Secular trend in age at menarche for women born between 1920 and 1979 in Rio de Janeiro, Brazil

PRIMARY OBJECTIVE: This article presents data on the secular trend in age at menarche for 1955 women from 16 to 76 years of age born between 1920 and 1979 and studied under the Nutrition and Health Survey conducted in the municipality of Rio de Janeiro, Brazil, in 1996. METHODS AND PROCEDURES: Age at menarche was defined by the retrospective method. Women were grouped according to decade of birth, and the trend was estimated using simple linear regression between age at menarche and year of birth for the following specific periods: 1920-1940, 1920-1960, 1960-1979 and 1920-1979. MAIN OUTCOMES AND RESULTS: Mean age at menarche decreased from 13.07 to 12.40 years when comparing the group of women born in the 1920s with the 1970s birth cohort, corresponding to a mean rate of -0.0123 years per year (p < 0.001). The downward trend was -0.0120 years per year (p > 0.05) for the 1920s, 30s and 40s, -0.0093 years per year (p < 0.05) for the period from 1920 to 1960, and -0.0224 years per year (p < 0.01) for the 1960s/70s. CONCLUSIONS: The results suggest a secular trend in age at menarche. The literature points to such environmental variables as improved living conditions and expanded access to health services. Within this context, age at menarche could be used as a marker for social development.     

Is soft drink consumption associated with gestational hypertension? Results from the BRISA cohort

It is still unknown whether excessive consumption of sugar-sweetened beverages may be linked to gestational hypertensive disorders, other than preeclampsia. This study investigated the association between soft drink consumption and hypertension during pregnancy, analyzing the relationship from the perspective of counterfactual causal theory. Data from pregnant women of the BRISA cohort were analyzed (1,380 in São Luis and 1,370 in Ribeirão Preto, Brazil). The explanatory variable was the frequency of soft drink consumption during pregnancy obtained in a prenatal interview. The outcome was gestational hypertension based on medical diagnosis, at the time of delivery. A theoretical model of the association between soft drink consumption and gestational hypertension was constructed using a directed acyclic graph. Marginal structural models (MSM) weighted by the inverse of the probability of soft drink consumption were also employed. Using Poisson regression analysis, high soft drink consumption (≥7 times/week) was associated with gestational hypertension in São Luís (RR=1.48; 95%CI: 1.03-2.10), in Ribeirão Preto (RR=1.51; 95%CI: 1.13-2.01), and in the two cohorts combined (RR=1.45; 95%CI: 1.16-1.82) compared to lower exposure (<7 times/week). In the MSM, the association between high soft drink consumption and gestational hypertension was observed in Ribeirão Preto (RR=1.63; 95%CI: 1.21-2.19) and in the two cohorts combined (RR=1.51; 95%CI: 1.15-1.97), but not in São Luís (RR=1.26; 95%CI: 0.79-2.00). High soft drink consumption seems to be a risk factor for gestational hypertension, suggesting that it should be discouraged during pregnancy.     

Pilot attempt of advanced prostate cancer treatment T3NxMx−1 by intermittent more complete androgen blockade

The aim of the prospective pilot study was evaluating efficacy and tolerance of pharma-cological more complete androgen blockade (mMAB) by using Zoladex LA 10.8 mg, Casodex 50 mg and Proscar 5 mg in patients with advanced prostate cancer (T3,Nx Mx-1). Methods: This five-year study involved 14 patients aged 67–82 years (average 73). Zoladex LA was administered subcutaneously every 3rd month of treatment, and every day 1 tablet Casodex and 1 tablet Proscar. In the time when PSA was <0.1 mg/ml Zoladex and Casodex were withdrawn, and only Proscar was left. The mMAB treatment was resumed when PSA 0.1 ng/ml. Before and every 3 months the following laboratory tests were made: PSA, sedimentation, bilirubine, transaminase, phosphatase, ultrasonography (USG); and adverse events were registered. The following criteria of assessment were adopted: CR – complete response – examination tests normal, improved condition, reduction of prostate dimension in USG and value of PSA < 0.1 ng/ml; PR – partial response i.e. no progression, the PSA level drops down to the reference values and a reduction of prostate dimension in USG occurs, NR – no response i.e. progression, increased prostate dimension in USG and/or metastases in scintygraphy, as well as PSA above normal. Results: The mean followup time was 60 months. After the initial 6 months two patients were off-therapy mMAB because they were qualified for radiotherapy. A successive patient (no. 5) was off-therapy (after 4 years) because he left Warsaw to go abroad. After 60 months results mMAB were based on 11 patients records, and a complete response was confirmed in 7 patients, partial response in 3 patients and no response in one patient. Conclusion: Results of this study show that pharmacological intermittent mMAB is an efficient way of treating advanced prostate cancer. Side effects are low and occur in moderate intensity and do not oblige to treatment withdrawal.     

Distribution of collagen type VII in connective tissues of postmenopausal stress-incontinent women

Objective.?This study aimed to disclose the distribution changes of collagen VII-immunoreactive (CVII-IR) structures in the arcus tendineus fasciae pelvis (ATFP) of postmenopausal women with stress urinary incontinence (SUI).

Patients and methods.?Fifty-five postmenopausal patients with a history of incontinence were examined for SUI. In patients with SUI, colposuspension was performed either after intravaginal estrogen therapy (ESTR) or without it (NON-ESTR). Age-matched patients without incontinence served as controls. During the surgery, connective tissue specimens from the ATFP and the rectus muscle external fascia (RMEF) were collected and prepared for immunohistochemistry.

Results.?SUI was diagnosed in 23 patients, 20 of them entered either the ESTR or the NON-ESTR group. No differences were found in the distribution of CVII-IR structures in RMEF specimens obtained from all groups. The organization of CVII-IR fibrils in the ATFP of stress-incontinent women was severely affected by degenerative processes. Within the ESTR group, the degree of CVII-IR fiber disintegration was lower.

Conclusions.?Connective tissue from the urogenital suspensory apparatus of women with SUI demonstrates a degenerative distribution pattern of collagen type VII fibers.     

Pretreatment serum levels of bFGF and VEGF and its clinical significance in endometrial carcinoma

ObjectiveIn this study, we examined the frequency of serum elevation as well as the prognostic significance of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in endometrial cancer (EC) type I and a biologically aggressive variant of EC type II.Materials and methodsPretreatment serum levels of bFGF and VEGF were evaluated by commercially available enzyme-linked immunosorbent assay (ELISA) for cancer patient samples with type I EC (n = 70) and type II EC (n = 64) and compared to a cohort of normal individuals (n = 64). Values were correlated with clinicopathological characteristics and outcome.ResultsMedian pretreatment VEGF values were 470.4 pg/ml (range, 164.3–598.4 pg/ml) for type I EC, 608.8 pg/ml (range, 354.2–783.6 pg/ml) for type II of EC patients and 215.6 pg/ml (range, 128.3–332.9 pg/ml) for normal healthy subjects (p < 0.001). Elevated serum VEGF concentration correlated significantly with advanced FIGO stage in type II EC (p = 0.011). Median values of bFGF were 10.7 pg/ml (range, 0.5–22.5 pg/ml) for type I EC, 21.2 (range, 0.5–62.4 pg/ml) for type II EC and 1.1 (range, 0–7.2 pg/ml) in controls (p < 0.0001). The pretreatment bFGF levels correlated with advancing tumor stages in types I and II EC (p  < 0.05). Multivariate analysis with Cox proportional hazard regression models revealed that high bFGF serum level correlated with shorter overall survival (OS) in type I EC (HR, 0.39, p < 0.001) and in type II EC (HR, 0.47, p = 0.01) and disease-free survival (DFS) (HR, 0.53, p = 0.03 and HR, 0.51, p = 0.02, respectively).ConclusionHigh preoperative bFGF levels predict a poor prognosis in patients with EC, and the prognostic value is independent of established prognostic parameters. These data suggest that bFGF might potentially serve as a marker in prognosis and offer a possibility to individualize treatment regimen.     

Imiquimod is highly effective for extensive, hyperproliferative condyloma in children

We describe a dramatic response to imiquimod of long-lasting, highly proliferative extensive perianal condylomas involving the anal canal in a 19-month-old girl. Her mother was free of condyloma and allegedly had no human papillomavirus (HPV) infection during pregnancy. There was no evidence of sexual abuse. Application of 5% imiquimod cream to the child every other day for 3 weeks resulted in almost complete resolution of the warts, with total clearance within another 2 weeks. The inflammatory reaction was moderate. Since there is still discussion of whether imiquimod may be prescribed for small children, this case of very extensive condyloma provides evidence that the compound is safe and highly effective.     

Involvement of capsaicin-sensitive afferent nerves and cholecystokinin 2/gastrin receptors in gastroprotection and adaptation of gastric mucosa to Helicobacter pylori-lipopolysaccharide

Lipopolysaccharide (LPS) is one of the virulence factors in the Helicobacter pylori (Hp)-infected stomach, but it remains unknown whether single and prolonged pretreatment with Hp-LPS can affect the course of gastric damage induced by aspirin (ASA). We compared the effects of Hp-LPS with those induced by LPSs isolated from intestinal Bacteroides fragilis, Yersinia enterocolitica, and Campylobacter jejuni applied for 4 days on acute ASA-induced gastric lesions in rats. The area of ASA-induced gastric lesions, gastric blood flow (GBF), expression of mRNA and protein of leptin and plasma leptin, gastrin, interleukin-1beta, and tumor necrosis factor-alpha levels were examined. Single (once) or repeated (five times) i.p. injections of Hp-LPS (1 mg/kg) or intestinal LPSs failed to produce macroscopic gastric damage and did not affect the GBF when compared with vehicle. Hp-LPS injected repeatedly suppressed the gastric acid secretion, up-regulated leptin mRNA and protein, and increased plasma leptin and gastrin levels. Hp-LPS significantly reduced the ASA-induced gastric damage and the accompanying decline in the GBF, and these effects were significantly attenuated by capsaicin denervation and selective antagonism of cholecystokinin-B (CCK2) receptors by RPR-102681 [N-(metoxy-3 phenyl) N-(N-methyl N-phenyl-carbamylmethyl) carbamoylmethyl]-3 ureido]-3 phenyl]-2 propronique] but not by loxiglumide, an antagonist of CCK1 receptors. We conclude that 1) daily application of Hp-LPS enhances gastric mucosal resistance against ASA damage due to the increase of GBF and the expression and release of leptin and gastrin exerting trophic and gastroprotective effects, and 2) this enhanced resistance to ASA damage in Hp-LPS-adapted stomach is mediated by the sensory afferents and specific CCK2/gastrin receptors.     

Menarche,early pregnancy,and obesity in selected Brazilian women from a health care center in Belo Horizonte,Minas Gerais,Brazil

The aim of this study was to investigate obstetric variables potentially associated with obesity among 486 Brazilian childbearing-age women aged 15-59 residing in the municipality of Belo Horizonte, Minas Gerais State. Body fat (BF) was measured through impedance analysis, and obesity was defined as BF > 30%. The association between obstetrics factors and obesity was evaluated through multivariate logistic regression. The following variables remained in the logistic regression after adjustments for total income, smoking, alcohol consumption, and physical activity: age at menarche < 12 years (OR = 3.02; 95% CI: 1.62-5.61), age > 30 and < 39 (OR = 1.72; 95% CI: 1.01-2.92), age > 40 years (OR = 3.32; 95% CI: 1.76-6.27), age at first childbirth (OR = 1.99; 95% CI: 1.07-3.68), and the following interaction: age group > 30 and < 39 and age at menarche (OR = 0.27; 95% CI: 0.09-0.83). It appears that obstetric factors affect obesity through a complex network of interrelations that involve the covariates studied above. It is important to support efficient programs to prevent obesity, as well as family planning programs emphasizing a reduction in the prevalence of teenage pregnancies.