Orientador: Egle Cristina Couto de Carvalho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T11:06:18Z (GMT). No. of bitstreams: 1 Guimaraes_JoaoAgripino_M.pdf: 1627287 bytes, checksum: b5aedfb0c0a3b2d807c0d3324ae57317 (MD5) Previous issue date: 2012 / Resumo: Contexto e objetivo: Alterações imunológicas podem estar associadas à infertilidade e endometriose. O objetivo deste estudo foi avaliar se, na infertilidade inexplicada e na infertilidade associada à endometriose, ocorre polarização da resposta imunológica Th1ou Th2. Tipo de estudo e local: Foi realizado um estudo de corte transversal no Centro de Atenção Integral a Saúde da Mulher (CAISM), Universidade de Campinas (Unicamp), Campinas, São Paulo, Brasil, de janeiro a junho de 2010. Métodos: 142 mulheres foram alocadas em três grupos (52 com infertilidade inexplicada, 38 inférteis com endometriose e 52 férteis) para dosagem de citocinas Th1 (interleucina 2, fator de necrose tumoral-ALFA' e do interferon-y ) e citocinas Th2 (interleucinas 4 e 10). Os dados foram descritos através de média, desvio-padrão e mediana, e através de frequências absolutas e relativas. Os grupos foram comparados em relação às variáveis através dos testes de qui-quadrado ou exato de Fisher. As citocinas foram comparadas entre os grupos através do teste de Kruskal-Wallis; em caso de diferença significativa, foram feitas comparações dois a dois através do teste de Mann-Whitney e aceitou-se nível de significância 5%. Resultados: As mulheres com infertilidade inexplicada apresentaram menores níveis de interferon-y (p = 0,0012) e maiores níveis de interleucina-4 (p < 0,0001) do que as mulheres férteis, e maiores níveis de interferon-y (p = 0,0001) e de interleucina-4 (p = 0,0005) do que as mulheres inférteis com endometriose. Aquelas com infertilidade primária apresentaram menores níveis de interferon-y e maiores de interleucina-4 que as mulheres férteis. Conclusão: Não foi detectado qualquer tipo de polarização da resposta imunológica Th1 ou Th2 nas mulheres com infertilidade inexplicada ou com endometriose, quando comparadas com mulheres férteis / Abstract: Context and objective: Immunological alterations may be associated with infertility and endometriosis. The aim of this study was to evaluate the polarization of Th1 and Th2 immune response in women with unexplained infertility and infertility associated with endometriosis. Design and setting: A cross-sectional study was performed at the Center for Integral Attention to Women's Health (CAISM) from University of Campinas (UNICAMP), SP, Brazil, from January to June 2010. Methods: 142 women were allocated into three groups (52 with unexplained infertility, 38 infertile women with endometriosis and 52 fertile women) for measurement of Th1 (interleukin 2, tumor necrosis factor-? and interferon-?) and Th2 cytokines (interleukins 4 and 10). Data were reported as mean, standard deviation, median, and by absolute and relative frequencies. The groups were compared with respect to variables using the chi-square or Fisher exact test. Cytokines were compared between groups using the Kruskall-Wallis test and, if significant differences were noted, comparisons were made in pairs by Mann-Whitney test, with 5% significance level. Results: Women with unexplained infertility showed lower levels of interferon-? (p = 0.0012) and increased levels of interleukin-4 (p <0.0001) than fertile women, and higher levels of interferon-? (p = 0.0001) and interleukin-4 (p = 0.0005) than infertile women with endometriosis. Those with primary infertility had lower levels of interferon-? and interleukin-4 over than fertile women. Conclusion: We could not detect any polarization of Th1 or Th2 immune response in women with unexplained infertility or infertility with endometriosis, when compared with fertile women / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

L’endométriose est une maladie gynécologique pour laquelle l’exposition à certains contaminants chimiques environnementaux est évoquée parmi les facteurs de risque associés. Les conclusions des études épidémiologiques existantes restent toutefois non convergentes. Leur hétérogénéité en termes de lésions décrites, de méthodologie et d’effectifs contribuent à ce constat, de même que l’étendue limitée des marqueurs d’exposition considérés dans ces études. Nous avons réalisé une étude cas-témoins appariés à partir d’une bio-collection de 113 patientes réunissant68 cas de patientes opérées d’endométriose profonde et 45 patientes témoins. Un ensemble unique de 78 polluants organiques persistants a été recherché, incluant dioxines, polychlorobiphényles, retardateurs de flamme polybromés, et pesticides organochlorés. Les niveaux d’exposition interne des sujets ont été mesurés à la fois dans les tissus adipeux pariétal et épiploïque ainsi que dans le sérum. La distribution de ces différents polluants au sein de ces trois compartiments a tout d’abord été caractérisée. Celle-ci a permis la prise en compte encore très rare de l’équilibre entre compartiments de stockage et compartiment circulant, ce rapport de concentration apparaissant comme un potentiel indicateur additionnel permettant d’affiner d’éventuels liens de causalité entre exposition chronique à des dangers chimiques et pathologie chez l’homme. Certains des contaminants ciblés sont ensuite apparus significativement associés à l’endométriose profonde, la stratification plus fine de notre population de cas indiquant un lien d’autant plus significatif en présence d’endométriome. Les mécanismes sous-jacents de cette association restent toutefois à élucider. / Endometriosis is a gynecological disease for whichexposure to some environmental chemicals is evocatedamong the associated risk factors. Epidemiological studies are however globally non convergent and finally fairly conclusive. Their heterogeneity in terms of lesion localization and sub-phenotype, methodology, size and nature of the populations studied, as well as the limited number of monitored markers of exposure contribute to this situation. We realized a matched case-control study based on a biocollection of 113 patients including 68 patients suffering of deep endometriosis and 45 controls. We characterized the internal exposure levels of an extended range of around 78 persistent organic pollutants (including dioxins, polychlorobiphenyls, brominated flame retardants and organochlorine pesticides). Internal level exposures were measured in three biological compartments (omental fat, subcutaneous fat and serum). First, the distribution of these chemicals was characterized within these compartments. These extended exposure data from deep infiltrating endometriosis patients are the first ones available for France and give a new insight about the equilibrium of chemicals between storage and circulating compartments that should be further considered as a potential indicator permitting to establish a possible association between a chronic exposure to chemical hazards and human pathology. Afterwards, some of the targeted chemicals appeared significantly associated with deep endometriosis. A sub-stratification of our case population indicated a more significant relationship with the presence of endometrioma. Underlying mechanisms remain to be determined.

Background: Endometriosis is a gynecological disease caused by endometrium, or cells similar to the endometrium, that grows outside the uterus and creates a chronic inflammation. The most commonly reported symptoms are dysmenorrhoea, dyspareunia, severe or irregular bleedings and pelvic pain. The underlying cause of the disease is not yet established and 5,726,6% of women in fertile age are estimated to be affected. Health care professionals has an important role in nursing care, as it might affect quality of life in women with endometriosis. Purpose: The aim of the study is to describe women's experiences of living with endometriosis. Method: Literature study based on an analysis of 18 scientific articles with qualitative and quantitative content. Results: Four main themes are represented in the result; Experiences of health care, Physical consequences, Mental pain and Endometriosis controls women’s social lives. Conclusion: The literature study shows that endometriosis has a major impact on women's lives, which affects relationships, life opportunities and quality of life. The majority have experienced negative meetings with health care and a lack of knowledge. This leads to a long wait for diagnosis and insufficient treatment options. Further research should focus on results-oriented treatments and symptomatic therapies for endometriosis patients. Studies should also include transgender patients and patients that has undergone gender reassignment surgery, that is seeking health care for endometriosis-related symptoms.

Endometrios är en kronisk inflammatorisk sjukdom som drabbar ungefär tio procent av alla personer i reproduktiv ålder, födda med en livmoder. Sjukdomen kan medföra besvärliga smärtor för personer som lever med den. Fördröjning av diagnostisering och behandling förekommer för personer som lever med endometrios vilket pekar på en bristande kunskap hos vårdpersonal gentemot dem. Syftet med denna litteraturöversikt var att beskriva personers upplevelser av att leva med endometrios. Litteraturöversikt användes som metod. Sjutton vetenskapligt granskade artiklar inhämtades från PubMed och CINAHL. Inklusionskriterierna var att studiedeltagarna skulle vara mellan 18 – 55 år och leva med en bekräftad endometrios. Sophiahemmet Högskolas bedömningsunderlag användes för kvalitetsgranskning. Artiklarnas resultat lästes igenom upprepade gånger och delades därefter i kategorier och subkategorier. Tre kategorier och elva subkategorier identifierades: att leva med symtom (symtom, fysisk aktivitet/funktionsförmåga, privata relationer, sexualitet/reproduktion, känslor/psykisk hälsa samt coping), mötet med sjukvården (att bli diagnostiserad och bemötande) samt påverkan på socioekonomiska aspekter (utbildning, arbete/sjukskrivning och privatekonomi). Samtliga aspekter av personernas liv påverkades av att leva med endometrios. Framförallt smärta hade inverkan på psykiska, fysiska, sociala och ekonomiska aspekter i personernas liv. Att leva med endometrios kan medföra övervägande negativa upplevelser av smärtsamma symtom, nedsatt funktionsförmåga, arbetsförmåga, privatekonomi och psykisk hälsa, negativt bemötande från sjukvårdspersonal samt negativ inverkan på privata relationer och sexualitet/reproduktion. Mer forskning och kunskapsspridning om endometrios behövs. Genom att öka medvetenheten om hur endometrios påverkar livet hos personer som lever med tillståndet kan kunskap bland sjukvårdspersonal samt omhändertagande och bemötande av dessa personer förbättras. Därmed kan personernas sårbarhet bejakas och deras tillit till sjukvården förhoppningsvis förbättras. / Endometriosis is a chronic inflammatory disease which affects approximately ten percent of all persons in reproductive ages, born with a uterus. The disease can entail troublesome pains for the persons who live with it. Delay of diagnosis and treatment occurs which indicates a lack of knowledge among care staff towards the persons living with endometriosis. The aim of this literature review was to describe the experiences of persons living with endometriosis. The applied method was literature review. Seventeen peer reviewed articles were retrieved from PubMed and CINAHL. Inclusion criteria were that the study participants had to be between 18 and 55 years of age and live with confirmed endometriosis. Sophiahemmet Högskolas assessment tool was utilised during the quality audit. The articles were read repeatedly, and their contents were then divided into categories and subcategories. Three categories and eleven subcategories were identified: to live with symptoms (symptoms, physical activity/functional ability, private relationships, sexuality/reproduction, emotions/mental health and coping), encounters with health care (to be diagnosed and personal treatment), and consequences in everyday life (education, employment/absenteeism, and personal finances). In essence, almost all of the aspects of the persons’ lives were affected by living with endometriosis. Pain had a particular influence on mental, physical, social, and economical aspects of their lives. Living with endometriosis can entail troublesome negative experiences of painful symptoms, reduced ability to function physically, working ability, personal finances and mental health, negative encounters with health care staff, and negative influences on private relationships and sexuality/reproduction. Further research and dissemination of knowledge about endometriosis is necessary. Knowledge among health care staff, caretaking and personal treatment may be improved by increased awareness of how endometriosis affects the lives of people living with the condition. Hence, the persons’ vulnerability may be affirmed and their trust towards health care may hopefully improve.

Endometriosis is a gynaecological disorder that affects an estimated 176 million women worldwide. Endometriosis causes serious societal impacts, such as loss of work productivity and effectiveness of non-work-related activities. Regardless that a significant number of women are impacted, many clinical questions remain unanswered, treatment failures are common, diagnosis takes an average of seven and a half years, and there is little investment in investigating disease mechanisms. At the same time, in the last few decades, endometriosis has been repeatedly mislabelled, which still presents indications on the current endometriosis care. Furthermore, there is still a tendency to exclude women's experiential knowledge, which presents one of the biggest burdens of endometriosis. The Degree Project demonstrates communication barriers to early diagnosis from 262 women using survey data and aims to understand women and medicine's power relations. Through this analysis, women's perspective is presented and discussed. The analytical discussion is divided into four chapters: medical knowledge, pain communication, desired communication support and experiential support. The study identifies how the relationship of knowledge and power impact pain communication and consequently the diagnosis of endometriosis. This study contributes to endometriosis, gender and communication for development studies by suggesting the incorporation of women’s experiential knowledge to address the challenges of pain communication and the diagnostic delay.

Bakgrund: Endometrios är en kronisk sjukdom som drabbar en av tio fertila kvinnor världen över. Trots den höga prevalensen avdrabbade kvinnor är kunskapen om sjukdomen låg. Det dröjerungefär åtta år innan kvinnorna får sin diagnos. Det vanligaste symtomet är kroppslig smärta men sjukdomen påverkar även kvinnornas psykiska-, reproduktiva- och sexuella hälsa. Sjuksköterskan behöver kunskap om endometrios för att i mötet med kvinnorna kunna uppmärksamma symtom och tecken. Syfte: Syftet var att belysa kvinnors upplevelser av att leva med endometrios. Metod: En litteraturöversikt utifrån tio kvalitativa originalartiklar hämtade från databaserna Cinhal Complete och PubMed. Artiklarna analyserades utifrån Fribergs analysmodell. Resultat: Att leva med endometrios påverkade kvinnorna i stor utsträckning och kunde orsaka dem lidande. Smärta var ett utmärkande symtom som gav kvinnorna svårigheter att leva ett fullt fungerande liv. Majoriteten av kvinnornas sociala liv, relationer och arbete påverkades negativt av sjukdomen vilket begränsade deras liv. Kvinnorna upplevde att vårdpersonalenhade bristande kunskap och förståelse om sjukdomen. Infertilitet och bristande sexualitet orsakade även en oro hos kvinnorna. Slutsats: För att erbjuda god vård, främja hälsa och lindra lidande behöver vården ökad kunskap om endometrios. Det är av stor betydelse att kvinnorna får tidig diagnos och adekvatbehandling. Fortsatt forskning inom området är viktigt för att uppmärksamma sjukdomen. / Background: Endometriosis is a chronic disease that affects one in ten fertilewomen worldwide. Knowledge about the disease are low despite the high prevalens of affected women. It takes about eight years before the women receive their diagnosis. The mostcommon symptom is physical pain, but the disease also affects women’s mental, reproductive and sexual health. The nurserequire knowledge about endometriosis to recognize symptoms and signs when encountering these women. Aim: The aim of this study was to shead light on women’sexperiences of living with endometriosis. Method: A literature review based on ten qualitative original articles gather from the databases Cinhal Complete and PubMed. The articles were analyzed based on Friberg’s analysis model. Results: Living with endometriosis affected the women to a great extent and could cause them suffering. Pain was a distinctive symptom that made it difficult for the women to live a fully functioning life. The majority of the women’s social life, relationships and work were negatively affected by the disease, which limited their lives. The women felt that the healthcare workers lacked knowledge and understanding of the disease. Women were also concernd about infertility and lack of sexuality. Conclusion: Increased knowledge about endometriosis is required by the healthcare to provide good care, promote health and relieve suffering. It is essential that the women receive an early diagnosis and adequate treatment. In order to draw attention to the disease continued research is needed in the field.

Background: Endometriosis is a common disease that affects approximately 10 % of people born with a uterus. The most common and noticeable symptom of endometriosis is pain. Symptoms usually occur in adolescence and can be lifelong, but often subside with menopause. Aim: To describe how women with endometriosis experience health care encounters Method: A literature-based study was used to obtain an enhanced understanding of the phenomenon. Nine qualitative articles and one mixed method article were analyzed. Results: Two main themes were identified; The theme relinquishing power to external sources describes the vulnerability and objectification experienced by women during healthcare encounters. Conversely, trust can be established if the women feel acknowledged and validated. The theme being stigmatized describes how women experience stigmatization and a lack of credibility in their interactions with healthcare professionals, resulting in a sense of distrust. Conclusion: In order to improve healthcare experience for women with endometriosis nurses must address the issues of vulnerability, objectification, stigmatization, and lack of credibility these women encounter. By applying the core competencies, the nurse enables the fulfillment of nursing needs for women with endometriosis.

Endometriosis is characterized by aberrant estrogen signaling and chronic inflammation that results in prolonged pelvic pain and infertility. Research from our lab along with others have found that the chronic inflammatory state is maintained by a high ratio of inflammatory/ tolerant (Th17/ Tregs) cells systemically as well as increased Treg localization (tolerance) within endometriotic lesions, allowing endometriotic lesions to escape effector immune clearance. Moreover, this phenotype creates an intolerant environment for successful implantation which poses a risk of infertility and pre-term delivery in this group of women. Our previous research has also found that women with endometriosis have microbial dysbiosis within both gastrointestinal and urogenital (GI/UG) environments that may contribute to abnormal metabolism of parent estrogens. We hypothesized that microbial disruption alters enterohepatic recirculation of endogenous hormones by changing expression of cytochrome P450 (CYPs) enzymes that metabolize parent estrogens. Along with presence of disease, many external factors might also contribute to microbial disruption within the urogenital environment such as sexual partner encounters. Surgical intervention and use of hormonal therapies for treatment of endometriosis, may also contribute to microbial composition within the GI and UG environments in diseased patients. Our goal for this study was to 1) measure several CYP enzyme gene expressions in both eutopic endometrium and ectopic endometriotic lesions of diseased subjects; and 2) investigate the association of sexual partner number on microbial profiles in vaginal, urine and fecal samples of diseased patients, and whether hormonal therapy and surgical intervention affect microbial dynamics within the GI and UG environments. Our data showed that CYP1B1 gene expression was altered in eutopic endometrium of diseased patients. Hormonal therapy (HT) increased CYP1B1 gene expression in both eutopic and ectopic endometrial tissue. Patients who had more than 7 sexual partners had increased microbial dysbiosis indicated by increased composition of anaerobic bacteria in fecal and vaginal samples, indicating that increased number of sexual partners further altered microbial dysbiosis in patients with endometriosis. In conclusion, our long-term goal is to identify a unique microbiome that may serve as a potential marker to detect the early onset of endometriosis. Our study contributes to current knowledge on the expression of CYP enzyme metabolites on endometriosis. Since our patient cohorts are divided based on hormonal and surgical treatment, we hope to contribute additional knowledge on the impact of pharmacological and surgical therapy on the expression of CYP enzymes in endometriosis. Moreover, we hope to gain more understanding about mechanisms that cause alteration of CYPs gene expression in patients with endometriosis. Understanding the pathophysiology of endometriosis is critical for advancement of novel therapeutic targets and treatment of disease. Through investigation of a patient’s immune system, endocrine regulation and microbial profiling, we hope to advance our understanding of the disease and identify potential areas for improving diagnostics and therapeutic interventions.

No description available.

Endometriosis is a chronic disease that is thought to potentially begin at menarche and progress through a woman’s reproductive years. Adolescents with endometriosis present with dysmenorrhea and chronic pelvic pain. Endometriosis can be treated with medical and surgical management. Levonorgestrel intrauterine devices (LNG-IUD) are an effective option for medical management in adolescents. The primary objective of this study was to determine the rate of IUD insertion after laparoscopy for endometriosis in adolescents. The secondary objective was to compare the characteristics of the adolescent population with and without an IUD placed at the time of surgery. The medical records of 109 adolescent patients </= 21 years old were retrospectively reviewed for patient demographic information and surgical information. In our cohort, 36% of patients had an IUD placed at the time of laparoscopic surgery for endometriosis. Patients with an IUD placed at the time of surgery had a significantly higher BMI than patients who did not have an IUD placed (p = 0.004). The most reported symptoms were dysmenorrhea (77.1%) and chronic pelvic pain (94.5%). Patients with an IUD placed had higher rates of excision of endometriosis while patients who did not have an IUD placed had higher rates of ablation of endometriosis (p = 0.003, p = 0.05). Dysmenorrhea and pelvic pain are commonly reported by adolescent patients with endometriosis. LNG-IUDs are often placed at time of excision of endometriosis surgery for adolescents and further studies are warranted to see if they are effective in the long term postoperative medical management of adolescents who have completed surgery.