M.Tech. (Homoeopathy) / Menopause is the natural or iatrogenic termination of menstrual periods as a result of decreasing ovarian function. Natural menopause begins when menstrual periods have been absent for one year (Beers et al., 2006). The Climacteric is the period which encompasses the transition from the reproductive state to the non-reproductive state. Menopause, therefore, is a specific event that takes place during the climacteric (Collins et al., 2010). The symptoms are usually treated conventionally with Hormonal Replacement Therapy (HRT), but a large number of adverse side-effects are associated with its use (Harvey and Champe., 2009). De Schepper (2001) states that the true Homoeopathic Similimum strengthens a person’s vital force which results in the improvement of disease symptoms. Barton (2008) states that it is very difficult to accurately find the Homoeopathic Similimum for each case; therefore, Grant Bentley and his team have worked to develop a system of analysis, to facilitate the identification of the Similimum for each case. The Grant Bentley Method requires photography of the face and analysis of the facial features necessary to ascertain the miasmatic category into which the participant falls (Barton, 2008). There is no research verifying the effectiveness of this method in the treatment of climacteric symptoms. The aim of the study is to evaluate the effect of the Homoeopathic Similimum, using the Grant Bentley-method, on Climacteric symptoms. The study was carried out in the form of case studies over a twelve week period. Eleven females, between the ages of forty and sixty-five years, who were experiencing climacteric symptoms and who met the inclusion and exclusion criteria were recruited, using purposive sampling, by placing advertisements (Appendix A) in local newspapers, pharmacies and medical practices in the Vanderbijlpark area and at the Doornfontein Campus of the University of Johannesburg. The process of the study was explained to the participants and consent forms were signed (Appendix C and D). Participants, with the researcher’s help, completed a Suitability Criteria Questionnaire (Appendix B). During the first consultation the Menopause Rating Scale (MRS) (Appendix E and F) was completed and evaluated (Appendix G). The Homoeopathic case studies took the form of one-on-one conversations in order to complete a Case Taking Form (Appendix I) and incorporated a relevant physical examination and a Grant Bentley Evaluation of each participant’s facial features from which their miasmatic categories were determined (Appendix H). The participant’s case information was examined in accordance with the principles of homoeopathic classical prescribing, based on the entirety of symptoms. From this process the similimum was determined and given according to homoeopathic principles...

Objective: To evaluate associations between anxiety and severe impairment of quality of life (QoL) in Latin American postmenopausal women. Methods: This was a secondary analysis of a multicenter cross-sectional study among postmenopausal women aged 40 to 59 from 11 Latin American countries. We evaluated anxiety (The Goldberg Depression and Anxiety Scale), and QoL (Menopause Rating Scale [MRS]), and included sociodemographic, clinical, lifestyle, and anthropometric variables in the analysis. Poisson family generalized linear models with robust standard errors were used to estimate prevalence ratios (PRs) and 95% CIs. There were two adjusted models: a statistical model that included variables associated with the outcomes in bivariate analyses, and an epidemiologic model that included potentially confounding variables from literature review. Results: Data from 3,503 women were included; 61.9% had anxiety (Goldberg). Severe QoL impairment (total MRS score >=17) was present in 13.7% of women, as well as severe symptoms (MRS subscales): urogenital (25.5%), psychological (18.5%), and somatic (4.5%). Anxiety was independently associated with severe QoL impairment and severe symptoms in the epidemiological (MRS total score: PR 3.6, 95% CI, 2.6-5.0; somatic: 5.1, 95% CI, 2.6-10.1; psychological: 2.8, 95% CI, 2.2-3.6; and urogenital: 1.4, 95% CI, 1.2-1.6) and the statistical model (MRS total score: PR 3.5, 95% CI, 2.6-4.9; somatic: 5.0, 95% CI, 2.5-9.9; psychological: 2.9, 95% CI, 2.2-3.7; and urogenital: 1.4; 95% CI, 1.2-1.6). Conclusions: In this postmenopausal Latin American sample, anxiety was independently associated with severe QoL impairment. Hence, screening for anxiety in this population is important.

Objetivo do estudo: Estimar a prevalência de lesões malignas e prémalignas nos pólipos endometriais e correlacionar com fatores associados com risco de neoplasia de endométrio. Métodos: Revisados dados sobre características clínicas e resultado anatomopatológico dos pólipos ressecados em histeroscopias cirúrgicas com polipectomia realizados entre janeiro de 2005 e julho de 2013 no Hospital de Clínicas de Porto Alegre (HCPA). Resultados: Incluídas 359 pacientes submetidas a polipectomias histeroscópicas. 87,2% das pacientes apresentaram pólipos benignos e 9,9% apresentaram hiperplasia sem atipias. Pólipos com hiperplasia atýpica corresponderam a 2,6% da amostra, enquanto que adenocarcinoma de endométrio foi encontrado de 0,3% dos casos. Verificou-se correlação de resultado maligno/pré-maligno dos pólipos com idade da paciente, seu status menopausal e a presença de sangramento uterino anormal. Todas as mulheres com resultados malignos/pré-malignos apresentaram sangramento uterino anormal. Observou-se maior frequência de malignidade dos pólipos entre usuárias de tamoxifeno, porém sem significância estatística (p 0,059%). Não houve correlação com hipertensão arterial, diabetes mellitus, obesidade, uso de terapia hormonal, espessura endometrial ou diâmetro do pólipo. Conclusão: A prevalência de lesões malignas/pré-malignas nos pólipos endometriais é baixa, tendo sido nula nas pacientes sem sangramento. Não se recomenda a exérese rotineira dos pólipos em pacientes assintomáticas. / Objective: To estimate the prevalence of malignant and premalignant lesions among endometrial polyps and correlate this prevalence with risk factors for endometrial neoplasms. Methods: Review of clinical and histopathological data on polyps resected during hysteroscopic polypectomies performed from January 2005 through July 2013 at Hospital de Clínicas de Porto Alegre (HCPA), Brazil. Results: The sample comprised 359 patients who underwent hysteroscopic polypectomy. Overall, 87.2% of patients had benign polyps and 9.9% had hyperplasia without atypia. Polyps with atypical hyperplasia were found in 2.6% of patients, and endometrial adenocarcinoma, in 0.3%. Polyp malignancy/premalignancy correlated with patient age, menopausal status, and presence of abnormal uterine bleeding. All women with malignant/premalignant lesions had abnormal uterine bleeding.The rate of polyp malignancy was higher among tamoxifen users, although the difference did not reach statistical significance (p=0.059). There was no correlation with hypertension, diabetes mellitus, obesity, hormone replacement therapy, endometrial thickness, or polyp diameter. Conclusion: The prevalence of malignancy/premalignancy among endometrial polyps is low; no cases were identified in patients without uterine bleeding. Routine excision of asymptomatic polyps cannot be recommended.

Orientadores: Lúcia Helena Simões da Costa Paiva, Ana Lúcia Ribeiro Valadares / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T11:55:03Z (GMT). No. of bitstreams: 1 Gomes_DeboraAlessandradeCastro_D.pdf: 2529493 bytes, checksum: f23f380cf45b3dbde66f595b53dd5ef9 (MD5) Previous issue date: 2014 / Resumo: Os avanços científicos com a utilização da terapia antiretroviral altamente potente (TARV), proporcionaram significativo aumento na expectativa de vida das mulheres HIV soropositivas. Por outro lado, elas estão vivenciando afecções próprias do envelhecimento, como a osteoporose de etiologia provavelmente multifatorial. Objetivo: Avaliar a densidade mineral óssea e fatores associados em mulheres climatéricas HIV soropositivas. Sujeitos e Métodos: Realizado estudo de corte transversal com 273 mulheres HIV soropositivas e 264 mulheres HIV soronegativas de 40 a 60 anos de idade, acompanhadas em atendimento ambulatorial especializado. Foram avaliadas características clínicas, laboratoriais e densidade mineral óssea. Análise estatística: Foram utilizados os testes de Yates, qui-quadrado de Pearson, Mann-Whitney e análises de regressão múltipla de Poisson e regressão linear. Resultados: A média etária das mulheres HIV soropositivas foi 47,7 anos e das soronegativas 49,8 anos. As mulheres HIV soropositivas apresentavam IMC menor que 25Kg/m² (51,6%) e 59,3% estavam na pré ou perimenopausa enquanto as HIV soronegativas 29,3% tinham IMC menor que 25 kg/m² e 42,1% estavam na pré ou peri menopausa. A prevalência de baixa massa óssea em L1-L4 foi de 33,5% no grupo soropositivo e 33,2 % no grupo soronegativo (p>0.999). No colo do fêmur foi de 33,1% no grupo HIV soropositivo e 27,6 % no grupo soronegativo (p=0,266). A análise de regressão linear múltipla mostrou associação inversa entre DMO da coluna lombar e estar na pós menopausa, ser HIV soropositiva, FSH > 40 mUI/ml e direta com IMC >25 Kg/m² . Em relação a DMO no colo do fêmur houve uma associação inversa com estar na pós menopausa, cor branca e associação direta com maior paridade e IMC >25 Kg/m². Dentre as mulheres HIV soropositivas o tempo médio da infecção era de 9.9 anos, 92% usavam TARV, tempo médio de TARV era de 9,4 anos, tempo decorrido desde o diagnóstico foi em média 9,9 anos. Os fatores associados à baixa massa óssea em L1-L4 foram maior idade (p<0,001), paridade > 2 (p=0,03), estar na pós menopausa (p<0,01) e FSH > 40 mUI/ml (p<0,001). No colo do fêmur a baixa massa óssea esteve associada à maior idade (p<0,001), não usar drogas ilícitas (p=0,03), estar na pós menopausa (p<0,01) e FSH >40 mUI/ml (p<0,001). Não houve associação de baixa massa óssea na coluna lombar (L1-L4) e colo do fêmur com variáveis associadas diretamente ao HIV. A análise de regressão múltipla de Poisson verificou associação entre baixa DMO em L1-L4 e colo do fêmur apenas com estar na pós menopausa. Conclusão: Não houve diferença significativa na DMO na coluna lombar L1-L4 e no colo do fêmur nas mulheres climatéricas HIV soropositivas e soronegativas. A prevalência de osteopenia/osteoporose em mulheres climatéricas HIV soropositivas recebendo TARV foi de 33,5% em L1-L4 e de 33,1% no colo do fêmur, enquanto nas soronegativas foram 33,2 % em L1-L4 e 27,6% no colo do fêmur. Os principais fatores associados à baixa DMO foram estar na pós menopausa e menor IMC em mulheres HIV soropositivas e negativas. Ser HIV soropositivo esteve associado a baixa DMO apenas em L1-L4 / Abstract: Scientific advances in the use of highly active antiretroviral therapy (HAART), have provided a significant increase in the life expectancy of HIV positive women. Moreover, they themselves are experiencing disorders of aging, such as osteoporosis probably multifactorial etiology. Objective: To evaluate bone mineral density and associated factors in menopausal women HIV positive. Subjects and Methods: Conducted cross-sectional study of 273 HIV seropositive women and 264 HIV-seronegative women 40-60 years old, followed in a specialized outpatient care. Clinical and laboratory characteristics and bone mineral density were evaluated. Statistical analysis: tests Yates Mann-Whitney analysis of multiple Poisson regression and linear regression were used chi-square test, and. Results: The mean age of the HIV positive women was 47.7 years and 49.8 years for seronegative. HIV seropositive women had a BMI less than 25 kg / m² (51.6%) and 59.3% were pre- or perimenopausal HIV seronegative while 29.3% had a BMI less than 25 kg / m² and 42.1% were in pre- or peri-menopausal. The prevalence of low bone mass in L1-L4 was 33.5% in the HIV-positive group and 33.2% in the seronegative group (p> 0.999). Femoral neck was 33.1% in HIV-seropositive group and 27.6% in the seronegative group (p = 0.266). A stepwise multiple linear regression analysis showed an inverse association between lumbar spine BMD and being postmenopausal, be HIV seropositive, FSH> 40 mIU / ml and direct with BMI> 25 kg / m². In relation to BMD at the femoral neck there was an inverse association with being postmenopausal, white and direct association with higher parity, and BMI> 25 kg / m². Among the HIV-seropositive women the average time of infection was 9.9 years, 92% were using HAART, median time to ART was 9.4 years, time since diagnosis averaged 9.9 years. Factors associated with low bone mass in L1-L4 were older age (p <0.001), parity> 2 (p = 0.03), being postmenopausal (p <0.01) and FSH> 40 mIU / ml (p <0.001). Femoral neck low bone mass was associated with older age (p <0.001), not using illicit drugs (p = 0.03), being postmenopausal (p <0.01) and FSH> 40 mIU / ml (p <0.001). There was no association between low bone mass at the lumbar spine (L1-L4) and femoral neck variables associated directly with HIV. The analysis of multiple Poisson regression found an association between low BMD at L1-L4 and femoral neck only to be postmenopausal. Conclusion: There was no significant difference in BMD at the L1-L4 lumbar spine and femoral neck in women seropositive and seronegative climatic HIV. The prevalence of osteopenia / osteoporosis in menopausal women seropositive HIV receiving ART was 33.5% in L1-L4 and 33.1% at the femoral neck, while 33.2% were seronegative at L1-L4 and 27.6 % in the femoral neck. The main factor associated with low BMD were being menopausal and have lower BMI in HIV positive and negative women. HIV seropositive was associated with low BMD only in L1-L4 / Doutorado / Fisiopatologia Ginecológica / Doutora em Ciências da Saúde

Orientador: Mario Roberto Marostica Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-14T12:39:16Z (GMT). No. of bitstreams: 1 Netto_ClaudiaCardoso_D.pdf: 2053109 bytes, checksum: cc5fdf0563fa6ad34d6e60af9b0a023c (MD5) Previous issue date: 2009 / Resumo: Prebióticos são oligossacarídeos não digeríveis (ONDs) seletivamente fermentados pelas bactérias intestinais e agem como agentes bifidogênicos melhorando a saúde e o bem estar do hospedeiro. Os átomos de carbono das moléculas de hexosil fermentados são transformados em ácidos graxos de cadeias curtas (AGCC) e, uma vez absorvidos na mucosa intestinal, estes são metabolizados pelos enterócitos, células hepáticas e musculares. O interesse primário em relação aos AGCC tem sido relacionado à sua função colônica, especialmente o butirato. Porém, esses AGCC também estão relacionados a outros benefícios em relação a saúde do hospedeiro, como por exemplo, podem aumentar a absorção intestinal de minerais e conseqüentemente reduzir a perda de massa óssea. Como a perda de massa óssea é um processo fisiológico associado ao envelhecimento animal, o objetivo deste trabalho foi avaliar se ratas idosas com 10 (dez) meses de idade suplementadas com diferentes tipos de prebióticos (fructooligossacarídeos, inulina e galactooligossacarídeos) apresentavam redução dessa perda de massa óssea. Foram realizadas as seguintes análises: densitometria óssea (DXA) do fêmur e mandíbula; morfometria e propriedades biomecânicas do fêmur; parâmetros estáticos da histomorfometria e microscopia eletrônica de varredura da epífise proximal da tíbia; dosagem sérica de hormônio da paratireóide (PTH), osteocalcina (OC), osteoprotegerina (OPG), fator receptor ativador nuclear ?appa B ligante(RANk-L), fragmentos de colágeno tipo I (CTX-I), atividade da fosfatase alcalina (FA) total e cálcio total. Os resultados foram analisados em ANOVA (p<0,05) através do software GraphPad versão 6.0 e as diferenças estatísticas determinadas através do teste de Tukey ou t de Student. Todos os protocolos experimentais foram aprovados pelo Comitê de Ética para Experimentação Animal da Universidade Estadual de Campinas. Os experimentos foram iniciados com ratas Wistar de dez meses de idade, visto que estas apresentaram alterações significativas no metabolismo ósseo associadas à idade quanto comparadas às ratas jovens, como por exemplo, aumento no nível sérico de PTH. O consumo de prebióticos promoveu a redução da perda de massa óssea fisiológica associada ao envelhecimento, porém, outros estudos precisam ser realizados com a finalidade de descrever os mecanismos de ação / Abstract: Prebiotics are non-digestible oligosaccharides (NDO) selectively fermented by intestinal bacteria that are bifidogenic agents with health benefit on the host associated. The carbon atoms of the fermented hexosyl moiety are recovered in the short-chain fatty acids (SCFA) and once absorbed, they are metabolized by cells of cecocolonic epithelium, liver cells and muscle cells. The primary interest in SCFA has been related with colonic function as a result of their uptake and metabolism by colonocytes, specifically butyrate. Although, SCFA are also described with other benefits properties as improving intestinal mineral absorption and consequently reducing bone loss. As bone loss during later life is a physiologic mechanism, the objective of this study was to evaluate if different kinds of prebiotics attenuate age related bone loss in female rats. Old female rats (10 month-old) were treated with different kinds of prebiotics (Fructooligosaccharides, Inulin and Galactooligosaccharides). Femur and mandible bone mass was measured using dual-energy X-ray absorptiometry. Femur quality was examined using morphometry and diaphysis biomechanic properties (proportional limit, rupture limit, resilience, rigidy and tenacity) using three-point bending. Histomorphometry static parameters and scanning electron microscopy images were taken on tibiae methaphysis cancellous bone. The biochemical assays were serum parathyroid hormone (PTH), osteocalcin (OC), osteoprotegerin (OPG), receptor activator for nuclear factor ?appa B ligand (RANk-L), C-terminal peptides of type I collagen (CTXI), alkaline phosphate activity (ALP) and total calcium. All data were analyzed by twoway ANOVA (p<0,05) using GraphPad software version 6.0 and the significant differences were determined with Tukey¿s test or Student t-test. All the protocol experimental designs were approved by Animal Experimental Ethics Committee of the University of Campinas. Our experimental were taken with aged female Wistar rats that showed a satisfactory model to evaluate age related changes on bone metabolism as well as to study osteoporosis and their mechanisms. The consumption of prebiotics preserved bone mass and reduced bone turnover. Despite our prebiotics results had been positive, more studies are required to establish mechanisms of action / Doutorado / Nutrição Experimental e Aplicada à Tecnologia de Alimentos / Doutor em Alimentos e Nutrição

Orientador: Lúcia Helena Simões da Costa Paiva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T21:42:31Z (GMT). No. of bitstreams: 1 Bastos-Silva_Yasmin_M.pdf: 1080942 bytes, checksum: 7599dbea7c337dddf84a74226180fc92 (MD5) Previous issue date: 2015 / Resumo: O risco de fratura osteoporótica pode ser avaliado clinicamente baseado em fatores clínicos e pela densidade mineral óssea (DMO), entretanto esses parâmetros não são bons preditores do risco de fratura. Recentemente, o Brasil foi incluído no instrumento fracture risk assessment tool- FRAX-BRASIL, porém seu uso tem sido limitado na prática clínica. OBJETIVO: Avaliar o grau de concordância entre o risco de fratura em 10 anos calculado pelo FRAX-BRASIL com e sem densitometria em mulheres brasileiras na pós-menopausa. MÉTODO: Realizou-se um estudo de corte transversal no período de novembro de 2014 a fevereiro de 2015, com 402 mulheres em acompanhamento no Ambulatório de Menopausa do Hospital da Mulher Prof. Dr. José Aristodemo Pinotti em Campinas-SP. Foram incluídas mulheres com 40 anos ou mais, em amenorreia há pelo menos 12 meses e com exame de densitometria óssea prévio a qualquer tratamento medicamentoso para osteopenia ou osteoporose. As mulheres foram entrevistadas por um pesquisador durante a consulta de rotina, na qual foram coletadas informações sobre fatores de risco necessários para o questionário FRAX-BRASIL e dados da densitometria óssea. Os dados obtidos foram inseridos na plataforma online FRAX-BRASIL, em que foi calculado o risco para uma fratura maior e de quadril, utilizando-se somente os fatores de risco clínicos e o risco incluindo valores de DMO do colo do fêmur em g/cm2. ANÁLISE ESTATÍSTICA: Para análise do grau de concordância entre os riscos de fraturas com e sem densitometria óssea foi utilizado o coeficiente de correlação intraclasse (ICC). O Teste de Mann-whitney foi utilizado para comparação entre as médias do risco de fratura calculado com e sem DMO; para comparação entre as frequências de alto risco calculadas com e sem DMO foi utilizado o Teste de comparação entre duas proporções. Para análise da associação entre as variáveis clinico/demográficas e a variação do risco de fratura foi utilizada a análise de regressão linear. O nível de significância adotado foi <0,05. RESULTADOS: A probabilidade de fratura em 10 anos calculada pelo FRAX-BRASIL para fratura de quadril e para fratura maior somente pelos fatores de risco clínicos foi de 0,84% ±1,92 e 4,03% ±2,98 e com DMO foi de 0,83% ±1,76 e 4,05% ±2,98 respectivamente. O coeficiente de correlação intraclasse entre o FRAX-BRASIL com e sem DMO foi de 0,76 (IC95% 0,716-0,799) para uma fratura maior e de 0,644 (IC95% 0,583-0,698) para fratura de quadril. Ao avaliar as mulheres utilizando o FRAX com DMO 0,75% e 5,22% excederam os limiares de alto risco para fratura maior e de quadril, respectivamente. Sem o acréscimo da densidade óssea 1% e 11,44% apresentaram alto risco para fratura maior e de quadril, respectivamente. Dessa forma a recomendação de tratamento foi concordante entre o FRAX com e sem DMO em 99,75% dos casos de alto risco de fratura maior e de 93,78% para o quadril. Os fatores associados a menor variação FRAX com e sem foram maior idade, menor DMO, menor T-score e ausência de fratura previa tanto para fratura maior como para quadril. O menor IMC esteve associado a menor variação do FRAX apenas para fratura maior. CONCLUSÃO: O risco de fratura maior ou de quadril foi baixo na população estudada. O FRAX-BRASIL apresentou alta concordância para estimar o risco de fratura maior e concordância moderada para fratura de quadril apresentando uma estimativa de risco para fratura semelhante com ou sem DMO em nossa população / Abstract: The risk of osteoporotic fracture can be clinically evaluated based on clinical factors and by the bone mineral density (BMD), but these parameters are not good predictors of fracture risk. Recently, Brazil was included in the fracture risk assessment tool- FRAX-BRAZIL, but its use has been limited in clinical practice. GOAL: To evaluate the degree of correlation between the degree of correlation between the risk of fracture in 10 years calculated by FRAX-BRAZIL with and without densitometry in Brazilian postmenopausal women. METHODS: A cross-sectional study was conducted with 402 women followed up at the Menopause Ambulatory at the Women's Hospital Prof. Dr. José Aristodemo Pinotti in Campinas-SP. Women were included with 40 years or more in amenorrhea for at least 12 months and with bone densitometry exam prior to any drug treatment for osteopenia or osteoporosis. A researcher interviewed the women during a routine visit, where information about risk factors necessary for the FRAX-BRAZIL questionnaire and data of bone densitometry were collected. The collected data were inserted on the online platform FRAX-BRAZIL where the risk for major fractures and of the hip using only clinical risk factors and the risk including femoral neck BMD values in g / cm2. STATISTICAL ANALYSIS: To analyze the degree of correlation between the risk of fractures with and without bone densitometry was used the intraclass correlation coefficient (ICC). The Mann-Whitney test was used to compare the averages of fracture risk calculated with and without BMD; to compare the frequencies of high risk calculated with and without BMD was used the compare Test between two proportions. For analysis of the association between clinical / demographic variables and the change of the fracture risk was used linear regression analysis. The significance level was <0.05. RESULTS: The fracture probability calculated in 10 years by using the FRAX-BRAZIL for hip fracture and major fracture only by clinical risk factors was 0.84% ± 1.92 and 4.03 ± 2.98% and BMD was 0.83% ± 1.76 and 4.05 ± 2.98%, respectively. The intraclass correlation coefficient between the FRAX-BRAZIL with and without BMD was 0.76 (IC95% 0.716-0.799) for a major fracture and 0.644 (IC95% 0.583-0.698) for hip fracture. When evaluating women using FRAX with BMD 0.75% and 5.22% exceeded the high-risk thresholds for major and hip fracture, respectively. Without the increase of the bone density 1% and 11.44% presented high risk for major fractures and of hip, respectively. Then the treatment recommendation was consistent between the FRAX with and without BMD in 99.75% of cases of high risk of major fracture and 93.78% for the hip. Factors associated with less variation FRAX with and without were older, lower BMD, lower T-score, and no previous fracture both for major fracture as to hip fracture. The BMI was associated with lower variation in the FRAX only to major fracture. CONCLUSION: The risk of major fracture or of the hip was low in the study population. The FRAX-BRAZIL presented a high correlation to estimate the risk of major fractures and moderate agreement for hip fracture presenting a risk estimate for similar fracture with or without BMD in our population. The FRAX-BRAZIL presented a high correlation to estimate the risk of major fractures and moderate correlation for hip fracture presenting a risk estimate for similar fracture with or without BMD in our population / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Objetivo: Avaliar os efeitos da Sulpirida 50mg/dia comparado a placebo sobre os sintomas vasomotores (frequência e intensidade) e na qualidade de vida de mulheres climatéricas. Métodos: Mulheres climatéricas (N=28), idade entre 47 e 62 anos, com pelo menos cinco episódios de sintomas vasomotores por dia, foram recrutadas em uma clínica especializada de um hospital terciário no sul do Brasil e através de chamamentos na mídia; após os critérios de inclusão e de exclusão, elas foram randomizadas. Placebo (n=14) e Sulpirida 50mg/dia (n=14) foram administrados durante o ensaio. O número e a intensidade dos fogachos foram registrados 1 semana antes e ao longo de 8 semanas após intervenção. Aplicou-se o WHQ – 36 itens para avaliação da qualidade de vida. Resultados: As frequências e as intensidades dos fogachos/dia foram similares em ambos os grupos, observando-se uma redução em ambos os parâmetros durante as semanas de follow-up após a intervenção com Sulpirida (p=0,019 e p=0,009, respectivamente). Quanto à qualidade de vida das mulheres, Sulpirida 50mg/dia reduziu os escores dos problemas com o sono após 8 semanas de tratamento, quando comparada ao grupo placebo (p=0,017). Conclusions: Nossos resultados sugerem que o tratamento com a Sulpirida 50mg/dia se apresentou com tendências significativas na redução dos sintomas climatéricos, se justificando a replicação e outros estudos que investiguem os possíveis mecanismos pelos quais a Sulpirida poderia reduzir os fogachos, de forma segura. / Objective: To assess the effects of Sulpiride 50mg/day compared with placebo on vasomotor symptoms (frequency and intensity) and on quality of life of climacteric women. Methods: Climacteric women (N=28), aged between 47–62 years, with at least five episodes of vasomotor symptoms per day were recruited from a specialized outpatient clinic at a tertiary hospital in the south of Brazil and through a media call after inclusion and exclusion criteria were ensured. Placebo (n=14) and Sulpiride 50mg/day (n=14) were administrated during all trial period. The number and intensity records of hot flushes were evaluated for 1 week before and along 8 weeks after the intervention. The 36-item version Women’s Health Questionnaire (WHQ) was applied to assess the quality of life. Results: The frequencies and the intensities of hot flushes /day happened in a similar way in both groups, with an observed reduction of both parameters during the weekly follow up after the Sulpiride intervention (p=0.019 and p=0.009, respectively). Regarding women’s quality of life, Sulpiride 50mg/day reduced sleep problems scores after 8 weeks of treatment, when compared to placebo group (p=0.017. Conclusions: Our results suggest that the Sulpiride 50mg/day treatment showed significant trends on reducing climacteric vasomotor symptoms, justifying replication and further studies addressing the possible mechanisms by which Sulpiride could safely reduce hot flushes.

Breast cancer is the second leading cause of death in women in the U.S. The CDC estimates that between 2010 and 2020, there will be an increase in breast cancer in women in the United States by 21%, or greater 900,000 new cases per year. (CDC) Women are at increased risk for breast cancer due to the fact that some breast cancers have cells which are responsive to the hormone estrogen. Further, the risk of developing cancer increases as women age. Women who experience menopause after age 55 have an increased risk of developing breast cancer. (Surakasula et al., 2014) Phytoestrogens, which include isoflavones, are compounds found in plants and processed foods, which structurally and functionally mimic the hormone estrogen. Soy is frequently found in processed foods regularly consumed in the average American diet and is a source of isoflavones, including genistein, daidzein, and daidzein’s metabolite, equol. Phytoestrogens can bind to the estrogen receptor and change the expression of genes that respond to estrogen, such as the oncogene c-Fos, a protein in breast cancer cells which can suppress breast cancer cell growth when it is mutated (Lu et al., 2005). Phytoestrogens have been shown to reduce the severity and frequency of some of the symptoms of menopause, including a reduction in hot flashes and other estrogen deficiency-related symptoms of menopause. (Chen et al., 2015). Phytoestrogens have been used therapeutically in menopausal women, as they can compensate for lower levels of estrogen in the body. There is, however, limited research regarding the consumption of soy and increased risk for cancer in postmenopausal women. The objective of this study was to determine whether increasing levels of urinary phytoestrogen are correlated with a decreased risk of postmenopausal breast cancer. The analysis observes 2,439 postmenopausal female subjects equal to or greater than 45 years of age who had urinary phytoestrogen and reproductive health data in the 1999-2010 National Health and Nutrition Examination Survey database. The dietary data was obtained from the U.S. Department of Agriculture’s Agricultural Research Service database. Logistic regression models constructed using SAS were used to assess the change in the relative risk for cancer across low, medium, and high levels of urinary daidzein, genistein, and equol. Variables of interest, including demographic, body measures, dietary patterns, and lab measures, were compared to a base model, which adjusts for age only. It was found that the relative risk for postmenopausal breast cancer was not significantly different in the tertiles and quintiles of urinary phytoestrogens. The greatest increase in the likelihood of postmenopausal breast cancer was found to be 1.53 times in the second tertile of daidzein, increasing the risk by 53%. There was no significant protective effect of increasing levels of urinary phytoestrogens against postmenopausal breast cancer.

京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第21611号 / 理博第4518号 / 新制||理||1648(附属図書館) / 京都大学大学院理学研究科生物科学専攻 / (主査)教授 正高 信男, 准教授 後藤 幸織, 教授 髙井 正成 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DFAM

Early menopause, the cessation of ovarian function prior to age 45, affects 5-10% of Western women and is associated with an increased risk of adverse health outcomes, including premature mortality and cardiovascular disease. Recent literature suggests that high vegetable protein intake may prolong female reproductive function, but no study has evaluated the association between this exposure and early menopause. Therefore, we evaluated the relationship between cumulative vegetable protein intake as a percentage of total calories and early menopause in the Nurses’ Health Study II cohort. Women included in analyses were premenopausal at baseline (1991) and followed for up to 20 years. Cases (n=2,077) were defined as women experiencing natural menopause before age 45; women were excluded if early menopause was a result of hysterectomy, oophorectomy or radiation treatment. Non-cases were women whose age at menopause was 45 or greater or who were older than 45 and still premenopausal in 2011 (n=51,007). Intake of vegetable and animal protein was assessed every four years via food frequency questionnaires. In Cox proportional hazard models adjusting for age, smoking, diet, and behavioral factors, women in the highest quintile of cumulatively averaged vegetable protein intake (median=6.5%) had a significant 18% lower likelihood of experiencing early menopause as compared to women in the lowest quintile (3.9%) (95% CI: 0.71-0.94; P-trend=0.004). In contrast, animal and total protein was unrelated to risk. Results were similar in analyses limited to never smokers and never oral contraceptive users. Our findings suggest vegetable protein intake may be inversely associated with early menopause.