Oral manifestations among people living with HIV/AIDS in Tanzania

Background : This study aimed to determine the prevalence of various oral and peri‐oral manifestations in people living with HIV/AIDS in Tanzania. Methods : A cross sectional study. A total of 187 persons with HIV infection were recruited from non‐governmental organisations serving people living with HIV/AIDS, 16.6% were males and females 83.4%. Information on weight and height, as well as extra oral and intra oral examinations for different manifestations were gathered. Treatment and referral for special care were offered. Results : At least one oral lesion was present in 45% of the participants. Candidiasis (28.9%) and non‐tender lymphadenopathy (11.8%) were the most common lesions. Candidiasis occurred most frequently on lips/mucosa, and the tongue, and pseudomembranous candidiasis was the most frequent type. Candidiasis occurred with several other conditions and was statistically significantly associated with low body mass index (BMI). Conclusion : This community survey carried out in an African sub‐Saharan country showed that oral lesions are frequent among people living with HIV/AIDS. As emphasised by the World Health Organization Global Oral Health Programme, national HIV/AIDS programmes should incorporate oral health components.     

Neuropeptide Y modulates membrane excitability in neonatal rat mesencephalic V neurons

Neuropeptide Y (NPY) is one of a number of neuropeptides with powerful orexigenic effects. Intracerebroventricular administration of NPY induces increases in food intake and alters feeding rate. Besides it role in feeding behavior, NPY also has significant effects on neuronal systems related to other spontaneous behaviors such as rearing and grooming. In the present study, we examined the direct effects of NPY on mesencephalic V neurons (Mes V), which are important sensory neurons involved in oral motor reflexes and rhythmical jaw movements, as well as masticatory proprioception. Coronal brain slices were prepared from neonatal Sprague-Dawley rats (P3-17) and whole-cell patch clamp recordings were obtained from Mes V neurons. Bath application of NPY depolarized the membrane potential and induced inward current in most neurons. Application of NPY shortened the duration of the afterhyperpolarization following an action potential, and increased the mean spike frequency during repetitive discharge. In those neurons which exhibited rhythmical burst discharge in response to maintained current injection, the bursting frequency was also increased. These effects were mediated predominately by both Y1 and Y5 receptors.     

Sessile polyps and pedunculated polyps respond differently to oral contraceptives

Endometrial polyp is the lesion frequently found by hysteroscopy. The presence of endometrial polyp is associated with abnormal uterine bleeding and is probably associated with infertility. Until today, clinical guidelines for endometrial polyp remain elusive. The aim of this preliminary study was to estimate whether the shape of endometrial polyps affects the response to the treatment with an oral contraceptive (OC). We performed a retrospective case series study on 50 women diagnosed as endometrial polyps by hysteroscopy and managed by the administration of OC. Hysteroscopy was performed in the follicular phase of the menstrual cycle before medical treatment. Endometrial polyps were classified as pedunculated polyps (n?=?25) or sessile polyps (n?=?25). After diagnosis, OC was administered for 2–5 months (median 3 months) intermittently: To quantify the regression rate of lesions, the area index of endometrial polyps was assessed. In the study group, when comparing the efficacy of treatment with OC, there was a statistically significant difference in the regression rate between sessile polyps and pedunculated polyps (76% vs. 44%, p?=?0.042). We conclude that sessile polyps are more sensitive to OC treatment than pedunculated polyps, implying usefulness of the hysteroscopic classification of the shape of polyps in the management of endometrial polyps.     

Effect of ethinylestradiol/cyproterone acetate on endothelial function in young non-obese women with polycystic ovary syndrome: a pilot study

Background.?Combined oral contraceptives are used in polycystic ovary syndrome (PCOS) women for the treatment of hyperandrogenism and menstrual cycle disturbances.

Aim.?To assess the effect of ethinylestradiol and cyproterone acetate (EE/CA) on endothelial function in young, non-obese PCOS women in a pilot study.

Methods.?Thirteen young, non-obese PCOS women (20.9?±?3.7 years, 23.0?±?4.0?kg/m²) received 35?mcg EE & 2?mg CA for 6 months. Fourteen age- and body mass index (BMI)-matched healthy women served as controls. Endothelial function assessed by brachial artery flow-mediated dilation (FMD), indices of hyperandrogenism, and insulin resistance were studied at baseline and 6-month follow-up.

Results.?FMD was impaired in PCOS compared to control women (4.67?±?2.38% vs. 10.12?±?3.19%, p?<?0.001), but increased significantly following EE/CA (9.99?±?2.11%, p?<?0.001 vs. baseline), reaching normal values (p?=?NS vs. controls). EE/CA also significantly decreased hyperandrogenism indices and increased total and HDL cholesterol and triglycerides (p?<?0.05 vs. baseline). The only independent predictor of treatment-induced FMD improvement in PCOS women was the decrease in free androgen index.

Conclusions.?Treatment with combination of estrogens and antiandrogens reverses endothelial dysfunction in young, non-obese PCOS women mainly via improving hyperandrogenism. Further research is needed to investigate whether this treatment may also reduce cardiovascular risk in these women.     

Inflammatory-metabolic parameters in obese and nonobese normoandrogenemic polycystic ovary syndrome during metformin and oral contraceptive treatment

Our aim was to evaluate the optimal treatment strategy addressing cardiovascular risk in obese and nonobese patients with polycystic ovary syndrome (PCOS). We planned a prospect?ve randomized clinical study. Normoandrogenemic and oligoamenorrheic women with PCOS and impaired glucose tolerance (n?=?96) were enrolled in the study. Six months of treatment with metformin HCL or oral contraceptive pills (OCPs) were given to the patients. Group 1 were obese and receiving metformin. Group 2 were obese and receiving OCPs. Group 3 were nonobese and receiving metformin, and Group 4 were nonobese receiving OCPs. ADMA, homocysteine, high sensitive C-reactive protein (hs-CRP) and homeostasis model assessment estimate of insulin resistance (HOMA-IR) were investigated. ADMA, homocysteine, hs-CRP and HOMA-IR were similar in obese and nonobese groups before the treatment. After 6 months of treatment, a significant decrease was observed in ADMA, homocysteine and HOMA-IR levels in Groups 1 and 3. An increase in ADMA and hs-CRP levels was observed in Groups 2 and 4. In this study, metformin treatment leads to improvement in hormonal and metabolic parameters and decreases ADMA and homocysteine levels possibly independent of BMI. However, the use of oral contraceptives in obese and nonobese patients with PCOS with impaired glucose tolerance increases ADMA and hs-CRP levels and creates an increase in the metabolic risk.     

Aromatase expression in the eutopic endometrium of myomatous uteri: The influence of the menstrual cycle and oral contraceptive use

Aims. To detect aromatase expression in the endometrium of myomatous uteri and to correlate it with the location of the myoma, phase of the menstrual cycle, the presence of menorrhagia and oral contraceptive use.

Method. Aromatase p450 expression was measured using immunohistochemical methods in the endometrium of 116 patients. Sixty-one patients had menorrhagia associated with intramural/submucous myomas and nine had subserous myomas and no excessive bleeding. Forty-six patients had no uterine pathology and served as controls. Nineteen out of 61 patients with menorrhagia were oral contraceptive users at the time of the examination. Endometrial samples were obtained by hysteroscopy in all cases.

Results. Aromatase p450 expression was detected more frequently in the eutopic endometrium of patients with submucous or intramural myomas than in those in the subserous group, and was significantly greater during the proliferative phase than during the luteal phase or following the use of oral contraceptives. In normal uteri, aromatase expression was detected in the endometrium in less than 10% of users.

Conclusions. Aromatase expression in the endometrium was affected by the location of the myoma, the presence of symptoms, and the phase of the menstrual cycle. Oral contraceptives, on the other hand, inhibited aromatase expression in the eutopic endometrium of patients with submucous/intramural myomas.     

Encephalopathy and psychosis following administration of the combined oral contraceptive pill in an 11-year-old female

We report herein the first case of psychosis after short-term use of the combined oral contraceptive (COC) pill in a young patient with no previous psychiatric history. An 11-year-old girl was placed on the COC pill for treatment of menorrhagia, 5 months after her menarche. She developed an initial encephalopathy, which progressed to psychosis. The estrogenic component of the COC pill is the most likely cause of this psychosis. COC pills should be used with caution in patients with an already high estrogenic state as occurs near menarche.     

Effects of pre- and postmenopausal use of exogenous hormones on receptor content in normal human breast tissue: A randomized study

Objective. To examine the effects of exposure to endogenous and exogenous hormones on estrogen receptor-α (ERα) and progesterone receptor (PR) levels in normal human breast tissue.

Methods. In a randomized study of women scheduled for mammary reduction plasty (n = 81), ERα and PR content in breast parenchyma was analyzed in premenopausal (n = 49) and postmenopausal (n = 16) women. Premenopausal women were randomized to surgery in the follicular or luteal phase of the menstrual cycle or after oral contraceptive treatment for 2 months. Postmenopausal women were randomized to sequential or estrogen-only therapy for 2 months prior to surgery.

Results. ERα content was higher in parous than in nulliparous (p = 0.009) premenopausal women and displayed a positive association with age (r_s = 0.51, p = 0.0002). Compared with premenopausal women in the follicular phase, postmenopausal women had higher ERα content (p = 0.040) whereas premenopausal women on oral contraception had lower ERα (p = 0.048) and PR (p = 0.007) content. Smokers had lower PR content than non-smokers (p = 0.02).

Conclusion. In the present study ERα content was higher in parous than in non-parous women and associated with premenopausal age. Short-term oral contraceptives yielded lower ERα and PR contents. Postmenopausal estrogen/progestogen combined therapy yielded lower PR content than estrogen-only therapy.     

The efficacy and tolerability of Valette®: a postmarketing surveillance study

Objectives and methods A postmarketing survey was carried out to determine the efficacy and tolerability of Valette® (dienogest 2.0 mg and ethinylestradiol 0.03 mg) in routine gynecological practice.

Results Valette had excellent contraceptive efficacy (unadjusted Pearl index 0.14), with 11 unplanned pregnancies from a total of 92 146 cycles of exposure, of which at least four were attributable to user failure.

Cycle control was good, with spotting and breakthrough bleeding, which affected 5.0% and 3.4% of women, respectively, during the first cycle, becoming less frequent thereafter. Silent menstruation, i.e. the absence of withdrawal bleeding, affected on average 2.0% of women per cycle and 5.9% within the observation period.

Valette was well tolerated. The most common adverse drug reactions were mastalgia (1.46% of all users), weight gain (1.11%), headache (0.98%), nausea/vomiting (0.96%), dysmenorrhea (0.35%), decreased libido (0.31%) and depressive moods (0.28%). The dropout rate due to adverse drug reactions was only 3.2%. Only six of the 16267 women reported events which were considered to be serious adverse drug reactions; all recovered with appropriate treatment.

Conclusions These results confirm those from previous clinical trials, and demonstrate that Valette is highly effective, very well tolerated and produces excellent cycle control in routine practice.     

Endometrial injury in the menstrual cycle prior to assisted reproduction techniques to improve reproductive outcomes

Abstract

Objective: Oral contraceptive pills (OCP) are widely used for treating women with polycystic ovary syndrome (PCOS). Metformin has beneficial effects on insulin resistance and endothelial functions. The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl estradiol (EE) alone or in combination with metformin on the flow-mediated vasodilatation (FMD) and carotid intima media thickness (CIMT) in women with PCOS.

Methods: Fifty women with PCOS (mean age 23?±?5) were randomized to oral treatment of OCP alone (n?=?25) or an OCP combination with metformin (n?=?25) for 6 months. FMD from the brachial artery and CIMT were calculated. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months' treatment, echocardiographic measurements and laboratory tests were also obtained.

Results: After 6 months' treatment we observed a small decrease in FMD in the OCP group (14.9?±?9.4 versus 14.4?±?9.9, p?=?0.801) and a slight increase in the combination group (14.5?±?9.1 versus 15.0?±?8.0, p?=?0.715) but neither of them reached significance. CIMT increased in the OCP group (0.048?±?0.011 to 0.050?±?0.010?cm, p?=?0.433) and decreased slightly in the combination group (0.049?±?0.012, 0.048?±?0.011?cm, p?=?0.833).

Conclusion: We demonstrated that adding metformin to OCP treatment may have beneficial effect on FMD and CIMT that represent vascular function in patients with PCOS. These results suggest that adding metformin to OCP treatment for PCOS could preserve the cardiovascular system and improve it.