Premenstrual dysphoric disorder review: concept, history, epidemiology and etiology

Epidemiologic studies show that till 80% of the women have physical and/or psychiatric symptoms in the premenstrual period, and in about 3% till 11% of them, this disease has serious consequences, causing familiar or professional damages; characterizing the premenstrual dysphoric disorder. The premenstrual dysphoric symptoms happen in the week before menstruation, stopping in the first days after menstruation beginning. A lot of theories have been proposed to justify its etiology. Hormonals, psychological and environmental factors seem to be involved, however there are no strict conclusions to justify this pathology.Estudos epidemiológicos demonstram que até 80% das mulheres apresentam sintomas físicos e/ou psíquicos no período pré-menstrual e que cerca de 3% a 11% os apresentam de maneira severa, havendo prejuízos sociais, familiares ou profissionais, o que caracteriza o transtorno disfórico pré-menstrual (TDPM). O TDPM apresenta sintomas que aparecem na semana que antecede a menstruação, cessando nos primeiros dias após o início desta. Diversas teorias têm sido propostas para justificar a sua etiologia. Fatores hormonais, psicológicos e ambientais parecem estar envolvidos; no entanto, ainda não há conclusões precisas que justifiquem essa patologia

Análisis del Comportamiento de la Precipitación Estimada a partir de datos TRMM sobre Áreas de Intensa Deforestación en La Amazonía Legal en el Periodo 2001-2013

With 6.5 million km2, the Amazon basin is the largest hydrological system in the world, with estimated discharges of 209,000 m3s-1, it is the largest continuous extension of tropical forest. However, this region is the target of constant threats, whether due to deforestation or climate change. In this context, understanding the functioning of the system is essential, either to assist in decision-making or studies of future scenarios. The aim of this study was to analyze the spatial-temporal distribution of precipitation in areas with high deforestation rates in the Brazilian Amazon basin. For this analysis, NASA’s Tropical Rainfall Measuring Mission (TRMM), product 3B43_V6 during the period 2001-2013, estimated monthly rainfall data and the annual rate of deforestation estimated by PRODES are used. Rainfall estimation of the TRMM satellite show good correlations with the data of the observed stations, besides it represents satisfactorily the annual variations of precipitation during the studied period. For the years with the highest rate of deforestation (2001-2006 and 2008), there was a precipitation deficit represented by negative anomalies, while in the recovery period (2009-2013) positive correlations were obtained. Overall, deforestation seems to exert some influence on precipitation. The extensive application of remote sensing techniques using the new Earth Observation programs for monitoring of the correlation studied in The Legal Amazon as a future line areproposed.Con 6,5 millones de Km2, la cuenca Amazónica es el mayor sistema hidrológico del mundo, con descargas estimadas de 209.000 m3s-1, es la mayor extensión continua de bosque tropical. Sin embargo, esta región es el blanco de constantes amenazas, sea por deforestación o por alteraciones climáticas. En este contexto, comprender el funcionamiento del sistema es esencial, sea para auxiliar en la toma de decisiones o estudios de escenarios futuros. Este trabajo tuvo como objetivo analizar la distribución espacio-temporal de la precipitación sobre áreas con alta tasa de deforestación en la cuenca de La Amazonía Legal de Brasil. Para este análisis se utilizaron datos de precipitación mensual estimada por la misión Tropical Rainfall Measuring Mission (TRMM) de NASA, producto 3B43_V6 durante el periodo 2001-2013 y la tasa anual de deforestación estimada por PRODES. Las estimaciones de la precipitación del satélite TRMM muestran buenas correlaciones con los datos de las estaciones observadas, además representa satisfactoriamente las variaciones anuales de precipitación durante el periodo estudiado. Para los años de mayor tasa de deforestación (2001-2006 y 2008) existió un déficit de precipitación representado por las anomalías negativas mientras que en el periodo de recuperación (2009-2013) se obtiene correlaciones positivas. De modo general, se observó que la deforestación parece ejercer ciertas influencias sobre la precipitación. Se propone como línea futura la aplicación extensiva de técnicas de teledetección de los nuevos programas de Observación de la Tierra para el monitoreo de la correlación estudiada en La Amazonía Legal

Eosinophilic esophagitis in patients with typical gastroesophageal reflux disease symptoms refractory to proton pump inhibitor

BACKGROUND: TREATMEN The contribution of eosinophilic esophagitis (EoE) to refractory gastroesophageal reflux disease (GERD) remains unknown. When EoE and GERD overlap, the clinical, endoscopic and histological findings are nonspecific and cannot be used to distinguish between the two disorders. Limited data are available on this topic, and the interaction between EoE and GERD is a matter of debate. AIM: We have conducted a prospective study of adult patients with refractory GERD to evaluate the overlap of reflux and EoE. METHODS: Between July 2006 and June 2008, we consecutively and prospectively enrolled 130 male and female patients aged 18 to 70 years old who experienced persistent heartburn and/or regurgitation more than twice a week over the last 30 days while undergoing at least six consecutive weeks of omeprazole treatment (at least 40 mg once a day). The patients underwent an upper digestive endoscopy with esophageal biopsy, and intraepithelial eosinophils were counted after hematoxylin/eosin staining. The diagnosis of EoE was based on the presence of 20 or more eosinophils per high-power field (eo/HPF) in esophageal biopsies. RESULTS: Among the 103 studied patients, 79 (76.7%) were females. The patients had a mean age of 45.5 years and a median age of 47 years. Endoscopy was normal in 83.5% of patients, and erosive esophagitis was found in 12.6%. Only one patient presented lesions suggestive of EoE. Histological examination revealed >20 eo/HPF in this patient. CONCLUSION: Our results demonstrated a low prevalence of EoE among patients with refractory GERD undergoing omeprazole treatment

Historical analysis of the Brazilian cervical cancer screening program from 2006 to 2013: a time for reflection

BACKGROUND: The Cervical Cancer Database of the Brazilian National Health Service (SISCOLO) contains information regarding all cervical cytological tests and, if properly explored, can be used as a tool for monitoring and managing the cervical cancer screening program. The aim of this study was to perform a historical analysis of the cervical cancer screening program in Brazil from 2006 to 2013. MATERIAL AND METHODS: The data necessary to calculate quality indicators were obtained from the SISCOLO, a Brazilian health system tool. Joinpoint analysis was used to calculate the annual percentage change. RESULTS: We observed important trends showing decreased rates of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and an increased rate of rejected exams from 2009 to 2013. The index of positivity was maintained at levels below those indicated by international standards; very low frequencies of unsatisfactory cases were observed over the study period, which partially contradicts the low rate of positive cases. The number of positive cytological diagnoses was below that expected, considering that developed countries with low frequencies of cervical cancer detect more lesions annually. CONCLUSIONS: The evolution of indicators from 2006 to 2013 suggests that actions must be taken to improve the effectiveness of cervical cancer control in Brazil

Trend analysis of the quality indicators for the Brazilian cervical cancer screening programme by region and state from 2006 to 2013

Quality indicators for the Brazilian cervical cancer screening programme can provide a perspective on its effectiveness in Brazilian macro-regions and states. The aim of this study was to perform a trend analysis of the cervical cancer screening program's quality indicators, according to Brazilian regions and states, from 2006 to 2013.(undefined)info:eu-repo/semantics/publishedVersio

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years