RESUMO
Background: Some studies indicated that body mass index (BMI) is inversely proportional to serum testosterone concentrations in men. Purposes: This study aimed to analyze the effects of aging and obesity on total testosterone (TT), free testosterone (FT), bioavailable testosterone (BT), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG) levels. Methods: A cross-sectional study was performed to assess the clinical and laboratory profiles of 701 patients treated at a private urology clinic in Ponta Grossa, Brazil, from January 2016 to December 2018. Results: Patients' age ranged from 16 to 88 years (mean, 56.9 ± 13.62 years). Age did not significantly influence serum TT concentrations, except compared to patients aged >70 years. However, changes were observed in FT and BT (p < 0.05). The mean SHBG increased with age (p < 0.05). A tendency toward LH elevation was observed in older patients, but it was not statistically significant. An inverse proportional relationship between TT, FT, and BT and the testosterone deficiency rate (TT < 300 ng/dL) was observed within BMI groups (p < 0.05). The testosterone deficiency rate was 21.5% in individuals with normal BMI, 29% in overweight individuals, and 37% in obese individuals. Conclusions: Aging affected the testosterone concentrations in men and became increasingly evident using FT and BT instead of TT. SHBG increased with age. Obesity was associated with a decrease in TT, FT, and BT but also increased the rate of hypogonadism. (AU)
Fundamentos: Alguns estudos indicam que o índice de massa corporal (IMC) é inversamente proporcional à con-centração de testosterona sérica em homens. Objetivos: O objetivo deste estudo é analisar o efeito do envelhe-cimento e da obesidade na testosterona biodisponível total e livre, bem como nos níveis de hormônio luteinizante e globulina ligadora de hormônio sexual. Métodos: Foi realizado um estudo transversal abordando o perfil clínico e laboratorial de 701 pacientes atendidos em uma clínica privada de urologia em Ponta Grossa, Brasil, de janei-ro de 2016 a dezembro de 2018. Resultados: A idade dos pacientes variou de 16 a 88 anos (média de 56,9 ± 13,62 anos). A idade não influenciou significativamente as concentrações séricas de testosterona total, exceto quando comparada a pacientes com mais de 70 anos. No entanto, foi observada diferença na testosterona livre e biodisponível (p <0,05). A média de globulina de ligação aos hormônios sexuais aumentou com a idade (p <0,05). Embora uma tendência à elevação da luteinização tenha sido observada em pacientes mais idosos, ela não foi significativa. Relação inversa entre testosterona total, livre e biodisponível e taxa de deficiência de testosterona (testosterona total <300 ng / dL) foi observada dentro dos grupos de índice de massa corporal (p <0,05). A taxa de deficiência de testosterona em indivíduos com índice de massa corporal normal foi de 21,5%, indivíduos com sobre-peso foi de 29% e em indivíduos com obesidade foi de 37%. Conclusões: O envelhecimento afetou a concentração de testosterona em homens, mais evidente ao avaliar testosterona livre e biodisponível em vez de testosterona total. A globulina de ligação aos hormônios sexuais aumentou com a idade. A obesidade foi associada à redução da testosterona total, livre e biodisponível e ao aumento da taxa de hipogonadismo. (AU)
Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Globulina de Ligação a Hormônio Sexual , Hormônio Luteinizante , Índice de Massa Corporal , Estudos Transversais , HipogonadismoRESUMO
O diabete melito está entre as principais causas de mortalidade no mundo e pode ser agravada pela inatividade física. O objetivo deste estudo descritivo transversal foi identificar as barreiras percebidas para a prática de atividade física sob a perspectiva dae pacientes diabéticos tipo 2. Participaram 220 pacientes (111 mulheres e 109 homens), com média de idade de 62,9 anos. Foram coletados índice de massa corporal, dados sociodemográficos e informações relacionadas ao histórico de doenças preexistentes. Para a análise das barreiras percebidas para a prática de atividades físicas, utilizou-se um questionário estruturado e validado para a população adulta brasileira proposto por Martins&Petroski. As barreiras foram analisadas individualmente e agrupadas em domínios ambiental, comportamental, físico e social. Em conclusão, as barreiras percebidas foram a falta de interesse (38,6%), cansaço físico (32,3%) e jornada de trabalho extensa (26,3%) e, assim, medidas devem ser adotadas visando minimizar os efeitos dessas barreiras e promover a atenção primária à saúde à essa população
Diabetes is among the leading causes of mortality in the world and can be aggravated by physical inactivity. This descriptive cross-sectional study aimed to identify the perceived barriers to the practice of physical activity from the perspective of type 2 diabetic patients. 220 diabetic patients participated in the research (111 women and 109 men), with a mean age of 62.9 years. Body mass index, sociodemographic data and information related to the history of preexisting diseases were collected. For the analysis of perceived barriers to the practice of physical activities, a structured and validated questionnaire for the Brazilian adult population proposed by Martins&Petroski was used. Barriers were analyzed individually and grouped into environmental, behavioral, physical and social domains. In conclusion, the main barriers perceived were lack of interest (38.6%), physical fatigue (32.3%) and long working hours (26.3%) and, them, measures should be taken to minimize the effects of these barriers, in order to promote primary health care in this population
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Exercício Físico , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus , Comportamento SedentárioRESUMO
OBJECTIVE: Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. METHODS: We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. RESULTS: Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the original implant. CONCLUSION: Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.
OBJECTIVO: Infecção e exposição da prótese são algumas das complicações mais comuns e preocupantes após reconstrução da mama com implantes. Atualmente, ainda não há consenso quanto ao manejo destas complicações. O objetivo deste estudo foi o de revisar os casos da nossa instituição e apresentar um protocolo clínico. MéTODOS: Realizou-se uma revisão retrospectiva de todos os casos consecutivos submetidos a reconstrução mamária imediata com prótese entre 2014 e 2016. Todos os casos foram conduzidos de acordo com um protocolo específico e estruturado. RESULTADOS: A exposição do implante ocorreu em 33 de 227 reconstruções (11,9%). Dentre estas, duas pacientes tinham histórico de radioterapia, e foram submetidas a remoção da prótese e posterior reconstrução com retalho miocutâneo. Sinais de infecção local grave foram observados em 12 pacientes, e, em 5, necrose extensa de tecido, e todas foram submetidas a remoção dos implantes; destas, 8 foram reconstruídas com expansor, e 2, com retalho miocutâneo. As 14 pacientes remanecentes não haviam sido submetidas previamente à radioterapia, não tinham sinais de infecção, nem necrose extensa; portanto, foram submetidas a sutura primária em uma tentativa de salvar a prótese. Dessas, 8 pacientes (57,1%) conseguiram manter os implantes originais. CONCLUSãO: Nosso protocolo clínico é baseado em três pontos principais: histórico de radioterapia, infecção grave, e necrose extensa de tecido. Ele constitui um método prático e potencialmente reprodutível de manejo de uma das complicações mais comuns da reconstrução mamária com implantes.
Assuntos
Implantes de Mama , Neoplasias da Mama , Mamoplastia , Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Protocolos Clínicos , Feminino , Humanos , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Dispositivos para Expansão de Tecidos/efeitos adversosRESUMO
Abstract Objective Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. Methods We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. Results Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the Conclusion Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.
Resumo Objectivo Infecção e exposição da prótese são algumas das complicações mais comuns e preocupantes após reconstrução da mama com implantes. Atualmente, ainda não há consenso quanto ao manejo destas complicações. O objetivo deste estudo foi o de revisar os casos da nossa instituição e apresentar um protocolo clínico. Métodos Realizou-se uma revisão retrospectiva de todos os casos consecutivos submetidos a reconstrução mamária imediata com prótese entre 2014 e 2016. Todos os casos foram conduzidos de acordo com um protocolo específico e estruturado. Resultados A exposição do implante ocorreu em 33 de 227 reconstruções (11,9%). Dentre estas, duas pacientes tinham histórico de radioterapia, e foram submetidas a remoção da prótese e posterior reconstrução com retalho miocutâneo. Sinais de infecção local grave foram observados em 12 pacientes, e, em 5, necrose extensa de tecido, e todas foram submetidas a remoção dos implantes; destas, 8 foram recons truídas com expansor, e 2, com retalho miocutâneo. As 14 pacientes remanecentes não haviam sido submetidas previamente à radioterapia, não tinham sinais de infecção, nem necrose extensa; portanto, foram submetidas a sutura primária em uma tentativa de salvar a prótese. Dessas, 8 pacientes (57,1%) conseguiram manter os implantes originais. Conclusão Nosso protocolo clínico é baseado em três pontos principais: histórico de radioterapia, infecção grave, e necrose extensa de tecido. Ele constitui um método prático e potencialmente reprodutível de manejo de uma das complicações mais comuns da reconstrução mamária com implantes.
Assuntos
Humanos , Feminino , Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Implantes de Mama/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Dispositivos para Expansão de Tecidos/efeitos adversos , Protocolos Clínicos , Estudos RetrospectivosRESUMO
The way in which transcriptional activity overcomes the physical DNA structure and gene regulation mechanisms involves complex processes that are not yet fully understood. Modifications in the cytosine-guanine sequence of DNA by 5-mC are preferentially located in heterochromatic regions and are related to gene silencing. Herein, we investigate evidence of epigenetic regulation related to the B chromosome model and transposable elements in A. scabripinnis. Indirect immunofluorescence using anti-5-mC to mark methylated regions was employed along with quantitative ELISA to determine the total genomic DNA methylation level. 5-mC signals were dispersed in the chromosomes of both females and males, with preferential accumulation in the B chromosome. In addition to the heterochromatic methylated regions, our results suggest that methylation is associated with transposable elements (LINE and Tc1-Mariner). Heterochromatin content was measured based on the C-band length in relation to the size of chromosome 1. The B chromosome in A. scabripinnis comprises heterochromatin located in the pericentromeric region of both arms of this isochromosome. In this context, individuals with B chromosomes should have an increased heterochromatin content when compared to individuals that do not. Although, both heterochromatin content and genome methylation showed no significant differences between sexes or in relation to the occurrence of B chromosomes. Our evidence suggests that the B chromosome can have a compensation effect on the heterochromatin content and that methylation possibly operates to silence TEs in A. scabripinnis. This represents a sui generis compensation and gene activity buffering mechanism.
Assuntos
Characidae/metabolismo , Cromossomos/metabolismo , Citidina/análogos & derivados , Metilação de DNA , Elementos de DNA Transponíveis , Inativação Gênica , Heterocromatina/metabolismo , Animais , Citidina/farmacologia , Citogenética , Ensaio de Imunoadsorção Enzimática , Epigênese Genética , Feminino , Hibridização in Situ Fluorescente , Isocromossomos , Masculino , MetilaçãoRESUMO
RESUMO: Introdução: As pessoas transexuais encontram uma série de dificuldades no atendimento médico, tanto na rede privada como na pública no Brasil. Objetivo: Demonstrar aos profissionais da área da saúde a realidade vivida pelas pessoas transexuais, quando necessitam de atendimento médico no Brasil, visando aprimorar os conhecimentos sobre o atendimento a este grupo populacional. MeÌtodos: Coleta de dados realizada em fevereiro de 2020 com buscas nas bases eletrônicas: PubMed, Scielo, Lilacs e Google Scholar. Utilizou-se os descritores em associação: transgender; medical care; transexual; cross-sex hormone therapy, no período entre 2000 a 2020. Resultados: Encontramos 720 publicações com as palavras-chave transgender persons e medical care, 30 com as palavras-chave transgender, medical care e cross-sex hormone therapy, sendo escassos os estudos feitos no Brasil. Conclusão: Para que ocorra uma melhora no atendimento à saúde das pessoas transexuais é necessário que sejam inseridas disciplinas específicas sobre este tema na grade curricular dos cursos técnicos, de graduação e de pós-graduação da área da saúde. (AU)
ABSTRACT: Introduction: Transsexual people encounter a series of difficulties in medical care, both in the private and public health systems in Brazil. Objectives: Demonstrate to health professionals the reality experienced by transsexual people when they need medical care in Brazil, in order to improve knowledge about the care of this population group. Methods: Data collection was carried out in February 2020 with searches in electronic databases: Pubmed, Scielo, Lilacs and Google Scholar. The following descriptors were used: transgender; medical care; transsexual; cross-sex hormone therapy from 2000 to 2020.Results: We found 720 publications with the keywords transgender persons and medical care, 30 with the keywords transgender, medical care and cross-sex hormone therapy, with few studies conducted in Brazil Conclusion: To improve the health care of transgender people, it is necessary to insert specific disciplines on this topic in the curriculum of technical, undergraduate and graduate courses in the health area. (AU)
Assuntos
Humanos , Pessoal de Saúde , Cuidados Médicos , Pessoas Transgênero , Minorias Sexuais e de Gênero , Sistemas Públicos de Saúde , Educação MédicaRESUMO
BACKGROUND AND OBJECTIVES: Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB identification rate. METHODS: A prospective study of patients with cT1-T4, cN1-N2 breast cancer who underwent US-guided fine-needle aspiration biopsy (FNAB) of suspected LNs and concomitant marking with 4% CMS was performed. After NAC, LNs marked with 4% CMS and those marked with Patent Blue V dye (PBV) were identified and resected. RESULTS: Of the 123 patients included, 74 (60.1%) had positive LNs at FNAB. During axillary surgery, 4% CMS was identified in 121 of 123 patients (98.3%) and blue sentinel LNs in 91% (112 of 123 patients) (P = .0103). Comparing isolated results of PBV and 4%CMS + PBV, the association was better in identifying positive LNs (72.2% vs 97.7%) (P = .02). CONCLUSION: The association of 4% CMS and PBV is feasible and significantly increased the identification rate of positive LNs. 4% CMS may play an important role as a complementary technique in patients submitted to NAC.
Assuntos
Neoplasias da Mama/patologia , Carbono/administração & dosagem , Linfonodo Sentinela/patologia , Antraciclinas/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Biópsia por Agulha Fina/métodos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Tamanho da Partícula , Estudos Prospectivos , Linfonodo Sentinela/diagnóstico por imagem , Taxoides/administração & dosagemRESUMO
The follicular fluid environment surrounding the oocytes may play a critical role in fertilization and subsequent embryo development. The goal of our study was to evaluate the oxidative stress markers in the semen, blood serum, and follicular fluid of couples undergoing Intracytoplasmic Sperm Injection (ICSI). Two hundred and eight infertile couples underwent ICSI and the levels of superoxide dismutase (SOD) and catalase and lipid peroxidation (LPO) were evaluated. Semen Catalase was highly correlated with fertilization and cleavage rates, but not with pregnancy rates. Fertilization and cleavage rates were correlated with the levels of SOD and Catalase in the follicular fluid. After adjusting for age, a negative correlation was detected between LPO levels in follicular fluid and pregnancy rates. Follicular fluid LPO levels may be a marker as a metabolic activity within the follicle need for establishing a pregnancy.
Assuntos
Catalase/metabolismo , Líquido Folicular/metabolismo , Infertilidade/metabolismo , Sêmen/metabolismo , Superóxido Dismutase/metabolismo , Fatores Etários , Análise de Variância , Transferência Embrionária , Feminino , Fertilização in vitro , Humanos , Infertilidade/terapia , Peroxidação de Lipídeos , Masculino , Gravidez , Taxa de Gravidez , Injeções de Esperma IntracitoplásmicasRESUMO
OBJECTIVE: To evaluate the effect of cigarette smoking on antioxidant levels and the presence of leukocytospermia in infertile men. DESIGN: Prospective study. SETTING: Academic medical center. PATIENT(S): Ten fertile donors and 112 infertile patients were included in the study. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Semen analysis was performed according to the World Health Organization guideline. The activity of the superoxide dismutase was based on the adrenochrome concentration, and the catalase activity was determined by the velocity of hydrogen peroxide consumption. RESULT(S): Lower levels of superoxide dismutase and catalase were seen in infertile patients compared with fertile donors. Superoxide dismutase was significantly correlated with sperm concentration and negatively correlated with leukocytospermia. In addition, leukocytospermia was inversely correlated with sperm motility. Superoxide dismutase levels were negatively related to cigarette smoking. CONCLUSION(S): Cigarette smoking may impair sperm motility and decrease the antioxidant activity (negative correlation with superoxide dismutase) in the seminal plasma.
Assuntos
Antioxidantes/análise , Infertilidade Masculina/sangue , Sêmen/química , Fumar/efeitos adversos , Catalase/sangue , Humanos , Leucocitose/epidemiologia , Masculino , Estudos Prospectivos , Contagem de Espermatozoides , Motilidade dos Espermatozoides , Superóxido Dismutase/sangueRESUMO
OBJECTIVE: To evaluate semen characteristics, testicular volume, and hormonal levels of normal fertile men requiring vasectomy for sterilization. DESIGN: Retrospective study. SETTING(S): Academic medical centers. PATIENT(S): A total of 889 patients underwent a vasectomy for sterilization. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Semen volume, sperm concentration, motility, and morphology according to the World Health Organization (WHO); complex motion parameters evaluated by computer-assisted semen analyzer; FSH, LH, and T levels; and both testicular volumes. RESULT(S): When compared with the WHO values, 87.2% of the patients presented normal sperm morphology below the normal level. The other semen parameters (semen volume, pH, sperm concentration, and sperm motility) differed from the WHO parameters in 6%-32.2% of patients. Semen volume and sperm concentration presented a progressive increase according to the duration of sexual abstinence. However, patients with 5 days or more of abstinence had a decrease in sperm motility. Mean testicular size had the strongest correlation with serum FSH levels, total sperm count, and sperm concentration. CONCLUSION(S): Low sperm motility and morphology were found in men who request a vasectomy for sterilization. Semen volume and sperm concentration present a progressive increase and sperm motility a decrease according to the duration of sexual abstinence. Sperm concentration had stronger correlations with testicular size than did sperm quality. Therefore, the WHO normal values need to be reconsidered.