Both systemic lupus erythematosus (SLE) and its treatment can cause immunosuppression and a decreased response to vaccination. We evaluated 30 children and adolescents with SLE, and 14 age-matched healthy subjects (control group) regarding immunophenotyping and lymphocyte apoptosis by flow cytometry, while measles and tetanus antibodies were measured by enzyme-linked immunosorbent assay (ELISA). The SLE group was divided according to disease activity into inactive SLE and active SLE. Individuals with active SLE had lower CD4+ T and natural killer (NK) cells/mm(3) than the control group. Active and inactive SLE individuals had more CD38 molecules/CD8+ T cells and more CD4+ T, CD8+ T and B cells in apoptosis (as assessed by caspase-3 expression) than the control group. Patients with active SLE had a diminished CD28 expression on both CD4+ T and on CD8+ T cells and a higher CD86 expression on B cells than the control group. Measles antibody levels in the SLE groups were similar to the control group. In contrast, tetanus antibody levels were lower in the SLE groups than in the control group. The latter also directly correlated with the CD4+ T-cell and NK-cell counts from SLE patients (regression coefficient, 2.686 and 1.782; p = 0.010 and p = 0.039, respectively). We concluded that despite being up-to-date for tetanus vaccine, SLE patients presented with a poor immune response to tetanus vaccine.

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

CONTEXT AND OBJECTIVE: Serological testing for CA125 has been widely used to detect endometriosis and to monitor its progression. However, controversy still exists regarding the usefulness of the plasma CA125 assay for diagnosing endometriosis. Furthermore, some authors have described superficial endometriosis as a cyclical and normal phenomenon in women's lives, and have indicated that development and progression of this disease would only occur in some women as a result of immunological changes. This study aimed to determine the frequency of endometriosis and the correlation between serum CA125 levels and the presence of endometriotic lesions in the peritoneum of asymptomatic fertile patients. DESIGN AND SETTING:Cross-sectional study at the Family Planning outpatient clinic of Faculdade de Medicina do ABC. METHODS:Eighty asymptomatic fertile patients who underwent tubal sterilization surgery were studied. Blood and peritoneum samples were collected. CA125 levels were measured from blood samples, and peritoneum biopsies were studied using histopathological tests. RESULTS:Histopathological evaluation of the peritoneum revealed that 16.25% of the patients had minimal or mild endometriosis. There was no statistically significant difference in CA125 levels between patients with and without endometriosis. CONCLUSION:The presence of endometriotic lesions in the peritoneum of fertile patients supports the hypothesis that incidental findings of minimal or mild endometriosis may not be of clinical significance, and that the progression of the disease probably occurs as a result of immunological and genetic abnormalities. Serum CA125 levels did not show any diagnostic significance with regard to detecting the disease.RESUMO CONTEXTO E OBJETIVO: O teste sorológico para CA125 tem sido largamente usado para detectar e monitorar a progressão da endometriose, entretanto, a utilidade do ensaio do CA125 plasmático para o diagnóstico da endometriose ainda é controversa. Além disso, alguns autores descreveram a endometriose superficial como sendo um fenômeno cíclico e normal na vida de uma mulher, e que o desenvolvimento e progressão desta doença ocorreriam apenas em algumas mulheres como resultado de alterações imunológicas. Este estudo teve como objetivo determinar a freqüência de endometriose e a correlação entre os níveis séricos de CA125 e a presença de lesões endometrióticas em peritônio de pacientes férteis assintomáticas. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no Ambulatório de Planejamento Familiar da Faculdade de Medicina do ABC.MÉTODOS: Foram estudadas 80 pacientes férteis assintomáticas submetidas à cirurgia de esterilização tubária. Amostras de sangue e peritônio foram coletadas. Os níveis de CA125 foram medidos a partir das amostras de sangue e as biópsias de peritônio foram estudadas por ensaio histopatológico. RESULTADOS:O estudo histopatológico do peritônio revelou que 16,25% das pacientes apresentavam endometriose mínima e leve. Os níveis de CA125 não demonstraram diferença estatística sign...

Introduction During the COVID-19 pandemic period, the structure of the Intensive Care Unit (ICU) activities changed fast. It was observed that the mental and physical health of the frontline workers reached levels of extreme clinical and psychological concern. Objective Understand the impact that COVID-19 is having on the front-line clinical team in the ICU environment, as well as reveal what proposals are being made to mitigate the clinical and psychological impacts that this group experiences. Method A systematic review was made following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). We included any type of study on health workers during the COVID-19 pandemic, with results about their mental health. We were, therefore, interested in quantitative studies examining the prevalence of problems and effects of interventions, as well as qualitative studies examining experiences. We had no restrictions related to study design, methodological quality or language. Results Twenty-one studies reported on the urgent need for interventions to prevent or reduce mental health problems caused by COVID-19 among health professionals in ICU. Eleven studies demonstrated possibilities for interventions involving organizational adjustments in the ICU, particularly linked to emotional conflicts in the fight against COVID-19. Conclusion The disproportion between the need for technological supplies of intensive care medicine and their scarcity promotes, among many factors, high rates of psychological distress. Anxiety, irritability, insomnia, fear and anguish were observed during the pandemic, probably related to extremely high workloads and the lack of personal protective equipment.

Resumo:Objetivo: Descrever as características sócio-demográficas e clínicas de vítimas de violência sexual e sua associação com o tempo decorrido entre a agressão sexual e a chegada ao serviço de saúde. Método: Estudo retrospectivo de 439 casos de mulheres vítimas de agressão sexual, atendidas por serviço público de São Bernardo do Campo, São Paulo, Brasil, no período de 2000 a 2007. Resultados: De 439 pacientes incluídas, 374 chegaram antes de 72 horas ao hospital. A média de idade foi de 24,5 anos; 45,1% cursava ou havia concluído o segundo grau. A penetração vaginal foi a ocorrência mais comum, sendo exclusiva em 43,9% dos casos, enquanto que a associação desta com penetração anal ou oral ocorreu em 31,4% dos casos. Foram estatisticamente significantes para a chegada após 72 horas da agressão: a ausência de trauma não genital (OR = 2,58; IC95%: 1,04; 6,38), a não realização de denúncia policial (OR = 2,74; IC 95%: 1,58; 4,78) e o agressor conhecido (OR = 0,51; IC95%: 0,28; 0,96). Conclusões: O traumatismo não genital e a denúncia policial foram protetores para as vítimas, trazendo-as ao hospital dentro das primeiras 72 horas após a ocorrência; já o agressor conhecido foi fator determinante no atraso à chegada ao serviço de saúde. Políticas públicas para capacitação, divulgação e integração entre os setores envolvidos na abordagem deste tipo de violência podem reduzir as complicações dela decorrentes.Palavras-chave: saúde pública; saúde da mulher; violência sexual; prevenção e controle; infecção por HIV. Abstract:Background: We aimed to describe the social, demographic and medical characteristics of victims of sexual violence and their association with the lapsed time between the aggression and the search for medical attention, and to identify the possible reasons for delay in access to hospital. Methods: We reviewed the records of 439 female cases of sexual violence, treated through the medical services in Sao Bernardo do Campo, Brazil, during an eight-year period, from 2000 to 2007. Results: Of the 439 patients, 374 arrived at the hospital within 72 hours after the aggression. The average age was 24.5 years; 45.1% completed or were finishing high school. The most common form of sexual aggression was vaginal penetration in 43.9% of the cases, followed by multiple forms of penetration such as vaginal plus anal, or vaginal plus oral in 31.4% of the patients. Patients who did not suffer extra-genital injury and those who did not notify the authorities were significantly more likely to present to care after 72 hours: OR = 2.58 (95%CI: 1.04; 6.38) and OR = 2.74 (95%CI: 1.58; 4.78) respectively. Patients who had prior knowledge of their aggressor were significantly less likely to present after 72 hours (OR = 0.51; 95%CI: 0.28; 0.96). Conclusions: patients who suffered from extra-genital trauma and those who notified the authorities were more likely to seek care within 72 hours whereas patients who knew their aggressor were more likely to suffer the consequences of seeking care later than 72 hours. Public policies a...

Background: The quality of life (QoL) of patients with endometriosis and infertility was assessed in different stages and correlated with the clinical features of the cases. Methods: The present study was a cross-sectional study; 106 women were included, divided in two endometriosis groups (Grade I/II, 26 women, and Grade II/IV, 74 women). All participants attended the Endometriosis and Infertility

Background: Dysfunctions in the folate metabolism can result in DNA hypomethylation and abnormal chromosome segregation. Two common polymorphisms of this enzyme (C677T and A1298C) reduce its activity, but when associated with aneuploidy studies the results are confl icting. The objective of the present study is to analyze the MTHFR gene polymorphisms in women with Turner Syndrome and in a control group, correlating the fi ndings to the chromosomal aneuploidy. Methods: The study comprised 140 patients with Turner Syndrome, of which 36 with chromosome mosaicism and 104 nonmosaics, and a control group of 209 fertile and healthy women without a history of any offspring with aneuploidy. Polymorphisms C677T and A1298C were studied by RFLP-PCR and the results were statistically analyzed. Results: The frequency of genotypes MTHFR 677CC, 677CT and 677TT in the patients with Turner Syndrome and chromosome mosaicism was, respectively, 58.3%, 38.9% and 2.8%. Among the patients with non-mosaic Turner Syndrome, 47.1% presented genotype 677CC, 45.2% genotype 677CT, and 7.7% genotype 677TT. Among the 209 individuals of the control group, genotypes 677CC, 677CT and 677TT were found at the following frequencies: 48.3%, 42.1% and 9.6%, respectively. As for polymorphism A1298C, the patients with Turner

there was no association of KHQ scores with BMI. There was also no correlation between the parameters of clinical history and of the urodynamic study with BMI.