Antiphospholipid antibody syndrome (APS) is a systemic, autoimmune, prothrombotic disease characterized by persistent antiphospholipid antibodies (aPLs), thrombosis, recurrent abortion, complications during pregnancy, and occasionally thrombocytopenia. The objective of the present study was to review the pathophysiology of APS and its association with female infertility. A bibliographic review of articles of the past 20 years was performed at the PubMed, Scielo, and Bireme databases. Antiphospholipid antibody syndrome may be associated with primary infertility, interfering with endometrial decidualization and with decreased ovarian reserve. Antiphospholipid antibodies also have direct negative effects on placentation, when they bind to the trophoblast, reducing their capacity for invasion, and proinflammatory effects, such as complement activation and neutrophil recruitment, contributing to placental insufficiency, restricted intrauterine growth, and fetal loss. In relation to thrombosis, APS results in a diffuse thrombotic diathesis, with global and diffuse dysregulation of the homeostatic balance. Knowing the pathophysiology of APS, which is closely linked to female infertility, is essential for new therapeutic approaches, specialized in immunomodulation and inflammatory signaling pathways, to provide important advances in its treatment.

Objectives The main objective of the study was to describe and compare the feasibility of using fractional CO2 laser to the usual treatment with Clobetasol. Randomized clinical trials brought together 20 women from a Brazilian university hospital, 9 of them were submitted to Clobetasol treatment and 11 to laser therapy. Sociodemographic data were obtained and quality of life parameters, vulvar anatomy, self-perception and histopathological analysis of vulvar biopsies were evaluated. Evaluations were made before the beginning of the treatment, during its implementation, right after its completion (3 months), and 12 months after. The SPSS 14.0 software was used, obtaining descriptive measurements. The level of significance adopted was 5%. Results The clinical/anatomical characteristics of the vulva did not differ between the treatment groups, as much before as after its performance. There was no statistically significant difference between the treatments performed regarding the impact on the life quality of the patients. A higher satisfaction degree with the treatment was obtained with the patients in the Laser group in the third month of evaluation. Laser therapy also revealed higher occurrence of telangiectasia after treatment completion. Fractional CO2 laser has proven to be well accepted and is a promising therapeutic option. Registration number and name of trial registry The institutional review board status was approved by the Research Ethics Committee of HU/ UFJF under advisory number 2881073 and registered in the Brazilian Clinical Trials, with consent under registration RBR-4p9s5y. Access link: https://ensaiosclinicos.gov.br/rg/RBR-4p9s5y

Approximately 50% of the causes of infertility are of genetic origin. The objective of this study was to analyze the role of genetics in human reproduction by reviewing the main genetic causes of infertility and the use of preimplantation genetic testing in Brazil. This literature review comprised articles in English and Portuguese published on databases PubMed, Scielo, and Bireme from 1990 to 2019. Randomized clinical trials and specialized guidelines were given preference whenever possible. Genetic cause can be traced back to up to 20% of the cases of severe azoospermia or oligozoospermia. Subjects with these conditions are good candidates for genetic screening. In women, genetic causes of infertility (fragile X syndrome, X-trisomy, and Turner's syndrome, some of which diagnosed with karyotyping) culminate with premature ovarian failure. Genetic screening helps advise couples of the risk of experiencing early reproductive capacity loss and of the chances of their offspring carrying genetic disorders. In addition to enhancing the prevention of serious diseases in the offspring of couples at increased risk of genetic diseases, preimplantation genetic screening improves the success rates of assisted reproduction procedures by allowing the selection of euploid embryos for transfer. The interface between genetics and human reproduction has gained significant relevance, but discussions are still needed on which procedures are clinically and ethically acceptable and how they should be regulated.

Objective The present study aimed to understand patient perception of the adverse effects of contraceptives to improve health care and adherence to treatment. Methods An online questionnaire was available for women in Brazil to respond to assess their perception of adverse effects and their relationship with contraceptive methods. Results Of all 536 women who responded, 346 (64.6%) reported current contraceptive use. One hundred and twenty-two (122–34.8%) women reported having already stopped using contraception because of the adverse effects. As for the contraceptive method used, the most frequent was the combined oral contraceptive (212–39.6%). When we calculated the relative risk for headache, there was a relative risk of 2.1282 (1.3425–3.3739; 95% CI), suggesting that the use of pills increases the risk of headache, as well as edema, in which a relative risk of 1.4435 (1.0177–2.0474; 95% CI) was observed. For low libido, the use of oral hormonal contraceptives was also shown to be a risk factor since its relative risk was 1.8805 (1.3527–2.6142; 95% CI). As for acne, the use of hormonal contraceptives proved to be a protective factor, with a relative risk of 0.3015 (0.1789–0.5082; 95% CI). Conclusion The choice of a contraceptive method must always be individualized, and the patients must be equal participants in the process knowing the expected benefits and harms of each method and hormone, when present.

Introdução: O Acidente Vascular Cerebral (AVC) é uma das maiores causas de morte e incapacidade adquirida em todo o mundo. Além da alta mortalidade, o AVC é um importante causador de déficits neurológicos irreversíveis que necessitam de reabilitação, sendo que aproximadamente 70% dos pacientes não retomarão ao seu trabalho e 30% necessitarão de auxílio para caminhar. Entender o perfil epidemiológico e a contribuição de cada fator de risco é essencial para estabelecer políticas locais específicas para diminuir a incidência da doença e prevalência de complicações que ocorrem devido ao AVC, tanto para o bem-estar a curto e a longo prazo da população. A prevenção pode ser feita em até 90% dos casos de AVC, visto que estes podem ser atribuídos a fatores de risco modificáveis. Objetivo: Conscientizar e orientar a população da cidade de Juiz de Fora, Minas Gerais acerca dos fatores de risco modificáveis do AVC e, consequentemente, sobre sua prevenção. Relato de experiência: No mês de outubro de 2018 foram realizadas palestras educativas e orientações a respeito do AVC e seus fatores de risco. Além disso, os pacientes do serviço de Neurologia, seus acompanhantes e transeuntes locais tiveram dois dos fatores de risco modificáveis associados ao AVC avaliados: a pressão arterial sistêmica e a circunferência abdominal. Aqueles com alterações foram orientados e encaminhados a procurar um serviço específico. Conclusão: A educação da população sobre as formas de prevenção de doenças cardiovasculares, em especial o acidente vascular cerebral, que é uma doença conhecida por apresentar tantos fatores causais modificáveis, é essencial para evitar o aumento da incidência dessas patologias tão prevalentes no país.

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Objective To determine the prevalence and possible variables associated with anal intraepithelial neoplasia and anal cancer in immunocompetent women with high-grade cervical intraepithelial neoplasia. Methods A cross-sectional study involving immunocompetent women with a histological diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer, conducted between January 2016 and September 2020. All women underwent anal cytology and answered a questionnaire on characterization and potential risk factors. Women with altered cytology were submitted to anoscopy and biopsy. Results A total of 69 women were included in the study. Of these, 7 (10.1%) had abnormal anal cytology results: (high-grade lesion, atypical squamous cells of undetermined significance, and atypical squamous cells, cannot exclude high-grade lesions: 28,5% each; low grade lesion: 14,3%). Of the anoscopies, 3 (42.8%) showed alterations. Of the 2 (28,5% of all abnormal cytology results) biopsies performed, only 1 showed low-grade anal intraepithelial neoplasia. The average number of pregnancies, vaginal deliveries, and abortions was associated with abnormal anal cytology. However, the highest mean regarding the cesarean sections was associated with normal cytology. Conclusion The prevalence of anal intraepithelial neoplasia was compatible with data from recent studies, especially those conducted in Brazil. Opportunistic screening for anal intraepithelial neoplasia in this high-risk population should be considered. Anal cytology is suitable for this purpose, due to its low cost and feasibility in public health services.

Introduction: Doppler flowmetry of uterine arteries allows identifying women at risk of developing preeclampsia (PE), mainly early preeclampsia; it also facilitates the timely use of prophylaxis. Minidose Acetylsalicylic Acid (ASA) can help preventing/delaying preeclampsia development, as well as reducing its severity and the risk of complications. However, not all patients can use this medication; therefore, it is necessary finding clinical alternatives for pregnant women who do not tolerate ASA, as well as evaluating the possibility of increasing this prophylaxis with new drugsthe use of omega 3 is one of these alternatives. Thus, it is possible assuming that omega use by pregnant women could reduce the vascular resistance of uterine arteries and facilitate placentation. The aim of the current study is to evaluate uterine artery resistance and pulsatility indices, as well as bilateral notch in pregnant women presenting identifiable risk factor for PE development, who use omega 3 in association, or not, with ASA. Methodology: The current research is a randomized-controlled, non-blind, parallel, two-arm, open-label preventive clinical trial. Patients were divided into two groups: group 1-use of ASA; and group 2-use of ASA+omega 3. Omegabased supplementations comprised doses of 400 mg/day in gelatin capsules, at DHA: EPA ratios 2.5:1 and 5.0:1. Results: Patients' mean age was 33.48+4.68 years. Mean pregnancies and childbirths were 1.93+1.30 and 0.59 ± 0.37, respectively. Results of uterine artery Doppler flowmetry were associated with omega and/or ASA use; patients who used ASA in association with omega (ASA+omega) recorded the highest uterine artery resistance and pulsatility indices-results were statistically significant. The comparison between ASA use in association, or not, with omega did not show difference in PE, prematurity, oligohydramnios, IUGR or hospitalization in neonatal ICU frequency. There were no cases of fetal death or Hellp Syndrome in either groups. Conclusion: The omega 3 use in association with ASA has increased the uterine artery resistance and pulsatility indices of the investigated patients; however, it did not make any difference in primary and secondary outcomes.