OBJETIVO: avaliação da expressão gênicado receptor do fator de crescimento semelhante à insulina de (Insulin-Like Growth Factor- IGF) 1 em células da granulosa luteinizadas do cumulusde mulheres não obesas, com sensibilidade à insulina normal, com síndrome dos ovários policísticos (SOP) tratadas e não tratadas com metformina. MODELO DO ESTUDO: prospectivo, longitudinal, randomizado. PACIENTES E MÉTODOS: avaliamos 12 mulheres com ciclosovulatórios, 9 mulheres com SOP e 8 mulheres com SOP e tratadas com metformina, ao menos 8 semanas na dose de 1.700 mg/dia. Todos os grupos foram similares com relação ao peso, ao índice de massa corporal (IMC), à circunferência da cintura e com sensibilidade à insulina normal. Todas as mulheres foram submetidas à estimulação ovariana controlada com uso de agonista de GnRH em protocolo longo e gonadotrofinas para ciclos de FIV/ICSI. As células da granulosa do cumulusforam obtidas por microdissecção dos cinco maiores folículos pré-ovulatórios. A expressão gênica do receptor de IGF-1 foi determinada com técnica da Reação da Polimerase em Cadeia a partir da Transcrição Reversa (Reverse transcriptase - Polymerase Chain ReactionRT-PCR) emiquantitativa. Foram avaliadas as concentrações séricas e foliculares de estradiol, progesterona, testosterona, hormônio folículo estimulante (Follicle-Stimulating Hormone- FSH), hormônio luteinizante (Luteinizing Hormone - LH), Sex Hormone-Binding Globulin(SHBG), glicose, insulina e IGF-1. Para análise estatística, foram utilizados os testes: ANOVA, Newman-Keuls, coeficiente de Pearsone regressão linear múltipla, sendo considerado nível de significância de 5%. RESULTADOS: não foram observadas diferenças com relação à expressão gênica do receptor de IGF-1 nos três grupos analisados (P>0,05). O número de oócitos (20,4 vs. 13,1 vs.11,5, P= 0,009), os níveis séricos de estradiol (1.896,00 pcg/mL vs. 985,20 pcg/mL vs.908,10 pcg/mL,P = 0,03) e testosterona (1,43 ng/mL vs.0,89 ng/mL vs. 0,82 ng/mL pcg/mL,P = 0,02) foram maiores no grupo de mulheres com SOP não tratadas com metformina em comparação com as mulheres com ciclos ovulatórios e tratadas com metformina, respectivamente. As mulheres com ciclos ovulatórios (50.710±42.520 ng/mL) apresentaram maiores concentrações foliculares de progesterona quando comparados com as mulheres com SOP tratadas (13.660±5.212 ng/mL) e não tratadas com metformina (17.680±6.644 ng/mL) (P=0,01). Na avaliação da regressão múltipla, a testosterona sérica não sofreu influência da expressão gênica do receptor de IGF-1 ou do IMC. CONCLUSÕES: as altas concentrações séricas de estradiol e testosterona, maior número de oócitos no grupo de mulheres com SOP não tratadas com metformina nos levam a concluir que mulheres com SOP provavelmente têm uma maior sensibilidade à estimulação da esteroidogênese ovariana quando comparadas com mulheres sem essa doença, embora não tenhasido encontrada diferença na expressão do receptor de IGF-1 nos trêsgrupos analisados. A similaridade dos resultados deste estudo entre mulheres com SOP tratadas com metformina e com ciclos ovulatórios nos levam a \"hipotetizar\" que um dos possíveis mecanismos de ação da metformina no sistema IGF-1 nas células da granulosa do cumulus poderia ser por mecanismos pós-receptores. / OBJECTIVE: evaluation of the gene expression of the IGF-I receptor in luteinized cumulus granulosa cells from non-obese women with normal insulin sensitivity and with polycystic ovarian syndrome (PCOS)treated or nor with metformin. STUDY MODEL: prospective,longitudinal, randomized. PATIENTS AND METHODS: we evaluated 12 women withovulatory cycles and 9 women with PCOS who had been treated for at least 8 weeks with a metformin dose of 1700 mg/day. All groups were similar interms of weight, body mass index (BMI), and waist circumference and all had normal insulin sensitivity. All women were submitted to controlled ovarian stimulation with a GnRH agonist in a long protocol and with gonadotropins for IVF/ICSI cycles. Cumulus granulosa cells were obtained by microdissection of the five largest pre-ovulatory follicles. Gene expression of the IGF-1 receptor was determined by semiquantitative RT-PCR. Serum and follicular concentrations of estradiol, progesterone, testosterone, FSH, LH, insulin, SHBG, and IGF-1 were determined. Data were analyzed statistically by ANOVA and by the Newman-Keuls test and the Pearson coefficient and linear multiple regression were calculated, with the level of significance set at 5%. RESULTS: no difference in geneexpression of the IGF-I receptor were observed between the three groups studied (P>0.05). The number of oocytes (20.4 vs. 13.1 vs. 11.5, P= 0.009) and the serum levels of estradiol (1,896.00 pcg/mL vs. 985.20 pcg/mL vs.908.10 pcg/mL,P = 0.03) and testosterone (1.43 ng/mL vs.0.89 ng/mL vs. 0.82 ng/mL pcg/mL,P = 0.02) were higher in the group of women with PCOS not treated with metformin than in women with ovulatory cycles and in women treated with metformin, respectively. The women with ovulatory cycles (50.710±42.520 ng/mL) presented higher follicular concentrations of progesterone compared with women with PCOS treated (13.660±5.212 ng/mL) or not with metformin (17.680±6.644 ng/mL) (P=0.01). Multiple regression revealed that serum testosterone was not affected by the gene expression of the IGF-1 receptor or by BMI. CONCLUSIONS: the high serum concentrations of estradiol and testosterone and the larger number of oocytes in the group ofwomen with PCOS not treated with metformin lead us to conclude that women with PCOS probably have greater sensitivity to stimulation ofovarian steroidogenesis than women without the disease, although no difference was detected in the expression of the IGF-I receptor between the three groups studied. The similarity ofthe present results for the women with PCOS treated with metformin and for the women with ovulatory cycles leads us to hypothesize that one of the possible mechanisms of action of metformin on the IGF-1 system in cumulus granulosa cells may be of the post-receptor type.

Made available in DSpace on 2016-08-19T18:16:07Z (GMT). No. of bitstreams: 1 DISSERTACAO GLAUCIA.pdf: 908683 bytes, checksum: 091f16039227a3ac61c8e3a16db34d0c (MD5) Previous issue date: 2012-06-18 / Polycystic Ovary Syndrome (PCOS) is diagnosed by consensus of the National Institute of Health (NIH- USA, 1990), Rotterdam (Netherlands, 2003) and Androgen Excess Syndrome - PCOS (AES-PCOS, 2006). It is important to recognize the clinical characteristics of PCOS patients in Maranhão to submit a profile Objectives: To evaluate the prevalence of the PCOS according to the current guidelines for PCOS and Maranhão women, s profile. Methodology: A cross sectional sample of 102 women diagnosed with PCOS, attending at the gynecology clinic of the Materno Infantil Hospital in São Luís -MA. The clinical classification was analyzed by applying the inclusion and exclusion criteria of the NIH, and AES- PCOS. Data were tabulated and analyzed using Microsoft Office Excel 2007 by graphs and frequency tables. Results: Most of the patients were between 20 and 25 years old with 41,2%(n= 42); brown 50%(n= 51), single 52,9%(n=54); 11years of school,44,1%(n= 45) and menarche between 12 and 14 years old with 34,3% (n= 50). They were within normal anthropometrically exception to the waist circumference where the abnormality was more common in 65, 8 %(n= 52). Clinical hyperandrogenism was observed in 51 %( n= 52) of patients, predominance of hirsutism with 32,3% (n= 33) and the laboratorial with 13,7%(n= 14). Ovulatory dysfunctional was the predominant complaint in 90, 2% ( n= 92), highlights for oligomenorrhea with 61,8%(n= 63). As for the phenotypes, there was a predominance of ovary dysfunction and policistose ovarian at 48% (n= 49) (ROTTERDAM), hyperandrogenism and dysfunction was more frequent phenotypes with 81, 1% (n= 43) (NIH) and 42, 1% (n= 43) (AES-PCOS). Conclusion: The most common feature of PCOS was hyperandrogenism and the most prevalent clinical expression was found by applying the Rotterdam criteria. / A síndrome dos ovários policísticos (SOP) é diagnosticada pelos consensos do Instituo Nacional de Saúde (National Institute of Health- NIH/ EUA, 1990), de Rotterdam (Holanda, 2003) e da Sociedade de Excesso de Androgênios e Síndrome dos Ovários Policísticos (AES- PCOS, 2006 É importante reconhecer as características clinicas da SOP nas pacientes maranhenses para a apresentação de um perfil. Objetivos: Avaliar a prevalência da SOP de acordo com os consensos vigentes para SOP e Conhecer o perfil da SOP nas mulheres maranhenses. Metodologia: Estudo transversal, com amostra de 102 mulheres com diagnóstico clínico de SOP, atendidas no ambulatório de ginecologia especializada do Hospital Universitário Materno Infantil em São Luís MA. A classificação clínica foi estabelecida pelos consensos de NIH, e AES- PCOS. Os dados foram tabulados e analisados no programa Microsoft Office Excel 2007 por meio de gráficos e tabelas de frequência. Resultados: A maioria das pacientes tinha entre 20 e 25 anos (41,2% - n=42),parda 50%(n=51), solteiras 52,9%(n=54), com ensino médio 44,1%(n=45) e menarca entre 12 e 14 anos com 34,3% (n=50), aumento de colesterol total em 22,5% (n=23), HDL em 23,5 %( n=24), Triglicérides em 9,8%( n=10), glicemia aumentada em 5,8%( n=6),com hipertensão arterial sistólica, 5,8%( n=6) e diastólica, 15,7%( n=16); índice de Massa Corpórea estava maior que 30 kg/m² em 25,5%(n=26); com 51%(52) destas mulheres com a cintura abdominal acima da normalidade(88 cm). O hiperandrogenismo foi evidente em 68,6%(70) com hirsutismo em 54,3% (32) e a disfunção ovulatória ocorreu em 90,2% (92) e ovários policísticos em 78,4% (80) das pacientes.De acordo com os consensos,os aspectos disfunção ovulatória, policistose e hiperandrogenismo com 39,2% (40) pelo consenso de Rotterdam. Nos critérios do AES, foram 58,8%(60) com hiperandrogenismo e disfunção ovulatória e o hiperandrogenismo e a disfunção ovulatória pelo NIH com 58,8% (60). Conclusão: Hiperandrogenismo, disfunção ovulatória e ovários policísticos foram mais frequentes e a queixa mais comum foi a oligomenorréia. E o hiperandrogenismo, foi a expressão clínica mais prevalente independente do critério adotado.

Το σύνδρομο των πολυκυστικών ωοθηκών (PCOS) είναι η συχνότερη ενδοκρινοπάθεια σε γυναίκες αναπαραγωγικής ηλικίας, προσβάλλοντας το 6%-10% του πληθυσμού και είναι το κυριότερο αίτιο ανωοθηλακιορηκτικής υπογονιμότητας στις γυναίκες. Χαρακτηρίζεται από υπερτρίχωση, ανωοθηλακιορηξία και υπερανδρογοναιμία και σχετίζεται σε μεγάλο βαθμό με την παχυσαρκία και την αντίσταση στην ινσουλίνη (IR). Ο σκοπός της μελέτης μας ήταν να διερευνήσουμε αν πολυμορφισμοί των γονιδίων τα οποία σχετίζονται με ειδικά χαρακτηριστικά του PCOS συνδέονται με κλινικές παραμέτρους του συνδρόμου, όπως η υπερανδρογοναιμία, ο βασικός μεταβολικός ρυθμός (BMR) και αντίσταση στην ινσουλίνη. Τα υποψήφια γονίδια τα οποία επιλέχθηκαν σε αυτήν την μελέτη ήταν τα γονίδια των αδρενεργικών υποδοχέων α2Β, β3, το γονίδιο της 17β-Υδροξυστεροειδούς Δεϋδρογενάσης τύπος 5 (HSD17B5), το γονίδιο του υποδοχέα της ινσουλίνης (IRS-1) και το γονίδιο PPARγ. Τα γονίδια των αδρενεργικών υποδοχέων α2Β, β3 είχαν συσχετισθεί με χαμηλό μεταβολικό ρυθμό και αύξηση του σωματικού βάρους σε προηγούμενες μελέτες. Καθώς η παχυσαρκία αποτελεί χαρακτηριστικό των γυναικών με PCOS, διερευνήσαμε εάν ο πολυμορφισμός του α2Β βρίσκεται στο PCOS. Το γονίδιο της 17β-Υδροξυστεροειδούς Δεϋδρογενάσης τύπος 5, (HSD17B5) είναι το γονίδιο του ενζύμου για την αναγωγή της ανδροστενεδιόνης σε τεστοστερόνη. Το γονίδιο IRS-1 έχει ένα σημαντικό ρόλο στην ρύθμιση του κυτταρικού αποτελέσματος της ινσουλίνης. Ο πολυμορφισμός της πρωτεΐνης του IRS-1 (Gly972Arg refSNP ID: rs1801278) απαντά στο 5-6% του γενικού πληθυσμού, διαταράσσει την λειτουργία του IRS-1 και σχετίζεται με την αντίσταση στην ινσουλίνη, την υπερλιπιδαιμία και σακχαρώδη διαβήτη τύπου 2. Το γονίδιο PPARγ ρυθμίζει την έκφραση πολλών γονιδίων τα οποία ενέχονται στην ομοιοστασία της γλυκόζης και των λιπιδίων. Εμείς βρήκαμε ότι ο πολυμορφισμός του α2Β (έλλειψη 301-303) δεν επηρεάζει τον βασικό μεταβολικό ρυθμό, την αντίσταση στην ινσουλίνη ή την αύξηση του σωματικού βάρους σε γυναίκες με PCOS και η επίπτωση του δεν διαφέρει από ότι στον γενικό πληθυσμό. Ο πολυμορφισμός του HSD17B5 σχετίσθηκε με αυξημένα επίπεδα τεστοστερόνης ορού και ελαττωμένο τον λόγο ανδροστενεδιόνης (Α)/ τεστοστερόνη (Τ). Η διάγνωση του PCOS βασίσθηκε στην ταυτόχρονη παρουσία βιοχημικής υπερανδρογοναιμίας, η οποία ορίσθηκε ως αυξημένη τεστοστερόνη ορού και/ή αυξημένο δείκτη ελευθέρων ανδρογόνων, χρόνια ανωορρηξία και πολυκυστική μορφολογία ωοθηκών στους υπερηχογραφικό έλεγχο. Τα αποτελέσματα της μελέτης μας επιβεβαιώνουν προηγούμενη αναφορά ότι ο πολυμορφισμός δεν έχει σημαντικό ρόλο στην γενετική παθογένεια του PCOS. Ωστόσο η παρουσία του πολυμορφισμού έχει κλινική σημασία καθώς συμβάλλει στην βαρύτητα της υπερανδρογοναιμίας. Οι συχνότητες των πολυμορφισμών των γονιδίων Pro12Ala στο PPARγ και Gly972Arg στο IRS-1στις γυναίκες με PCOS δεν διαφέρουν από το γενικό πληθυσμό, αν και η παρουσία του πολυμορφισμού Pro12Ala του PPARγ σχετίσθηκε με χαμηλό μεταβολικό ρυθμό (BMR). / Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-age women, affecting 6%–10% of the population and is the leading cause of anovulatory infertility in women. It is characterized by hirsutism, anovulation, and hyperandrogenemia and is highly associated with obesity and insulin resistance (IR). The aim of our study was to investigate, whether polymorphisms of genes associated with certain characteristics of PCOS were linked with various clinical parameters of PCOS, such as hyperandogenemia, basic metabolic rate (BMR) and insulin resistance. The candidate genes chosen for this study were the α2Β, β3 adrenergic receptor gene, 17b-Hydroxysteroid dehydrogenase type 5 gene, the IRS-1 gene, and the PPARγ gene. The α2Β, β3 adrenergic receptor gene polymorphisms were associated with low basal metabolic rate and weight gain in previous studies. As obesity is a characteristic of PCOS women, we investigated whether α2Β adrenergic receptor polymorphism is present in PCOS. 17b-Hydroxysteroid dehydrogenase type 5 (HSD17B5) is the enzyme responsible for reduction of androstenedione to testosterone. IRS-1 has an important role in regulating the cellular effect of insulin. (Gly972Arg refSNP ID: rs1801278) the polymorphism of IRS-1 protein which occurs in about 5-6% of the general population, significantly impairs IRS-1 function and is associated with IR, lipid abnormalities, and type 2 diabetes mellitus. PPARγ gene modulates the expression of many genes involved in glucose and lipid homeostasis. We found that α2Β adrenoreceptor 301–303 deletion polymorphism does not influence basal metabolic rate, insulin resistance or weight gain in women with PCOS and its prevalence did not differ from the general population. HSD17B5 variant was associated with increased serum testosterone levels and decreased androstenedione (A)/testosterone (T) ratio. Diagnosis of PCOS was based on the simultaneous presence of biochemical hyperandrogenism, which was defined as increased serum Testosterone and/or increased free androgen index, chronic anovulation, and polycystic ovarian morphology on ultrasound. The results of our study confirm an earlier report that the polymorphism can not play a major role in the genetic pathogenesis of PCOS. However the presence of the polymorphism has a clinical significance as it contributes to the severity of hyperandrogenemia in PCOS patients with biochemical hyperandrogenism. Genotype frequencies of the Pro12Ala in PPARγ2 and the Gly972Arg in IRS-1 gene polymorphisms among PCOS women did not differ from that of the general population, still the presence of Pro12Ala polymorphism of PPARγ2 was associated with lower Basic Metabolic Rate (BMR).

OBJETIVO: avaliação da expressão gênicado receptor do fator de crescimento semelhante à insulina de (Insulin-Like Growth Factor- IGF) 1 em células da granulosa luteinizadas do cumulusde mulheres não obesas, com sensibilidade à insulina normal, com síndrome dos ovários policísticos (SOP) tratadas e não tratadas com metformina. MODELO DO ESTUDO: prospectivo, longitudinal, randomizado. PACIENTES E MÉTODOS: avaliamos 12 mulheres com ciclosovulatórios, 9 mulheres com SOP e 8 mulheres com SOP e tratadas com metformina, ao menos 8 semanas na dose de 1.700 mg/dia. Todos os grupos foram similares com relação ao peso, ao índice de massa corporal (IMC), à circunferência da cintura e com sensibilidade à insulina normal. Todas as mulheres foram submetidas à estimulação ovariana controlada com uso de agonista de GnRH em protocolo longo e gonadotrofinas para ciclos de FIV/ICSI. As células da granulosa do cumulusforam obtidas por microdissecção dos cinco maiores folículos pré-ovulatórios. A expressão gênica do receptor de IGF-1 foi determinada com técnica da Reação da Polimerase em Cadeia a partir da Transcrição Reversa (Reverse transcriptase - Polymerase Chain ReactionRT-PCR) emiquantitativa. Foram avaliadas as concentrações séricas e foliculares de estradiol, progesterona, testosterona, hormônio folículo estimulante (Follicle-Stimulating Hormone- FSH), hormônio luteinizante (Luteinizing Hormone - LH), Sex Hormone-Binding Globulin(SHBG), glicose, insulina e IGF-1. Para análise estatística, foram utilizados os testes: ANOVA, Newman-Keuls, coeficiente de Pearsone regressão linear múltipla, sendo considerado nível de significância de 5%. RESULTADOS: não foram observadas diferenças com relação à expressão gênica do receptor de IGF-1 nos três grupos analisados (P>0,05). O número de oócitos (20,4 vs. 13,1 vs.11,5, P= 0,009), os níveis séricos de estradiol (1.896,00 pcg/mL vs. 985,20 pcg/mL vs.908,10 pcg/mL,P = 0,03) e testosterona (1,43 ng/mL vs.0,89 ng/mL vs. 0,82 ng/mL pcg/mL,P = 0,02) foram maiores no grupo de mulheres com SOP não tratadas com metformina em comparação com as mulheres com ciclos ovulatórios e tratadas com metformina, respectivamente. As mulheres com ciclos ovulatórios (50.710±42.520 ng/mL) apresentaram maiores concentrações foliculares de progesterona quando comparados com as mulheres com SOP tratadas (13.660±5.212 ng/mL) e não tratadas com metformina (17.680±6.644 ng/mL) (P=0,01). Na avaliação da regressão múltipla, a testosterona sérica não sofreu influência da expressão gênica do receptor de IGF-1 ou do IMC. CONCLUSÕES: as altas concentrações séricas de estradiol e testosterona, maior número de oócitos no grupo de mulheres com SOP não tratadas com metformina nos levam a concluir que mulheres com SOP provavelmente têm uma maior sensibilidade à estimulação da esteroidogênese ovariana quando comparadas com mulheres sem essa doença, embora não tenhasido encontrada diferença na expressão do receptor de IGF-1 nos trêsgrupos analisados. A similaridade dos resultados deste estudo entre mulheres com SOP tratadas com metformina e com ciclos ovulatórios nos levam a \"hipotetizar\" que um dos possíveis mecanismos de ação da metformina no sistema IGF-1 nas células da granulosa do cumulus poderia ser por mecanismos pós-receptores. / OBJECTIVE: evaluation of the gene expression of the IGF-I receptor in luteinized cumulus granulosa cells from non-obese women with normal insulin sensitivity and with polycystic ovarian syndrome (PCOS)treated or nor with metformin. STUDY MODEL: prospective,longitudinal, randomized. PATIENTS AND METHODS: we evaluated 12 women withovulatory cycles and 9 women with PCOS who had been treated for at least 8 weeks with a metformin dose of 1700 mg/day. All groups were similar interms of weight, body mass index (BMI), and waist circumference and all had normal insulin sensitivity. All women were submitted to controlled ovarian stimulation with a GnRH agonist in a long protocol and with gonadotropins for IVF/ICSI cycles. Cumulus granulosa cells were obtained by microdissection of the five largest pre-ovulatory follicles. Gene expression of the IGF-1 receptor was determined by semiquantitative RT-PCR. Serum and follicular concentrations of estradiol, progesterone, testosterone, FSH, LH, insulin, SHBG, and IGF-1 were determined. Data were analyzed statistically by ANOVA and by the Newman-Keuls test and the Pearson coefficient and linear multiple regression were calculated, with the level of significance set at 5%. RESULTS: no difference in geneexpression of the IGF-I receptor were observed between the three groups studied (P>0.05). The number of oocytes (20.4 vs. 13.1 vs. 11.5, P= 0.009) and the serum levels of estradiol (1,896.00 pcg/mL vs. 985.20 pcg/mL vs.908.10 pcg/mL,P = 0.03) and testosterone (1.43 ng/mL vs.0.89 ng/mL vs. 0.82 ng/mL pcg/mL,P = 0.02) were higher in the group of women with PCOS not treated with metformin than in women with ovulatory cycles and in women treated with metformin, respectively. The women with ovulatory cycles (50.710±42.520 ng/mL) presented higher follicular concentrations of progesterone compared with women with PCOS treated (13.660±5.212 ng/mL) or not with metformin (17.680±6.644 ng/mL) (P=0.01). Multiple regression revealed that serum testosterone was not affected by the gene expression of the IGF-1 receptor or by BMI. CONCLUSIONS: the high serum concentrations of estradiol and testosterone and the larger number of oocytes in the group ofwomen with PCOS not treated with metformin lead us to conclude that women with PCOS probably have greater sensitivity to stimulation ofovarian steroidogenesis than women without the disease, although no difference was detected in the expression of the IGF-I receptor between the three groups studied. The similarity ofthe present results for the women with PCOS treated with metformin and for the women with ovulatory cycles leads us to hypothesize that one of the possible mechanisms of action of metformin on the IGF-1 system in cumulus granulosa cells may be of the post-receptor type.

The purpose of this study was to investigate the relative contributions of previously identified Polycystic ovary syndrome (PCOS) manifestations (infertility, hirsutism, obesity, menstrual problems) to multiple psychological symptoms. Participants were 126 female endocrinology patient volunteers diagnosed with PCOS who completed a cross-sectional study of PCOS manifestations and psychological symptoms. Participants had significantly elevated scores on nine subscales of psychological symptoms. Menstrual problems were significantly associated with all symptom subscales as well as the global indicator, while hirsutism and obesity were significantly related to five or more subscales. After controlling for demographic factors, menstrual problems were the strongest predictor of psychological symptoms. Findings suggest features of excess body hair, obesity, and menstrual abnormalities carry unique risks for adverse psychologic symptoms, but menstrual problems may be the most salient of these features and deserve particular attention as a marker for psychological risk among women with PCOS.

Introduktion: Polycystiskt ovarialsyndrom ( PCOS)  är en av de vanligaste orsakerna till infertilitet och metabola störningar bland kvinnor i fertil ålder. Diagnosen vid PCOS karakteriseras av tre relaterade hälsotillstånd: ovulationsstörningar, hyperandrogenism och polycystiskt ovarial morfologi (PCOM). Oberoende av ovanstående huvuddiagnoser verkar insulinresistens (IR) och kompensatorisk hyperinsulinism spela en viktig roll för patogenesen av PCOS. Till följd av detta har ämnen som ökar insulinkänsligheten, såsom myo-inositol, hamnat i allt större fokus som en potentiell behandling av PCOS. Syftet med detta arbete var att undersöka effekten av ett kosttillskott med MI hos kvinnor som lider av infertilitet och ovulationsstörningar, med PCOS som bakomliggande sjukdom.   Metod: Detta är en litteraturstudie där litteratur sökts via databaserna PubMED och MEDLINE. Sökningen genomfördes med sökorden “PCOS” “Inositol PCOS” “myo-inositol PCOS” “myo-inositol metabolic effects PCOS” and “myo-inositol endocrine effects”. Totalt åtta originalstudier svarade mot utvalda urvalskriterier. Utifrån de utvalda studierna analyserades och sammanställdes vidare relevanta effekter av MI tillskott på infertilitet och ovulationsstörningar.  Resultat: Alla de undersökta studierna visade statistiskt signifikanta förbättringar när det gällde ovulationsstörningar. Detta indikerar även en förbättrad fertilitet hos patienterna. Signifikanta minskningar av androgena nivåer (särskilt testosteron) samt en ökad insulinkänslighet rapporterades därtill i ytterligare en majoritet av studierna (6 av 8 resp 5 av 8 studier).  Slutsats: Resultaten visar att Mi som tillskott verkar lindra ovulationsstörningar och förbättra fertilitet, vilket därtill stärker hypotesen om MI som en möjlig behandling av reproduktiva störningar hos kvinnor med PCOS. Fler studier bör genomföras för att fastställa effekten av MI-tillskott vid PCOS. / Introduction: Polycystic ovarian syndrome, PCOS is one of the most common causes of infertility and metabolic disturbances among women in reproductive age. The diagnosis of the syndrome assumes the occurrence of three interrelated health stages:  ovulation disorders, hyperandrogenism and polycystic ovarian morphology (PCOM). In addition to the main diagnoses, insulin resistance (IR) and compensatory hyperinsulinemia seems to  play an important role in the pathogenesis of PCOS. Recent studies have furthermore investigated insulin sensitizers, such as myo-inositol (MI), as a potential alternative treatment of PCOS. The aim of this study was thereby to investigate the effect of MI- supplement on PCOS patients suffering from infertility and ovulation disorders.  Method: This is a literature study relevant literature was gathered through PubMed and MEDLINE. The keywords used for the search were “PCOS” “Inositol PCOS” “myo-inositol PCOS” “myo-inositol metabolic effects PCOS” and “myo-inositol endocrine effects”. A total of 8 studies were selected based on previously determined selection criteria. Among the selected studies, relevant effects of MI-supplement on infertility and ovulation disorders in PCOS patients were further analyzed and compiled. Results: A majority of the studies reported either statistic significant ameliorated or normalized ovulation disorders, indicating an increased fertility among the patients. Likewise, a statistically significant amelioration in androgenic levels (especially testosterone) and insulin levels were also reported in a majority of the studies.  Conclusion: According to the compiled results, there seems to be an enhancing effect of MI-supplement on ovulation disorders and infertility, furthermore strengthening the hyphothesis of MI as a potential treatment for reproductive disorders in PCOS patients. Finally, more studies should be conducted to determine the effect of MI supplements on PCOS.

Das polyzystische Ovarsyndrom (PCOS) mit einer Prävalenz von 5 % – 10 % ist eine der häufigsten Endokrinopathien bei Frauen vor der Menopause. Wie bisher vermutet, handelt es sich bei PCOS um ein sogenanntes multifaktorielles Krankheitsgeschehen. Einzelne Manifestationen des Metabolischen Syndroms (MetS), wie Hyperandrogenämie, Insulinresistenz (IR) und damit verbundene Hyperinsulinämie, Dyslipidämie und ein erhöhter CRP-Spiegel, werden bereits als Risikofaktoren für Typ 2 Diabetes mellitus (DM-II) und kardiovaskulären Krankheiten (KVK) bei den Patientinnen mit PCOS verwendet. Die Konzentrationen von Leptin und Adiponektin könnten nützliche und zuverlässige Marker für das Ausmaß der metabolischen Störung bei PCOS-Patientinnen sein. In zahlreichen Studien wurde davon berichtet, dass eine additive Gabe von Metformin die IR und andere Surrogat-Parameter des MetS in gleicher Weise bei adipösen und normalgewichtigen Probandinnen verbessert. In dieser Studie wurde der Insulin-Spiegel im Rahmen eines oralen Glukose-Toleranz-Test bei der Erstdiagnose und ca. ein bis eineinhalb Jahren nach der Metformintherapie bestimmt. Die Nüchtern-Insulinwerte der Vor-Therapie-Gruppe sind im Vergleich zur Nach-Therapie-Gruppe bei 75 % der Teilnehmerinnen signifikant aus dem hyperinsulinämischen Bereich in den normoinsulinämischen Bereich abgesunken (29.7 ± 6.7 µU/ml bzw. 13.7 ± 2.7 µU/ml, P = 0.045). Vergleichbar signifikant haben sich die Werte nach ein und zwei Stunden verbessert (154.5 ± 13.6 µU/ml vs. 96.2 ± 13.9 µU/ml, P = 0.0096 bzw. 128.0 ± 19.0 µU/ml vs. 59.2 ± 13.3 µU/ml, P = 0,0104). Konsistent damit senkte sich der HOMA-Index (5.9 ± 1.4 vs. 2.8 ± 1.6, P = 0,521). Die Leptin-Konzentration sank um 50 % (39.9 ± 9.7 vs. 20.3 ± 2.9 ng/ml, P = 0.0737 bzw. (mittlere Insulinspiegel nüchtern) 29.7 ± 6.7 µU/ml vs. 13.7 ± 2.7 µU/ml, P = 0,045), und die Adiponektin-Konzentration der Nach-Therapie-Gruppe im Vergleich zur Vor-Therapie-Gruppe stieg deutlich an (5.34 ± 0.6 vs. 6.35 ± 0.8 ug/ml, P = 0.4666, ns). Somit sind die Plasmaspiegel von Leptin und Adiponektin günstige Marker zur Risikoabschätzung und Diagnostik eines PCOS, zweitens eine metabolische Frühdiagnostik, und eine frühere Erwägung und Anwendung einer Strategie zur Senkung der Insulinresistenz sind aus präventiver Sicht ratsam.

Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder characterized by at least two of the following three features: hyperandrogenism, ovulatory dysfunction and/or polycystic ovaries. Prevalence is estimated at 5-10 % of women of reproductive age worldwide and may impact between five and ten million women in the U.S. alone. Rather than a distinct disease entity, PCOS is characterized as a clustering of clinical concerns which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. Our intent was to examine how these three PCOS characteristics impact psychological symptoms (e.g., depression, anxiety, interpersonal sensitivity) and PCOS health related quality of life concerns (weight, hair, infertility, menstrual, emotions). Design: Cross-sectional, correlational Setting: Women were recruited from private endocrinology practices in the rural Southeastern U.S. Patients/Participants: The study sample consisted of 126 women with PCOS. Half of these women were currently attempting to conceive in addition to being treated for their PCOS. The average woman in the study was 30 years of age (M=30.3, range=18-48), White (98 %) and married (79%). On average, participants weighed over 200 pounds (M=213.6 lbs, 116-361 lbs). Methods: During the seven-month enrollment period, women diagnosed with PCOS were invited to participate. Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Insulin level predicted increased levels of symptoms related to somatization, psychoticism, and a global symptom severity index. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to have a baby had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life. Future attention might focus on screening and possible referring to mental health services for women not trying or no longer trying to conceive.

O objetivo do presente trabalho consistiu na identificação de elementos valorativos e perceptivos que o Poder Judiciário tem em relação ao agente de segurança penitenciária (ASP), discriminando temas, ênfases e tendências. Para a sua consecução, foram realizadas oito entrevistas semidirigidas com juízes atuantes em Varas de Execução Criminal do Estado de São Paulo. A apresentação do estado da arte demonstrou a pluralidade de ângulos sob os quais a temática relativa aos agentes penitenciários vem sendo estudada. O levantamento bibliográfico revelou ser escassa a literatura sobre a percepção do Poder Judiciário acerca dos ASPs. Foram criadas, a partir das entrevistas realizadas, dez categorias de análise: preparo, papel e formas de atuação do ASP; relacionamento entre os ASPs e o Poder Judiciário; relacionamento entre ASP e preso; relacionamento entre ASP e a direção da unidade prisional em que trabalham; probidade dos ASPs; vulnerabilidade e segurança do ASP no exercício da sua profissão; valorização, por parte do Poder Judiciário, do depoimento do ASP; condições de trabalho do ASP; fatores emocionais relacionados ao trabalho do ASP; impacto do crime organizado na atuação do ASP. Da apresentação e análise dos dados resultaram 18 súmulas analítico-descritivas. No capítulo destinado às conclusões, foram apresentadas as principais contribuições desta pesquisa, as quais consistiram na identificação dos principais temas que premeiam a visão do Judiciário sobre os ASPs e dentro deles as tendências e as ênfases prevalecentes. Estes temas foram agrupados em cinco linhas perceptivas: função do ASP: ressocializadora vs. disciplinar ênfase sobre a valorização da ressocialização; poder do ASP tendência dos juízes em respaldar o ASP para aumentar seu poder e ênfase no rearranjo no equilíbrio de poder em face da atuação das facções criminosas; influência da facção criminosa no trabalho do ASP ênfase sobre o atentado à probidade do agente e ao aumento de vulnerabilidade dos ASPs; impactos psicossociais do trabalho do ASP ênfase no adoecimento decorrente da prática profissional e no processo de prisionalização; e contexto de atuação do ASP ênfase na insalubridade e nos aspectos relativos à carreira do ASP. A seguir, é apresentado um conjunto de reflexões críticas com base nos resultados da pesquisa, na análise da literatura estudada e em diálogo com as vivências profissionais da pesquisadora. Em seguida, foram sugeridos temas para novas pesquisas e, por fim, propostas de interação envolvendo os principais especialistas e atores no processo de execução penal. / The objective of this work is to identify the perceptions and value attributed to Penitentiary Correctional Officers (PCOs) by the Judiciary, pointing out themes, emphases, and trends. This work was accomplished through eight semi-directed interviews conducted with judges active in the Criminal Court on the Enforcement of Sentences of the State of Sao Paulo. The execution of this work has demonstrated the wide array of ways in which correctional officers are studied. The bibliographical search has revealed a scarcity of literature referring to the Judiciary\'s perception of the PCOs. Ten categories of analysis emerged from the interviews conducted: the preparation, role and work of the PCOs; the relationship between the PCOs and the Judiciary; the relationship between the PCO and the incarcerated; the relationship between the PCOs and the management of the prison unit in which they work; probity of the PCOs; vulnerability and security of the PCOs in the workplace; credit of the PCOs testament, as perceived by the Judiciary; work conditions of the PCOs; emotional factors related to the work of the PCOs; and the impact of organized crime in the work of the PCOs. The presentation and analysis of the data resulted in 18 descriptive-analytic summaries. The concluding chapter presents the main contributions of this research, consisting in the identification of the main themes that inform the vision of the Judiciary regarding PCOs and its prevailing emphases and trends. These themes were grouped into five lines of thought: the function of the PCO: resocializing vs. disciplinary - emphasis on the value of resocialization: the power of the PCO - the tendency of the judges in supporting PCOs to increase their power and the emphasis in the rearrangement of the balance of power vis-a-vis criminal factions; the influence of the criminal faction in the work of the PCO -- emphasis on the attempts to discredit PCOs and increasing vulnerability of the PCOs; psycho-social impact of the work of the PCO - emphasis on illness associated with the work and imprisonment; and context of the work of the PCO - emphasis on the unhealthfulness relative to the career of the PCO. Next follow critical reflections based on research results, the analysis of the literature review, and in dialogue with the professional experiences of the researcher. Following that is a presentation of themes for future research and, finally, a proposal for the evolving interaction of the primary specialists and actors in the process of penal execution.

Metformineinnahme scheint reproduktive und metabolische Funktionen bei Frauen mit PCOS zu verbessern. Die zwiespältige aktuelle Studienlage kann bisher keine konkrete Aussage liefern, ob Metformin eine erfolgreiche therapeutische Möglichkeit des Syndroms darstellt. Ziel der vorliegenden randomisierten, placebo-kontrollierten Studie war es, die Auswirkung des antihyperglykämischen Medikaments Metformin in Kombination mit Ernährungsberatung und Sport auf übergewichtige Frauen mit PCOS zu ermitteln. Besondere Aufmerksamkeit galt der Wirkung des Medikaments hinsichtlich Insulin und Glukose-Stoffwechsel, endokrinologischen und biochemischen Parametern, sowie dem Menstruationszyklus. 46 adipöse Frauen mit PCOS im Alter von 22 bis 39 Jahren und mit einem mittleren BMI von 38,1 nahmen an der Studie teil. Die verabreichte Dosis von Metformin betrug 1,5 g (3x500 mg) täglich über einen Zeitraum von 16 Wochen. Gemessen wurden Veränderungen von FSH, LH, Oestradiol, Testosteron, DHEA-S, SHBG, Cholesterol, Triglyzeriden, Insulin, Glukose, HbA1c, Leptin und IGF-I im Serum. Monatlich wurde eine Ernährungsberatung angeboten. Jede Teilnehmerin erhielt darüber hinaus individuelle dietätische Beratung. Signifikante Gewichtsreduktion (P / Use of metformin seems to improve reproductive and metabolic abnormalities in women with PCOS. However, the disparity of results in clinical studies cannot give us a conclusive answer if metformin is a new line therapy of the syndrome. The present randomised, placebo-controlled study was designed to compare the antihyperglycemic drug metformin vs. placebo combined with lifestyle modification in the treatment of polycystic ovary syndrome in obese women. Special attention was paid to the effects of this medication on insulin and glucose metabolism, endocrine and biochemical parameters, and menstrual function. Forty six obese women with PCOS, aged between 22-39 years and mean BMI 38.1 were randomized to receive either metformin (500 mg three times a day for 16 weeks) or placebo. The metformin and placebo groups were matched for age, endocrinological and metabolic parameters. Changes in FSH, LH, estradiol, testosterone, DHEA-S and SHBG, total cholesterol, triglycerides, insulin, glucose, HbA1c, leptin and IGF-I were assessed. Group therapy with aspects in nutrition and physical activity was conducted monthly. Each woman received individual counselling by a dietician. Significant (P