Orientador: Adriana Orcesi Pedro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T12:20:09Z (GMT). No. of bitstreams: 1 Carmignani_LucioOmar_M.pdf: 2392759 bytes, checksum: a5c2901d4556742da71bc7aadac07581 (MD5) Previous issue date: 2008 / Resumo: Objetivos: Comparar os efeitos da ingestão diária de um suplemento alimentar à base de soja, terapia hormonal (TH) de baixa dosagem e placebo sobre os sintomas menopausais psicológicos, somáticos e urogenitais em mulheres na pós-menopausa e avaliar os efeitos sobre os principais marcadores de risco cardiovascular. Métodos: Ensaio clínico randomizado, duplo-cego e controlado envolvendo 60 mulheres sintomáticas com tempo médio desde a menopausa de 4,1 anos, com idade entre 40 e 60 anos. Foram selecionadas e randomizadas em três grupos: um grupo recebeu um suplemento alimentar à base de soja (isoflavona 90mg/dia), outro grupo recebeu terapia hormonal de baixa dose (estradiol 1mg e acetato de noretisterona 0,5mg) e um grupocontrole que recebeu placebo, por um período de 16 semanas. Foi utilizado o Menopause Rating Scale (MRS) para avaliar as mudanças nos sintomas climatéricos no início e após 16 semanas de tratamento. Também foram avaliados o perfil lipídico, glicemia, índice de massa corpórea, pressão arterial e relação cintura-quadril em todas as participantes no início e final do tratamento. Com o intuito de avaliar os efeitos deste tratamento sobre os níveis hormonais endógenos, foi medida a concentração sérica do hormônio folículo-estimulante (FSH) e o 17'beta'-estradiol. A análise estatística foi realizada usando-se o teste do qui-quadrado, teste exato de Fisher, análise de co-variância, teste não paramétrico de Kruskal-Wallis, teste t de Student pareado, teste de Kruskal-Wallis (seguido por Mann-Whitney), teste de Wilcoxon pareado, teste ANOVA (seguido de Tukey) e teste não paramétrico de Kruskal-Wallis (seguido de Mann-Whitney). Resultados: os resultados mostraram uma diminuição da pontuação do MRS total, comparando-se o início e o final do tratamento em todos os grupos, não havendo diferença estatística entre eles. Houve uma melhora significativa dos sintomas somáticos (fogachos e queixas articulares/musculares) e urogenitais (secura vaginal) nos grupos TH e soja. Em relação aos sintomas psicológicos, não houve diferença entre os grupos estudados: todos apresentaram uma melhora semelhante. Após 16 semanas de intervenção, o colesterol total diminuiu em 11,3% e o LDL-colesterol diminuiu 18,6% apenas no grupo TH. As triglicérides, HDL-colesterol, glicemia, índice de massa corpórea, pressão arterial, e relação cintura-quadril não se alteraram durante o tratamento nos três grupos. O FSH diminuiu e o 17'beta'-estradiol aumentou apenas no grupo TH. Conclusões: Este estudo sugere que o tratamento com suplemento alimentar à base de soja pode ser uma terapia alternativa efetiva para os sintomas somáticos e urogenitais relacionados à menopausa. O suplemento alimentar à base de soja não mostrou efeito favorável significativo sobre os marcadores de risco cardiovascular quando comparados ao uso da TH / Abstract: Objectives: To compare the effects of daily ingestion of soy dietary supplement, low-dose hormone therapy (HT) and placebo on menopausal psychological, somatic and urogenital symptoms in postmenopausal women and to assess the effects on the main biomarkers of cardiovascular health. Methods: This was a double-blind, randomized and controlled intention-to-treat trial. Sixty healthy postmenopausal women, aged 40-60, 4.1 years mean time since menopause were recruited and randomly assigned to three groups: a soy dietary supplement group (isoflavone 90mg/day), a low-dose HT group (estradiol 1mg plus noretisterone acetate 0.5mg) and a placebo group. The Menopause Rating Scale (MRS) was used to assess change in menopausal symptoms at baseline and after 16 weeks of treatment. Lipid profile, glucose level, body mass index, blood pressure and abdominal/hip ratio were evaluated in all the participants at the baseline and after 16 weeks. To examine the effects of this regime on endogenous hormone levels, follicle-stimulating hormone (FSH) and 17 'beta'-estradiol were measured. Statistical analyses were performed using chi-square test, Fisher¿s exact test, repeated-measures analysis of co-variance, Kruskal-Wallis non-parametric test, paired Student¿s t test, Kruskal-Wallis test (followed by Mann-Whitney test), paired Wilcoxon test, ANOVA test (followed by Tukey test) and Kruskal-Wallis non-parametric test (followed by Mann-Whitney test). Results: The data showed decrease in MRS total score comparing baseline values and after 16 weeks in all of the groups, but without statistical difference among the groups. There was significant improvement in somatic (hot flashes and joint/muscle complaints) and urogenital (vaginal dryness) symptoms from baseline to after 16 weeks for both the HT and soy groups, compared with the placebo group. There was no difference among the studied groups concerning psychological symptoms: all three groups showed a similar improvement. After a 16 weeks intervention period, total cholesterol decreased 11.3% and LDLcholesterol decreased 18.6% in HT group, but in the soy dietary supplement and placebo groups it did not change. The values for triglycerides, HDL-cholesterol, glucose level, body mass index, blood pressure, and abdominal/hip ratio did not change over the time in all of the three groups. FSH decreased and 17'beta'-estradiol increased only in the HT group. Conclusions: This study suggests that a soy dietary supplement may be an effective alternative therapy for somatic and urogenital symptoms. The use of dietary soy supplement did not show a significant favorable effect on cardiovascular health biomarkers comparing with HT / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

Corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) are major physiological stimulators of adrenocorticotropin (ACTH) secretion from the pituitary gland, while glucocorticoids act as inhibitors. In addition to acting alone, CRH, AVP and glucocorticoids interact with each other to regulate ACTH release in response to stress. Prolonged or repeated stimulus results in attenuated ACTH responsiveness, a process termed as desensitization. The aim of this study was to investigate the effects of interactions between CRH, AVP and steroids on desensitization of the ACTH response to AVP. Perifused ovine anterior pituitary cells were stimulated with three 5-min pulses of 100 nM AVP at 120, 200 and 280 min, and were continuously exposed to CRH (0.2 nM) from 80 min and/or cortisol (10-500 nM) from 0 min onwards. Desensitization was induced by a 15 min pre-treatment with 5 nM (0.5 nM for CRH alone) AVP immediately preceding the second AVP pulse. When CRH was absent, pre-treatment with 0.5 nM AVP did not influence the ACTH response to the second AVP pulse. In the presence of CRH, the response to the second AVP pulse was reduced to 66.7±2.2% of control (n=6, P<0.0001, t-test). On the other hand, following 5 nM AVP pre-treatment, continuous perifusion with cortisol (100 nM) results in a significantly smaller reduction in the response to the second AVP pulse compared with that seen in its absence (78.4±1.7% c.f. 66.7±1.9% of control; n=10, P<0.001, t-test). In contrast to this, following 5 nM AVP pre-treatment, continuous CRH and cortisol in combination results in a greater reduction in the response to the second AVP pulse compared with that obtained in the absence of these two hormones (46.5±1.7% c.f. 66.2±1.7 of control; n=8, P<0.0001, t-test). Taken together, these data suggest that desensitization of the ACTH response to AVP can be modulated by CRH and/or cortisol: CRH or CRH and cortisol in combination amplify this desensitization, whereas cortisol reduces it.

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El presente trabajo de investigación se ha realizado teniendo en cuenta el Reglamento de Grados y Títulos de la Escuela de Pre Grado de la Facultad de Medicina de la Universidad Nacional Mayor de San Marcos, con la finalidad de obtener el título de Médico Cirujano. Objetivo: La investigación estuvo orientada a identificar los factores de riesgo asociados al uso de terapia de reemplazo hormonal, en mujeres posmenopáusicas que se atendieron en el Hospital Nacional Arzobispo Loayza en el período comprendido entre el 01 de Enero y el 31 de Diciembre del 2009 Muestra: La muestra seleccionada estuvo comprendida por 178 pacientes, 89 casos y 89 controles. Instrumentos: Los instrumentos empleados estuvieron conformados por una ficha de recolección de datos convenientemente elaborada para los fines de estudio, se analizó la asociación de las variables a través de la prueba del Chi cuadrado, asimismo la fuerza de asociación con OR, se consideró α: 0,05. Tipo de Estudio: Observacional. Diseño de investigación: Analítico de casos y controles, transversal y retrospectivo. Resultado: La investigación nos demuestra un mayor uso de terapia de reemplazo hormonal en la población femenina con grado de instrucción secundaria (n=40), en las pacientes sin antecedente patológicos (n=51), en las que no presentan antecedentes quirúrgicos (n=30) y en pacientes con sintomatología climatérica (n=46). Conclusiones: Se concluye en el estudio que hay una asociación estadísticamente significativa del uso de terapia de reemplazo hormonal con el grado de instrucción (p=0.009) (OR=4.6), con antecedentes patológicos (p=0.009) (OR=3.0), con antecedentes quirúrgicos (p=0.017) (OR=0.4) y con síntomas climatéricos (p=0.034) (OR=0.5). / The present investigation work has been carried out keeping in mind the Regulation of Grades and Holding of the School of Pre Grade of the Ability of Medicine of the National University bigger than San Marcos, with the purpose of obtaining Medical Surgeon's title. Objective: The investigation was guided to identify the factors of risk associated to the use of therapy of hormonal substitution, in women posmenopáusicas that were assisted in the Hospital National Archbishop Loayza in the period understood between January 01 and December of the 2009. Sample: The selected sample was understood by 178 patients, 89 cases and 89 controls. Instruments: Were the used instruments conformed by a record of gathering of data meetly elaborated for the study ends, was the association of the variables analyzed through the test of the square Chi, was the association force with OR, considered also?: 0,05. Type of Study: Observational. Investigation design: Analytic of cases and controls, traverse and retrospective. Result: The investigation demonstrates us a bigger use of therapy of hormonal substitution in the feminine population with grade of secondary instruction (n=40), in the patients without pathological antecedent (n=51), in those that don't present surgical antecedents (n=30) and in patient with sintomatología climacteric (n=46). Conclusions: You concludes in the study that there is an association statistically significant of the use of therapy of hormonal substitution with the instruction grade (p=0.009) (OR=4.6), with pathological antecedents (p=0.009) (OR=3.0), with surgical antecedents (p=0.017) (OR=0.4) and with symptoms climacteric’s (p=0.034) (OR=0.5).

No description available.

Corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) are major physiological stimulators of adrenocorticotropin (ACTH) secretion from the pituitary gland, while glucocorticoids act as inhibitors. In addition to acting alone, CRH, AVP and glucocorticoids interact with each other to regulate ACTH release in response to stress. Prolonged or repeated stimulus results in attenuated ACTH responsiveness, a process termed as desensitization. The aim of this study was to investigate the effects of interactions between CRH, AVP and steroids on desensitization of the ACTH response to AVP. Perifused ovine anterior pituitary cells were stimulated with three 5-min pulses of 100 nM AVP at 120, 200 and 280 min, and were continuously exposed to CRH (0.2 nM) from 80 min and/or cortisol (10-500 nM) from 0 min onwards. Desensitization was induced by a 15 min pre-treatment with 5 nM (0.5 nM for CRH alone) AVP immediately preceding the second AVP pulse. When CRH was absent, pre-treatment with 0.5 nM AVP did not influence the ACTH response to the second AVP pulse. In the presence of CRH, the response to the second AVP pulse was reduced to 66.7±2.2% of control (n=6, P<0.0001, t-test). On the other hand, following 5 nM AVP pre-treatment, continuous perifusion with cortisol (100 nM) results in a significantly smaller reduction in the response to the second AVP pulse compared with that seen in its absence (78.4±1.7% c.f. 66.7±1.9% of control; n=10, P<0.001, t-test). In contrast to this, following 5 nM AVP pre-treatment, continuous CRH and cortisol in combination results in a greater reduction in the response to the second AVP pulse compared with that obtained in the absence of these two hormones (46.5±1.7% c.f. 66.2±1.7 of control; n=8, P<0.0001, t-test). Taken together, these data suggest that desensitization of the ACTH response to AVP can be modulated by CRH and/or cortisol: CRH or CRH and cortisol in combination amplify this desensitization, whereas cortisol reduces it.

Mestre -- Universidade de Sao Paulo. Faculdade de Saude Publica. Departamento de Saude Materno-Infantil, Sao Paulo, 2003.

Made available in DSpace on 2014-06-11T19:35:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-08-07Bitstream added on 2014-06-13T20:26:16Z : No. of bitstreams: 1 piagentini_m_dr_botfmvz.pdf: 267759 bytes, checksum: c4056ececa2c37d7a0e0df2a9a4aefa2 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O presente trabalho teve por objetivo comparar a composição bioquímica e as concentrações de testosterona e progesterona no líquido amniótico de fetos bovino da raça Nelore produzidos por fecundação in vivo, fecundação in vivo com transferência de embrião (TE) e produção in vitro (PIV). Os problemas fetais observados ao momento do parto e pós-parto imediato em animais oriundos de PIV e a escassez de pesquisas que determinem a composição do líquido amniótico associada aos três sistemas de produção embrionária permitiram o desenvolvimento deste trabalho. Utilizaram-se 60 animais divididos em: grupo 01 - vacas Nelore gestando bezerros oriundos de inseminação artificial (IA) (n=20); grupo 02 - receptoras gestando bezerros Nelore provenientes de inovulações de embriões oriundos de doadoras superovuladas pelo método convencional (n=20); grupo 03 - receptoras de embriões gestando bezerros Nelore originados de inovulações de embriões oriundos de doadoras pelo método de aspiração folicular (n=20). No momento do parto, após a visualização das bolsas, colheram-se 15mL de líquido amniótico por punção da bolsa com agulha e seringa adequadas. As amostras foram processadas e analisadas no serviço de laboratório clínico do Departamento de Clínica Veterinária da FMVZ/UNESP de Botucatu-SP e no Laboratório de Endocrinologia do departamento de Reprodução Animal e Radiologia Veterinária. Para análise bioquímica foram utilizados Kits comerciais seguindo a técnica recomendada pelo fabricante. A dosagem hormonal de progesterona (P4) e testosterona (T) foi determinada por meio de radioimunoensaio em fase sólida com a leitura realizada em contador Gama Count Cobra II. Os dados obtidos na avaliação bioquímica e no perfil hormonal foram submetidos à análise de variância (ANOVA) e, uma vez demonstrada diferença estatística por 22 esse teste aplicou-se o Método de Tukey, com 5% de nível de significância. / The present work had for objective to compare the biochemical composition and the concentrations of testosterone and progesterone in the amniotic fluid of fetuses of the Nelore cows produced by in vivo fecundation, in vivo fecundation at embryo transfer (ET) and in vitro production (IVP). The fetal problems observed at the delivery moment and at the immediate post-partum in animals originating from IVP and the shortage of researches that determine the composition of the amniotic fluid associated to the three systems of embryonic production allowed the development of this work, adding results to the studies that are being done by other researchers with the placenta of IVP animals. Sixty animals were used divided into 3 groups: Group 1 - Nelore cows pregnant with calves conceived by artificial insemination (AI) (n=20); Group 2 – receptor cows pregnant with Nelore calves provement from superovulation of embryo donors (n=20); Group 3 – receptor cows pregnant with Nelore calves obtained by in vitro production after follicular aspiration (n=20). At the delivery moment, after the visualization of the sacs, 15mL of amniotic liquid were collected by puncture. The samples were processed and analyzed in the service of clinical laboratory of the Department of Veterinary Clinic of FMVZ/UNESP of Botucatu-SP and in the Laboratory of Endocrinology of the department of Animal Reproduction and Veterinary Radiology. For biochemical analysis commercial kits were used following the technique recommended by the manufacturer. The hormonal determinaton of progesterone (P4) and testosterone (T) was performed through radioimmunossay (RIA) in solid phase with the reading accomplished in accountant Gama Count Collects II. The data obtained in the biochemical evaluation and in the hormonal profile were submitted to the variance analysis (ANOVA) and, once demonstrated a statistic difference by that method the Tukey test was applied, with a 24 5% of level significancy.