Profile of Brazilian climacteric women: results from the Brazilian Menopause Study.

OBJECTIVE: This study aims to understand the epidemiological characteristics of Brazilian menopausal women, and their view on menopause hormone therapy (MHT). METHODS: A national cross-sectional study with 1500 women between 45 and 65 years old was carried out through questionnaires. RESULTS: The overall median age of participants was 52 [47-56] years, and 55 [52-59] years for the postmenopausal subgroup. Menstrual irregularity started at median age 46 [44-49] years. Median menopause age was 48 [45-51] years with no differences between socioeconomic classes. The prevalence of any climacteric symptoms was 87.9% and hot flashes started at median age 47 [45-50] years. Among women in menopause/menopausal transition, 52.1% received any medical prescription, and MHT was recommended for 22.3%. Among those who started MHT, 45.4% were still using the treatment and the median duration of use was 8 months, but different among socioeconomic classes (24 months for class A against 3 months for class D/E). CONCLUSIONS: In this first Brazilian national population-based study on menopause and MHT, it was observed that, in spite of being symptomatic when entering menopause around 48 years of age, only a small part of Brazilian women started MHT and the median duration of treatment was less than 1 year, but the duration was higher for higher socioeconomic class.

Vaginal Health: Insights, Views & Attitudes survey in Latin America (VIVA-LATAM): focus on Brazil.

OBJECTIVE: A previous survey investigated postmenopausal vaginal atrophy in a sample of women across Latin America. To help implement a tailored approach to improve postmenopausal care and outcomes in Brazil, we consider results from the survey for this country. METHODS: A total of 2509 postmenopausal women resident in Argentina, Brazil, Chile, Colombia, or Mexico completed an online questionnaire. The Brazilian cohort comprised 504 women. RESULTS: Over half of the Brazilian cohort (56%) reported experiencing symptoms of vaginal atrophy; most described them as moderate or severe (76%), and almost half (48%) experienced symptoms for at least 1 year. Three-quarters of the Brazilian cohort (75%) were unaware of the chronic nature of the condition. Upon experiencing symptoms of vaginal atrophy, 92% had visited a health-care provider to discuss treatment options. Overall, 56% were aware of some form of local hormone therapy and 40% of those affected by vaginal atrophy had used such treatment. CONCLUSION: Postmenopausal women in Brazil are likely to benefit from increased awareness of the symptoms of vaginal atrophy. Health-care providers can potentially improve outcomes by helping women to understand the chronic nature of the condition and available treatment options. Women may be open to education pre menopause, before symptoms occur.

Vaginal Health: Insights, Views & Attitudes (VIVA-LATAM): results from a survey in Latin America.

OBJECTIVE: To investigate awareness in Latin America, knowledge of postmenopausal vaginal atrophy was evaluated in a sample of women from this region. METHODS: A total of 2509 postmenopausal women aged 55-65 years, resident in Argentina, Brazil, Chile, Colombia and Mexico, completed a structured online questionnaire. RESULTS: Over half the surveyed population (57%) reported experiencing symptoms of vaginal atrophy. Only 6% of the overall cohort attributed symptoms of vaginal atrophy directly to the condition, and 71% did not consider the condition to be chronic, resulting in many women not accessing effective therapy. Half the women (49%) affected by vaginal atrophy had used lubricating gels and creams; 36% had used some form of local hormone treatment. To understand symptoms and/or treatment options for vaginal discomfort, the majority of survey participants (92%) were willing to seek advice from health-care professionals; most (61%) felt/would feel comfortable talking to their doctor about this. CONCLUSION: Many women in Latin America lack knowledge of postmenopausal vaginal atrophy, not appreciating the chronic nature of the condition, and may benefit from dialog initiated by health-care professionals to facilitate greater understanding and increased awareness of the availability of effective treatment.

CYP56 (Dit2p) in Candida albicans: characterization and investigation of its role in growth and antifungal drug susceptibility.

The complete DNA sequence of Candida albicans DIT2, encoding cytochrome P450 family 56 (CYP56), was obtained, and heterologous expression was achieved in Escherichia coli, where CYP56 was targeted to the membrane fraction. In reconstituted assays with the purified enzyme, CYP56 was shown to catalyze the conversion of N-formyl tyrosine into N,N'-bisformyl dityrosine, a reaction that was dependent on cytochrome P450 reductase, NADPH, and oxygen, yielding a turnover of 21.6 min(-1) and a k(s) of 26 microM. The Hill number was calculated as 1.6, indicating that two molecules of the substrate could bind to the protein. Azole antifungals could bind to the heme of CYP56 as a sixth ligand with high affinity. Both chromosomal alleles of CYP56 were disrupted using the SAT1 flipper technique, and CYP56 was found to be nonessential for cell viability under the culture conditions investigated. Susceptibility to azole drugs that bind to cytochromes P450 was tested, and the mutant showed unaltered susceptibility. However, the mutant showed increased susceptibility to the echinocandin drug caspofungin, suggesting an alteration in 1,3-glucan synthase and/or cell wall structure mediated by the presence of dityrosine. Phenotypically, the wild-type and mutant strains were morphologically similar when cultured in rich yeast extract-peptone-dextrose medium. However in minimal medium, the cyp56Delta mutant strain exhibited hyphal growth, in contrast to the wild-type strain, which grew solely in the yeast form. Furthermore, CYP56 was essential for chlamydospore formation.

Hormone therapy following the Women's Health Initiative (WHI) study: perception of gynecologists in Brazil.

AIM: The objective of the present study was to evaluate the effects of the Women's Health Initiative (WHI) study on gynecologists in Brazil, with particular emphasis on knowledge, interpretation of the study and attitude regarding hormone therapy (HT). METHODS: A total of 806 gynecologists were evaluated through questionnaires. For the evaluation, questions regarding his/her degree of knowledge and interpretation of the WHI study, number of prescriptions written for HT and opinion regarding the ideal form of HT following the WHI study were analyzed. RESULTS: Physicians were found to have a good knowledge of the study (97.6%). The most common interpretation of the results of the WHI study referred to the single HT regimen used in the trial in patients with specific characteristics, this being the response of 66.3% of physicians. There was a reduction of 21.7% in the intention to prescribe HT, with 32.5% of gynecologists reporting changing to a different therapeutic regimen. After the WHI study, the gynecologists showed a preference for low doses of estrogens and progestogens. CONCLUSIONS: The WHI study had a relevant impact on the attitude of doctors in Brazil.

Superior cycle control with a contraceptive vaginal ring compared with an oral contraceptive containing 30 microg ethinylestradiol and 150 microg levonorgestrel: a randomized trial.

BACKGROUND: This trial was conducted to compare cycle control with vaginal ring a combined contraceptive vaginal ring, and a combined oral contraceptive (COC) delivering 30 mug ethinylestradiol (EE) and 150 mug levonorgestrel. METHODS: This open-label, randomized, multi-centre, Phase III study involved adult women from 11 countries. Subjects were treated with either vaginal ring or a COC for 13 cycles (12 months). RESULTS: A total of 1030 subjects (vaginal ring, n=512; COC, n=518) comprised the intention-to-treat (ITT) population. The percentage of women in the ITT population who completed the trial was 70.9% for vaginal ring and 71.2% for the COC group. The incidence of breakthrough bleeding and spotting over cycles 2-13, the primary efficacy parameter, was lower with vaginal ring (range 2.0-6.4%) than the COC (range 3.5-12.6%), and for cycles 2 and 9 the lower incidence with vaginal ring was confirmed as statistically significant (P=0.003 and P=0.002 respectively). The incidence of intended bleeding was significantly higher over all cycles with vaginal ring (58.8-72.8%) than with the COC (43.4-57.9%). CONCLUSIONS: Cycle control with vaginal ring was excellent and superior to that of a COC containing 30 mug EE.

Oral Candida flora from Brazilian human immunodeficiency virus-infected patients in the highly active antiretroviral therapy era.

One of the main opportunistic fungal infections amongst immunocompromised individuals is oral candidosis, which has been found in up to 90% of human immunodeficiency virus (HIV)-infected patients. This study employed yeasts isolated from the saliva and oral cavities of 114 HIV-infected patients living in Campinas, São Paulo. Of the isolates, 57.8% were identified as Candida albicans and 42.1% as non-C. albicans. The latter isolates were subsequently identified as C. krusei (7.5%), C. lusitaniae (5.2%), C. tropicalis (4.6%), C. parapsilosis (4.6%), C. glabrata (2.8%), C. kefyr (1.7%), C. guilliermondii (1.7%), C. intermedia (1.1%), C. norvegensis (0.5%), and Rhodotorula rubra (1.7%). Susceptibility of the isolates to amphotericin B, fluconazole, miconazole, and itraconazole was also determined by a microdilution method adopted by the National Committee for Clinical Laboratory Standards. The isolates demonstrated various susceptibilities to the antifungal agents. In particular 29 C. albicans and 13 non-C. albicans isolates showed low susceptibility to FLCZ (> 64 micro g/ml). This study revealed huge diversity of Candida species, in particular the increasing emergence of non-C. albicans associated with the oral flora of HIV-infected patients.

A prospective open-label study to evaluate the effects of the oral contraceptive Harmonet (gestodene75/EE20) on body fat.

This open-label study evaluated the effects on body fat of the use of a low-dose oral contraceptive (gestodene75/EE20) in a group of 61 women (OC-U group) as compared to a nonuser group (OC-N group) of 51 women who did not receive an oral contraceptive. Weight, body mass index (BMI), waist-over-hip ratio and body composition data, obtained by bioelectrical impedance [percentages of body fat (%FAT), water (%TBW) and lean mass (%FFM)], were assessed before and after six treatment cycles. Baseline OC-U group weight, BMI, %FAT, %TBW and %FFM did not differ from the OC-N group, either at baseline or at the end of the study, and did not significantly change within each group during the study. Also, there was no modification of fat distribution in either group. Among women in the OC-U group, there was a slight increase in total cholesterol levels and a trend towards higher triglycerides levels. No changes were detected in blood pressure. In conclusion, this low-dose oral contraceptive did not affect weight or body composition. Thus, our data suggest that gestodene75/EE20 represents an appropriate OC choice and may enhance compliance of women who mistakenly believe that the use of oral contraceptives always leads to weight gain.

Oral Candida flora from Brazilian human immunodeficiency virus-infected patients in the highly active antiretroviral therapy era

One of the main opportunistic fungal infections amongst immunocompromised individuals is oral candidosis, which has been found in up to 90 percent of human immunodeficiency virus (HIV)-infected patients. This study employed yeasts isolated from the saliva and oral cavities of 114 HIV-infected patients living in Campinas, São Paulo. Of the isolates, 57.8 percent were identified as Candida albicans and 42.1 percent as non-C. albicans. The latter isolates were subsequently identified as C. krusei (7.5 percent), C. lusitaniae (5.2 percent), C. tropicalis (4.6 percent), C. parapsilosis (4.6 percent), C. glabrata (2.8 percent), C. kefyr (1.7 percent), C. guilliermondii (1.7 percent), C. intermedia (1.1 percent), C. norvegensis (0.5 percent), and Rhodotorula rubra (1.7 percent). Susceptibility of the isolates to amphotericin B, fluconazole, miconazole, and itraconazole was also determined by a microdilution method adopted by the National Committee for Clinical Laboratory Standards. The isolates demonstrated various susceptibilities to the antifungal agents. In particular 29 C. albicans and 13 non-C. albicans isolates showed low susceptibility to FLCZ (> 64 æg/ml). This study revealed huge diversity of Candida species, in particular the increasing emergence of non-C. albicans associated with the oral flora of HIV-infected patients.

Latin american experience with two low-dose oral contraceptives containing 30 microg ethinylestradiol/75 microg gestodene and 20 microg ethinylestradiol/150 microg desogestrel.

The objective of this study was to compare cycle control, efficacy and tolerance of an oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel with a preparation containing 30 microg ethinylestradiol combined with 75 microg gestodene. This study involved 342 women and 4104 cycles use in Argentina, Brazil, Chile, and Mexico. Contraceptive efficacy was good with both formulations. Two pregnancies occurred in the desogestrel group but were not due to method failure. With respect to cycle control, the incidence of intermenstrual bleeding was higher during the first 3 cycles in the desogestrel group; it was significant (p <0.01) during the first 3 days of the cycle for a normal or heavy bleeding only in the Mexican group. Amenorrhea was not reported for any group, but the incidence of dysmenorrhea was significantly higher (p <0.01) in the Brazilian desogestrel group (13.8%) and was significantly lower (p <0.01) in the Mexican gestodene group (8.5%). Adverse events were similar in all the countries with headache, breast tension, and nausea, the most frequently reported symptoms. The range of mean increase in body weight varied from 0.2 kg in the Argentine group to 2.6 kg in the Chilean group (95% confidence limit, +/- 2.51) in the gestodene group, and 0.2 kg in the Argentine group to 2.5 kg in Brazilian group (95% confidence limit, +/- 2.36) in the desogestrel group. Fifteen women discontinued because of headache, but there were no significant differences between the groups regarding discontinuation for this and other medical or non-medical reasons. Both oral contraceptive preparations are reliable and well tolerated, and both have favorable effects on control cycle.

Efficacy and acceptability of two monophasic oral contraceptives containing ethinylestradiol and either desogestrel or gestodene.

OBJECTIVE: To assess the contraceptive efficacy, cycle control and acceptability of two monophasic oral contraceptives containing either 30 micrograms ethinylestradiol plus 150 micrograms desogestrel or 30 micrograms ethinylestradiol plus 75 micrograms gestodene. METHODS: In a randomized, open-label, six-cycle, group-comparative, multicenter study performed in Brazil, pregnancies, cycle-control parameters, incidence of side-effects and the presence and severity of acne vulgaris were assessed, and blood pressure and body weight were measured at pretreatment and after one, three and six cycles of oral contraceptive use. RESULTS: Of the 595 women enrolled, 274 (86.7%) in the desogestrel/ethinylestradiol group and 227 (81.4%) in the gestodene/ethinylestradiol group completed the six cycles, providing data for 1753 and 1487 treatment cycles, respectively. Two pregnancies occurred, one of which (in the desogestrel/ethinylestradiol group) was attributed to user failure, whilst the other (in the gestodene/ethinylestradiol group) was thought to result from method failure. Cycle control was observed to be excellent; the incidences of irregular bleeding and minor side-effects were low in both groups and decreased after an initial increase in the first cycle. Pre-existing acne improved in both groups, whereas blood pressure and body weight remained essentially unchanged. CONCLUSIONS: Both desogestrel/ethinylestradiol and gestodene/ethinylestradiol provide effective oral contraception with comparable cycle control and acceptability.

Mental health among perimenopausal women attending a menopause clinic: possible association with premenstrual syndrome?

BACKGROUND: Psychiatric symptoms are frequent in the perimenopause. They are similar to symptoms observed at different stages of a woman's life cycle, suggesting that there may be an association between mental disturbances of the perimenopause and those observed during premenstrual and postnatal periods. METHODS: This study aimed to determine the reliability of using a modified version of the Steiner premenstrual tension self-rating scale (PMTS) questionnaire for assessing retrospectively the presence of premenstrual complaints and to evaluate the association between previous premenstrual complaints and psychiatric symptoms at the time of the menopause. Forty-one perimenopausal women were selected to establish the reliability of the questionnaire to assess premenstrual symptoms retrospectively (4-8-week interval between measures); agreement between measurements was assessed using the kappa statistic. Ninety-six women were later recruited from a gynecological menopause outpatient clinic to study the association between premenstrual complaints and the presence of psychiatric symptoms at the time of the menopause (as measured by another self-reporting questionnaire, the SRQ-20); SRQ-20 total scores greater than 7 were considered to be indicative of psychiatric morbidity. RESULTS: All 36 PMTS items showed moderate to very good test-retest reliability (0.44 < kappa < 1.0). There was a significant correlation between total PMTS and SRQ-20 scores (Spearman correlation coefficient 0.75, p < 0.001), correlation coefficient and SRQ-20 total scores greater than 7 were found in 47.9% of patients. CONCLUSIONS: Premenstrual symptoms can be reliably measured in perimenopausal women. Women who report having experienced premenstrual dysphoria are more likely to present with psychiatric symptoms at the time of the menopause.

[Contraceptive use in women with heart disease]. / Uso de contraceptivos em portadoras de cardiopatia.

PURPOSE: To analyse efficacy, tolerance and adverse events of reversible contraceptives in women with cardiac disease. METHODS: We studied prospectively during 24-39 (mean = 29) months, 89 women with heart disease with a mean age of 25.6 (16-42) years. Rheumatic heart disease was present in 73 (82%) cases, congenital heart disease in 11 (11%), coronary artery disease in 2 (2%) and cardiomyopathy in 3 (3%) case. The patients were divided in three groups: GCO--35 patients taking combined oral contraceptives (30 micrograms ethinyl estradiol and 75 micrograms gestodene--COs); GIT--27 using injectable progestagens (depot medroxyprogesterone acetate-DMPA) and GUID--27 with intrauterine device (IUD). RESULTS: In GCO occurred 4 (11.4%) cases of arterial hypertension, 1 (2.8%) of a transient cerebral isquemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amnorrhea e 1 (2.8%) pregnancy. Interruption of this method occurred in 4 (11.4%) cases due to hypertension (2), pregnancy (1) and amenorrhea (1). In group GIT there were 2 (7.4%) cases of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 (18.5%) due to amnorrhea (2), weight gain (2) and headache (1). In GUID there was 1 (3.7%) case of infeccion, 1 (3.7%) pregnancy and 1 (3.7%) spontaneous expulsion of IUD. Interruption of use took place in 3 (11.1%) cases due to infeccion, pregnancy and expulsion. The comparation between the groups demonstrated a difference in the incidence of amenorrhea (p < 0.005) and descontinuation of use of the method (p < 0.025). CONCLUSION: Use of reversible contraceptives in heart disease women was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups, however intolerance was more observed in GIT.

PIP: The aim of this study was to analyze efficacy, tolerance, and adverse events of reversible contraceptives in women with cardiac disease. The authors studied prospectively, during a period of 24-39 (mean = 29) months, 89 women with heart disease of mean age 25.6 (16-42) years. Rheumatic heart disease was present in 73 cases (82%), congenital heart disease in 11 (11%), coronary artery disease in 2 (2%), and cardiomyopathy in 3 (3%). The patients were divided into three groups: GCO--35 patients taking combined oral contraceptives (30 mcg ethinyl estradiol and 75 mg gestodene); GIT--27 patients using injectable progestagens (depot medroxyprogesterone acetate); and GUID--27 patients with IUDs. In the GCO group were found 4 cases (11.4%) of arterial hypertension, 1 (2.8%) of a transient cerebral ischemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amenorrhea, and 1 (2.8%) of pregnancy. Interruption of this method occurred in 4 cases (11.4%): 2 due to hypertension, 1 due to pregnancy, and 1 due to amenorrhea. In the GIT group there were 2 cases (7.4%) of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 cases (18.5%): 2 due to amenorrhea, 2 due to weight gain, and 1 due to headache. In the GUID group there was 1 case (3.7%) of infection, 1 (3.7%) of pregnancy, and 1 (3.7%) of spontaneous expulsion of the IUD. Interruption of use took place in 3 cases (11.1%): 1 due to infection, 1 due to pregnancy, and 1 due to expulsion. The comparison between the groups demonstrated a difference in the incidence of amenorrhea (p 0.005) and method discontinuation (p 0.025). Use of reversible contraceptives in women with heart disease was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups; however, intolerance was observed more in the GIT group. (author's modified)

Oral estradiol-17 beta raises the level of plasma high-density lipoprotein in menopausal women by slowing down its clearance rate.

Plasma lipoprotein composition, plasma kinetics of autologous [125I]HDL and the metabolism of iv administered radioactively labelled artificial chylomicrons were studied in postmenopausal women during a control period and after 4 months of oral estradiol-17 beta treatment (1 mg/m2 body surface per day). Drug treatment significantly raised plasma HDL-cholesterol levels (19%) in the fasting state and total apolipoprotein A-I (16%), but did not interfere with triglyceride, VLDL, LDL or apolipoprotein-B values. As compared with the control period, estradiol-17 beta administration significantly slowed down plasma [125I]HDL clearance by about 82% and reduced the delipidation index of the injected artificial chylomicrons by 47% as a consequence of impaired plasma lipolytic activity.

Aspectos epidemiologicos e clinicos em 1.319 pacientes climatericas / Epidemiological and clinical findings in 1319 pos-menopausal woman

No periodo de junho de 1983 a setembro de 1989, foram estudadas 1319 mulheres climatericas (fase pos-menopausica) cujas idades variaram de 41 a 62 anos (media 51,3 anos), com o objetivo de avaliar, retrospectivamente, os principais parametros concernentes ao climaterio. Os seguintes resultados foram obtidos: a media etaria da menopausa foi 47,8 anos e a duracao media da menacme foi 34,3 anos; nao houve correlacao entre idade da menarca e a idade da menopausa; os sintomas vasomotores presentes em 74,6 por cento prevaleceram sobre todos os sintomas climatericos: queda de cabelo em 13,5 por cento; dor nas mamas 12,0 por cento; cefaleia 10,1 por cento; nervosismo 9,1 por cento; palpitacao 8,7 por cento, e outros. Entre as doencas associadas 28,4 por cento apresentavam hipertensao arterial; 14,1 por cento incontinencia urinaria; 13,8 por cento mioma uterino; 11,1 por cento doencas cardiovasculares; 5,4 por cento doencas osteoarticulares e 4,6 por cento diabetes mellitus. Concluem os autores que houve diferenca significativa quanto a sintomatologia entre as pacientes de peso normal e as obesas, quando comparadas com as pacientes magras, sendo a sintomatologia menos intensa nas pacientes de baixo peso; e, houve diferenca estatistica significativa quanto a sintomatologia entre as pacientes normotensas e hipertensas, pois os sintomas foram mais intensos nas hipertensas.

Terapeutica da candidiase vaginal com econazol sob nova forma galenica. / Therapeutic of vaginal candidiasis with econazole in a new galenical form

Os autores avaliaram, em 20 pacientes portadores de moniliase vaginal, a eficacia e tolerancia do econazol na forma de "ovulo mole" com a posologia de um ao dia durante tres dias. O diagnostico da moniliase vaginal foi estabelecido com base no interrogatorio, exame ginecologico e bacterioscopico (a fresco e apos coloracao pelo Gram) de secrecao vaginal. A avaliacao da eficacia, baseada tambem no quadro clinico e bacterioscopico, foi feita sete dias apos o tratamento.Das 19 pacientes que fizeram uso do medicamento por tres dias, 16 (84,21%) foram consideradas curadas. Uma segunda serie de tratamento por tres dias elevou o indice de cura para 100%. Nos casos avaliados nao houve ocorrencia de efeito colateral. A excelente eficacia e tolerancia, alem da posologia de curta duracao dessa nova apresentacao do econazol, levaram os autores a concluir pela sua grande utilidade na pratica clinica diari

Revascularizacao cerebral em obstrucoes de arteria carotida interna e seus ramos. / Cerebral revascularization in obstruction of the internal carotid arteries and their branches

Os autores tentaram demonstrar que lesoes de arteria carotida denominadas inacessiveis, ja nao sao assim consideradas, visto que pela microcirurgia sao corrigidas. A vascularizacao cerebral e feita pela anastomose da arteria temporal superficial com ramos corticais temporais da arteria cerebral

Ensaio clinico de um novo creme vaginal na terapeutica das colpites. / Clinical trial of a new vaginal cream in colpitis therapy

Os autores avaliaram a eficacia e a tolerabilidade de um novo creme vaginal em 32 pacientes portadoras de vaginitis por monilia e/ou tricomonas e/ou bacterias. A avaliacao da eficacia e da tolerancia foi feita baseada nos dados obtidos por ocasiao dos exames ginecologicos e complementares (bacterioscopia a fresco e apos coloracao pelo Gram), realizados 15 dias apos o final do tratamento. A eficacia foi considerada excelente e boa em 90,91% dos casos avaliados. Nao houve referencias a nenhum efeito colateral. Os autores concluem pela otima eficacia e excelente tolerabilidade deste novo creme vaginal, destacando-se pelo largo espectro de atividade em relacao aos diversos tipos de colpites