou-se análise descritiva e utilizaram-se os testes Qui-quadrado e Qui-quadrado de Pearson com simulações de Monte-Carlo (p˂0,05). A análise espacial foi realizada mediante mapa de densidade de Kernel. Resultados: foram incluídos 938 óbitos, e predominaram vítimas do sexo masculino (86,57%) com idade média de 66,24 anos. A taxa de mortalidade por COVID-19 variou de 82,2 óbitos por 100 mil médicos no sudeste a 739,2 no norte do Brasil. O maior número de óbitos foi apresentado na clínica médica (29,85%), que também obteve a maior taxa de mortalidade de 655,3. Observou-se diferença significativa entre os anos 2020 e 2021 para a faixa etária, com maior frequência nos grupos com mais de 60 anos (p=0,005) e para as áreas de atuação médica, com maior prevalência para a clínica médica (p=0,018). No ano de 2020, os estados brasileiros que apresentaram maiores taxas de mortalidades estão localizados, na sua maioria, nas regiões Norte e Nordeste. Conclusão: devem ser consideradas as diferentes situações que aumentam a vulnerabilidade dos médicos aos riscos de contrair a COVID-19; com isso ações de promoção, proteção e assistência à saúde devem ser aprimoradas, principalmente aos profissionais que estão na linha de frente, visando o preparo para pandemias.

Introduction: the pandemic coronavirus disease 2019 (COVID-19) has affected the world population, especially professionals who are working on the front lines, like the doctors. Objective: evaluate deaths in the Brazilian medical population using COVID-19. Methods: this is a study ecological and analytical on deaths in doctors due to COVID-19, in Brazil. Descriptive analysis was performed, and Pearson's chi-square and chi-square tests were used with Monte-Carlo simulations (p˂0.05). Spatial analysis was performed using density map a Kernel. Results: were included 938 deaths, predominantly male victims (86.57%) with a mean age of 66.24 years. The mortality rate due to COVID-19 ranged from 82.2 deaths per 100,000 doctors in the Southeast to 739.2 in the North of Brazil. The highest number of deaths was presented in the Medical Clinic (29.85%), which also had the highest mortality rate of 655.3. There was a significant difference between the years 2020 and 2021 for the age group, with greater frequency in groups over 60 years old (p=0.005) and for the areas of medical practice, with higher prevalence for Internal Medicine (p=0.018). The Brazilian states had the highest mortality rates in 2020 and were mostly from the North and Northeast regions. Conclusion: the different situations that increase the vulnerability of physicians to the risks of contracting COVID-19 must be considered. Therefore, actions for health promotion, protection and assistance must be improved, with these professionals who are on the front line, aiming to prepare for pandemics.

Effects of Cimicifuga racemosa (L.) Nutt on sexual function in women receiving tamoxifen for breast cancer.

To assess the effects of Cimicifuga racemosa (L.) Nutt on climacteric symptoms and sexual function in women receiving tamoxifen after breast cancer treatment. A prospective study of women treated at the Mastology Outpatient Clinic of the Department of Obstetrics and Gynecology of the Santa Casa de Sao Paulo School of Medical Science of the hospital was conducted between 2018 and 2021. Patients diagnosed with breast cancer that underwent surgical, radiotherapy and chemotherapy treatment more than one year prior, receiving tamoxifen, exhibited climacteric symptoms and were sexually active were selected. Total of 34 women were recruited and during outpatient visits completed sociodemographic questionnaire, Blatt-Kupperman Index (KI) and Female Sexual Function Index (FSFI). The group showed improvements in climacteric symptoms (p<.001) and sexual function (p=.011) after the 6-month follow-up. Cimicifuga racemosa (L.) Nutt promoted improvements in climacteric symptoms and sexual function in women surgically treated for breast cancer. Clinical Trials.gov ID: NCT02467686.Impact StatementWhat is already known on this subject? The medications used for the treatment of breast cancer can lead to important complaints of vasomotor manifestations with a negative impact on the success of their treatment, and cases have been described until their interruption. Cimicifuga racemosa (L.) Nutt. is described in several works as a therapy to alleviate these symptoms. Numerous works in the literature present climatic symptoms and sexual function with a selective approach to the themes.What do the results of this study add? Our study evaluated a group of women who were treated for breast cancer after menopause taking into account the following aspects: climacteric symptoms and sexual function. When we reviewed the literature, we did not find, so far, work similar to ours.What are the implications of these findings for clinical practice and/or further research? In clinical practice, assessing vasomotor symptoms and sexual response of breast cancer patients can contribute towards improving the lives of this patient group. Prescribing Cimicifuga racemosa (L.) Nutt in cases with climacteric complaints and poor sexual response can relieve distress and promote better health and life status for these women. Although the present investigation has generated important data on female breast cancer survivors, there are limitations regarding the number of participants. We recommend further clinical research with expansion of the sample studied and the results presented.

Tendência temporal da mortalidade por câncer de laringe no Brasil e regiões, no período de 1980 a 2019 / Temporal trend of larynx cancer mortality in Brazil and regions, from 1980 to 2019

Objetivo: analisar a tendência da mortalidade por câncer de laringe no Brasil e regiões no período de 1980 a 2019. Metodologia: trata-se de um estudo ecológico de série temporal. Os dados foram provenientes do SIM/DATASUS, e foram estratificados segundo faixa etária, ano, local e sexo. Foi calculada a taxa padronizada de mortalidade (TPM) e utilizada para análise de tendência, por intermédio do modelo JoinPoint. Resultados: foi possível observar que o Brasil apresentou alto número de mortes em toda série temporal com cerca de 112.693 óbitos. No tocante as suas regiões destacaram-se o Sudeste, seguido do Sul com 62.111 e 23.356 mortes pelo agravo, respectivamente. Dentre as faixas etárias analisadas, o grupo de 60-79 anos apresentou predominância em ambos os sexos, com 56.947 ocorrências. Já para o sexo, o masculino apresentou mais de 98 mil mortes em detrimento de mais de 13 mil para o feminino, uma diferença 85,6%. Avaliando a tendência, o Brasil apresentou estabilidade em boa parte da série temporal, com diminuição significativa a partir de 2009 (APC -1,6). Nas regiões, o Nordeste apresentou a maior tendência de crescimento (AAPC 2,7) e o Norte também demonstrou crescimento a partir de 1990 (APC 1,8), as demais apresentaram redução considerável e significativa, exceto Centro-oeste que não apresentou JoinPoints. Conclusão: ressalta-se a importância da revisão, melhoria e até implementação de novas políticas de rastreamento a fim de aumentar o quantitativo de diagnóstico precoce e evitar, a longo prazo, a mortalidade.

Objective: to analyze the trend of mortality from laryngeal cancer in Brazil and regions from 1980 to 2019. Methods: this is an ecological time series study. Data came from SIM/DATASUS, and were stratified according to age group, year, location and sex. Age Standard Rates (ASR) were calculated and these were used for trend analysis, performed using the Joinpoint model. Results: it was possible to observe that Brazil had a high number of deaths in the entire time series, with about 112,693 deaths. Regarding its regions, the Southeast stood out, followed by the South with 62,111 and 23,356 deaths from the disease, respectively. Among the age groups analyzed, the 60-79 age group showed a predominance in both sexes, with 56,947 occurrences. As for gender, males had more than 98 thousand deaths at the expense of more than 13 thousand for females, a difference of 85.6%. Assessing the trend, Brazil showed stability in most of the time series, with a significant decrease as of 2009 (APC -1.6). In the regions, the Northeast showed the greatest growth trend (AAPC 2.7) the North also showed growth from 1990 (APC 1.8), the others showed a considerable and significant reduction, except for the Midwest, which did not present Joinpoints. Conclusion: we emphasize the importance of reviewing, improving and even implementing new screening policies in order to increase the number of early diagnoses and prevent, in the long term, mortality.

Clinical Specialty Setting as Determinant of Management of Psoriatic Arthritis: A Cross-Sectional Brazilian Study.

OBJECTIVE: The aim of this study was to examine the effect of clinical specialty setting on the management of psoriatic arthritis (PsA) as well as disease activity/burden in Brazil. METHODS: This study is a post hoc analysis of the Brazilian population in a cross-sectional, observational study conducted in 17 countries. Patients were 18 years or older with suspected or confirmed PsA attending routine visits at participating sites. Primary end points were time from symptom onset to PsA diagnosis, from diagnosis to first conventional systemic disease-modifying antirheumatic drug (DMARD) or first biologic DMARD, and from first conventional systemic DMARD to first biologic DMARD. Potential associations were assessed using the Student t test or the Mann-Whitney U nonparametric test. Normality was tested using the Shapiro-Wilk and Kolmogorov-Smirnov tests. For qualitative variables, the χ2 test was adopted. RESULTS: Patients (n = 130) visited dermatology (n = 75) or rheumatology (n = 55) sites. All primary end points were similar between the 2 settings; however, dermatology patients had significantly greater enthesitis counts (2.1 vs 0.6; p = 0.002), absenteeism at work (Work Productivity and Activity Impairment, 19.7% vs 5.2%; p = 0.03), and pain (Health Assessment Questionnaire-Disability Index pain scale, 1.39 vs 1.01; p = 0.032), as well as worse quality of life related to psoriasis (Dermatology Life Quality Index total score, 8.5 vs 5.0; p = 0.019) and mental health (12-item Short-Form Health Survey, version 2.0 subscale, 42.4 vs 47.4; p = 0.029). CONCLUSIONS: In Brazil, PsA disease burden and disease activity were influenced by clinical specialty. Irrespective of setting, patients experienced a delay in being diagnosed with PsA, reinforcing the need for collaborative management of PsA by rheumatologists and dermatologists for better outcomes in these patients.

Oral dydrogesterone in frozen-thawed embryo transfer cycles

SUMMARY OBJECTIVE: The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer. METHODS: This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound. RESULTS: The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196). CONCLUSIONS: The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.

Cardiovascular Risk Assessment in Women With Rheumatoid Arthritis Through Carotid and Femoral Artery Doppler Ultrasound.

OBJECTIVE: The aims of this study were to assess cardiovascular risk in patients with rheumatoid arthritis (RA) classified as low-risk by the Framingham score, before and after the multiplication by 1.5 recommended by the European League Against Rheumatism (EULAR), and to stratify them using carotid and femoral Doppler ultrasound (DUS) in order to optimize the assessment of the asymptomatic cardiovascular disease incidence. METHODS: Thirty-five female patients with RA and 35 healthy women (control group), both with low cardiovascular risk by Framingham score, were enrolled in the study (randomized). All of them underwent carotid and femoral DUS studies. RESULTS: The mean age at diagnosis was 44.57 years, the mean disease duration was 12.11 years and the mean disease activity score according to the Disease Activity Score 28 was 1.91, whereas according to the Clinical Disease Activity Index, it was 6.176. The sample was homogeneous. Within the RA group, 46% showed changes in the carotid and/or femoral DUS, compared with 14% in the control group (p = 0.004). Of the DUS with abnormalities, in the RA group, 31% of the carotid DUS and 81% of the femoral DUS (p = 0.005) showed intima-media thickness and/or atherosclerotic plaques. After EULAR 1.5 multiplication factor, 66% remained low cardiovascular risk. Of these, 35% of the patients showed changes in the carotid and/or femoral DUS, compared with 14% of the control group (p = 0.07). CONCLUSIONS: The EULAR criteria are effective at identifying patients with high cardiovascular risk. Carotid DUS and, especially, femoral DUS are tools that can be used in clinical practice as ways to detect CVD even in its asymptomatic form.

Oral dydrogesterone in frozen-thawed embryo transfer cycles.

OBJECTIVE: The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer. METHODS: This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound. RESULTS: The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196). CONCLUSIONS: The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.

Morbidities and medications used by practicing nurses during the climacteric.

OBJECTIVE: This study aimed to identify the morbidities and medications used by nurses practicing in São Paulo, Brazil, during the climacteric period to raise awareness and contribute to future preventive health measures in this population. METHODS: A descriptive, cross-sectional study of 218 nurses aged 46-65 years based on data collected between January 2018 and July 2019 using a self-administered questionnaire was conducted. RESULTS: Respondents had a mean age of 53.9±5.1 years, mean weight of 71.3±13.6 kg, mean waist circumference of 91.6±14.5 cm, and mean body mass index of 27.8±4.9 kg/m2. Notably, 70.5% did not menstruate, had a mean age at last menstruation of 47.5±6.2 years and mean total score (Menopause Rating Scale) of 10.8±8.1, and reported the following morbidities: dyslipidemia (35.5%), subarachnoid hemorrhage (31.0%), rheumatologic diseases (14.8%), coronary heart disease (10.3%), diabetes (10.2%), malignant tumors (5.5%), deep venous thrombosis (3.2%), stroke (2.8%), and pulmonary embolism (0.5%). Medications used are antihypertensive agents (28.7%), antidyslipidemic agents (20.6%), antidiabetic agents (10.2%), antidepressants (9.6%), and anxiolytic agents (8.9%). CONCLUSIONS: The most prevalent climacteric symptoms were somatic and psychological, most notably physical and mental exhaustion and muscle and joint issues. The most common morbidities were anxiety, dyslipidemia, arterial hypertension, depression, arthrosis, arthritis and rheumatologic diseases, osteoporosis, diabetes mellitus, and coronary heart disease. The most frequently used medications were antihypertensive agents, antidyslipidemic agents (statins), antidiabetic agents, antidepressants, and calcium supplements. The study results furnish information on the health of practicing nurses during the climacteric period to inform preventive measures aimed at the main risk factors for morbidities to which nurses are exposed during this period.

Garlic: An Alternative Treatment for Group B Streptococcus.

Prenatal screening in pregnant women between 35 and 37 weeks of gestation and intrapartum antibiotic prophylaxis has successfully reduced the incidence of neonatal morbidity and mortality related to Streptococcus agalactiae. However, the contamination rates of newborns are still considerable. In traditional and folk medicines, it has been observed that garlic has been effective in treating S. agalactiae infection. The aim of this study was to isolate and identify the active compounds from garlic that have antimicrobial activity against S. agalactiae. In order to do this, SP80 (Sep-Pak 80%) obtained from crude garlic extract (CGE) was fractionated by reverse-phase ultrafast liquid chromatography with UV (RP-UFLC-UV) using a Shim-pack PREP-ODS column. All fractions obtained were tested using a microbial growth inhibition test against the S. agalactiae strain (ATCC 12386). Five clinical isolates were used to confirm the action of the fractions with antimicrobial activity, and the bacterial growth curve was determined. Identification of the antimicrobial compounds was carried out through liquid chromatography coupled with mass spectrometry (LC/MS) and nuclear magnetic resonance (NMR). The active compounds found to exhibit antimicrobial activity were Ƴ-glutamyl-S-allyl-cysteine (fraction 18), Ƴ-glutamyl-phenylalanine (fraction 20), and the two stereoisomers (E and Z) of ajoene (fraction 42). The MICs of these fractions were 5.41 mg/ml, 4.60 mg/ml, and 0.16 mg/ml, respectively, and they inhibited the growth of the clinical isolates tested. Antimicrobial compounds from garlic may be a promising source in the search for new drugs against S. agalactiae. IMPORTANCE Invasive disease due to group B streptococcal (GBS) infection results in a wide spectrum of clinical disease in neonates. Maternal colonization by GBS is the primary risk factor for disease. The strategy recommended by the Centers for Disease Control to reduce neonatal GBS infection is the culture-based screening of all pregnant women at 35 to 37 weeks of gestation and intrapartum antibiotic prophylaxis (IAP). However, indiscriminate use of antibiotics favors the selection and spread of resistant bacteria. The global scenario of antibacterial resistance has been of great concern for public health, and natural products can be a source of new substances to help us grapple with this problem.