Biomedical subjects

E Coutinho

Publications and source records attributed to E Coutinho.

At least 37 records · Page 2Linked to original sources

PubMed1997

Neuroendocrine mechanism of anovulation in users of contraceptive subdermal implant of nomegestrol acetate (Uniplant).

OBJECTIVE: To evaluate a nomegestrol acetate subdermal contraceptive implant's (Uniplant; Thermex, Monaco) effect on the hypothalamus-pituitary-ovarian axis. DESIGN: A prospective clinical trial. SETTING: San Borja-Arriarán Clinical Hospital, University of Chile, School of Medicine. PATIENT(S): Normally cycling healthy women. INTERVENTION(S): Insertion of Uniplant. MAIN OUTCOME MEASURE(S): Luteinizing hormone pulse and endocrine profiles were assessed before, 48 hours after insertion, and after prolonged use of the implant. RESULT(S): Anovulation was noted in 100% of users in the first month. Seventy percent of subjects demonstrated follicular development with the absence of ovulation and an endocrine profile similar to the follicular phase: (LH pulse/8 hours 6.85 +/- 0.67, LH amplitude 3.54 +/- 0.65 mIU/mL (conversion factor to SI unit, 1.00), and E2 193 +/- 29.4 pg/mL (conversion factor to SI unit, 3.67), whereas 30% demonstrated no follicular activity with an endocrine profile similar to the luteal phase: (LH pulse/8 hours; 3.66 +/- 0.66, LH amplitude 5.76 +/- 1.73 mIU/mL, and E2 67.5 +/- 4 pg/mL. Clinical characteristics, serum gonadotropin concentration, and LH pulse characteristics failed to predict which subjects would initiate or remain devoid of follicular activity. CONCLUSION(S): Uniplant results in anovulation via two mechanisms: hypothalamic suppression in subjects who lack follicular development, and likely suppression of the pituitary LH surge in subjects who initiate follicular activity.

Adult↗

PubMed1997

Hormonal profile, endometrial histology and ovarian ultrasound assessment during 1 year of nomegestrol acetate implant (Uniplant).

The present study assesses the endocrinological, endometrial histology and vaginal ultrasound profiles of nomegestrol acetate subdermal implant users at varying times after insertion. Follicle stimulatory hormone, luteinizing hormone, oestradiol, progesterone, vaginal ultrasound assessment of the ovaries and the histological dating of the endometrium were serially assessed for a period of 50 days immediately after the insertion, and after at 6 months and 12 months of use. The endocrinological results of this prospective observational clinical trial indicated that 75% of the cycles across the study period in Uniplant users were anovulatory, 63% showing development of a persistent non-luteinized follicle. Anovulatory cycles devoid of follicular development were seen primarily in the first months after Uniplant insertion. Ovulatory cycles represented 25% of the Uniplant cycles. Inadequate luteal phase or disregulation of follicular growth was a common feature of ovulatory cycles. In conclusion, these findings suggest that the contraceptive mechanisms of a single nomegestrol acetate subdermal implant involve prevention of follicular growth, development of a persistent non-luteinized follicle, inadequate luteal phase and disruption of the endometrial architecture.

Adult↗

PubMed1997

Brazilian multicentric study of psychiatric morbidity. Methodological features and prevalence estimates.

BACKGROUND: Psychiatric morbidity studies in developing countries have used diagnostic procedures of low reliability, without a clinical definition of caseness, producing descriptive data with limited application for mental health planning. METHOD: A two-stage cross-sectional design (with a sample size of 6476) was conducted to estimate the prevalence of DSM-III psychiatric diagnoses in three metropolitan areas of Brazil (Brasília, São Paulo and Porto Alegre). All subjects were screened for the presence of psychopathology with a 44-item instrument (the QMPA) and a subsample was selected for a psychiatric interview. RESULTS: Age-adjusted prevalence of cases potentially in need of care ranged from 19% (São Paulo) to 34% (Brasília and Porto Alegre). Anxiety disorders comprised the highest prevalences (up to 18%). Alcoholism yielded the most consistent prevalence levels, around 8% in all sites. Depression showed great variation between areas: from less than 3% (São Paulo and Brasília) to 10% (Porto Alegre). CONCLUSIONS: Overall prevalences were high in comparison with previous studies conducted in Brazil. A female excess of non-psychotic disorders (anxiety, phobias, somatisation and depression) and a male excess for alcoholism were consistently found.

Age Factors↗

PubMed1997

NMR and molecular dynamics studies of tachykinins: conformation of the C-terminal pentapeptide of substance P(SP7-11).

Substance P belongs to the tachykinin family of neuropeptides which exhibit diverse pharmacological activity. The conformation of Phe1-Phe2-Gly3-Leu4-Met5-NH2 the C-terminal pentapeptide of substance P (SP7-11) has been studied by NMR and molecular dynamics (MD) methods. NMR studies were carried out both in DMSO-d6 and 95% H2O. Based on the observed chemical shifts, 3JNH alpha coupling constants, temperature coefficients of chemical shifts of NH resonances and the pattern of inter- and intraresidue NOE's, a predominantly extended backbone conformation has been deduced for the peptide in both DMSO and H2O. MD calculations carried out in vacuo indicate that the global minimum energy conformation of the molecule is folded with an intramolecular hydrogen bond between the protonated N-terminal and the C-terminal CONH2 group. The simulation shows that beta-turns are energetically unfavourable, while alpha-helices are seen to be unstable for the peptide. gamma-Bends at either Gly3 or Leu4 are the most preferred ones. Simulations carried out in DMSO as well as in water show a preference for a nearly extended conformation.

Magnetic Resonance Spectroscopy↗

PubMed1996

Androgen levels in women using a single implant of nomegestrol acetate.

This study was undertaken to evaluate the effects of a single implant containing nomegestrol acetate (Uniplant) on plasma levels of sex hormone-binding globulin (SHBG), testosterone, free testosterone, androstenedione and on blood pressure, body weight, and the development of acne vulgaris. Plasma levels of sex hormone-binding globulin, testosterone, free testosterone and androstenedione were measured. Blood pressure and body weight were determined. The development of acne vulgaris was evaluated. Total testosterone and androstenedione decreased significantly during two years of Uniplant use but all levels were within the normal range. There were no significant differences in sex hormone-binding globulin and free testosterone during 24 months of Uniplant use. All changes observed in this study were within normal range. SHBG was not affected by Uniplant use. No significant increase in androgen levels and in the development of acne vulgaris was observed in these women using nomegestrol acetate implant during two years. Based on these results, it is possible to conclude that Uniplant had no androgenic effect in women during this study.

Acne Vulgaris↗

PubMed1996

Temporal relationship between Uniplant insertion and changes in cervical mucus.

This study was undertaken to determine the time required by a single implant containing nomegestrol acetate to affect cervical mucus production and sperm penetration in women. All subjects were investigated and, if necessary, treated for any kind of cervicitis or vaginitis prior to starting cervical mucus study. The subjects had not used hormonal contraception for at least three months prior to investigation. They were counseled to use condoms during this study and also to refrain from intercourse during the period of cervical mucus sampling. Follicular development and endometrial thickness were analyzed by transvaginal sonography. Cervical mucus examination, sperm penetration test, and transvaginal sonography were performed during the control cycle and during the first cycle of Uniplant use. Blood samples were taken for the measurement of estradiol, LH, and progesterone. Cervical mucus and sperm penetration tests were evaluated according to the World Health Organization (WHO) criteria. In the treated cycle, when cervical mucus reached a score of 8-10, Uniplant was inserted, independent of the day of the cycle. Cervical mucus was then collected at 0, 4, 8, 12, 24, 48, and 96 h later until a marked change in volume, consistency, ferning spinnbarkheit, and cellularity was observed. All samples were also used for sperm penetration test. Preovulatory estradiol and LH peak decreased significantly compared to pre-implant insertion. Progesterone levels were within the normal limit. Cervical mucus and sperm penetration tests were not affected by Uniplant in the first 12 h. Twenty-four hours after Uniplant insertion, cervical mucus and sperm penetration tests were affected in 70.6% of the women. Forty-eight hours after implant insertion, the women were affected. Follicular rupture occurred in the majority of the women 48 h after implant insertion. Based on these results, it is possible to conclude that Uniplant can affect estradiol and LH preovulatory peaks and disrupt the process of cervical mucus production and sperm penetration, but it was unable to prevent ovulation when inserted in the preovulatory phase.

Adult↗

PubMed1996

Effects of a single contraceptive Silastic implant containing nomegestrol acetate on ovarian function and cervical mucus production during 2 years.

OBJECTIVE: To study the mechanism of action of Uniplant (South to South Corporation in Reproductive Health, Salvador, Brazil), a single Silastic capsule containing nomegestrol acetate (Lutenyl, Theramex, France) in women during 2 years. DESIGN: Comparison between the hormonal levels, follicular development, cervical mucus (CM) production, and endometrial thickness in the menstrual cycle before implant insertion and at 1, 6, 12, 18, and 24 months after implant insertion. PARTICIPANTS: A total of 15 women of reproductive age were enrolled for the 1st year of use. Twelve of these women continued for a 2nd year of Uniplant use. MAIN OUTCOME MEASURES: Hormonal plasma levels were measured in control cycles and at 1, 6, 12, 18, and 24 months of Uniplant use. Cervical mucus, follicular development, and endometrial thickness also were evaluated. RESULTS: In this study, Uniplant blocks ovulation in 86 percent of cycles studied. Disturbances in follicular growth were observed also. Cervical mucus was scanty and viscous in all women during this study. Endometrial thickness was <8 mm in all cycles studied. CONCLUSION: This study shows that Uniplant is a long-acting contraceptive that probably acts at the hypothalamic-pituitary levels, on the ovary, on CM production, and on the endometrium. These properties suggest the use of Uniplant as a contraceptive agent, especially if one considers the lack of androgenic and metabolic effects and the maintenance of periodic bleeding similar to menstruation.

Adolescent↗

PubMed1996

Administration of Medroxprogesterone Acetate after Endomyometrial Resection

Seventy women (age 32-47 yrs) with a history of menorrhagia were evaluated by transvaginal sonography, hysteroscopy, and endometrial biopsy. Hysteroscopy revealed a normal uterine cavity in 60 patients, endometrial polyps in 4, and submucous myomas in 6. Endometrial biopsy revealed normal histology in 67 women and 3 cases of cystic endometrial hyperplasia. All patients underwent endometrial resection using the 27F resectoscope followed by coagulation with the rollerball. Glycine 1.5% was used as the distention medium. Endometrial resection was carried out under paracervical block plus intravenous propofol. Oral medroxyprogesterone acetate (MPA) 20 mg/day for 2 months was prescribed postoperatively for 40 women. The remaining women received a placebo. All patients were evaluated by transvaginal sonography at 1, 3, and 6 months after resection. The frequency of amenorrhea was 40% in the placebo group and 70% in the MPA group. These initial results suggest that postoperative treatment with MPA increases the frequency of amenorrhea after endometrial resection.

Journal Article↗

PubMed1996

Molecular mechanics calculations of opioid ligands of the 4-arylpiperidine class.

Molecular mechanics calculations have been carried out on N-methyl-4-phenyl-4-piperidinols substituted at 2,3-, 2,5- and 2,6-positions with methyl groups. Besides the alcohols, their esters and methiodides were also studied. The molecular mechanics conformations have been compared with conformations determined experimentally by NMR or X-ray diffraction.

Analgesics, Opioid↗

PubMed1995

Ovarian function after seven years' use of a levonorgestrel IUD.

Fifteen women with regular menstrual periods and seven amenorrheic women who had been using a levonorgestrel-releasing (LNg) IUD for more than seven years were studied. For controls, eight women using TCu380Ag IUDs for more than seven years were studied during two complete menstrual cycles. Ovarian function was assessed with hormonal determination and ultrasound examinations. The regularly menstruating women were studied for two complete menstrual cycles and the amenorrheic women for eight weeks. In the regularly menstruating LNg-IUD users, according to progesterone levels, 93% of the cycles were ovulatory but just 58% of these 'ovulatory' cycles showed normal follicular growth and rupture. Follicular cysts and luteinization of regressing follicles were observed in 42% of the 26 'ovulatory' cycles studied. SHBG capacity was decreased in the LNg-IUD users compared with the TCu380Ag users. Progesterone levels were lower in the LNg-IUD users compared with the TCu380Ag users but this difference was not statistically significant. Preovulatory estradiol and LH levels were lower in the LNg-IUD users than in the TCu380Ag users. These differences were not statistically significant. For the amenorrheic women, five had follicular cysts that disappeared spontaneously within 45 days. Two women showed follicular development and rupture. The presence of good cervical mucus was observed in 69% of the ovulatory cycles studied in the LNg-IUD users. This indicates that effects on cervical mucus cannot be the main mechanism of action of the LNg-IUDs. It is concluded that LNg-IUDs may exert a contraceptive effect in many different ways, such as inhibition of ovulation, endometrial changes preventing implantation, alteration of physical and chemical properties of cervical mucus affecting sperm transport and subtle disturbances in hypothalamic pituitary ovarian function, resulting in alterations of follicular development and rupture.

Adult↗

PubMed1995

The effects of nomegestrol acetate subdermal implant (Uniplant) on carbohydrate metabolism, serum lipoproteins and on hepatic function in women.

This study was undertaken to assess possible variations in body weight, blood pressure, fasting glucose, HbA1C, insulin, total cholesterol, HDL-C, LDL-C, triglycerides, SGPT, SGOT, GGT and bilirubin in women bearing a single subdermal Silastic implant containing 55 mg (10%) of nomegestrol acetate during two years. A total of eighteen volunteers of reproductive age who desired to avoid conception were enrolled in this study. Subjects were healthy women with no contraindications to hormonal contraception. All women were investigated before starting treatment and were followed up for one year. At the end of one year the capsules were removed and a new capsule was inserted. Fasting blood samples were drawn at 8:00 to 8:30 am twice prior to implant insertion and then at the first, third, sixth and twelfth months and every six months thereafter. Body weight increased from 54.9 +/- 1.5 kg at admission to 55.3 +/- 2.0 kg at 12 months of use (p < 0.05) and to 56.0 +/- 2.7 kg at 24 months of use. A slight increase in both systolic and diastolic blood pressure was recorded at month 12 (p < 0.01). At month 24, blood pressure was not significantly different from admission values. All levels were within the normal range. Insulin, HbA1C, LDL-C and GGT remained unchanged during twenty-four months of Uniplant use. A significant decrease in total cholesterol (p < 0.05) was observed in the third month while a significant decrease in HDL-C (p < 0.01) was observed only in the sixth month of Uniplant use.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

1H NMR investigation of the interaction of berberine and sanguinarine with DNA.

Interaction of the alkaloids, berberine and sanguinarine with calf thymus DNA has been studied by 1H NMR. All proton resonances of the two compounds have been assigned using 2D-COSY, NOESY and ROESY spectra. Berberine has been found to partially intercalate into DNA, while sanguinarine shows normal intercalation and also binds more firmly to DNA. The NMR experiments indicate that sanguinarine is more potent than berberine in its activity.

Alkaloids↗

PubMed1994

[Prevalence of organic brain syndrome in an elderly population in an metropolitan area of the southeastern region of Brazil].

This paper is a summary of the main findings concerning organic brain syndrome (O.S.S.) in a prevalence study carried out among the elderly population of the city of Rio de Janeiro, Brazil. The project selected three districts of the city-Copacabana, Méier and Santa Cruz-in view of a set of indicators. The study for the validation and reliability of the diagnostic instrument was carried out in the district of Copacabana. Prevalence results for organic brain syndrome were 5.9% in Copacabana, 9.84% in Méier and 29.75% in Santa Cruz. Several hypotheses have been formulated in the attempt to explain such diverse results within a single city. Associations with a variety of socio-economic indicators are presented. Dependence and loss of autonomy in elderly people are closely associated with organic brain syndrome. The results are compared with national and international findings.

Activities of Daily Living↗

PubMed1994

[The factor structure of the adult psychiatry morbidity questionnaire in a community sample of Brazilian cities].

Principal Components Analysis is a multivariate statistical technique for the purpose of examining the interdependence among variables. The main characteristic of this technique is the ability to reduce data, and it is currently used as an adjunct for the development of psychiatric research tools and the classification of psychiatric disorders. It has been applied to the study of the Factorial Structure of a Brazilian screening questionnaire, the Adult Psychiatric Morbidity Questionnaire (QMPA). The questionnaire is made up of 45 yes/no items for the identification of psychiatric symptoms and the use of psychiatric services and psychotropic drugs. The questionnaire was applied to 6.470 subjects over 15 years old in representative samples from three urban areas: Brasília, Porto Alegre and S. Paulo. Seven factors were found to explain 42.7% of the total variance: Anxiety/Somatization (eigenvalue = 3.81, 10.9%); Irritability/Depression (eigenvalue = 2.41, 6.9%); Cognitive Impairment (eigenvalue = 2.01, 5.8%); Alcoholism (eigenvalue = 1.90, 5.4%); Mood Elation (eigenvalue = 1.62, 4.6%); Hallucinatory/Delusional Disorders (eigenvalue = 1.60, 4.6%); and Drug/Therapies (eigenvalue = 1.60, 4.5%). A similar pattern of results was found when the analysis was carried out in the three places. It is suggested, on the banis of these findings, that some questions should be modified and some excluded in any future version of the questionnaire.

Adolescent↗

PubMed1993

The epidemiology of psychotropic use in the city of São Paulo.

This is a cross-sectional community study conducted to assess the one-year prevalence of psychotropic use in the city of São Paulo. A representative stratified sample of the city was drawn from three sub-districts selected on the basis of their health indicators (Ramos & Goihman, 1989). The probability of a psychiatric disorder was estimated by means of the Adult Psychiatric Morbidity Questionnaire (QMPA) developed by Santana (1982). The total sample comprised 1742 subjects: 11.7% of males and 24.6% of females were probable cases in the QMPA, at the cut-off point 7/8. The overall psychotropic consumption was 101.6 persons/1000 inhabitants. The rate of psychotropic use was higher for females (142.3 persons/1000 inhabitants) than males (50.0 persons/1000), a difference statistically significant (chi(2) = 18.0, 1 df, P < 0.001). The highest rate of consumption was for tranquillizers (80.4/1000 inhabitants) and the general physician was found to be the leading prescriber (46.9%), being followed by cardiologists (15.3%). A log-linear model was constructed to study the combined effect of sociodemographic factors on the probability of being a tranquillizer user. Women were found to take more tranquillizers than men, consumption increased with age, and the positives in the QMPA were more likely to be users than were the negatives. The higher the family income per capita the higher the risk of being a tranquillizer user. These findings applied regardless of the sub-district, marital status, and migration status of the subjects. These results are discussed in the light of the alternative possible interventions by general practitioners.

Adult↗

PubMed1993

Differences in serum potassium concentrations in normal men in different geographic locations.

Hypokalemia has been associated with the taking of gossypol, a potential oral antifertility drug for men. Because the frequency of this response differed in different parts of the world, this study was done to learn if "normal" serum [K+] also differed. [K+] was measured by flame photometry in serum from apparently normal men from Austria (n = 30), China (53), Brazil (100), the Dominican Republic (38), and the US (103), and in plasma from Nigerian men (82). The mean (SD) for [K+] in Chinese men, 3.82 (0.27) mmol/L, was lower than that in Brazilians [4.06 (0.29) mmol/L], Austrians [4.14 (0.44) mmol/L], Dominicans [4.37 (0.33) mmol/L], or Americans [4.38 (0.37) mmol/L]. Apparently there are regional differences in average serum [K+], with men in China having lower serum [K+] than men elsewhere. This may predispose them to hypokalemia.

Adolescent↗

PubMed1992

Conformational studies on cimetidine and ranitidine by PCILO calculations and NMR spectroscopy.

The conformational characteristics of two H2-receptor antagonists, cimetidine and ranitidine, have been investigated by quantum mechanical PCILO method and the results indicate a folded conformation for cimetidine stabilized by intramolecular hydrogen bonding and an extended backbone conformation for ranitidine. NMR investigations carried out on these two drugs in solution, however, indicate a predominance of an extended conformation for both the molecules. The significance of this result has been discussed in terms of the activity of these two drugs. Besides these studies, NMR experiments have also been carried out on the drugs incorporated into the lipid bilayers to investigate the drug-lipid interaction. The results from this study suggest that the hydrophobic portion of the drugs is buried in the hydrophobic hydrocarbon chains of the lipid bilayer, while the terminal hydrophilic end of the drug lies at the lipid-water interface.

Cimetidine↗

PubMed1991

Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS.

A levonorgestrel-releasing IUD and the Copper T 380Ag IUD were in randomized comparison for seven years in five clinics. In two other clinics the randomized study was truncated at five years, but use of the Copper T continued. No pregnancies occurred to users of either device in years 6 and 7. Cumulative pregnancy rates were 1.1 per 100 at seven years for the steroid-releasing and 1.4 per 100 for the copper-releasing IUDs. Cumulative rates of PID did not differ between devices. Infection rates appeared to be lowest during the sixth and seventh years of the study. Termination attributable to amenorrhea was the principal contributor to differences in cumulative continuation rates between devices. At the five clinics that carried the comparative study to seven years, cumulative continuation rates were 24.9 per 100 for LNg20 IUD users and 29.4 per 100 for TCu 380Ag users. Women who used either method for periods of five to seven years experienced, on average, marked to mild increases in hemoglobin as compared with levels at admission. The Copper T380 family and the LNg20 IUDs represent the most effective reversible contraceptive methods yet studied in long-term randomized trials.

Adolescent↗