Artigos - Ginecologia e Obstetrícia - FMB

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Expert Recommendations on Monkeypox (MPX) in Pregnancy, Postpartum and Lactating Women
(2022-12-01) Mattar, Rosiane; Neto, Antonio Rodrigues Braga; Luz, Adriana Gomes; Hatanaka, Alan; Zaconeta, Alberto; Guazzelli, Cristina Aparecida Falbo; Traina, Evelyn; Baptista, Fernanda Spadotto; Osanan, Gabriel; Duarte, Geraldo; Ramos, Jose Geraldo Lopes; Oppermann, Maria Lucia; Francisco, Rossana Pulcineli Vieira; Cardoso, Sigrid Maria Loureiro De Queiroz; Quintana, Silvana Maria; Sun, Sue Yazaki; Borges, Vera Therezinha Medeiros [UNESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal Fluminense (UFF); Universidade Estadual de Campinas (UNICAMP); Universidade de Brasília (UnB); Universidade de São Paulo (USP); Universidade Federal de Minas Gerais (UFMG); Universidade Federal Do Rio Grande Do Sul; Universidade Federal Do Amazonas; Universidade Estadual Paulista (UNESP)
Maternal care of the whole litter improves the success rate of diabetes in pregnancy in rats
(2022-12-01) Floriano, Juliana Ferreira [UNESP]; Barbosa, Angélica Mércia Pascon [UNESP]; de Oliveira, Rafael Guilen [UNESP]; Vega, Sofía [UNESP]; Catinelli, Bruna Bologna [UNESP]; Garcia, Gabriela Azevedo [UNESP]; Reyes, David Rafael [UNESP]; Sobrevia, Luis [UNESP]; Rudge, Marilza Vieira Cunha [UNESP]; Universidade Estadual Paulista (UNESP); Imperial College London; Pontificia Universidad Católica de Chile; Universidad de Sevilla; University of Queensland; School of Medicine and Health Sciences
Induction of diabetes mellitus by streptozotocin (STZ) in rats at birth is of high mortality and low success rate when male puppies are separated from females, prioritizing females breastfeeding. Cross-parental care of the entire litter and SZT-induced diabetes up to 12 h post-birth become with high success rate, low animal death, and females with glycaemia >140 mg/dL on the 90 postnatal day. Cross-parental care is more effective in STZ-induction of diabetes, which is maintained during pregnancy (diabetes in pregnancy), than the conventional protocol of male separation at birth.
Molecular subtypes as a prognostic breast cancer factor in women users of the São Paulo public health system, Brazil
(2023-01-01) Peres, Stela Verzinhasse; Arantes, Paola Engelmann; Fagundes, Marcela de Araújo; Ab'Saber, Alexandre Muxfeldt; Gimenes, Daniel Luiz; Curado, Maria Paula; Vieira, René Aloisio da Costa; Fundação Oncocentro de São Paulo; Cancer Epidemiology and Statistics Group - São Paulo (SP); Universidade de São Paulo (USP); Grupo Oncoclínicas de São Paulo; Graduate Program in Oncology - Barretos (SP)
OBJECTIVE: This study aimed to analyze the prognosis of women with breast cancer by molecular subtypes, sociodemographic variables, and clinical and treatment characteristics. METHODS: This hospital-based retrospective cohort study analyzed 1,654 women over 18 years of age diagnosed with invasive breast cancer from 2000 to 2018. Data were extracted from Brazil's Oncocenter Foundation of São Paulo. The variables analyzed were age, histology, molecular subtypes, clinical staging, treatment type, and diagnosis-to-treatment time. Cox regression analysis was applied to estimate death risk. RESULTS: Women with HER-2-positive (nonluminal) and triple-negative molecular subtypes were more than twice more likely to be at risk of death, with adjusted hazard ratio - HRadj=2.30 (95% confidence interval - 95%CI 1.34-3.94) and HRadj=2.51 (95%CI 1.61-3.92), respectively. A delayed treatment associated with an advanced clinical stage at diagnosis increased fourfold the risk of death (HRadj=4.20 (95%CI 2.36-7.49). CONCLUSION: In summary, besides that interaction between advanced clinical stage and longer time between diagnosis and treatment, HER-2-positive (nonluminal) and triple-negative phenotypes were associated with a worse prognosis. Therefore, actions to reduce barriers in diagnosis and treatment can provide better outcome, even in aggressive phenotypes.
Prediction and prevention of preeclampsia by physicians in Brazil: An original study
(2022-01-01) Cunha Filho, Edson Vieira da; Rodrigues, Tamara Cristina Gomes Ferraz; Sandrim, Valeria Cristina [UNESP]; Veiga, Eduardo Carvalho de Arruda; Cavalli, Ricardo Carvalho; Hospital Moinhos de Vento; Universidade de São Paulo (USP); Universidade Estadual Paulista (UNESP)
Background: Considering the worldwide importance of preeclampsia, especially in Brazil, the screening of pregnant women at greater risk of developing the disease and the application of preventive measures are essential. This study aimed to assess the medical performance in this context in Brazil. Methods: A survey was developed to quantify the number of physicians who prescribe acetylsalicylic acid (ASA) and/or calcium for preeclampsia prevention. The survey was sent to all Brazilian obstetricians affiliated to the Brazilian Federation of OBGYN by email and WhatsApp. The survey remained opened for 6 months and included questions about the use of ASA and calcium, as well as about the use of a complementary test to predict preeclampsia. Results: The sample consisted of 360 responding physicians and 100% coverage of responses from physicians from the five different regions of Brazil was obtained. The vast majority of respondents (94.72%) prescribe ASA to prevent preeclampsia, with 80.3% prescribing a dose of 100 mg/day. Calcium is prescribed by 83.9% of the respondents. The majority of the interviewed sample (58.6%) requests uterine artery Doppler imaging to predict preeclampsia and 31.7% do not request any additional test. When the analysis was performed by region, only the northern region differed from the other Brazilian regions regarding the use of ASA and calcium for preeclampsia prevention. While more than 90% of physicians in the other regions prescribe ASA, 40% in the northern region do not use it (p < 0.0001). Regarding calcium, 30% of physicians in northern Brazil do not use the drug for preeclampsia prevention, a percentage that also differs from the other regions where the medication is prescribed by 80 to 90% of physicians (p = 0.021). Conclusions: The vast majority of Brazilian physicians prescribe low-dose aspirin and calcium carbonate to prevent preeclampsia in high-risk pregnant women. In addition to the identification of clinical risk factors, most doctors use Doppler of the uterine arteries as a predictive method. In the northern region of Brazil, physicians use aspirin and calcium less frequently for preventing preeclampsia compared to the rest of the country.
Genetic Ancestry of 1127 Brazilian Breast Cancer Patients and Its Correlation With Molecular Subtype and Geographic Region
(2023-01-01) da Costa Vieira, René Aloisio; Sant'Anna, Débora; Laus, Ana Carolina; Bacchi, Carlos Eduardo; Silva, René Julias Costa; de Oliveira-Junior, Idam; da Silva, Vinicius Duval; Pereira, Rui; Reis, Rui Manuel; Barretos Cancer Hospital; Botucatu School of Medicine; Bacchi Laboratory; IPATIMUP; University of Minho; ICVS/3B's-PT Government Associate Laboratory
Purpose: Breast cancer molecular subtypes show significant differences in different ethnic groups in the United States, but no study has evaluated genetic ancestry in breast cancer in Brazilian women. Methods: Breast cancer patients from distinct parts of Brazil were evaluated. Molecular subtypes were determined by immunohistochemistry. Genetic ancestry was evaluated using a panel of 46 AIMs (ancestry informative markers), which classified genetic ancestry as European, African, Asian, and Amerindian. PCR products were subjected to capillary electrophoresis and analyzed using GeneMapper 4.0 software. Ancestry was evaluated with Structure v.2.3.3 software. Ancestry was tested for correlations with geographic region and molecular subtype. The chi-square test and ANOVA with Bonferroni adjustment were applied. Results: Genetic ancestry and clinical data were evaluated in 1127 patients. Higher rates of self-reported white ethnicity, European ancestry, and HER-2− luminal tumors were identified in the South region, which may influence age at diagnosis and result in a higher rate of early tumors. Conversely, higher rates of African ancestry in the North and Northeast regions, self-reported nonwhite ethnicity, HER-2+ tumors, and triple-negative tumors were noted. Triple-negative and HER-2+ tumors were associated with higher advanced and metastatic disease rates at diagnosis, with triple-negative tumors being more frequent in young women. Conclusion: Differences in genetic ancestry, self-reported ethnicity, and molecular subtype were found between Brazilian demographic regions. Knowledge of these features may contribute to a better understanding of age at diagnosis and the molecular distribution of breast cancer in Brazil.
Do anti-VEGFs used in the ophthalmic clinic cause Müller glial cell stress?
(2023-01-01) da Silva, Rafael André [UNESP]; Ferreira, Luiz Philipe de Souza; Roda, Vinicius Moraes de Paiva; Soares Junior, José Maria; Simões, Manuel de Jesus; Regatieri, Caio Vinicius Saito; Universidade Estadual Paulista (UNESP); Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
Assessment by ABPM verified the presence of hypertension in patients with self-reported hypertension, pregnant women, as well as differences between ethnicities in women aged 38-39 years in the Ribeirão Preto cohort
(2022-11-09) Brandão, Tetzi Oliveira; Veiga, Eduardo Carvalho de Arruda; Levy, Rozeli Ferreira; Damaso, Enio Luis; Sandrim, Valeria Cristina [UNESP]; Cavalli, Ricardo Carvalho; Universidade de São Paulo (USP); Federal University of Paraiba; Universidade Estadual Paulista (UNESP)
Introduction: Arterial hypertension is a global health problem and one of the main risk factors for cardiovascular diseases (CVD), and therefore for morbidity and mortality among adult men and women. Factors related to obstetric history, family history, sociodemographic characteristics, and lifestyle habits are known determinants of arterial hypertension. Methods: Case-control study of women belonging to the 1978/79 birth cohort conducted in the city of Ribeirão Preto/SP. Sociodemographic data, presence of comorbidities, maternal comorbidities, paternal comorbidities, comorbidities during pregnancy, and biometric and biophysical markers associated with blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM) were assessed in women aged 38–39 years. We want to study which variables of the previous sentence are related to the presence of hypertension measured by ABPM. Results: Data from 281 women were analyzed. Our results showed that ethnicity, a history of hypertension, and gestational hypertension reported by the women were significantly associated with the presence of hypertension measured by ABPM. Other factors such as marital status, educational level, comorbidities of the woman, paternal or maternal comorbidities, anthropometric measurements or serum levels of cardiovascular markers were not associated with the presence of hypertension measured by ABPM. Conclusion: We conclude that ethnicity, self-reported hypertension, and gestational hypertension are associated with arterial hypertension measured by ABPM.
Use of propolis for skin wound healing: systematic review and meta-analysis
(2023-05-01) Machado Velho, Julia Carnelós [UNESP]; França, Thais Amaral [UNESP]; Malagutti-Ferreira, Maria José [UNESP]; Albuquerque, Edilson Rodrigues; Lívero, Francislaine Aparecida dos Reis; Soares, Murilo Racy; Soares, Ademilson Espencer Egea; Ribeiro-Paes, João Tadeu [UNESP]; Universidade Estadual Paulista (UNESP); Universidade Paranaense (UNIPAR); Universidade de São Paulo (USP)
Propolis is a natural resin that is produced by bees. It has anti-inflammatory and antibiotic properties, promotes reepithelization, and stimulates skin regeneration. Propolis has great potential for the development of new therapeutic approaches to treat skin ulcers. The present study performed a systematic review and meta-analysis of published studies of the use of propolis for the regeneration of cutaneous wounds and its efficacy as a therapeutic agent. Data were collected from articles in the PubMed, SCOPUS, and Web of Science databases that were published since 1900 by searching the terms “propolis” AND “wound healing.” This search yielded 633 articles, of which 43 were included in this systematic review and meta-analysis. The results showed that interest in the therapeutic efficacy of propolis has increased over the years. The studies reported that the propolis was effective for the treatment of skin ulcers by promoting a higher percentage of healing than classically employed interventions. The mode of propolis application has also evolved. An increasing number of studies combined it with other substances and materials to achieve additive or synergistic effects on the skin regeneration process. Propolis appears to be an effective therapeutic alternative for the treatment of skin ulcers.
Sex differences in Parkinson's Disease: An emerging health question
(2022-01-01) Philipe de Souza Ferreira, Luiz; André da Silva, Rafael [UNESP]; Marques Mesquita da Costa, Matheus; Moraes de Paiva Roda, Vinicius; Vizcaino, Santiago; Janisset, Nilma R.L.L.; Ramos Vieira, Renata; Marcos Sanches, José; Maria Soares Junior, José; de Jesus Simões, Manuel; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual Paulista (UNESP); Universidade Federal do Ceará (UFC); Universidade de São Paulo (USP); University of Texas Southwestern Medical Center
Oncoplastic surgery for Paget’s disease of the breast
(2023-01-01) Pelorca, Rafael José Fábio [UNESP]; de Oliveira-Junior, Idam [UNESP]; da Costa Vieira, René Aloisio [UNESP]; Universidade Estadual Paulista (UNESP); Barretos Cancer Hospital; Hospital de Câncer de Muriaé
Introduction: Paget’s disease of the breast (PDB) is a rare nipple entity associated with multifocality. Due to its location, resection of the entire nipple-areolar complex is necessary. Historically central quadrantectomy and mastectomy have the surgical treatments of choice. The feasibility of oncoplastic breast surgery (OBS) for PDB is unknown. Methods: This was a retrospective study performed in a Brazilian oncological hospital. We evaluated the factors related to the performance of OBS in PDB. In addition, the impact of OBS on local recurrence and survival was analysed. Comparisons were made between groups using the chi-square test, Mann−Whitney U test, and Kaplan–Meier method. To assess the impact factor of the variables on the performance of OBS, logistic regression was performed. Results: Eighty-five patients were evaluated. OBS was performed in 69.4% (n=59), and of these, 16 (27.2%) were symmetrized with contralateral surgery. Mastectomy without reconstruction was performed in 28.3% of the patients. The primary procedure performed was mastectomy with reconstruction (n=38; 44.7%), and the preferential technique for immediate reconstruction was skin-sparing mastectomy with prosthesis; for late reconstruction, the preferred technique was using the latissimus dorsi. Breast conserving-surgery was performed in 27.0% (n=23), primarily using the plug-flap technique (OBS). Age was associated with the use of OBS; as patients aged 40-49 exhibited a higher rate of OBS (p = 0.002; odds ratio 3.22). OBS did not influence local recurrence (p=1.000), overall survival (p=0.185), or cancer-specific survival (p=0.418). Conclusion: OBS improves options related to surgical treatment in PDB without affecting local recurrence or survival rates.
Gold nanoparticle intratesticular injections as a potential animal sterilization tool: Long-term reproductive and toxicological implications
(2023-06-15) Coimbra, John L P; Dantas, Graziela de P F; de Andrade, Lídia M; Brener, Marcos R G; Viana, Pedro I M; Lopes, Roberta A.; O G Gontijo, Daniele; Ervilha, Luiz O G; Assis, Mirian Q.; Barcelos, Luciola S.; E Szawka, Raphael; Damasceno, Débora C [UNESP]; Machado-Neves, Mariana; Mota, Ana P.; Costa, Guilherme M J; Universidade Federal de Minas Gerais (UFMG); MG; Universidade Estadual Paulista (UNESP)
This study aimed to evaluate the gold nanoparticles (AuNPs) animal sterilizing potential after intratesticular injections and long-term adverse reproductive and systemic effects. Adult male Wistar rats were divided into control and gold nanoparticle (AuNPs) groups. The rats received 200 µL of saline or AuNPs solution (16 µg/mL) on experimental days 1 and 7 (ED1 and ED7). After 150 days, the testicular blood flow was measured, and the rats were mated with females. After mating, male animals were euthanized for histological, cellular, and molecular evaluations. The female fertility indices and fetal development were also recorded. The results indicated increased blood flow in the testes of treated animals. Testes from treated rats had histological abnormalities, shorter seminiferous epithelia, and oxidative stress. Although the sperm concentration was lower in the AuNP-treated rats, there were no alterations in sperm morphology. Animals exposed to AuNPs had decreased male fertility indices, and their offspring had lighter and less efficient placentas. Additionally, the anogenital distance was longer in female fetuses. There were no changes in the histology of the kidney and liver, the lipid profile, and the serum levels of LH, testosterone, AST, ALT, ALP, albumin, and creatinine. The primary systemic effect was an increase in MDA levels in the liver and kidney, with only the liver experiencing an increase in CAT activity. In conclusion, AuNPs have a long-term impact on reproduction with very slight alterations in animal health. The development of reproductive biotechnologies that eliminate germ cells or treat local cancers can benefit from using AuNPs.
Evolution of Myocardial Hypertrophy Associated With Pregnancy in Hypertensive Women Six Months Postpartum
(2023-09-01) Vasconcelos, Milena Miranda [UNESP]; Ganan, Camilla Sousa [UNESP]; da Silveira, Caroline Ferreira da Silva Mazeto Pupo [UNESP]; Malagutte, Karina Nogueira Dias Secco [UNESP]; Poiati, Juliane Rosa [UNESP]; Nunes, Hélio Rubens de Carvalho [UNESP]; Martin, Luis Cuadrado [UNESP]; Bazan, Rodrigo [UNESP]; Borges, Vera Therezinha Medeiros [UNESP]; Bazan, Silméia Garcia Zanati [UNESP]; Universidade Estadual Paulista (UNESP)
Systemic arterial hypertension (SAH) is one of the principal risk factors for developing cardiovascular disease. When a hypertensive woman becomes pregnant, new hemodynamic condition is installed, with addition from chronic pressure overload to chronic volume overload. This new hemodynamic condition can provide greater myocardial hypertrophy(LVH), whose postpartum evolution has been little studied in the literature. To evaluate LVH in hypertensive women in the third trimester of pregnancy and 6 months postpartum and to establish which clinical variables are associated with elevated risk of LVH. Prospective longitudinal study including 41 pregnant women beyond 35 gestational weeks and with previous SAH. They were submitted to clinical and echocardiographic evaluation at the gestational period and 6 months postpartum. Statistical analysis: multivariate logistic regression with the exposures most strongly associated with maintenance of hypertrophy in univariate analysis. Significance level: P<0.05. The mean age was 29±6.2 years. The majority of the women were white(85.4%). Before pregnancy 23(59%) women used antihypertensive drugs and 28(71.8%) used during pregnancy. At the end of gestation, all women presented LVH, 79% maintained hypertrophy 6 months postpartum. In multivariate analysis, exposures significantly associated with hypertrophy maintenance: systolic blood pressure(SBP) at the end of gestation, OR=1.16(1.03-1.30);P=0.013 and SBP increase at 6 months postpartum in relation to end of gestation, OR=22.9(1.8-294);P=0.016. In hypertensive pregnant women, LVH frequency is elevated at the end of pregnancy, and recovery frequency of this hypertrophy, at 6 months postpartum, is very low. The increase of SBP 6 months postpartum was associated with maintenance of hypertrophy.
Increase in cesarean sections in Brazil - a call to reflection
(2023-04-27) Braga, Antonio; Sun, Sue Yazaki; Zaconeta, Alberto Carlos Moreno; Trapani, Alberto; Luz, Adriana Gomes; Osanan, Gabriel; Duarte, Geraldo; Ramos, José Geraldo Lopes; Wender, Maria Celeste Osório; Nomura, Roseli Mieko Yamamoto; Francisco, Rossana Pulcineli Vieira; Borges, Vera Therezinha Medeiros [UNESP]; Mattar, Rosiane; Rio de Janeiro Federal University; Fluminense Federal University; Vassouras University; Universidade Federal de São Paulo (UNIFESP); University of Brasilia; Universidade Federal de Santa Catarina (UFSC); Universidade Estadual de Campinas (UNICAMP); Universidade Federal de Minas Gerais (UFMG); Universidade de São Paulo (USP); Universidade Federal do Rio Grande do Sul; Universidade Estadual Paulista (UNESP)
Integration of nutrigenomics, melatonin, serotonin and inflammatory cytokines in the pathophysiology of pregnancy-specific urinary incontinence in women with gestational diabetes mellitus
(2023-08-01) França, Danielle Cristina Honorio [UNESP]; França, Eduardo Luzía; Sobrevia, Luis [UNESP]; Barbosa, Angélica Mércia Pascon [UNESP]; Honorio-França, Adenilda Cristina; Rudge, Marilza Vieira Cunha [UNESP]; Universidade Estadual Paulista (UNESP); Federal University of Mato Grosso (UFMT); Pontificia Universidad Católica de Chile; Universidad de Sevilla; University of Queensland; University of Groningen; School of Medicine and Health Sciences
Gestational diabetes mellitus is an important public health problem and has been associated with the development of pregnancy-specific urinary incontinence. The interaction is related to hyperglycemia, and inflammatory and hormonal patterns, which favor functional alterations in different organs and systems. Several genes associated with human diseases have been identified and partially characterized. Most of these genes are known to cause monogenic diseases. However, about 3 % of diseases do not fit the monogenic theory due to the complex interactions between multiple genes and environmental factors, as in chronic metabolic diseases such as diabetes. The nutritional, immunological, and hormonal patterns associated with changes in maternal metabolism may influence and contribute to greater susceptibility to urinary tract disorders. However, early systematic reviews have not yielded consistent findings for these associations. This literature review summarizes important new findings from integrating nutrigenomics, hormones, and cytokines in women with Gestational diabetes mellitus and pregnancy-specific urinary incontinence. Changes in maternal metabolism due to hyperglycemia can generate an inflammatory environment with increased inflammatory cytokines. This environment modulated by inflammation can alter tryptophan uptake through food and thus influence the production of serotonin and melatonin. As these hormones seem to have protective effects against smooth muscle dysfunction and to restore the impaired contractility of the detrusor muscle, it is assumed that these changes may favor the onset of urinary incontinence specific to pregnancy.
Criteria for selection and classification of studies in medical events
(2023-01-01) da Costa Vieira, René Aloisio [UNESP]; Paulinellli, Regis Resende; Rodrigues, Fábio Francisco Oliveira; Moreira, Marise Amaral Rebouças; Caponero, Ricardo; Pessoa, Eduardo Carvalho [UNESP]; Rahal, Rosemar Macedo Sousa; Facina, Gil; de Freitas Junior, Ruffo; Universidade Estadual Paulista (UNESP); Universidade Federal de Goiás (UFG); Instituto do Câncer Dr. Arnaldo Vieira de Carvalho; Hospital Alemão Oswaldo Cruz; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: The aim of this study was to evaluate the impact of study methodology and evaluation type on the selection of studies during the presentation of scientific events. METHODS: A prospective, observational, transversal approach was applied to a cohort of studies that were submitted for presentation at the 2021 Brazilian Breast Cancer Symposium. Three forms of criteria (CR) were presented. CR1 was based on six criteria (method, ethics, design, originality, promotion, and social contribution); CR2 graded the studies from 0 to 10 for each study, and CR3 was based on five criteria (presentation, method, originality, scientific knowledge, and social contribution). To evaluate the item correlation, Cronbach's alpha and factorial analysis were performed. For the evaluation of differences between the tests, we used the Kruskal-Wallis and post-hoc Dunn tests. To determine the differences in the study classifications, we used the Friedman test and Namenyi's all-pairs comparisons. RESULTS: A total of 122 studies were evaluated. There was also a good correlation with the items concerning criterion 1 (α=0.730) and 3 (α=0.937). Evaluating CR1 methodology, study design and social contribution (p=0.741) represents the main factor and CR3 methodology, and the scientific contribution (p=0.994) represents the main factor. The Kruskal-Wallis test showed differences in the results (p<0.001) for all the criteria that were used [CR1-CR2 (p<0.001), CR1-CR3 (p<0.001), and CR2-CR3 (p=0.004)]. The Friedman test showed differences in the ranking of the studies (p<0.001) for all studies (p<0.01). CONCLUSION: Methodologies that use multiple criteria show good correlation and should be taken into account when ranking the best studies.
Efficacy and safety of ultra-low-dose estradiol and norethisterone in postmenopausal Brazilian women
(2023-01-01) Bonassi Machado, R.; Pompei, L. de Melo; Nahas, E. A.P. [UNESP]; Nahas-Neto, J. [UNESP]; Costa-Paiva, L. da; Del Debbio, S. Y.O.; Badalotti, M.; Wender, M. C.O.; Cruz, A. M.; Jundiai School of Medicine; ABC School of Medicine; Universidade Estadual Paulista (UNESP); Universidade Estadual de Campinas (UNICAMP); CEPIC; PUC-RS; UFRGS–Federal University of Rio Grande do Sul; Libbs Farmacêutica Ltda
Objective: This study aimed to evaluate the efficacy and safety of oral ultra-low-dose continuous combination of 17β-estradiol (17β-E2) and norethisterone acetate (NETA) in postmenopausal Brazilian women. Methods: Postmenopausal women (age 45–60 years) with amenorrhea >12 months and intact uterus, with moderate to severe vasomotor symptoms, were included. The vasomotor symptoms and endometrial bleeding were evaluated by a daily diary for 24 weeks, and the women were assessed at baseline and endpoint. Results: A total of 118 women were included. The group treated with 0.5 mg 17β-E2/0.1 mg NETA (n = 58) showed a percentage reduction of 77.1% in the frequency of vasomotor symptoms versus 49.9% in the placebo group (n = 60) (p = 0.0001). The severity score showed a reduction in the treatment group when compared to the placebo (p < 0.0001). The adverse events were comparable between the groups; however, in the 0.5 mg 17β-E2/0.1 mg NETA group there were more complaints of vaginal bleeding; despite that, in most cycles in both treatment groups, more than 80% of women experienced amenorrhea. Conclusions: The combination of 0.5 mg 17β-E2/0.1 mg NETA in a continuous combination regimen was shown to be effective in reducing the frequency and severity of vasomotor symptoms in Brazilian postmenopausal women.
Maternal-fetal toxicity of Strychnos pseudoquina extract treatment during pregnancy
(2023-07-15) Souza, Maysa Rocha [UNESP]; Brito, Evelyn Caroline Barbosa; Furtado, Linne Stephane; Barco, Vinícius Soares [UNESP]; Cruz, Larissa Lopes da [UNESP]; Moraes-Souza, Rafaianne Queiroz [UNESP]; Monteiro, Gean Charles [UNESP]; Lima, Giuseppina Pace Pereira [UNESP]; Damasceno, Débora Cristina [UNESP]; Volpato, Gustavo Tadeu; Federal University of Mato Grosso - Barra do Garças; Universidade Estadual Paulista (UNESP)
Ethnopharmacological relevance: Plants and herbs have been used by women throughout history for therapeutic purposes. Strychnos pseudoquina, a plant used in the treatment of various diseases, can also function as an abortive herb. There is no scientific confirmation of its effects during pregnancy, and the activity of this plant needs to be substantiated or refuted with experimental evidence. Aim of the study: Evaluating the effect of the S. pseudoquina aqueous extract on maternal reproductive toxicity and fetal development. Materials and methods: The aqueous extract of S. pseudoquina bark was evaluated in Wistar rats. Pregnant rats were distributed into four experimental groups (n = 12 rats/group): Control = treated with water (vehicle); Treated 75, Treated 150, and Treated 300 = treated with S. pseudoquina at dose 75, 150 and 300 mg/kg, respectively. The rats were treated by an intragastric route (gavage) from day 0 to day 21 of pregnancy. At the end of pregnancy, maternal reproductive outcomes, organs, biochemical and hematological profiles, fetuses, and placentas were analyzed. Maternal toxicity was evaluated through body weight gain, water, and food intake. With knowledge of the harmful dosage of the plant, other rats were used on gestational day 4 for the evaluation of morphological analyses before embryo implantation. P < 0.05 was considered as statistically significant. Results: The S. pseudoquina treatment showed elevated liver enzymatic activities. The Treated 300 group presented toxicity with reduced maternal body weight, water and food intake, and increased kidney relative weight compared to those of the Control group. At a high dosage, the plant presents an abortifacient activity, confirmed by embryo losses before and after implantation and degenerated blastocysts. In addition, the treatment contributed to an increased percentage of fetal visceral anomalies, decreased ossification sites, and intrauterine growth restriction (300 mg/kg dose). Conclusion: In general, our study showed that an aqueous extract of S. pseudoquina bark caused significant abortifacient activity that testified to its traditional use. Furthermore, the S. pseudoquina extract caused maternal toxicity that contributed to impaired embryofetal development. Therefore, the use of this plant should be completely avoided during pregnancy to prevent unintended abortion and risks to maternal-fetal health.
Effect of ischemic compressions versus extracorporeal shockwave therapy on myofascial trigger points: A protocol of a randomized controlled trial
(2023-01-01) Nahomi Kuroda, Melissa [UNESP]; Thomaz de Aquino Nava, Guilherme [UNESP]; Baldini Prudencio, Caroline [UNESP]; Affonso Paulo, Daiane [UNESP]; Peixouto, Isadora [UNESP]; Yoshi Moroshima, Maiki [UNESP]; de Almeida Lourenço, Mariana; Nogueira da Silva, Caroline [UNESP]; Mércia Pascon Barbosa, Angélica [UNESP]; Rodrigues Pedroni, Cristiane [UNESP]; Universidade Estadual Paulista (UNESP); Educational Foundation of the City of Assis (FEMA)
INTRODUCTION: The myofascial trigger points (MTrPs) are hyperirritable nodules present in a tight muscle band. Among the symptoms, pain is one of the most common, but the individuals may have other sensory, motor, and autonomic changes. Athletes can have MTrPs more intensely due to the high physical and emotional demand. There are a variety of treatments, but not all have strong or moderate evidence of their effectiveness. Thus, the aim of this study is to compare the effects of ischemic compression (IC) and extracorporeal shockwave therapy (ESWT) on pressure pain threshold immediately after the intervention and after 48h. METHODS: This randomized clinical trial was registered in the Brazilian Registry of Clinical Trial (RBR-6wryhb9) and was approved by the Research Ethics Committee (CAAE 46682921.9.0000.5406). Forty participants will be randomized to receive IC or ESWT treatment once in each MTrPs. The protocol will consist of evaluations before (T0), immediate after (T1), and after forty-eight hours (T2) of the intervention. The primary outcome will be pressure pain threshold and the secondary outcomes will be jump height, muscle strength, dorsiflexion range of motion (ROM), the correlation between MTrPs and temperature and participant's satisfaction. CONCLUSIONS: The IC and ESWT have been shown to be efficient in decreasing pain, however, the studies that compare the efficiency of these two treatments are limited in the literature, mainly in the muscles of the lower limbs, which are of great importance and are commonly injured. This study will provide evidence of the IC and ESWT in the triceps surae muscles, assisting in a better treatment for the individual with MTrPs.
Rosemary (Rosmarinus officinalis L.) Glycolic Extract Protects Liver Mitochondria from Oxidative Damage and Prevents Acetaminophen-Induced Hepatotoxicity
(2023-03-01) Guimarães, Natalia S. S.; Ramos, Vyctória S.; Prado-Souza, Laura F. L.; Lopes, Rayssa M.; Arini, Gabriel S.; Feitosa, Luís G. P.; Silva, Ricardo R.; Nantes, Iseli L.; Damasceno, Debora C. [UNESP]; Lopes, Norberto P.; Rodrigues, Tiago; University of Mogi das Cruzes (UMC); Federal University of ABC; Universidade de São Paulo (USP); Universidade Estadual Paulista (UNESP)
Rosmarinus officinalis L. (rosemary) is an aromatic culinary herb. Native to the Mediterranean region, it is currently cultivated worldwide. In addition to its use as a condiment in food preparation and in teas, rosemary has been widely employed in folk medicine and cosmetics. Several beneficial effects have been described for rosemary, including antimicrobial and antioxidant activities. Here, we investigated the mechanisms accounting for the antioxidant activity of the glycolic extract of R. officinalis (Ro) in isolated rat liver mitochondria (RLM) under oxidative stress conditions. We also investigated its protective effect against acetaminophen-induced hepatotoxicity in vivo. A crude extract was obtained by fractionated percolation, using propylene glycol as a solvent due to its polarity and cosmeceutical compatibility. The quantification of substances with recognized antioxidant action revealed the presence of phenols and flavonoids. Dereplication studies carried out through LC-MS/MS and GC-MS, supported by The Global Natural Product Social Molecular Networking (GNPS) platform, annotated several phenolic compounds, confirming the previous observation. In accordance, Ro decreased the production of reactive oxygen species (ROS) elicited by Fe2+ or t-BOOH and inhibited the lipid peroxidation of mitochondrial membranes in a concentration-dependent manner in RLM. Such an effect was also observed in liposomes as membrane models. Ro also prevented the oxidation of mitochondrial protein thiol groups and reduced glutathione (GSH). In model systems, Ro exhibited a potent scavenger activity toward 2,2′-diphenyl-1-picrylhydrazyl (DPPH) radicals and superoxide anions. It also demonstrated an Fe2+ chelating activity. Moreover, Ro did not exhibit cytotoxicity or dissipate the mitochondrial membrane potential (∆Ψ) in rat liver fibroblasts (BRL3A cells). To evaluate whether such antioxidant protective activity observed in vitro could also be achieved in vivo, a well-established model of hepatotoxicity induced by acute exposure to acetaminophen (AAP) was used. This model depletes GSH and promotes oxidative-stress-mediated tissue damage. The treatment of rats with 0.05% Ro, administered intraperitoneally for four days, resulted in inhibition of AAP-induced lipid peroxidation of the liver and the prevention of hepatotoxicity, maintaining alanine and aspartate aminotransferase (ALT/AST) levels equal to those of the normal, non-treated rats. Together, these findings highlight the potent antioxidant activity of rosemary, which is able to protect mitochondria from oxidative damage in vitro, and effects such as the antioxidant and hepatoprotective effects observed in vivo.
Calcium Supplementation on Glucose Tolerance, Oxidative Stress, and Reproductive Outcomes of Diabetic Rats and Their Offspring
(2023-01-01) Klöppel, Eduardo [UNESP]; Souza, Maysa Rocha [UNESP]; Barco, Vinícius Soares [UNESP]; Gallego, Franciane Quintanilha [UNESP]; Sinzato, Yuri Karen [UNESP]; Corrente, José Eduardo [UNESP]; Rodrigues, Tiago; Volpato, Gustavo Tadeu [UNESP]; Damasceno, Débora Cristina [UNESP]; Universidade Estadual Paulista (UNESP); Mato Grosso State; Universidade Federal do ABC (UFABC)
Diabetes mellitus increases the risk of obstetric complications, morbidity, and infant mortality. Controlled nutritional therapy with micronutrients has been employed. However, the effect of calcium (Ca2+) supplementation on diabetic pregnancy is unclear. We aimed to evaluate whether diabetic rats supplemented with Ca2+ during pregnancy present better glucose tolerance, redox status, embryonic and fetal development, newborn weight, and the prooxidant and antioxidant balance of male and female pups. For this, newborn rats received the beta-cytotoxic drug streptozotocin for inducing diabetes on the day of birth. In adulthood, these rats were mated and treated with Ca2+ twice a day from day 0 to day 20 of pregnancy. On day 17, the pregnant rats were submitted to the oral glucose tolerance test (OGTT). At the end of pregnancy, they were anesthetized and killed to collect blood and pancreas samples. The uterine horns were exposed for an evaluation of maternal reproductive outcomes and embryofetal development, and the offspring’s liver samples were collected for redox status measurement. Nondiabetic and diabetic rats supplemented with Ca2+ showed no influence on glucose tolerance, redox status, insulin synthesis, serum calcium levels, and embryofetal losses. The reduced rate of newborns classified as adequate for gestational age (AGA) and higher rates of LGA (large) and small (LGA) newborns and higher -SH and GSH-Px antioxidant activities in female pups were observed in diabetic dams, regardless of supplementation. Thus, maternal supplementation caused no improvement in glucose tolerance, oxidative stress biomarkers, embryofetal growth and development, and antioxidants in pups from diabetic mothers.

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