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1.
Maturitas ; 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32209279

RESUMO

INTRODUCTION: Dyslipidemias are common and increase the risk of cardiovascular disease. The menopause transition is associated with an atherogenic lipid profile, with an increase in the concentrations of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein B (apoB) and potentially lipoprotein (a) [Lp(a)], and a decrease in the concentration of high-density lipoprotein cholesterol (HDL-C). AIM: The aim of this clinical guide is to provide an evidence-based approach to management of menopausal symptoms and dyslipidemia in postmenopausal women. The guide evaluates the effects on the lipid profile both of menopausal hormone therapy and of non-estrogen-based treatments for menopausal symptoms. MATERIALS AND METHODS: Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS: Initial management depends on whether the dyslipidemia is primary or secondary. An assessment of the 10-year risk of fatal cardiovascular disease, based on the Systematic Coronary Risk Estimation (SCORE) system, should be used to set the optimal LDL-C target. Dietary changes and pharmacological management of dyslipidemias should be tailored to the type of dyslipidemia, with statins constituting the mainstay of treatment. With regard to menopausal hormone therapy, systemic estrogens induce a dose-dependent reduction in TC, LDL-C and Lp(a), as well as an increase in HDL-C concentrations; these effects are more prominent with oral administration. Transdermal rather than oral estrogens should be used in women with hypertriglyceridemia. Micronized progesterone or dydrogesterone are the preferred progestogens due to their neutral effect on the lipid profile. Tibolone may decrease TC, LDL-C, TG and Lp(a), but also HDL-C concentrations. Low-dose vaginal estrogen and ospemifene exert a favorable effect on the lipid profile, but data are scant regarding dehydroepiandrosterone (DHEA). Non-estrogen-based therapies, such as fluoxetine and citalopram, exert a more favorable effect on the lipid profile than do sertraline, paroxetine and venlafaxine. Non-oral testosterone, used for the treatment of hypoactive sexual desire disorder/dysfunction, has little or no effect on the lipid profile.

2.
Gynecol Endocrinol ; : 1-5, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32103691

RESUMO

This review updates the knowledge regarding the association between the polycystic ovary syndrome (PCOS) and the risk of gynecological cancer. We performed a literature review of clinical and epidemiological studies concerning PCOS and the risk of breast, endometrial and ovarian cancer after selecting information by quality of scientific methodology. It was found that evidence does not support a link between PCOS and breast cancer risk. There is an increased risk of endometrial cancer, while data concerning ovarian cancer are contradictory. Regarding PCOS and its association to cervical, fallopian tube, and vulvar cancer, the quality of evidence is heterogeneous. In conclusion, women with PCOS should be screened for endometrial cancer and more research is warranted to determine in this population the true risk of developing other gynecological cancers such as breast and ovarian.

3.
Eur J Clin Nutr ; 74(2): 231-247, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31907366

RESUMO

Vitamin D deficiency and insufficiency has become a pandemic health problem with a consequent increase of requests for determining circulating levels of 25-hydroxyvitamin D [25(OH)D]. However, the analytical performance of these immunoassays, including radioimmunoassay and ELISA, is highly variable, and even mass spectrometric methods, which nowadays serves as the gold standard for the quantitatively determination of 25(OH)D, do not necessarily produce comparable results, creating limitations for the definition of normal vitamin D status ranges. To solve this problem, great efforts have been made to promote standardization of laboratory assays, which is important to achieve comparable results across different methods and manufacturers. In this review, we performed a systematic analysis evaluating critically the advantages and limits of the current assays available for the measure of vitamin D status, i.e., circulating 25(OH)D and its metabolites, making suggestions that could be used in the clinical practice. Moreover, we also suggest the use of alternatives to blood test, including standardized surveys that may be of value in alerting health-care professionals about the vitamin D status of their patients.

4.
Gynecol Endocrinol ; : 1-5, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31994945

RESUMO

Metformin may decrease cell senescence, including bone; hence we aimed at evaluating the association between metformin use and osteoporosis. This was a cross-sectional study carried out in 1259 Latin American adult women aged 40 or more who were not on anti-osteoporotic drugs, were on metformin and had a bone densitometry performed. Of the whole sample, 40.3% reported being on metformin (at least 1 year), 30.2% had type 2 diabetes mellitus and 22.6% had osteoporosis. Median (interquartile range) body mass index (BMI) for the whole cohort was 27.7 (4.6) kg/m2 and 30.2% had type 2 diabetes mellitus. Current use of hormone therapy, calcium, and vitamin D corresponded respectively to 10.7%, 47.7%, and 43.1% of all surveyed women. A logistic regression model was used to analyze the association of osteoporosis with various covariates incorporated into the model such as age (OR: 1.07, 95% CI: 1.05-1.09), BMI (OR: 0.92, 95% CI: 0.89-0.96) and metformin use (OR: 0.44, 95% CI: 0.32-0.59). Metformin use, regardless of the presence of type 2 diabetes or obesity, was associated with a lower risk of osteoporosis in adult women. We propose that one explanation for this observation could be the effect of the drug over cellular senescence.

5.
Maturitas ; 131: 91-101, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31740049

RESUMO

INTRODUCTION: Globally, the total number of people with depression exceeds 300 million, and the incidence rate is 70 % greater in women. The perimenopause is considered to be a time of increased risk for the development of depressive symptoms and major depressive episodes. AIM: The aim of this position statement is to provide a comprehensive model of care for the management of depressive symptoms in perimenopausal and early menopausal women, including diagnosis, treatment and follow-up. The model integrates the care provided by all those involved in the management of mild or moderate depression in midlife women. MATERIALS AND METHODS: Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS: Awareness of depressive symptoms, early detection, standardized diagnostic procedures, personalized treatment and a suitable follow-up schedule need to be integrated into healthcare systems worldwide. Recommended treatment comprises antidepressants, psychosocial therapies and lifestyle changes. Alternative and complementary therapies, although widely used, may help with depression, but a stronger evidence base is needed. Although not approved for this indication, menopausal hormone therapy may improve depressive symptoms in peri- but not in postmenopausal women, especially in those with vasomotor symptoms.


Assuntos
Depressão/terapia , Transtorno Depressivo Maior/terapia , Perimenopausa/psicologia , Pós-Menopausa/psicologia , Adulto , Idoso , Antidepressivos/uso terapêutico , Terapias Complementares , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Europa (Continente) , Feminino , Hormônios/uso terapêutico , Humanos , Estilo de Vida , Menopausa/psicologia , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Sociedades Médicas , Resultado do Tratamento
6.
Diagnostics (Basel) ; 9(3)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31540369

RESUMO

Somatosensory evoked potentials (SSEPs) are a valuable tool to assess functional integrity of the somatosensory pathways and for the prediction of sensorimotor outcome in perinatal injuries, such as perinatal hypoxia-ischemia (HI). In the present research, we studied the translational potential of SSEPs together with sensory function in the male adult rat with perinatal HI compared to the male healthy adult rat. Both somatosensory response and evoked potential were measured at 10-11 months after global perinatal HI. Clear evoked potentials were obtained, but there were no group differences in the amplitude or latency of the evoked potentials of the preceding sensory response. The bilateral tactile stimulation test was also normal in both groups. This lack of effect may be ascribed to the late age-of-testing and functional recovery of the rats.

7.
J Multidiscip Healthc ; 12: 583-590, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413585

RESUMO

Objectives: This study was designed to assess the use and preferences for information and communication technologies (ICTs) among patients with hypertension in Ecuador. Methods: We conducted an anonymous cross-sectional study during 2018, in which 207 patients with hypertension were surveyed using an adapted version of the Michigan questionnaire. The survey included 16 questions in total, in which patients were asked to quantify their use for each ICT, and their interest in using ICTs to receive information and communicate with health care providers. Adjusted binomial and multinomial regression analyses were performed. Results: Of the surveyed population, 74.9% of patients reported owning a smartphone, while 79.2% of responders reported having access to the internet. In general, web-based internet (53.7%) remains the main source for obtaining information related to hypertension, followed by YouTube (39.5%) and Facebook (30.2%). WhatsApp and Facebook were rated with the highest interest for receiving and asking health-related information. Older age and lower educational levels were consistently associated with less interest and usage for most ICTs. Conclusions: The widespread use of ICTs opens new possibilities for improving the care of patients with hypertension through self-management education strategies. Further studies should be conducted to demonstrate how to develop and promote interventions through ICTs more effectively, based on the studied patterns of use and preferences of ICTs for specific patients.

8.
Gynecol Endocrinol ; : 1-4, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31402763

RESUMO

The transcription/export complex (TREX) is formed by a core called THO. These are necessary for the transcription and packaging of messenger RNA and its subsequent nuclear exportation. Studies have correlated THO-specific polymorphisms with abnormalities of HDL-C metabolism. To correlate lipid and metabolic parameters with the genetic variants of the rs8135828 polymorphism of the THOC5 gene in middle-aged women. DNA was extracted from the whole blood of 183 women aged 40-65 and tested for the rs8135828 polymorphism of the THOC5 gene using real-time PCR. HDL-C, LDL-C, triglyceride, and total cholesterol levels, as well as other metabolic parameters, were correlated with the polymorphism genotypes: GG, AG, and AA. Mean age of women was 50.6 ± 6.3 years, 54.6% were postmenopausal and 16.4% had the metabolic syndrome. GG was the most frequently determined genotype (62.3%). There were no differences in lipid levels according to genotypes; although there was a trend for lower HDL-C levels for the AA and AG + AA genotypes. Those with the AG and AG + AA genotypes displayed significantly higher glucose levels (p = .02 and p = .002, respectively); with a trend toward a higher metabolic syndrome prevalence and increased abdominal perimeters in both variants (AG and AG + AA). The AG genotype was related to higher glucose levels but not with abnormal lipid parameters. There is a need for more research in this regard.

9.
Maturitas ; 123: 82-88, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31027683

RESUMO

INTRODUCTION: While the associations of genetic, reproductive and environmental factors with the timing of natural menopause have been extensively investigated, few epidemiological studies have specifically examined their association with premature (<40 years) or early natural menopause (40-45 years). AIM: The aim of this position statement is to provide evidence on the predictors of premature and early natural menopause, as well as recommendations for the management of premature and early menopause and future research. MATERIALS AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS: Strong genetic predictors of premature and early menopause include a family history of premature or early menopause, being a child of a multiple pregnancy and some specific genetic variants. Women with early menarche and nulliparity or low parity are also at a higher risk of experiencing premature or early menopause. Cigarette smoking (with a strong dose-response effect) and being underweight have been consistently associated with premature and early menopause. Current guidelines for the management of premature and early menopause mainly focus on early initiation of hormone therapy (HT) and continued treatment until the woman reaches the average age at menopause (50-52 years). We suggest that clinicians and health professionals consider the age at menopause of the relevant region or ethnic group as part of the assessment for the timing of HT cessation. In addition, there should be early monitoring of women with a family history of early menopause, who are a child of a multiple pregnancy, or who have had early menarche (especially those who have had no children). As part of preventive health strategies, women should be encouraged to quit smoking (preferably before the age of 30 years) and maintain optimal weight in order to reduce their risk of premature or early menopause.


Assuntos
Menopausa Precoce , Menopausa , Paridade , Fumar/epidemiologia , Magreza/epidemiologia , Peso Corporal , Terapia de Reposição de Estrogênios , Feminino , Humanos , Menarca , Menopausa/genética , Menopausa Precoce/genética , Gravidez , Fatores de Risco , Gêmeos
10.
11.
J Matern Fetal Neonatal Med ; : 1-16, 2019 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-30741051

RESUMO

OBJECTIVE: To compare the effect of misoprostol combined with a cervical single or double-balloon catheter versus misoprostol alone for labor induction of singleton pregnancies with an unfavorable cervix. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs) regarding the comparison of two schemes for labor induction of singleton cephalic pregnancies with a Bishop score ≤7 and no contraindication for vaginal delivery. Six research databases were searched for articles published in all languages up to 10 May 2018 comparing misoprostol (oral or vaginal) in combination with a cervical placed single or double balloon catheter versus misoprostol treatment alone. Random effects models and inverse variance were used for meta-analyses. Summary measures were mean differences (MDs) and risk ratios (RRs) with 95% confidence interval (CI). Risk of bias was evaluated with the Cochrane tool and publication bias was assessed with Begg's and Egger's tests. RESULTS: Fifteen RCTs reported predefined outcomes. Pooled analyses showed that the combined treatment (misoprostol + catheter) was associated with a shorter induction to delivery time interval (MD = -1.99 hours; 95% CI: -3.42, -0.56); in addition to fewer uterine hyperstimulations (RR = 0.39; 95% CI: 0.23, 0.67) and Neonatal Intensive Care Unit (NICU) admissions (RR = 0.75; 95% CI: 0.58, 0.97) as compared to misoprostol alone. There were no significant differences in RRs for tachysystole, chorioamnionitis, cesarean delivery rate, birthweight, and Apgar score at 5 minutes. CONCLUSION: The combined use of misoprostol and a cervical balloon catheter reduces the intervention to delivery time interval and number of NICU admissions in women induced with an unfavorable cervix.

12.
Arch Gynecol Obstet ; 299(5): 1215-1231, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30778728

RESUMO

OBJECTIVE: To assess the efficacy of cervical pessary application for the prevention of spontaneous preterm birth (SPB) in singleton pregnancies with a sonographically measured short cervix. METHODS: Searches were conducted in PubMed-Medline, Embase, Scopus, Web of Science, and Cochrane Library, and clinical trial registries for randomized controlled trials (RCTs) published in all languages from inception through 28 July 2018. Inclusion criteria were registered RCTs of singleton pregnants with a short cervix (≤ 25 mm) measured at 22-24 weeks comparing the use of a cervical pessary versus controls over the risk of SPB. Risk of bias was evaluated with the Cochrane tool. Risk ratios (RRs) and mean differences and 95% confidence intervals (CIs) were calculated. RESULTS: We identified three RCTs meeting defined inclusion criteria, including a total of 1612 pregnancies (805 used a cervical pessary). SPB risk at < 37 was lower for participants using the pessary (RR 0.46; 95% CI 0.28-0.77). Pessary application was associated with a higher risk of presenting vaginal discharge (RR 2.05; 95% CI 1.82-2.31). There were no significant differences between pessary users and controls in terms of SPB at < 28 and < 34 weeks, and for any type of preterm birth < 34 weeks; mean gestational age and infant weight at delivery; and the risks of chorioamnionitis, cesarean delivery, and perinatal or neonatal outcomes. Sub-analysis by risk of bias showed that there was a lower risk of SPB < 34 weeks (RR 0.33; 95% CI 0.16-0.66) in two RCTs with low risk of bias. CONCLUSION: Cervical pessary application was associated with a reduced risk of SPB at < 37 weeks and a higher risk of vaginal discharge.

13.
Behav Brain Res ; 362: 77-81, 2019 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-30639607

RESUMO

There is an urgent need for therapies that could reduce the disease burden of preterm hypoxic-ischemic encephalopathy. Here, we evaluate the long-term effects of multipotent adult progenitor cells (MAPC) on long-term behavioral outcomes in a preterm rat model of perinatal asphyxia. Rats of both sexes were treated with two doses of MAPCs within 24 h after the insult. Locomotor, cognitive and psychiatric impairments were evaluated starting at 1.5 (juvenile) and 6 months (adult). Hypoxia-ischemia affected locomotion, cognition, and anxiety in a sex-dependent manner, with higher vulnerability observed in males. The MAPC therapy partially attenuated deficits in object recognition memory in females of all tested ages, and in the adult males. The hypoxic insult caused delayed hyperactivity in adult males, which was corrected by MAPC therapy. These results suggest that MAPCs may have long-term benefits for neurodevelopmental outcome after preterm birth and global hypoxia-ischemia, which warrants further preclinical exploration.


Assuntos
Asfixia Neonatal/fisiopatologia , Encéfalo/fisiopatologia , Hipóxia-Isquemia Encefálica/fisiopatologia , Células-Tronco Multipotentes/citologia , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Feminino , Hipóxia/tratamento farmacológico , Masculino , Ratos Sprague-Dawley
14.
Menopause ; 26(2): 203-210, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30085981

RESUMO

OBJECTIVE: The aim of the study was to validate the Portuguese language version of the 10-item Cervantes Scale (CS-10), a self-reporting instrument that assesses menopausal symptoms, and to compare the results (both symptom severity and multigroup invariance) of middle-aged women who completed the questionnaire in paper-and-pencil format (PPF) or in the online format (OF). METHODS: A total of 292 women, aged 45 to 65 years, completed the questionnaires (PPF = 66; OF = 226). Construct (factorial and convergent) and external validity, as well as reliability and psychometric sensitivity were studied. Multigroup confirmatory factor analysis was performed to compare PPF with OF, regarding the measure's invariance. RESULTS: The CS-10 showed good psychometric properties (ie, factor and external validity), as well as good sensitivity and reliability. The association with the Utian Quality of Life Scale (UQoLS) was significant and positive, though weak. The measured structure was invariant when comparing both subsamples (PPF and OF), evidencing an equivalent structure in both. No differences in reported symptoms were observed between the two subgroups. CONCLUSIONS: The Portuguese language version of the CS-10 rendered data with good psychometric properties in a sample of middle-aged Portuguese women. Therefore, it can be used in both clinical and community settings. The weak association between both instruments (UQoLS and CS-10) might be due to the different conceptualization of the quality of life construct: the CS-10 focuses on symptom severity, whereas the UQoLS assesses domains such as work-related or health-related behaviors.

15.
Healthc Inform Res ; 24(4): 292-299, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30443417

RESUMO

Objectives: The aim of the present study was to assess the frequency of use, and preferences regarding information and communication technologies (ICTs) among Ecuadorian patients with chronic kidney disease (CKD) undergoing hemodialysis. Methods: We conducted an anonymous cross-sectional survey-based study from January 2016 to April 2017, involving 393 patients with end-stage renal disease from 9 hemodialysis centers, in which they rated their use and preferences of various ICTs through a modified version of the Michigan Questionnaire. The questionnaire collected information regarding demographics, patients' interest in obtaining health-related information through ICTs, and interest in using ICTs as a potential way to communicate with their healthcare providers. A chi-square test for association and adjusted regression analyses were performed. Results: Among all patients who participated, 64.3% reported owning a cellphone, with less than a third reporting active Internet connection. The most used ICT for obtaining information about CKD and/or hemodialysis was web-based Internet, followed by YouTube. SMS was rated the highest to receive and seek health-related information, followed by Facebook. Younger age and higher levels of education were associated with a higher overall usage of ICTs. Finally, more than half of the patients reported interest in using WhatsApp for communicating with their healthcare providers. Conclusions: Understanding the preferences of ICTs among patients with CKD undergoing hemodialysis could help to improve their outcomes through the potential uses and benefits of ICTs. Further research is needed to assess their role in improving the care of patients with chronic diseases.

16.
Maturitas ; 117: 6-10, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30314563

RESUMO

INTRODUCTION: Whether menopause increases the risk of type 2 diabetes mellitus (T2DM) independently of ageing has been a matter of debate. Controversy also exists about the benefits and risks of menopausal hormone therapy (MHT) in women with T2DM. AIMS: To summarise the evidence on 1) the effect of menopause on metabolic parameters and the risk of T2DM, 2) the effect of T2DM on age at menopause, 3) the effect of MHT on the risk of T2DM, and 4) the management of postmenopausal women with T2DM. MATERIALS AND METHODS: Literature review and consensus of experts' opinions. RESULTS AND CONCLUSION: Metabolic changes during the menopausal transition include an increase in and the central redistribution of adipose tissue, as well as a decrease in energy expenditure. In addition, there is impairment of insulin secretion and insulin sensitivity and an increase in the risk of T2DM. MHT has a favourable effect on glucose metabolism, both in women with and in women without T2DM, while it may delay the onset of T2DM. MHT in women with T2DM should be administered according to their risk of cardiovascular disease (CVD). In women with T2DM and low CVD risk, oral oestrogens may be preferred, while transdermal 17ß-oestradiol is preferred for women with T2DM and coexistent CVD risk factors, such as obesity. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as progesterone, dydrogesterone or transdermal norethisterone. Postmenopausal women with T2DM should be managed primarily with lifestyle intervention, including diet and exercise. Most of them will eventually require pharmacological therapy. The selection of antidiabetic medications should be based on the patient's specific characteristics and comorbidities, as well on the metabolic, cardiovascular and bone effects of the medications.


Assuntos
Diabetes Mellitus Tipo 2 , Menopausa , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/terapia , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Humanos , Incidência , Menopausa/metabolismo , Fatores de Risco
18.
Pregnancy Hypertens ; 14: 213-221, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29934014

RESUMO

OBJECTIVE: To investigate the association between endometriosis and preeclampsia and/or its severe forms (eclampsia and/or the hemolysis, elevated liver enzymes and low platelet count [HELLP] syndrome) in pregnancies conceived either spontaneously or by assisted reproductive technology (ART). DESIGN AND METHODS: Systematic review and meta-analysis of observational studies. Search in PubMed-Medline, Scopus, Web of Science, Cochrane Library, Clinicaltrials.gov, the UK Clinical Trials Gateway, and the Australian New Zealand Clinical Trials Registry was conducted from inception through 21 June 2017, without language restrictions. Primary outcome was preeclampsia and/or its severe forms (eclampsia and/or HELLP syndrome) in pregnant women. Random-effects models were used for meta-analyses. Endometriosis effect was estimated as odds ratio (OR) with 95% confidence interval (CI). RESULTS: A total of 9 cohort and 4 case-control studies were eligible for data analysis, including 39,816 pregnancies with endometriosis and 2,831,065 without. Women with endometriosis diagnosed through biopsy did not have a higher preeclampsia, eclampsia and HELLP syndrome risk as compared to those without (OR 1.01, 95% CI 0.56-1.82); this was found the same even if endometriosis was diagnosed using other procedures (OR 1.15, 95% CI 0.94-1.40). Preeclampsia, eclampsia and HELLP syndrome risk was also not increased in women with endometriosis conceiving spontaneously (OR 1.21; 95% CI 0.94-1.56) or through ART (OR 0.74; 95% CI 0.41-1.35). CONCLUSION: This meta-analysis evidences that endometriosis was not associated to a higher risk of preeclampsia and/or its severe forms in pregnancies either conceived spontaneously or through ART.


Assuntos
Endometriose/epidemiologia , Pré-Eclâmpsia/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Endometriose/complicações , Feminino , Humanos , Estudos Observacionais como Assunto , Pré-Eclâmpsia/etiologia , Gravidez , Sistema de Registros , Técnicas de Reprodução Assistida , Fatores de Risco
19.
Rev. argent. microbiol ; 50(2): 136-146, jun. 2018. ilus, tab
Artigo em Inglês | LILACS-Express | ID: biblio-977230

RESUMO

The aim of the present study was to gather information regarding the molecular epidemiology of Human papillomavirus (HPV) and related risk factors in a group of women with low- and high-grade cervical lesions and cancer from the coastal region of Ecuador. In addition, we studied the evolution of HPV variants from the most prevalent types and provided a temporal framework for their emergence, which may help to trace the source of dissemination within the region. We analyzed 166 samples, including 57 CIN1, 95 CIN2/3 and 14 cancer cases. HPV detection and typing was done by PCR-sequencing (MY09/MY11). HPV variants and estimation of the time to most recent common ancestor (tMRCA) was assessed through phylogeny and coalescence analysis. HPV DNA was found in 54.4% of CIN1, 74.7% of CIN2/3 and 78.6% of cancer samples. HPV16 (38.9%) and HPV58 (19.5%) were the most prevalent types. Risk factors for the development of cervical lesions/cancer were the following: three or more pregnancies (OR = 4.3), HPV infection (OR = 3.7 for high-risk types; OR = 3.5 for HPV16), among others. With regard to HPV evolution, HPV16 isolates belonged to lineages A (69%) and D (31%) whereas HPV58 isolates belonged only to lineage A. The period of emergence of HPV16 was in association with human populations (tMRCA = 91 052 years for HPV16A and 27000 years for HPV16D), whereas HPV58A preceded Homo sapiens evolution (322 257 years). This study provides novel data on HPV epidemiology and evolution in Ecuador, which will be fundamental in the vaccine era.


El objetivo del presente estudio fue aportar información sobre la epidemiología molecular del virus del papiloma humano (human papillomavirus [HPV]) y los factores de riesgo asociados al desarrollo de lesiones cervicales y cáncer en mujeres de la costa del Ecuador. Además, se estudiaron la evolución de las variantes de los HPV más prevalentes y el marco temporal de su emergencia, para ayudar a rastrear la fuente de dispersión en la región. Se analizaron 166 muestras, incluyendo 57 y 95 casos de neoplasia intraepitelial cervical tipo 1 (CIN1) y tipo 2/3 (CIN2/3), respectivamente, y 14 de casos de cáncer. La detección/tipificación de HPV se realizó por PCR-secuenciación (MY09/MY11). La caracterización de variantes y la datación del ancestro común más reciente (tMRCA) se realizaron mediante filogenia y coalescencia. Se encontró ADN de HPV en el 54,4% de las muestras de CIN1, el 74,7% de las muestras de CIN2/3 y el 78,6% de las muestras de cáncer. Los tipos HPV16 (38,9%) y HPV58 (19,5%) fueron los más frecuentes. Los factores de riesgo para el desarrollo de lesiones cervicales/cáncer fueron 3 o más embarazos (OR = 4,3) e infección por HPV (O = 3,7 para HPV de alto riesgo, OR = 3,5 para HPV16), entre otros. En cuanto a la evolución viral, los aislados del HPV16 pertenecían a los linajes A (69%) y D (31%), mientras que los aislados del HPV58 pertenecían únicamente al linaje A. El período de emergencia del HPV16 estuvo asociado a poblaciones humanas (tMRCA = 91.052 años para HPV16Ay 27.000 para HPV16D), mientras que el del HPV58A precedió a la evolución de Homo sapiens (322.257 años). Este estudio proporciona datos novedosos sobre la epidemiología y la evolución del HPV en Ecuador, los cuales serán fundamentales en la era de la vacuna.

20.
Gynecol Endocrinol ; 34(11): 987-994, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29842806

RESUMO

Objective: This systematic review and meta-analysis of Spanish studies assessed the association of maternal 25-hydroxyvitamin D [25(OH)D] levels on perinatal outcomes. Methods: PubMed, Cochrane Library, Embase, Scielo, Scopus, and Web of Science research databases were searched from inception through December 30 2017 using the terms 'vitamin D', 'pregnancy', and 'Spain'. Studies that compared first or second half of pregnancy normal 25(OH)D (≥30.0 ng/mL) versus insufficient (20.0-29.9 ng/mL) or deficient (<20.0 ng/mL) circulating levels and perinatal outcomes were systematically extracted. Data are presented as pooled odds ratios and their 95% confidence intervals (CIs) for categorical variables or mean differences and CIs for continuous variables. Risk of bias was evaluated with the Newcastle-Ottawa Scale. Results: Five cohort studies met inclusion criteria. The risk of gestational diabetes mellitus, preeclampsia, preterm birth, and small-for-gestational-age infants, and birthweight was not influenced by first half of pregnancy maternal 25(OH)D levels. In addition, second half of pregnancy 25(OH) levels did not affect birthweight. Conclusion: Maternal 25(OH)D levels during pregnancy did not affect studied perinatal outcomes and birthweight.


Assuntos
Resultado da Gravidez , Vitamina D/análogos & derivados , Adulto , Peso ao Nascer , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido Pequeno para a Idade Gestacional , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez , Nascimento Prematuro/epidemiologia , Espanha/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/complicações
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