Observational study of vaginal pH in healthy Portuguese women.

AIM: To date, few epidemiological data are available regarding vaginal pH in Portugal. Thus, an epidemiological study was conducted to evaluate vaginal pH in healthy Portuguese women, attending a private gynecologist and its relation with women's socio-demographics, sexual activity and clinical characteristics. METHODS: This was an observational cross-sectional, multicenter and national study in 990 healthy women older than 18 years recruited from September-December 2007. Data regarding socio-demographics, sexual activity (1-5 score ordinal scale: 5 represent the best scenario), physiological status, concomitant treatment and vaginal symptoms were collected. Vaginal pH was measured through specific test strips. RESULTS: The study enrolled women with a median age of 37 years (min-max: 18-83 years) and a median BMI of 24 kg/m2; 63.5% of women practiced some physical activity, 84% were employed, 62.6% were of reproductive age, 22.1% in their post-menopausal phase and 10.4% pregnant. Women considered their sexual lives satisfactory. Median vaginal pH was 4.7 (min-max: 3.5-7.4). Vaginal pH showed positive correlation with age (rs=0.283) and BMI (rs=0.180). Employed women presented a lower median vaginal pH than retired or housewives (4.7 versus 5.6 and 5.3). Higher scores for sexual activity regarding interest, satisfaction, frequency and importance presented lower vaginal pH (respectively rs=-0.171, rs=-0.168, rs=-0.133 and rs=-0.158). Use of contraceptives and pregnancy were associated respectively to lower median levels of vaginal pH. Concomitant treatments and presence of vaginal symptoms were associated with higher median levels of vaginal pH. CONCLUSION: Vaginal pH increases with age, BMI, sexual intercourse without barrier contraception, dryness and irritation symptoms and decreases with physical activity, professional activity and hormone replacement therapy.

Environmental tobacco smoke (ETS) exposure and respiratory morbidity in school age children.

INTRODUCTION: Tobacco smoke is a risk factor for Chronic Obstructive Pulmonary Disease and a major public health problem. Prenatal maternal smoking and post-natal environmental tobacco smoke (ETS) lead to dose-dependent decrease in lung function and respiratory morbidity. Influence of different socioeconomic indicators and ETS in the home has also been suggested. METHODS: Data on 313 children (52 % male) from 4 public schools in Lisbon was analyzed [1st (46 %) and 4th graders]. ETS assessment and respiratory symptoms were based on a self-answered questionnaire. All children performed standard spirometry in the school setting and 54 % were acceptable according to ATS/ERS criteria. Descriptive and bivariate analysis of the most relevant variables was done, followed by multiple logistic regression analysis adjusted to the variables with clinical/statistical relevance. RESULTS: ETS in the home was found in 41 % (maternal smoking during pregnancy 18 %, smoking mother 32 %, smoking father 38 %). Smoking fathers had lower education and less qualified occupation. Cough was more frequent in children with a smoking mother (adjusted OR = 2.1 95CI 1.1-4.0) and wheezing in children with maternal smoking during pregnancy and smoking parents. All differences were significant (p < 0.05). No association was found between parental education and cough/wheeze or ETS and respiratory infections/asthma/decreased spirometric values. CONCLUSIONS: Children in Lisbon are frequently exposed to ETS which results in significant respiratory morbidity. Targeted interventions must have social conditions in consideration. In this study, field spirometry was not helpful in early detection of lung function disability in children associated with ETS.

An economic analysis of erlotinib, docetaxel, pemetrexed and best supportive care as second or third line treatment of non-small cell lung cancer.

AIM: Evaluate costs and benefits of erlotinib as 2nd or 3rd line treatment of advanced or metastatic nonsmall cell lung cancer (NSCLC) versus docetaxel, pemetrexed and best supportive care. MATERIALS AND METHODS: Cost-minimisation and cost-utility analysis were performed. Time horizon of two years. Portuguese National Health System (NHS) perspective was applied. Survival and time to progression were obtained from three clinical trials. Base-case analysis: 2nd or 3rd line patients with advanced or metastatic NSCLC. Quality Adjusted Life Years (QALYs) were obtained from a UK study. Resource consumption was estimated by a Portuguese panel of experts. Costs were calculated according to official Portuguese databases (updated to 2008). Only direct health costs were applied. Annual discount rate: 5%. Sensitivity analysis included different subpopulations, a three year time horizon and a probabilistic analysis. RESULTS: The cost per patient was lower with erlotinib (26,478 euro) than docetaxel (29,262 euro) or pemetrexed (32,762 euro) and higher than best supportive care (16,112 euro). QALYs per patient were higher with erlotinib (0.250) than docetaxel (0.225), pemetrexed (0.241) or best supportive care (0.186). Erlotinib was dominant in the cost-utility analysis, with a lower cost and a higher efficacy than docetaxel and pemetrexed. The sensitivity analysis confirmed the robustness of the base-case analysis results. CONCLUSIONS: The use of erlotinib instead of docetaxel or pemetrexed could contribute to annual savings for the NHS (substitution rates: 5%-65%) ranging from 135,046 euro-1,755,602 euro (docetaxel replacement) and 291,801 euro-3,793,409 euro (pemetrexed replacement), with a gain in terms of QALYs.

Effects of mouse ovarian tissue cryopreservation on granulosa cell-oocyte interaction.

BACKGROUND: Current ovarian tissue cryopreservation protocols have yet to be assessed in terms of somatic-germ cell interaction. Accordingly, post-thaw analysis of antral follicles can yield relevant data on the disruption of the granulosa-oocyte interface. METHODS: We compared fresh mouse ovarian tissue with tissues that had been either cryopreserved using dimethylsulphoxide (DMSO) or glycerol as cryoprotectants, or exposed to such cryoprotectants without freezing. The assessed parameters were: number of immature oocytes retrieved per ovary, allocation of the oocytes to different classes regarding antral follicle size and oocyte-granulosa cell adhesion, and the relative density of transzonal processes containing filamentous actin (TZPs-Act). RESULTS: Although cryopreservation reduces the average number of oocytes retrieved per ovary, it increases the relative distribution of granulosa-free oocytes while decreasing that of granulosa-enclosed ones. Additionally, a post-thaw decrease in TZPs-Act density was recorded. This decrease was also observed after cryoprotectant exposure without freezing, although at a lower level. For the assessed parameters, DMSO was more effective than glycerol as a cryoprotectant. CONCLUSIONS: In situ cryopreservation of granulosa-oocyte complexes with current protocols disrupts the granulosa-oocyte interface. The different patterns of granulosa cell adhesion and interaction in oocytes derived from different-sized antral follicles further suggests that the granulosa-oocyte interface may be developmentally regulated.