Orientadores: Cristina Laguna Benetti Pinto, Rose Luce Gomes do Amaral / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-28T09:13:50Z (GMT). No. of bitstreams: 1 GiraldoSouza_HelenaPatriciaDonovan_M.pdf: 2305470 bytes, checksum: add3640d7732bc5676b5b9eb414466b0 (MD5) Previous issue date: 2015 / Resumo: Introdução: Insuficiência Ovariana Prematura 46XX (IOP) é um estado de hipogonadismo, caracterizado por oligoamenorréia, infertilidade e deficiência estrogênica em mulheres abaixo de 40 anos. Mulheres com IOP deveriam ser tratadas com reposição estrogênica até pelo menos a idade da menopausa, para reduzir os sinais e sintomas do hipoestrogenismo e se possível, preservar a massa mineral óssea. Objetivos: Avaliar se Terapia Hormonal (TH) com baixa dose estrogênica é adequada para reduzir a perda de massa óssea de mulheres com IOP. Métodos: Estudo de corte transversal. Foram avaliadas 239 mulheres com IOP: 132 usando TH baixa dose (17-Beta-Estradiol 1mg + Noretisterona ou estrogênio conjugado 0,625mg + acetado de Medroxiprogesterona) e 107 mulheres sem TH. Todas responderam anamnese detalhada (idade, idade na última menstruação e idade no início de tratamento) e foram submetidas a avaliação de densidade mineral óssea (DMO) na coluna lombar (CL), colo femoral (CF) e fêmur total (FT) através da técnica DEXA. Resultados: As médias de idade, idade na última menstruação e de IMC para o grupo sem tratamento e para o grupo com TH foram 38,1 ± 6,1 e 36,8 ± 7,3 anos; 31,4 ± 7,3 e 30,7 ± 7,2 anos; 26,6 ± 7,1 e 25,8 ± 4,6, respectivamente (p=NS). A DMO média na CL foi 1,06 ± 0,15 e 1,00 ± 0,17g/cm2 (p=0,003), para CF 0,92 ± 0,15 e 0,89 ± 0,14 (p=0,0479) e FT de 0,92 ± 0,19 e 0,91 ± 0,13 g/cm2 (p=0,039), respectivamente para os grupos. Verificou-se DMO alterada na CL em 45,1% (35,2% Osteopenia e 9,8% Osteoporose) das mulheres sem tratamento e 60,1% (38,1 Osteopenia e 22% Osteoporose) quando usavam TH baixa dose (p=0,01). No CF 25,4% (21,5% Osteopenia e 3,9% Osteoporose) das mulheres sem tratamento e 29,6% (22,8% Osteopenia e 6,7% Osteoporose) quando usavam TH baixa dose (p=0,38) mostravam alteração e, para FT, em 32,35% (19,6% Osteopenia e 12,7% Osteoporose) das sem tratamento e 36,4% (21,2% Osteopenia e 15,2% Osteoporose) para TH de baixa dose (p=0,34). Conclusão: A TH de baixa dose não parece ser adequada para reduzir a perda de massa óssea de coluna lombar, colo de fêmur e fêmur total em mulheres com IOP / Abstract: Introduction: Premature Ovarian Insufficiency (POI) is a hypogonadism state, characterized by oligoamenorhea, infertility and estrogen deficiency in women below the age of 40. Women with POI should be treated with estrogen replacement until at least the age of menopause, in order to reduce the signs and symptoms of hypoestrogenism and if possible, preserve bone mineral density (BMD). Aim: To assess whether hormone therapy (HT) with low estrogen dose is sufficient to avoid bone mass loss in women with POI. Methods: Cross-sectional study. Two hundred and thirty nine women were evaluated: 132 using low dose TH (1 mg of 17-Beta-Oestradiol + Norethisterone or 0.625 mg of conjugated estrogen + medroxyprogesterone acetate) and 107 women without HT. Detailed history was obtained from the studied women (age, age of last menstrual period and age of onset of treatment) and were subjected to evaluation of bone mineral density (BMD) in the lumbar spine (LS), femoral neck (FN) and total femur (TF) through DEXA technique. Results: The mean age, age at last menstrual period and BMI for the untreated group and the group with HT were 38.1 ± 6.1 and 36.8 ± 7.3 years; 31.4 ± 7.3 and 30.7 ± 7.2 years; 26.6 ± 7.1 and 25.8 ± 4.6 respectively (p = NS). The mean LS BMD was 1.06 ± 0.15 and 1.00 ± 0,17g / cm2 (p = 0.003), CF 0.92 ± 0.15 and 0.89 ± 0.14 (p = 0.0479) and FT 0.92 ± 0.19 and 0.91 ± 0.13 g / cm2 (p = 0.039) respectively for the groups. BMD at LS was compromised in 45.1% (35.2% osteopenia and osteoporosis 9.8%) for women without treatment and 60.1% (38.1% osteopenia and 22% osteoporosis) low dose HT (p = 0.01). For the FN 25.4% (21.5% Osteopenia and Osteoporosis 3.9%) of women without treatment and 29.6% (22.8% Osteopenia and Osteoporosis 6.7%) for the ones in use of TH low dose, were compromised (p = 0 38). For TF compromise was found in 32.35% (19.6% osteopenia and 12.7% osteoporosis) of the untreated women and 36.4% (21.2% and 15.2% osteoporosis osteopenia) for low dose HT (p = 0.34). Conclusion: The low dose HT seems to be inadequate to reduce bone loss in the lumbar spine, femoral neck and total femur in women with IOP / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Apart from its slender appearance, four main factors lead to questions regarding the bone density, mineral content and morphology of the giraffe skeleton: X A rapid vertical growth rate ¡V especially in the neck and metapodials X Biomechanical considerations pertaining to the tall and slender shape of the skeleton X A proportionally larger skeleton in relation to body mass X A seemingly abnormal mineral balance in their diet with possible signs of mineral deficiency (i.e. osteophagia) In this study the skeleton of the giraffe was compared with that of the African buffalo with regards to bone density, skeletal calcium (Ca) and phosphorus (P) content and certain femoral and metacarpal morphological characteristics. The aim was to establish if, compared to buffalo, the features of the giraffe skeleton differed in any unique way. Fourteen similar bones or parts of bones were collected from carcasses of six adult giraffe bulls and nine adult buffalo bulls. These bones were cleaned, weighed and their volume determined through water displacement, from which their density could be calculated. Hereafter, Ca and P content were analysed in 10 bones from each carcass. Morphological characteristics of cross-sections from femoral and metacarpal shafts were also measured. No significant differences between the density or mineral content of bones in the two species could be found. In both species 19,5% Ca and 9,5% P were measured in defatted bone. Although similar in mineral concentration, the giraffe skeleton contains three times more absolute Ca and P, which translates into a 1,5-2-fold higher dietary requirement for these minerals compared to buffaloes. A gradation in the volume and weight of cervical vertebrae was also seen in giraffes. This could hold biomechanical advantage for the carriage and manoeuvrability of the long neck. Bone wall thickness of the giraffe femur and metacarpus is increased compared to buffaloes. This could hold biomechanical advantage for the slender legs that are subjected to increased vertical forces. Adequate Ca seems to be acquired through very specific browse selection, which seems to be of evolutionary origin, while the acquisition of adequate P seems to be critical and a possible cause for osteophagia. This study is the first of its kind in these species and therefore also provide valuable baseline data for future work in this field. / Dissertation (MSc (Veterinary Science))--University of Pretoria, 2004. / Production Animal Studies / unrestricted

The purpose of this project was to further elucidate the effects post-exercise alcohol ingestion. This project had many novel aspects including using a resistance exercise (RE) only exercise design and the inclusion of women. To our knowledge, we are the first to investigate the effect of post-RE alcohol ingestion in women. In the first chapter of this project, information on the prevalence of alcohol use and the importance of skeletal muscle as a dynamic and metabolic tissue was provided. In chapter two, the effects of post-RE alcohol ingestion in men and women are detailed. The major findings of this study was that although RE elicited similar mTORC1 signaling both in men and in women, alcohol ingestion appeared to only attenuate RE-induced phosphorylation of the mTORC1 signaling pathway in men. The third chapter focused on examining the effects of post-RE alcohol ingestion on acute testosterone bioavailability. The primary findings of this study was that alcohol substantially elevated serum total and free testosterone concentrations during recovery from a bout of resistance exercise. The fourth chapter detailed factors that contribute to bone density in men. The major findings of this study was that young adult male long-distance runners who participated in resistance training at least once per week had greater bone mineral density than their non-resistance trained and non-exercise trained peers.

Fracture risk reduction is the main goal of treating osteoporosis, a condition which, in the absence of fragility fractures, is diagnosed by bone densitometry. Bone density, however, although an important factor predicting fracture risk, is not the only one and several other factors modulate the fracture risk such as the patient's age, body mass index, family history, cigarette smoking, medications and the risk of falling: most fractures are preceded by falls. When developing a treatment strategy it is therefore important to take into consideration other factors apart from bone density. Several algorithms and instruments are available for this purpose. The FRAX (Fracture Risk Assessment) tool developed under the aegis of the World Health Organization and the Garvan Fracture Risk Calculator are commonly used to estimate the patient's fracture risk. Both have advantages and limitations. It must be emphasized, however, that treatment decisions are clinical ones.

Fracture risk reduction is the main goal of treating osteoporosis, a condition which, in the absence of fragility fractures, is diagnosed by bone densitometry. Bone density, however, although an important factor predicting fracture risk, is not the only one and several other factors modulate the fracture risk such as the patient's age, body mass index, family history, cigarette smoking, medications and the risk of falling: most fractures are preceded by falls. When developing a treatment strategy it is therefore important to take into consideration other factors apart from bone density. Several algorithms and instruments are available for this purpose. The FRAX (Fracture Risk Assessment) tool developed under the aegis of the World Health Organization and the Garvan Fracture Risk Calculator are commonly used to estimate the patient's fracture risk. Both have advantages and limitations. It must be emphasized, however, that treatment decisions are clinical ones.

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