Influence of antiangiogenic agent Bevacizumab on endometriosis experimentally induced in rats

A endometriose, caracterizada por crescimento de tecido endometrial fora da cavidade uterina, é responsável por sintomas álgicos com grande impacto na qualidade de vida da paciente. Várias linhas de medicações têm sido estudadas para essa o tratamento da endometriose, já que a cirurgia não é o tratamento de escolha sempre e, quando realizado, não é um tratamento definitivo. O conhecimento da patogenia da endometriose é fundamental para o estudo de novas classes de medicações. Uma delas, os fatores inibitórios da angiogênese, tem papel fundamental no estabelecimento e crescimento de lesões de endometriose. Neste estudo, buscamos a influência da Bevacizumab, droga anti-fator de crescimento endotelial (anti-VEGF), utilizada em duas dosagens diferentes, em endometriose peritoneal induzida em ratas, modelo animal já bem estabelecido para o estudo de endometriose. As ratas permaneceram sob tratamento durante 4 semanas, após as quais foram sacrificadas, sendo as lesões e o corno uterino remanescente retirados para posterior avaliação. Foi realizada avaliação da área das lesões de cada rata, da presença de tecido endometrial à microscopia, da positividade para o anticorpo antiVEGF na imunohistoquímica e da expressão gênica de PCNA, MMP9, Tp63 e VEGFA. O bevacizumab atuou reduzindo a área das lesões nos grupos que receberam medicação (p=0,002) e reduzindo a expressão gênica para Tp63 nas lesões (p=0,04). Não houve resultado significativo nas outras avaliaçõesEndometriosis, characterized by growth of endometrial tissue outside the uterine cavity, is responsible for painful symptoms with great impact on the quality of life of women. Several lines of medications have been studied for endometriosis\'s treatment, since surgery is not always the treatment of choice and, when done, it is not a definitive treatment. Knowing the pathogenesis of this disease is fundamental for the study of new classes of medications. One of them, the inhibitory factors of angiogenesis, plays a fundamental role in the establishment and growth of endometriosis lesions. In this study, we sought the influence of Bevacizumab, an anti-endothelial growth factor (anti-VEGF) drug, used in two different dosages, in peritoneal endometriosis induced in rats, an animal model well established for the study of endometriosis. The rats remained under treatment for 4 weeks, after which they were sacrificed, with the remaining lesions and uterine horn being removed for further evaluation. An evaluation of the lesion area of each rat, the presence of endometrial tissue under microscopy, the positivity of the anti-VEGF antibody in immunohistochemistry and the gene expression of PCNA, MMP9, Tp63 and VEGFA were performed. Bevacizumab worked by reducing the area of the lesions in the groups receiving medication (p = 0.002) and reducing the gene expression for Tp63 in the lesions (p = 0.04). There was no significant result in the other evaluation

Endometriosis in a Patient with Mayer-Rokitansky-Küster-Hauser Syndrome

Objective. To report a case of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) in which there were two nonfunctional rudimentary uteruses with the presence of ovarian endometrioma, corroborating that there are valid alternative theories to the existence of endometriosis, rather than Sampson’s theory alone, such as the coelomic metaplasia theory. Design. A case report. Setting. A tertiary referral center, which is also a university hospital. Patient. A fifteen-year-old patient with MRKH syndrome and endometriosis. Intervention. Laparoscopic approach for diagnostic confirmation and treatment of the endometrioma. Results. Evidence of endometriosis in a patient with no functional uterus. Conclusions. This case report and a few others that are available in the literature reinforce the possibility that coelomic metaplasia could be the origin of endometriosis. Patients with müllerian agenesis and pelvic pain should be carefully evaluated, and the presence of pelvic endometriosis should not be excluded

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or >= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care